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RISC II is superior to TRISS in predicting 30-day mortality in blunt major trauma patients in Hong Kong

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Abstract

Purpose

Hong Kong (HK) trauma registries have been using the Trauma and Injury Severity Score (TRISS) for audit and benchmarking since their introduction in 2000. We compare the mortality prediction model using TRISS and Revised Injury Severity Classification, version II (RISC II) for trauma centre patients in HK.

Methods

This was a retrospective cohort study with all five trauma centres in HK. Adult trauma patients with Injury Severity Score (ISS) > 15 suffering from blunt injuries from January 2013 to December 2015 were included. TRISS models using the US and local coefficients were compared with the RISC II model. The primary outcome was 30-day mortality and the area under the receiver operating characteristic curve (AUC) for tested models.

Results

1840 patients were included, of whom 1236/1840 (67%) were male. Median age was 59 years and median ISS was 25. Low falls were the most common mechanism of injury. The 30-day mortality was 23%. RISC II yielded a superior AUC of 0.896, compared with the TRISS models (MTOS: 0.848; PATOS: 0.839; HK: 0.858). Prespecified subgroup analyses showed that all the models performed worse for age ≥ 70, ASA ≥ III, and low falls. RISC II had a higher AUC compared with the TRISS models in all subgroups, although not statistically significant.

Conclusion

RISC II was superior to TRISS in predicting the 30-day mortality for Hong Kong adult blunt major trauma patients. RISC II may be useful when performing future audit or benchmarking exercises for trauma in Hong Kong.

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Data may be available from the corresponding author on specific request.

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Acknowledgements

We thank all the staff from all 5 trauma registries in Hong Kong, namely the Prince of Wales Hospital, Queen Elizabeth Hospital, Princess Margaret Hospital, Tuen Mun Hospital and Queen Mary Hospital for their contribution to the study.

Funding

No funding available.

Author information

Authors and Affiliations

  1. Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, Hong Kong

    Kei Ching Kevin Hung, Chun Yu Lai, Janice Hiu Hung Yeung, Ling Yan Leung, Chi Hung Cheng, Nai Kwong Cheung & Colin Alexander Graham

  2. Trauma and Emergency Centre, Prince of Wales Hospital, Shatin, Hong Kong

    Kei Ching Kevin Hung, Chun Yu Lai, Janice Hiu Hung Yeung, Chi Hung Cheng, Nai Kwong Cheung & Colin Alexander Graham

  3. Cologne-Merheim Medical Center (CMMC), Department of Trauma and Orthopedic Surgery, University Witten/Herdecke, Campus Cologne-Merheim, Cologne, Germany

    Marc Maegele

  4. Trauma Service, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong

    Po Shan Lily Chan

  5. Department of Surgery, Princess Margaret Hospital, 2‑10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong

    Ming Leung

  6. Trauma Service, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong Island, Hong Kong

    Hay Tai Wong

  7. Trauma Service, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong

    John Kit Shing Wong

  8. School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong

    Marc Chong

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  1. Kei Ching Kevin Hung
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Contributions

KH CL JY contributed to the conception of the study. KH CL JY LC ML HW JW designed the study, contributes to the coordination of the study and the acquisition of the study data. KH CL MM analysed the data, LY MC CC NC CG interpreted data for the work. KH drafted the manuscript, all authors critically revised the manuscript and agreed to the final version of the manuscript. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Colin Alexander Graham.

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Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

Ethical approval obtained from the Joint CUHK-NTEC Clinical Research Ethics Committee (CREC) (2016.538), NTWC CREC (NTWC/CREC/17031), KCC/KEC CREC (KC/KE-1–0194/ER-2), KWC CREC (KW/EX-17–056(110–02)) and HKU/HKWC CREC (UW 16–2070).

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Hung, K.C.K., Lai, C.Y., Yeung, J.H.H. et al. RISC II is superior to TRISS in predicting 30-day mortality in blunt major trauma patients in Hong Kong. Eur J Trauma Emerg Surg 48, 1093–1100 (2022). https://doi.org/10.1007/s00068-021-01667-3

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