Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  28 (2024)
Volume  27 (2023)
Volume  26 (2022)
Volume  25 (2021)
Volume  24 (2020)
Volume  23 (2019)
Volume  22 (2018)
Volume  21 (2017)
Volume  20 (2016)
Volume  19 (2015)
Volume  18 (2014)
Volume  17 (2013)
Volume  16 (2012)
Volume  15 (2011)
Volume  14 (2010)
Volume  13 (2009)
Volume  12 (2008)
Volume  11 (2007)
Volume  10 (2006)
Volume  9 (2005)
Volume  8 (2004)
Related articles

VOLUME 10 , ISSUE 4 ( October, 2006 ) > List of Articles

RESEARCH ARTICLE

The new injury severity score: A more accurate predictor of need ventilator and time ventilated in trauma patients than the injury severity score

Azim Honarmand, Mohammadreza Safavi

Keywords : Injury severity score, intubation, mechanical ventilation, new injury severity score

Citation Information : Honarmand A, Safavi M. The new injury severity score: A more accurate predictor of need ventilator and time ventilated in trauma patients than the injury severity score. Indian J Crit Care Med 2006; 10 (4):219-224.

DOI: 10.4103/0972-5229.29839

License: CC BY-ND 3.0

Published Online: 01-10-2010

Copyright Statement:  Copyright © 2006; The Author(s).


Abstract

Objectives: This study validates the accuracy of the injury severity score (ISS) and the new injury severity score (NISS) systems for prediction of need for intubation (NI), need for mechanical ventilation (NMV) and duration of MV (DMV) in intensive care unit (ICU) trauma patient admissions. Design: On the day of admission, data were collected from each patient to compute the ISS and NISS. Setting: Prospective cohort study. Materials and Methods: One hundred and ten nonselected trauma patients were included in our study in a consecutive period of six months. Results: The predictive accuracies of the ISS and the NISS were compared using receiver operator characteristic (ROC) curves and Hosmer-Lemeshow (H-L) statistics for the logistic regression model of ICU admission. For prediction of NI, the best cut-off points were 22 for ISS and 27 for NISS. The positive prediction value was 91.6% in NISS and 87.8% in ISS. The Youden index had best cut-off points at 0.47 for NISS and 0.57 for ISS. The area under ROC curve was 0.79 in the ISS and 0.86 in the ISS. There were statistical differences among NISS with ISS in terms of Youden Index and the area under the ROC curve (P < 0.05). For the prediction of NMV, NISS yielded significantly better results in the area under the ROC curve and Youden index than those of ISS (P < 0.05). None of the two scoring systems provided good discrimination in prediction of more than three or five days assisted-ventilation under MV. Conclusions: For prediction of NI or NMV, the NISS has better accuracy than ISS.

PDF Share
  1. Balk R, Bone RC. Classification of acute respiratory failure. Med Clin North Am 1983;67:551-6.
  2. Gillespie DJ, Marsh HM, Divertie MB, Meadows JA 3rd. Clinical outcome of respiratory failure in patients requiring prolonged (more than 24 hours) mechanical ventilation. Chest 1986;90:364-9.
  3. Sporn PH, Morganroth ML. Discontinuation of mechanical ventilation. Clin Chest Med 1988;9:113-26.
  4. Jabour ER, Rabil DM, Truwit JD, Rochester DF. Evaluation of a new weaning index based on ventilatory endurance and the efficiency of gas exchange. Am Rev Respir Dis 1991;144:531-7.
  5. Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991;324:1445-50.
  6. Diringer MN, Edwards DF, Aiyagari V, Hollingsworth H. Factors associated with withdrawal of mechanical ventilation in a neurology/neurosurgery intensive care unit. Crit Care Med 2001;29:1792-7.
  7. Sapijaszko MJ, Brant R, Sandham D, Berthiaume Y. Nonrespiratory predictor of mechanical ventilation dependency in intensive care unit patients. Crit Care Med 1996;24:601-7.
  8. Ross BJ, Barker DE, Russell WL, Burns RP. Prediction of long-term ventilatory support in trauma patients. Am Surg 1996;62:19-25.
  9. Seneff MG, Zimmerman JE, Knaus WA, Wagner DP, Draper EA. Predicting the duration of mechanical ventilation. The importance of disease and patient characteristics. Chest 1996;110:469-79.
  10. Strauffer JL, Fayter NA, Graves B, Cromb M, Lynch JC, Goebel P. Survival following mechanical ventilation for acute respiratory failure in adult men. Chest 1993;104:1222-9.
  11. Wagner DP. Economics of prolonged mechanical ventilation. Am Rev Respir Dis 1989;140:S14-8.
  12. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: The TRISS methodology. J Trauma 1987;27:370-8.
  13. Husum H, Strada G. Injury Severity Score versus New Injury Severity Score for penetrating injuries. Prehospital Disaster Med 2002;17:27-32.
  14. Champion HR, Copes WS, Sacco WJ, Lawnick MM, Keast SL, Bain LW Jr, et al. The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma 1990;30:1356-65.
  15. Fulda GJ, Tinkoff GH, Giberson F, Rhodes M. In-house trauma surgeons do not decrease mortality in a level I trauma center. J Trauma 2002;53:494-500.
  16. Baker SP, O′Neill B, Haddon W Jr, Long WB. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187-96.
  17. Stevenson M, Segui-Gomez M, Lescohier I, Di Scala C, McDonald-Smith G. An overview of the injury severity score and the new injury severity score. Inj Prev 2001;7:10-3.
  18. Lavoie A, Moore L, Lesage N, Liberman M, Sampalis JS. The Injury Severity Score or the New Injury Severity Score for predicting intensive care unit admission and hospital length of stay? Injury 2005;36:477-83.
  19. Lavoie A, Moore L, LeSage N, Liberman M, Sampalis JS. The new injury severity score: A more accurate predictor of in-hospital mortality than the injury severity score. J Trauma 2004;56:1312-20.
  20. Marelich GP, Murin S, Battistella F, Inciardi J, Vierra T, Roby M. Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: Effect on weaning time and incidence of ventilator-associated pneumonia. Chest 2000;118:459-67.
  21. Youden WJ. Index for rating diagnostic test. Cancer 1950;3:32-5.
  22. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982;143:29-36.
  23. Oh TE, Hutchinson R, Short S, Buckley T, Lin E, Leung D. Verification of the acute physiology and chronic evaluation scoring system in a Hong Kong intensive care unit. Crit Care Med 1993;21:689-705.
  24. Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma 1997;43:922-6.
  25. Brenneman FD, Boulanger BR, McLellan A, Redelmeier DA. Measuring injury severity: Time for a change? J Trauma 1998;44:580-2.
  26. Meyer AA, Messick WJ, Young P, Baker CC, Fakhry S, Muakkassa F, et al. Prospective comparison of clinical judgment and APACHE II score in predicting the outcome in critically ill surgical patients. J Trauma 19992;32:747-54.
  27. Le Gall JR, Loirat P, Alperovitch A, Glaser P, Granthil C, Mathieu D, et al. A simplified acute physiology score for ICU patients. Crit Care Med 1984;12:975-7.
  28. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al. The APACHE III prognostic system: Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991;100:1619-36.
  29. Cohen IL, Lambrinos J, Fein IA. Mechanical ventilation for the elderly patient in intensive care: Incremental changes and benefits. JAMA 1993;269:1025-9.
  30. Kritchevsky SB, Simmons BP. Continuous quality improvement: concepts and applications for physician care. JAMA 1991;266:1817-23.
  31. Krieger BP, Ershowsky P, Spivack D, Thorstenson J, Sackner MA. Initial experience with a central respiratory monitoring unit as a cost saving alternative to the intensive care unit or medicare patients who rquire long-term ventilator support. Chest 1988;93:395-7.
  32. Cohen IL, Bari N, Strosberg MA, Weinberg PF, Wacksman RM, Millstein BH, et al. Reduction of duration and cost of mechanical ventilation in an intensive care unit by use of a ventilatory management team. Crit Care Med 1991;19:1278-84.
  33. Owen JL, Bolenbaucher RM, Moore ML. Trauma registry databases: A comparison of data abstraction, interpretation and entry at two level I trauma centres. J Trauma 1999;46:1100-4.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.