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Comparison of two prognostic models in trauma outcome

Cook, A, Osler, T, Glance, L, Lecky, F, Bouamra, O, Weddle, J, Gross, B, Ward, J, Moore III, FO, Rogers, F and Hosmer, D 2018 , 'Comparison of two prognostic models in trauma outcome' , British Journal of Surgery, vol. 105, no. 5 , pp. 513-519 , doi: 10.1002/bjs.10764.

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Abstract

Background: The Trauma Audit and Research Network (TARN) in the UK publicly reports hospitalperformance in the management of trauma. The TARN risk adjustment model uses a fractionalpolynomial transformation of the Injury Severity Score (ISS) as the measure of anatomical injury severity.The Trauma Mortality Prediction Model (TMPM) is an alternative to ISS; this study compared theanatomical injury components of the TARN model with the TMPM.Methods: Data from the National Trauma Data Bank for 2011–2015 were analysed. Probability of deathwas estimated for the TARN fractional polynomial transformation of ISS and compared with the TMPM.The coefficients for each model were estimated using 80 per cent of the data set, selected randomly. Theremaining 20 per cent of the data were used for model validation. TMPM and TARN were comparedusing calibration curves, measures of discrimination (area under receiver operating characteristic curves;AUROC), proximity to the true model (Akaike information criterion; AIC) and goodness of model fit(Hosmer–Lemeshow test).Results: Some 438 058 patient records were analysed. TMPM demonstrated preferable AUROC (0⋅882for TMPM versus 0⋅845 for TARN), AIC (18 204 versus 21 163) and better fit to the data (32⋅4 versus153⋅0) compared with TARN.Conclusion: TMPM had greater discrimination, proximity to the true model and goodness-of-fit thanthe anatomical injury component of TARN. TMPM should be considered for the injury severity measurefor the comparative assessment of trauma centres.

Item Type: Article
Authors/Creators:Cook, A and Osler, T and Glance, L and Lecky, F and Bouamra, O and Weddle, J and Gross, B and Ward, J and Moore III, FO and Rogers, F and Hosmer, D
Keywords: stattistical models
Journal or Publication Title: British Journal of Surgery
Publisher: John Wiley & Sons Ltd
ISSN: 0007-1323
DOI / ID Number: 10.1002/bjs.10764
Copyright Information:

Copyright 2018 BJS Society Ltd.

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