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Naslov:Primerjava napovedne vrednosti rezultatov lestvic RISC (Revised Injury Severity Classification) in TRISS (Trauma and Injury Severity Score) na slovenskem vzorcu hudo poškodovanih
Avtorji:Brilej, Drago (Avtor)
Komadina, Radko (Mentor) Več o mentorju... Novo okno
Datoteke:.pdf DR_Brilej_Drago_2014.pdf (6,40 MB)
 
Jezik:Slovenski jezik
Vrsta gradiva:Doktorska disertacija (m)
Organizacija:MF - Medicinska fakulteta
Opis:IZHODIŠČA: Temeljni pogoj za zagotavljanje kakovosti zdravljenja je spremljanje rezultatov. Za objektivno oceno potrebujemo ustrezne podatke. Glavni namen registrov poškodovanih je pridobivanje podatkov o celotni verigi oskrbe od mesta nesreče do zaključka hospitalizacije. Zaradi razpršenosti poškodovancev po številnih bolnišnicah v Sloveniji je v Projektu razvoja mreže travmatološke dejavnosti predvidena uvedba nacionalnega registra poškodovancev. Za primerjavo rezultatov zdravljenja poškodovancev z mednarodnimi standardi se največ uporablja metodologija TRISS. Razvili so jo z multivariantno analizo skupine poškodovancev (MTOS), ki se pomembno razlikuje od slovenskega vzorca hudo poškodovanih. Zaradi te razlike se je porodil dvom o uporabnosti metodologije TRISS. Z vključitvijo slovenskih poškodovancev v nemški TR DGU pa smo prevzeli metodo RISC za primerjavo rezultatov zdravljenja z drugimi ustanovami. Nova metoda še ni bila ovrednotena na skupini, ki se razlikuje od poškodbenega vzorca v TR DGU. Namen naloge je preveriti uporabnost metode RISC na slovenskem vzorcu hudo poškodovanih in jo primerjati z metodo TRISS. METODE: Od vstopa v TR DGU v letu 2006 smo v SB Celje prospektivno zajeli podatke o kohortni skupini 376 hudo poškodovanih in jih vnesli v TR DGU. Primerjali smo dejavnike tveganja med poškodovanci v SB Celje in TR DGU ter izračunali vrednosti TRISS in RISC za vsakega poškodovanca. S statistiko M smo primerjali porazdelitev izračunanih verjetnosti preživetja med SB Celje, MTOS in TR DGU. Za ugotavljanje ustreznosti točkovnih lestvic (TRISS, RISC in RISC II) smo uporabili statistične metode diskriminacije (aROC), natančnosti (razlika v preživetju) in kalibracije (statistika H-L). REZULTATI: Povprečna starost poškodovancev je bila 47 let, 83 % je bilo moških, 95 % topih poškodb. Povprečna ISS vrednost je bila 26,4 (90 % ≥ 16). V bolnišnici je umrlo 17,5 % poškodovancev. Standardizirana umrljivost je pokazala za 1,9 % manjšo umrljivost, kot je predvidena s statističnimi modeli. Ugotovili smo pomembno odstopanje v dejavnikih tveganja med poškodovanci v SB Celje in TR DGU, kar lahko razložimo z drugačnimi vključitvenimi merili. Potrdili smo, da je slovenski vzorec hudo poškodovanih drugačen, in da je treba preveriti učinkovitost metode RISC. Primerjali smo preživetje med skupinami in ugotovili slabo ujemanje skupine poškodovancev v SB Celje z MTOS (M = 0,50) ter dobro ujemanje s TR DGU (M = 0,88). V dveh časovnih obdobjih (2006–07 in 2011–12) se porazdelitev v SB Celje ni pomembno spremenila (M = 0,90). Potrdili smo pomembno razliko med skupino MTOS in SB Celje, ki vpliva na uporabnost metode TRISS. Kljub razlikam v dejavnikih tveganja pa smo potrdili dobro ujemanje rezultatov med skupinama SB Celje in TR DGU, kar upravičuje uporabo metode RISC na slovenskem vzorcu hudo poškodovanih. Najboljšo diskriminacijo sta pokazali lestvici RISC in RISCII (aROC 0,91 in 0,90). Najbolj natančna je bila lestvica RISC (razlika v umrljivosti 1,9 %), ki je prav tako imela najboljšo in skoraj popolno kalibracijo (H-L 0,53). ZAKLJUČKI: Metoda RISC je pokazala boljšo diskriminacijo in kalibracijo, bila je bolj natančna kot metodologija TRISS za slovenski vzorec hudo poškodovanih. Primerjava podatkov v SB Celje v letih 2006-7 z leti 2011-2 je pokazala nekaj razlik. Predvsem je opazno izboljšanje na področju kazalnikov kakovosti oskrbe (krajši predbolnišnični čas, krajši čas na urgentnem oddelku). Toda te razlike niso vplivale na uporabnost metode RISC. Prestala je test sprememb v strukturi in obravnavi poškodovancev skozi čas. Metoda TRISS kljub novim koeficientom ni primerna za uporabo na slovenskem vzorcu hudo poškodovanih. Posodobljena RISC II je dobra metoda, a nič boljša od že uveljavljene RISC.
Ključne besede:hudo poškodovani, vrednotenje, Trauma and Injury Severity Score (TRISS), Revised Injury Severity Classification (RISC), register
Leto izida:2014
Izvor:Maribor
COBISS_ID:277161216 Povezava se odpre v novem oknu
NUK URN:URN:SI:UM:DK:37JLUMUE
Število ogledov:1029
Število prenosov:200
Metapodatki:XML RDF-CHPDL DC-XML DC-RDF
Področja:MF
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Sekundarni jezik

Jezik:Angleški jezik
Naslov:Prediction value of RISC (Revised Injury Severity Classification) and TRISS (Trauma and Injury Severity Score) in an independent Slovenian sample of major trauma patients
Opis:BACKGROUND: The fundamental condition for ensuring the quality of treatment is monitoring the results. For an objective assessment, proper data is required. The main purpose of trauma registries is to gather data on the complete course from the accident site to the completion of therapy. Because of the dispersion of trauma patients across multiple hospitals in Slovenia, a national major trauma registry is being considered for implementation. The TRISS methodology is most commonly used to compare treatment results to international standards. It was developed using a multivariate analysis of a trauma patient group (MTOS), which significantly differs from the Slovenian pattern of major trauma incidents. Because of this, the usefulness of the TRISS methodology has come under doubt. After including Slovenian trauma patients in the German Traumaregistry (TR DGU), we have implemented the RISC method for comparing treatment results with other centres. The new method has not yet been evaluated on a patient group which differs from the TR DGU pattern. The objective of the study is to assess the usefulness of the RISC method on the Slovenian pattern of major trauma patients and to compare it to the TRISS method. METHODS: Since the inclusion in the TR DGU in 2006, we have been prospectively gathering data on a cohort group of 376 major trauma patients at General Hospital Celje and sent it to the TR DGU. We have compared risk factors between trauma patients at General Hospital Celje and the TR DGU and calculated the TRISS and RISC score for every patient. The M-statistic was used to compare the distribution of probability of survival between General Hospital Celje, MTOS and TR DGU. TRISS, RISC and RISC II were evaluated using the statistical methods of discrimination (aROC), precision (difference in survival) and calibration (H-L Statistic). RESULTS: The average age of patients was 47 years, 83% of them were men, 95% had blunt trauma. The average ISS was 26,4 (90% ≥16). Their in-hospital mortality rate was 17,5%. The standardized mortality rate has shown a 1,9% lower mortality than predicted with statistical models. A significant discrepancy in risk factors between trauma patients at General Hospital Celje and the TR DGU was discovered, which can be attributed to different inclusion criteria. The Slovenian sample of major trauma patients was confirmed to be different, as was the need to evaluate the effectiveness of the RISC method. We have compared survival rates between patient groups and found a poor match between the patient group at General Hospital Celje and the MTOS group (M=0,50) and a good match with TR DGU (M=0,88). The distribution at General Hospital Celje has not changed significantly between the periods of 2006–07 and 2011–12 (M=0,90). We have confirmed a significant difference between the General Hospital Celje and the MOTS patients groups, which affects the usefulness of the TRISS method. We have confirmed a good match of results between the General Hospital Celje and the TR DGU patient groups, despite differences in risk factors, which justifies the use of the RISC method on the Slovenian pattern of major trauma patients. The RISC and RISCII scores have shown the best discrimination (aROC 0,91 and 0,90). The RISC score was the most precise (difference in mortality rate of 1,9%) and also had the best and almost perfect calibration (H-L 0,53). CONCLUSIONS: The RISC method was shown to have better discrimination, calibration and precision than the TRISS methodology for the Slovenian pattern of major trauma patients. The comparison of data at General Hospital Celje between 2006–07 and 2011–12 has shown a few differences. The improvement is best seen with indicators of treatment quality (shorter prehospital time, shorter ER time). These differences have not affected the usefulness of the RISC method, however. It has stood the test of time, as the structure and treatment of patients have changed. The TRISS method, despite new coefficients, is not suitable for the Slovenian pattern of major trauma pati
Ključne besede:Major trauma; evaluation; Trauma and Injury Severity Score (TRISS); Revised Injury Severity Classification (RISC), registry


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