Related Experiment Video
Updated: May 14, 2025
An R-Based Landscape Validation of a Competing Risk Model
Published on: September 16, 2022
Comparison of Risk Assessment Tools' Prediction of Outcomes for Penetrating Trauma
Jeffrey Santos1, Catherine M Kuza2, Xi Luo3
1Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, California.
Introduction:
The Trauma and Injury Severity Score (TRISS) uses anatomic and/or physiologic variables to predict mortality; however, Injury Severity Score is less reliable for penetrating trauma. National Surgical Quality Improvement Program Surgical Risk Calculator (NSQIP-SRC) and American Society of Anesthesiologists Physical Status (ASA-PS) include functional status and comorbidities. This study evaluates the accuracy of these tools in predicting mortality, length of stay (LOS), and complications for operative penetrating trauma.
Methods:
Adult penetrating trauma patients (≥18 y) who underwent surgery within 24 h of admission were included in this subgroup analysis of a prospective observational study at four trauma centers. The following three scoring models were compared: NSQIP-SRC, TRISS, and ASA-PS. Brier scores and area under the receiver-operating characteristic curve were used to compare mortality prediction. LOS prediction was assessed with linear regression and complications were evaluated with negative binomial regression. Likelihood ratio (LR) test was used to assess model fit.
Results:
Of 329 penetrating trauma patients, 13 (3.9%) died. The median LOS was 4 d (interquartile range 2-9), and median number of complications was zero (interquartile range 0-1). TRISS better predicted mortality than NSQIP-SRC or ASA-PS on Brier score (0.02 versus 0.03 versus 0.03) but all had similar area under the receiver-operating characteristic curve (0.93 versus 0.93 versus 0.91, P = 0.26). NSQIP-SRC and ASA-PS better predicted LOS on adjusted R2 (14.4% versus 14.1% versus 1.6%) and LR showed no difference between these two tools (P = 0.16). NSQIP-SRC best predicted complications compared to TRISS and ASA-PS (Pseudo R2: 10.3% versus 3.8% versus 5.5%; LR: P = 0.003).
Conclusions:
For penetrating trauma, all three models were similarly excellent at predicting mortality. NSQIP-SRC and ASA-PS better predicted LOS and NSQIP-SRC best predicted complications, suggesting these are better tools for prognostication of outcomes for penetrating trauma.
