Outcome Prediction in Elderly Trauma victims Based on Anatomical (ISS, NISS), Physiological (RTS) and Combined (TRISS) Trauma Scoring Systems

Abstract

Objectives: The accuracy of the Injury Severity Score (ISS), New Injury Severity Score (NISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) in predicting mortality in cases of geriatric trauma is investigated in this study. Design: The study was designed as a prospective observational study. Materials and Methods: This was a prospective observational study of 200 elderly trauma patients admitted to a tertiary care hospital over an 18-month period. Data were collected from each patient on the day of admission in order to compute the ISS, NISS, RTS, and TRISS. Results: The average age of the patients was 66.35 years. The most common mechanism of injury (94.0 percent) was a traffic accident, with a mortality rate of 17.0 percent. The predictive accuracies of the ISS, NISS, RTS, and TRISS for mortality prediction were compared using receiver operator characteristic (ROC) curves.  The Best cut-off points for predicting mortality in elderly trauma patient using TRISS system was a score of 91.6 (sensitivity 97%, specificity of 88%, area under ROC curve 0.972), similarly cut-off point under the NISS was score of 17(91%, 93%, 0.970); for ISS best cut-off point was at 15(91%, 89%, 0.963) and for RTS it was 7.108(97%,80%,0.947). There were statistical differences among ISS, NISS, RTS and TRISS in terms of area under the ROC curve (p <0.0001). Conclusion: When compared to the ISS, NISS, and RTS, TRISS was the strongest predictor of mortality in elderly trauma patients.