The Trauma Audit and Research Network (TARN) in the United Kingdom publicly reports hospital performance in the management of trauma. The TARN risk adjustment model uses a fractional polynomial 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. The lead author Dr. Alan Cook, a student in the master of science in epidemiology program at the University of Arizona Mel and Enid Zuckerman College of Public Health, and colleagues, compared the anatomical injury components of the TARN model with the TMPM. The study was published in the British Journal of Surgery on February 21.
The investigators analyzed data from the National Trauma Data Bank for 2011 – 2015. Probability of death was estimated for the TARN fractional polynomial transformation of ISS and compared with the TMPM.
Some 438,058 patient records were analyzed. TMPM demonstrated preferable area under receiver operating characteristic curves (AUROC), Akaike information criterion (AIC) and better fit to the data compared with TARN.
TMPM had greater discrimination, proximity to the true model and goodness-of-fit than the anatomical injury component of TARN. The findings suggest the TMPM should be considered for the injury severity measure for the comparative assessment of trauma centers.
Dr. Cook is also director of the Trauma Research Program at the Chandler Regional Medical Center in Chandler, Arizona.
Comparison of two prognostic models in trauma outcome.
British Journal of Surgery. February 21, 2018