Triss unexpected survivors

an outdated standard?

Rob Norris, Randy Woods, Brian Harbrecht, Timothy Fabian, Michael Rhodes, John Morris, Timothy R. Billiar, Anita P. Courcoulas, Anthony O. Udekwu, Christine Stinson, Andrew B. Peitzman

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Performance improvement is an essential component of the trauma center. TRISS methodology has been applied as a national standard against which trauma centers can compare their outcomes. Earlier reviews of TRISS unexpected survivors sustained the classification of unexpected survivor in the vast majority of cases. Our hypothesis was that the level of care that is currently expected has made the TRISS unexpected survivors a statistical phenomenon only. Two hundred seventy TRISS unexpected survivors at a Level I trauma center from 1991 to 1995 were reviewed. Each case was reviewed as a blinded abstract by six reviewers (three of whom are directors at other facilities) and classified as clinically unexpected survivor (confirmed TRISS classification) or clinically expected survivor (did not sustain TRISS classification as unexpected survivor). Data are expressed as mean ± SD. Statistical significance was achieved at p < 0.05. Among the 270 patients categorized by TRISS as unexpected survivors, only 10.7% were corroborated as clinically unexpected survivors by this peer review process and 89.3% were reclassified as clinically expected survivors. Confirmed clinically unexpected survivors were more likely to go directly from the emergency department to the operating room (82 vs. 46%;p < 0.05). Age (32 ± 12 years vs. 40 ± 19 years;p < 0.05), Injury Severity Score (46 ± 20 vs. 32 ± 14;p < 0.05), Revised Trauma Score (2.46 ± 1.89 vs. 3.11 ± 1.21;p < 0.05), probability of survival (0.13 ± 0.13 vs. 0.24 ± 0.15;p < 0.05), systolic blood pressure in the emergency department (60 ± 51 mm Hg vs. 109 ± 33 mm Hg;p < 0.05), hospital length of stay (39.6 ± 30.3 days vs. 24.0 ± 23.0 days;p < 0.05), and intensive care unit length of stay (19.5 ± 20.6 days vs. 9.6 ± 10.1 days;p < 0.05) were significantly different comparing confirmed versus unsustained classification as unexpected survivors. Only 10.7% of survivors classified as unexpected by TRISS were corroborated as unexpected by a blinded, peer-review process. TRISS needs to be updated for meaningful interpretation; modifications need to be made and coefficients need to be revised.

Original languageEnglish (US)
Pages (from-to)229-234
Number of pages6
JournalJournal of Trauma
Volume52
Issue number2
DOIs
StatePublished - Jan 1 2002

Fingerprint

Survivors
Trauma Centers
Length of Stay
Peer Review
Hospital Emergency Service
Blood Pressure
Injury Severity Score
Operating Rooms
Intensive Care Units
Survival

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Norris, R., Woods, R., Harbrecht, B., Fabian, T., Rhodes, M., Morris, J., ... Peitzman, A. B. (2002). Triss unexpected survivors: an outdated standard? Journal of Trauma, 52(2), 229-234. https://doi.org/10.1097/00005373-200202000-00005

Triss unexpected survivors : an outdated standard? / Norris, Rob; Woods, Randy; Harbrecht, Brian; Fabian, Timothy; Rhodes, Michael; Morris, John; Billiar, Timothy R.; Courcoulas, Anita P.; Udekwu, Anthony O.; Stinson, Christine; Peitzman, Andrew B.

In: Journal of Trauma, Vol. 52, No. 2, 01.01.2002, p. 229-234.

Research output: Contribution to journalArticle

Norris, R, Woods, R, Harbrecht, B, Fabian, T, Rhodes, M, Morris, J, Billiar, TR, Courcoulas, AP, Udekwu, AO, Stinson, C & Peitzman, AB 2002, 'Triss unexpected survivors: an outdated standard?', Journal of Trauma, vol. 52, no. 2, pp. 229-234. https://doi.org/10.1097/00005373-200202000-00005
Norris R, Woods R, Harbrecht B, Fabian T, Rhodes M, Morris J et al. Triss unexpected survivors: an outdated standard? Journal of Trauma. 2002 Jan 1;52(2):229-234. https://doi.org/10.1097/00005373-200202000-00005
Norris, Rob ; Woods, Randy ; Harbrecht, Brian ; Fabian, Timothy ; Rhodes, Michael ; Morris, John ; Billiar, Timothy R. ; Courcoulas, Anita P. ; Udekwu, Anthony O. ; Stinson, Christine ; Peitzman, Andrew B. / Triss unexpected survivors : an outdated standard?. In: Journal of Trauma. 2002 ; Vol. 52, No. 2. pp. 229-234.
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