Comparison of National Surgical Quality Improvement Program Surgical Risk Calculator and Trauma and Injury Severity...

Area of Science:

• Trauma Surgery
• Surgical Outcomes Research
• Predictive Analytics in Medicine

Background:

• The Trauma and Injury Severity Score (TRISS) and National Surgical Quality Improvement Program Surgical Risk Calculator (NSQIP-SRC) are established tools for predicting patient outcomes.
• It remains unclear which tool offers superior risk prediction for high-risk trauma patients, defined by American Society of Anesthesiologists Physical Status (ASA-PS) class IV or V.

Purpose of the Study:

• This study aimed to compare the predictive accuracy of TRISS and NSQIP-SRC for mortality, length of stay (LOS), and complications in high-risk operative trauma patients.
• The study also evaluated the combined predictive performance of TRISS and NSQIP-SRC.

Main Methods:

• A prospective study was conducted with high-risk (ASA-PS IV or V) trauma patients aged 18 years and older undergoing surgery across four trauma centers.
• The predictive abilities of TRISS alone, NSQIP-SRC alone, and a combination of TRISS + NSQIP-SRC were compared using logistic, linear, and negative binomial regression models.

Main Results:

• The combined TRISS + NSQIP-SRC model demonstrated superior prediction for mortality (AUROC: .877) and number of complications compared to either tool used alone.
• While the combined model showed improved prediction for mortality and complications, no significant difference was found in predicting length of stay (LOS) between the combined model and NSQIP-SRC alone.

Conclusions:

• The combination of TRISS and NSQIP-SRC provides enhanced risk prediction for mortality and complications in high-risk operative trauma patients.
• Future risk stratification and comparative analyses for this patient population should integrate both anatomic/physiologic data and patient comorbidities/functional status for improved accuracy.