CAJ | 학술논문

目的：分析四种常用损伤严重程度评分方法的应用现状，提高医务人员对损伤严重程度评分方法的熟悉程度和应用效果。方法总结归纳近年来国内外关于损伤严重程度评分方法的相关研究文献。结果四种常用损伤严重程度评分方法在应用中各有优缺点。损伤严重程度评分（ ISS）是目前评价损伤严重程度较为通用的标准，但是对多发伤评估效果差，且需要知道所有准确的解剖伤情况；基于ICD的损伤严重程度评分（ICISS）允许所有伤参与伤情的预测，提高伤员预后的预测准确性，对医务人员不需要特别的训练和经验，但是各医院之间的ICD-9编码存在差异，且ICISS容易高估一些小伤；新的损伤严重程度评分（ NISS）克服了ISS受解剖区域限制的缺陷，预测能力比ISS强，但是要求创伤专家提供准确的简明损伤定级标准（ AIS）值；创伤严重程度评分（ TRISS）结合解剖和生理双重指标，使大小不等的创伤中心之间的比较成为可能，同时还能用于儿童创伤患者的预后判断，但是需要一定的知识和训练理解复杂的统计术语，需要专业的创伤登记获得相关计算数据。结论一方面应加强损伤严重程度评分方法的优化，探索更标准化适应面更广的模型，另一方面应结合地区特点正确理解并合理利用这些方法，以提高创伤救治效果。
목적：분석사충상용손상엄중정도평분방법적응용현상，제고의무인원대손상엄중정도평분방법적숙실정도화응용효과。방법총결귀납근년래국내외관우손상엄중정도평분방법적상관연구문헌。결과사충상용손상엄중정도평분방법재응용중각유우결점。손상엄중정도평분（ ISS）시목전평개손상엄중정도교위통용적표준，단시대다발상평고효과차，차수요지도소유준학적해부상정황；기우ICD적손상엄중정도평분（ICISS）윤허소유상삼여상정적예측，제고상원예후적예측준학성，대의무인원불수요특별적훈련화경험，단시각의원지간적ICD-9편마존재차이，차ICISS용역고고일사소상；신적손상엄중정도평분（ NISS）극복료ISS수해부구역한제적결함，예측능력비ISS강，단시요구창상전가제공준학적간명손상정급표준（ AIS）치；창상엄중정도평분（ TRISS）결합해부화생리쌍중지표，사대소불등적창상중심지간적비교성위가능，동시환능용우인동창상환자적예후판단，단시수요일정적지식화훈련리해복잡적통계술어，수요전업적창상등기획득상관계산수거。결론일방면응가강손상엄중정도평분방법적우화，탐색경표준화괄응면경엄적모형，령일방면응결합지구특점정학리해병합리이용저사방법，이제고창상구치효과。
Objective To analysis the application of four kinds of widely used injury severity scoring meth-ods, and make medical personnel know well of them and use them appropriately.Methods The relevant research literature on the current situation of injury severity scoring systems in recent years were collected and summarized. Results The four kinds of widely used injury severity scoring methods all have strengths and weaknesses.Injury severity score ( ISS) is a national standard for assessing injury severity, but it decreases its ability to assess injury severity in patients with multiple injuries and cannot be truly calculated until all the exact anatomic injuries are known.International classification of disease-9-basedinjury severity score ( ICISS) improves the accuracy of pre-diction by allowing all injuries to contribute to the prediction and does not require special training or expertise, but there is variability of ICD-9 code used between hospitals and it often overestimates trivial injury.New injury se-verity score( NISS) provides better predictive ability than ISS by taking the three highest scores regardless of ana-tomic area, but it requires a trauma specialist to provide an accurate Abbreviated injury scale( AIS) scoring.Trau-ma score and injury severity score( TRISS) combines the anatomical and physiological criteria, makes the compari-sons between trauma centers possible regardless of size, and can predicts outcomes in pediatric trauma patients, but it needs knowledge and training to understand the complicate statistical terms and requires dedicated trauma regis-tries to obtain data for calculation.Conclusion On one hand, we should optimize the injury severity score sys-tems, explore a more standardized model which can be used more widely.On the other hand, we should consider the characteristics of the region and have a proper understanding and rational use of these methods in order to im-prove trauma rescue effects.