Accuracy of the Trauma and Injury Severity Score (TRISS) in the Predicting Mortality of Emergency Patients: Focus on Evaluation at Three Critical Time Intervals.

Fenny Tianda, Syahrun Syahrun, Kumboyono Kumboyono, Suryanto Suryanto

Abstract


Latar Belakang: Trauma merupakan penyebab utama morbiditas dan mortalitas global, termasuk di Indonesia. Sistem skoring trauma seperti Trauma and Injury Severity Score (TRISS) dan Injury Severity Score (ISS) digunakan untuk memprediksi mortalitas pasien trauma, namun efektivitasnya perlu dievaluasi di berbagai rentang waktu kritis.Tujuan: Menilai akurasi TRISS dalam memprediksi mortalitas pasien trauma di Instalasi Gawat Darurat (IGD) pada jam ke-6, 24, dan 48 setelah kejadian trauma, dengan ISS sebagai gold standard. Metode: Penelitian uji diagnostik cross-sectional dilakukan di RSUD IA Moeis Samarinda (Januari–Maret 2024) dengan sampel 166 pasien trauma (kriteria inklusi: usia >16 tahun, data lengkap; eksklusi: Death On Arrival, penyakit penyerta). Data dianalisis menggunakan uji Spearman’s rho, kurva ROC, serta par TRISS menunjukkan sensitivitas sangat tinggi (98,9%) di semua rentang waktu, dengan nilai AUC optimal (0,973–0,994), mengindikasikan kemampuan prediktif yang sangat baik. Spesifisitas TRISS meningkat dari 77,1% (jam ke-6) menjadi 85,7% (jam ke-48). Akurasi TRISS juga tinggi (89,7–93,3%), melebihi ISS (87,5%). Korelasi signifikan ditemukan antara skor trauma dengan mortalitas (p <0,001).ameter sensitivitas, spesifisitas, Positive Predictive Value (PPV), Negative Predictive Value (NPV), dan akurasi. Hasil: TRISS menunjukkan sensitivitas sangat tinggi (98,9%) di semua rentang waktu, dengan nilai AUC optimal (0,973–0,994), mengindikasikan kemampuan prediktif yang sangat baik. Spesifisitas TRISS meningkat dari 77,1% (jam ke-6) menjadi 85,7% (jam ke-48). Akurasi TRISS juga tinggi (89,7–93,3%), melebihi ISS (87,5%). Korelasi signifikan ditemukan antara skor trauma dengan mortalitas (p <0,001). Kesimpulan: TRISS unggul dalam memprediksi mortalitas pasien trauma di IGD, terutama pada evaluasi jam ke-48, dengan sensitivitas dan akurasi yang stabil. Rekomendasikan penggunaan TRISS untuk triase awal dan manajemen pasien trauma di fasilitas kesehatan dengan sumber daya terbatas.
Kata kunci: TRISS, ISS, mortalitas, trauma, prediksi, IGD

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References


Magee F, Wilson A, Bailey M, Pilcher D, Gabbe B, Bellomo R. Comparison of Intensive Care and Trauma-specific Scoring Systems in Critically Ill Patients. Injury. 2021 Sep;52(9):2543–50.

WHO. Injuries-and-Violence [Internet]. who.int. 2024 [cited 2025 Apr 22]. Available from: https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence

WHO. Injuries and violence [Internet]. 2021. Available from: https://www.who.int/news-room/fact•%0ASheets/detail/injuries-and-violence

Kostiuk M BB. Trauma Assessment. [Updated 2023 May 23] [Internet]. StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555913/

Larkin EJ, Jones MK, Young SD, Young JS. Interest of the MGAP score on in-hospital trauma patients: Comparison with TRISS, ISS and NISS scores. Injury. 2022 Sep;53(9):3059–64.

Andara R, Kadar PD, Albar HF. Comparison of Injury Severity Score (ISS), New Injury Severity Score (NISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) In Predicting Mortality In Polytrauma Patients At Haji Adam Malik General Hospital. Int J Sci Res Publ. 2022;12(5):400.

Farzan N, Foroghi Ghomi SY, Mohammadi AR. A retrospective study on evaluating GAP, MGAP, RTS and ISS trauma scoring system for the prediction of mortality among multiple trauma patients. Ann Med Surg [Internet]. 2022;76(March):103536. Available from: https://doi.org/10.1016/j.amsu.2022.103536

Milton M, Engelbrecht A, Geyser M. Predicting mortality in trauma patients - A retrospective comparison of the performance of six scoring systems applied to polytrauma patients from the emergency centre of a South African central hospital. African J Emerg Med [Internet]. 2021;11(4):453–8. Available from: https://www.sciencedirect.com/science/article/pii/S2211419X21000665

Mehmood A, Hung YW, He H, Ali S, Bachani AM. Performance of injury severity measures in trauma research: a literature review and validation analysis of studies from low-income and middle-income countries. BMJ Open [Internet]. 2019;9(1). Available from: https://bmjopen.bmj.com/content/9/1/e023161

Yilmaz S, Ak R, Hokenek NM, Yilmaz E, Tataroglu O. Comparison of trauma scores and total prehospital time in the prediction of clinical course in a plane crash: Does timing matter? Am J Emerg Med [Internet]. 2021;50:301–8. Available from: https://www.sciencedirect.com/science/article/pii/S0735675721006690

Girshausen R, Horst K, Herren C, Bläsius F, Hildebrand F, Andruszkow H. Polytrauma scoring revisited: prognostic validity and usability in daily clinical practice. Eur J Trauma Emerg Surg [Internet]. 2024;50(3):649–56. Available from: https://doi.org/10.1007/s00068-022-02035-5

Palmer C. Major trauma and the injury severity score--where should we set the bar? Annu proceedings Assoc Adv Automot Med. 2007;51:13–29.

Mohammed Z, Saleh Y, AbdelSalam EM, Mohammed NBB, El-Bana E, Hirshon JM. Evaluation of the Revised Trauma Score, MGAP, and GAP scoring systems in predicting mortality of adult trauma patients in a low-resource setting. BMC Emerg Med [Internet]. 2022;22(1):90. Available from: https://doi.org/10.1186/s12873-022-00653-1

Ahmed AA, Ibro SA, Melkamu G, Seid SS, Tesfaye T. Length of stay in the emergency department and its associated factors at jimma medical center, southwest ethiopia. Open Access Emerg Med. 2020;12:227–35.

Zhong S, Yang H, Zhao Z. Mortality rate analysis of patients on invasive mechanical ventilation in the intensive care unit on day 28. Biomed reports. 2024 Oct;21(4):140.

Javali RH, Krishnamoorthy, Patil A, Srinivasarangan M, Suraj, Sriharsha. Comparison of Injury Severity Score, New Injury Severity Score, Revised Trauma Score and Trauma and Injury Severity Score for Mortality Prediction in Elderly Trauma Patients. Indian J Crit care Med peer-reviewed, Off Publ Indian Soc Crit Care Med. 2019 Feb;23(2):73–7.

Vorbeck J, Bachmann M, Düsing H, Hartensuer R. Mortality Risk Factors of Severely Injured Polytrauma Patients (Prehospital Mortality Prediction Score). J Clin Med. 2023 Jul;12(14).

Indurkar SKS, Ghormade PS, Akhade S, Sarma B. Use of the Trauma and Injury Severity Score (TRISS) as a Predictor of Patient Outcome in Cases of Trauma Presenting in the Trauma and Emergency Department of a Tertiary Care Institute. Cureus. 2023 Jun;15(6):e40410.

Tianda F, Kumboyono K, Suryanto S. Comparison of Sensitivity, Specificity, and Accuracy of ISS, RTS, and TRISS Instruments in Predicting Mortality of Trauma Patients. J Heal Sains. 2024;5:328–46.

Putra, I. W. G. A. E., Sutarga, I. M., & Kardiwinata MP. Modul Penelitian Uji Diagnostik dan Skrining [Internet]. 2016. Available from: https://simdos.unud.ac.id/uploads/file_pendidikan_ 1_dir/d204d4a5ad0870 a0965416e671a38791.pdf

Çorbacıoğlu ŞK, Aksel G. Receiver operating characteristic curve analysis in diagnostic accuracy studies: A guide to interpreting the area under the curve value. Turkish J Emerg Med. 2023;23(4):195–8.

Sitch AJ, Dekkers OM, Scholefield BR, Takwoingi Y. Introduction to diagnostic test accuracy studies. Eur J Endocrinol. 2021 Feb;184(2):E5–9.

Mijaljica DR, Gregoric P, Ivancevic N, Pavlovic V, Jovanovic B, Djukic V. Predicting mortality in severe polytrauma with limited resources. Ulus travma ve acil cerrahi Derg = Turkish J trauma Emerg Surg TJTES. 2022 Oct;28(10):1404–11.

Roy N, Gerdin M, Schneider E, Kizhakke Veetil DK, Khajanchi M, Kumar V, et al. Validation of international trauma scoring systems in urban trauma centres in India. Injury. 2016 Nov;47(11):2459–64.

Chawda MN, Hildebrand F, Pape HC, Giannoudis P V. Predicting outcome after multiple trauma: which scoring system? Injury. 2004 Apr;35(4):347–58.

Stewart N, MacConchie JG, Castillo R, Thomas PG, Cipolla J, Stawicki SP. Beyond Mortality: Does Trauma-related Injury Severity Score Predict Complications or Lengths of Stay Using a Large Administrative Dataset. J Emerg Trauma Shock. 2021;14(3):143–7.

Yousefzadeh-Chabok S, Hosseinpour M, Kouchakinejad-Eramsadati L, Ranjbar F, Malekpouri R, Razzaghi A, et al. Comparison of Revised Trauma Score, Injury Severity Score and Trauma and Injury Severity Score for mortality prediction in elderly trauma patients. Ulus travma ve acil cerrahi Derg = Turkish J trauma Emerg Surg TJTES. 2016 Nov;22(6):536–40.




DOI: http://dx.doi.org/10.30872/j.kes.pasmi.kal.v8i1.21108

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