Trauma And Injury Severity Score Method Research Articles

Does the Probability of Survival Calculated by the Trauma and Injury Severity Score Method Accurately Reflect the Severity of Neurotrauma Patients Admitted to Regional Trauma Centers in Korea?

Assessing and improving the quality of trauma care is crucial in modern trauma systems and centers. In Korea, evaluations of regional trauma centers are conducted annually to assess and improve trauma management quality. This includes using the Trauma and Injury Severity Score (TRISS) method to calculate the W-score and mortality Observed-to-Expected ratio (O:E ratio), which are used to evaluate the quality of care. We analyzed the potential for overestimation of the probability of survival using TRISS method for patients with neurotrauma, as well as the potential for errors when evaluating and comparing regional trauma centers. We included patients who visited the regional trauma center between 2019 and 2021 and compared their probability of survival of the TRISS method, W-score, mortality O:E ratio, and misclassification rates. The patient groups were further subdivided into smaller subgroups based on age, Glasgow Coma Scale (GCS), and Injury Severity Score, and comparisons were made between the neurotrauma and non-neurotrauma groups within each subgroup. A total of 4,045 patients were enrolled in the study, with 1,639 of them having neurotrauma. The neurotrauma patient group had a W-score of -0.68 and a mortality O:E ratio of 1.044. The misclassification rate was found to be 13.3%, and patients with a GCS of 8 or less had a higher misclassification rate of 37.4%. The limitations of using the TRISS method for predicting outcomes in patients with severe neurotrauma are exposed in this study. The TRISS methodology demonstrated a high misclassification rate of approximately 40% in subgroups of patients with GCS less than 9, indicating that it may be less reliable in predicting outcomes for severely injured patients with low GCS. Clinicians and researchers should be cautious when using the TRISS method and consider alternative methods to evaluate patient outcomes and compare the quality of care provided by different trauma centers.

Validation of a Visual-Based Analytics Tool for Outcome Prediction in Polytrauma Patients (WATSON Trauma Pathway Explorer) and Comparison with the Predictive Values of TRISS.

Introduction: Big data-based artificial intelligence (AI) has become increasingly important in medicine and may be helpful in the future to predict diseases and outcomes. For severely injured patients, a new analytics tool has recently been developed (WATSON Trauma Pathway Explorer) to assess individual risk profiles early after trauma. We performed a validation of this tool and a comparison with the Trauma and Injury Severity Score (TRISS), an established trauma survival estimation score. Methods: Prospective data collection, level I trauma centre, 1 January 2018–31 December 2019. Inclusion criteria: Primary admission for trauma, injury severity score (ISS) ≥ 16, age ≥ 16. Parameters: Age, ISS, temperature, presence of head injury by the Glasgow Coma Scale (GCS). Outcomes: SIRS and sepsis within 21 days and early death within 72 h after hospitalisation. Statistics: Area under the receiver operating characteristic (ROC) curve for predictive quality, calibration plots for graphical goodness of fit, Brier score for overall performance of WATSON and TRISS. Results: Between 2018 and 2019, 107 patients were included (33 female, 74 male; mean age 48.3 ± 19.7; mean temperature 35.9 ± 1.3; median ISS 30, IQR 23–36). The area under the curve (AUC) is 0.77 (95% CI 0.68–0.85) for SIRS and 0.71 (95% CI 0.58–0.83) for sepsis. WATSON and TRISS showed similar AUCs to predict early death (AUC 0.90, 95% CI 0.79–0.99 vs. AUC 0.88, 95% CI 0.77–0.97; p = 0.75). The goodness of fit of WATSON (X2 = 8.19, Hosmer–Lemeshow p = 0.42) was superior to that of TRISS (X2 = 31.93, Hosmer–Lemeshow p < 0.05), as was the overall performance based on Brier score (0.06 vs. 0.11 points). Discussion: The validation supports previous reports in terms of feasibility of the WATSON Trauma Pathway Explorer and emphasises its relevance to predict SIRS, sepsis, and early death when compared with the TRISS method.

Validation of age-specific survival prediction in pediatric patients with blunt trauma using trauma and injury severity score methodology: a ten-year Nationwide observational study

BackgroundIn-hospital mortality in trauma patients has decreased recently owing to improved trauma injury prevention systems. However, no study has evaluated the validity of the Trauma and Injury Severity Score (TRISS) in pediatric patients by a detailed classification of patients’ age and injury severity in Japan. This retrospective nationwide study evaluated the validity of TRISS in predicting survival in Japanese pediatric patients with blunt trauma by age and injury severity.MethodsData were obtained from the Japan Trauma Data Bank during 2009–2018. The outcomes were as follows: (1) patients’ characteristics and mortality by age groups (neonates/infants aged 0 years, preschool children aged 1–5 years, schoolchildren aged 6–11 years, and adolescents aged 12–18 years), (2) validity of survival probability (Ps) assessed using the TRISS methodology by the four age groups and six Ps-interval groups (0.00–0.25, 0.26–0.50, 0.51–0.75, 0.76–0.90, 0.91–0.95, and 0.96–1.00), and (3) the observed/expected survivor ratio by age- and Ps-interval groups. The validity of TRISS was evaluated by the predictive ability of the TRISS method using the receiver operating characteristic (ROC) curves that present the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, area under the receiver operator characteristic curve (AUC) of TRISS.ResultsIn all the age categories considered, the AUC for TRISS demonstrated high performance (0.935, 0.981, 0.979, and 0.977). The AUC for TRISS was 0.865, 0.585, 0.614, 0.585, 0.591, and 0.600 in Ps-interval groups (0.96–1.00), (0.91–0.95), (0.76. − 0.90), (0.51–0.75), (0.26–0.50), and (0.00–0.25), respectively. In all the age categories considered, the observed survivors among patients with Ps interval (0.00–0.25) were 1.5 times or more than the expected survivors calculated using the TRISS method.ConclusionsThe TRISS methodology appears to predict survival accurately in Japanese pediatric patients with blunt trauma; however, there were several problems in adopting the TRISS methodology for younger blunt trauma patients with higher injury severity. In the next step, it may be necessary to develop a simple, high-quality prediction model that is more suitable for pediatric trauma patients than the current TRISS model.

The Forensic Pathology of Liver Trauma.

The forensic pathologist is an integral part of the trauma surgery team. Trauma surgeons depend on autopsy descriptions for accurate measurement of the severity of trauma and determination of the chance of mortality. The outcome of liver injury improved greatly during the 20th century, primarily due to improved diagnostic and management techniques. In many trauma cases, survival depends on injuries to areas other than the liver. Measurement of the severity of liver trauma often uses the TRISS (Trauma and Injury Severity Score) method, which depends on the nature, location, and size of injuries. Injuries produced by blunt trauma depend on the direction of the force and its interaction with the anatomic structures that surround the liver. Sharp force and gunshot injuries depend on the portions of the liver involved and the amount of kinetic energy transmitted to the tissue. The liver is susceptible to injury from resuscitation, although these injuries are usually not severe. Acad Forensic Pathol. 2018 8(2): 184-191.

Assessment of Survival and Hospital Care Quality in Patients with Traffic Injury in East Azerbaijan

Background: Traffic events are the second most common cause of mortality and the first cause of years of life lost (YLL) in Iran. Objectives: The aim of this study was to determine the survival of patients with traffic injury and evaluate hospital care quality using the trauma and injury severity score (TRISS) method. Methods: This cross-sectional study was conducted on 1000 patients aged 1 to 89 years old who were hospitalized in two university hospitals in East Azerbaijan, Iran. Patients were selected by using stratified sampling. Data were extracted from medical records and analyzed by STATA11 software. Injury severity score (ISS), revised trauma score (RTS), and expected survival were calculated using the TRISS software package. W-scores and Z-scores were calculated to evaluate the performance of hospitals. Finally, results were compared to those of the major trauma outcome study (MTOS). Results: Among 1000 patients, 246 (24.6%) were female. The mean age was 32.6 years (SD, 18.6). Mean ISS for living patients was 12.4 (SD, 4.3) while it was 36.9 (SD, 8.9) for fatal cases. The average RTS was reported to be 7.1 and 4.35 for alive and fatal cases, respectively (P < 0.001). Based on TRISS, 58 cases were expected to result in death; however, 65 fatalities were observed (65/1000). The W-score was -7 per 1000 and Z-score was + 0.02. The TRISS misclassification rate for survival status of patients with traffic injury was reported as 2.6%. Conclusions: Our findings indicate that the quality of care at the hospitals under study using the TRISS method was lower than the quality of care in the MTOS study. Further, survival of traffic injury patients was clearly influenced by the quality of hospital services provided

Bayesian Decision Trees for predicting survival of patients: A study on the US National Trauma Data Bank

Trauma and Injury Severity Score (TRISS) models have been developed for predicting the survival probability of injured patients the majority of which obtain up to three injuries in six body regions. Practitioners have noted that the accuracy of TRISS predictions is unacceptable for patients with a larger number of injuries. Moreover, the TRISS method is incapable of providing accurate estimates of predictive density of survival, that are required for calculating confidence intervals. In this paper we propose Bayesian inference for estimating the desired predictive density. The inference is based on decision tree models which split data along explanatory variables, that makes these models interpretable. The proposed method has outperformed the TRISS method in terms of accuracy of prediction on the cases recorded in the US National Trauma Data Bank. The developed method has been made available for evaluation purposes as a stand-alone application.

Prediction of survival probabilities with Bayesian Decision Trees

Practitioners use Trauma and Injury Severity Score (TRISS) models for predicting the survival probability of an injured patient. The accuracy of TRISS predictions is acceptable for patients with up to three typical injuries, but unacceptable for patients with a larger number of injuries or with atypical injuries. Based on a regression model, the TRISS methodology does not provide the predictive density required for accurate assessment of risk. Moreover, the regression model is difficult to interpret. We therefore consider Bayesian inference for estimating the predictive distribution of survival. The inference is based on decision tree models which recursively split data along explanatory variables, and so practitioners can understand these models. We propose the Bayesian method for estimating the predictive density and show that it outperforms the TRISS method in terms of both goodness-of-fit and classification accuracy. The developed method has been made available for evaluation purposes as a stand-alone application.

Impact on survival of whole-body computed tomography before emergency bleeding control in patients with severe blunt trauma

IntroductionWhole-body computed tomography (CT) has gained importance in the early diagnostic phase of trauma care. However, the diagnostic value of CT for seriously injured patients is not thoroughly clarified. This study assessed whether preoperative CT beneficially affected survival of patients with blunt trauma who required emergency bleeding control.MethodsThis retrospective study was conducted from January 2004 to December 2010 in two tertiary trauma centers in Japan. The primary inclusion criterion was patients with blunt trauma who required emergency bleeding control (surgery or transcatheter arterial embolization). CT before emergency bleeding control was performed at the attending physician's discretion based on individual patient condition (for example, hemodynamic stability or certain abnormalities in the primary survey). We assessed covariates associated with 28-day mortality with multivariate logistic regression analysis and evaluated standardized mortality ratio (SMR, ratio of observed to predicted mortality by Trauma and Injury Severity Score (TRISS) method) in two subgroups of patients who did or did not undergo CT.ResultsThe inclusion criterion was fulfilled by 152 patients with a median Injury Severity Score of 35.3. During the early resuscitation phase, 132 (87%) patients underwent CT and 20 (13%) did not. Severity of injury was significantly higher in the non-CT versus CT group patients. Observed mortality rate was significantly lower in the CT versus non-CT group (18% vs. 80%, P <0.001). Multivariate adjustment for the probability of survival (Ps) by TRISS method confirmed CT as an independent predictor for 28-day mortality (adjusted OR, 7.22; 95% CI, 1.76 to 29.60; P = 0.006). In the subgroup with less severe trauma (TRISS Ps ≥50%), SMR in the CT group was 0.63 (95% CI, 0.23 to 1.03; P = 0.066), indicating no significant difference between observed and predicted mortality in the CT group. In contrast, in the subgroup with more severe trauma (TRISS Ps <50%), SMR was 0.65 (95% CI, 0.41 to 0.90; P = 0.004) only in the CT group, whereas the difference between observed and predicted mortality was not significant in the non-CT group, suggesting a possible beneficial effect of CT on survival only in trauma patients at high risk of death.ConclusionCT performed before emergency bleeding control might be associated with improved survival, especially in severe trauma patients with TRISS Ps of <50%.

Modification of the Trauma and Injury Severity Score (TRISS) Method Provides Better Survival Prediction in Asian Blunt Trauma Victims

The objective of the present study was to identify logistic regression models with better survival prediction than the Trauma and Injury Severity Score (TRISS) method in assessing blunt trauma (BT) victims in Japan and Thailand. An additional aim was to demonstrate the feasibility of probability of survival (Ps) estimation without respiratory rate (RR) on admission, which is often missing or unreliable in Asian countries. We used BT patient data (n=15,524) registered in the Japan Trauma Data Bank (JTDB, 2005-2008). We also extracted data on BT patients injured in the Khon Kaen District between January 2005 and December 2008 (n=6,411) from the Khon Kaen Hospital Trauma Registry. For logistic regression analyses, we chose the Injury Severity Score (ISS), age year (AY), Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), RR, and their coded values (c) as explanatory variables, as well as the Revised Trauma Score (RTS). We estimated parameters by the method of maximum likelihood estimation, and utilized Akaike's Information Criterion (AIC), the area under the receiver operating characteristic curve (AUROCC), and accuracy for model comparison. A model having the lower AIC is considered to be the better model. The AIC of the model using AY was lower than that of the model using the coded value for AY (cAY) (used by the TRISS method). The model using ISS, AY and cGCS, cSBP, and cRR instead of the RTS demonstrated the lowest AIC in both data groups. The same trend could be observed in the AUROCCs and the accuracies. In the Khon Kaen data, we found no additional reduction of the AIC in the model using the cRR variable compared to the model without cRR. For better prediction of Ps, the actual number of the AY should be used as an explanatory variable instead of the coded value (used by the TRISS method). The logistic regression model using the ISS, AY, and coded values of SBP, GCS, and RR estimates the best prediction. Information about RR seems to be unimportant for survival prediction in BT victims in Asian countries.

Analysis of Trauma Outcome Using the TRISS Method at a Tertiary Care Centre in Pune

Out of the various systems used to assess the outcome of polytrauma patients, trauma and injury severity score (TRISS) is considered as the standard tool for evaluating the performance of trauma centres. The present study was carried out to evaluate the outcome of severely injured patients using the TRISS method in a developing country like India and to compare it with the major trauma outcome study (MTOS). A prospective study of 300 patients of trauma was done. Outcome assessment was done for the severely injured patients using the TRISS method. Road traffic accidents (213 cases) were the most common cause of injury. Fifty-seven (19%) cases were severely injured defined as having an injury severity score ≥16. Outcome assessment was done for these patients using the TRISS method. The predicted mortality was 15.7%, while the observed mortality was 33.3%. The mean revised trauma score was 6.63 ± 1.79 and the mean injury severity score (ISS) was 23.7 ± 8.17. Compared to the MTOS, the patients in the present study had more severe injuries with higher mortality. The present method of comparison of trauma care, i.e. TRISS which uses the MTOS coefficients, does not accurately predict survival of trauma patients in the developing countries as indicated by the present and other studies. There is a need for developing a national trauma registry to derive new coefficients for trauma scoring for the Indian subcontinent so that the quality of trauma care can be compared with that in the developed countries.

Acute traumatic coagulopathy decreased actual survival rate when compared with predicted survival rate in severe trauma

ObjectiveTo determine whether acute traumatic coagulopathy (ATC) should be combined with the trauma and injury severity score (TRISS) to predict outcome in severe trauma patients and investigate effects of the...

Comparison of the Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation II scoring system, and Trauma and Injury Severity Score method for predicting the outcomes of intensive care unit trauma patients

PurposeThe aim of this study was to assess the ability of the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system, and Trauma and Injury Severity Score (TRISS) method to predict group mortality for intensive care unit (ICU) trauma patients. MethodsThe medical records of 706 consecutive major trauma patients admitted to the ICU of Samsung Changwon Hospital from May 2006 to April 2010 were retrospectively examined. The SOFA and the APACHE II scores were calculated based on data from the first 24 hours of ICU admission, and the TRISS was calculated using initial laboratory data from the emergency department and operative data. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and TRISS equations. The ability to predict group mortality for the SOFA score, APACHE II score, and TRISS method was assessed by using 2-by-2 decision matrices and receiver operating characteristic curve analysis and calibration analysis. ResultsIn 2-by-2 decision matrices with a decision criterion of 0.5, the sensitivities, specificities, and accuracies were 74.1%, 97.1%, and 92.4%, respectively, for the SOFA score; 58.5%, 99.6%, and 91.1%, respectively, for the APACHE II scoring system; and 52.4%, 94.8%, and 86.0%, respectively, for the TRISS method. In the receiver operating characteristic curve analysis, the areas under the curve for the SOFA score, APACHE II scoring system, and TRISS method were 0.953, 0.950, and 0.922, respectively. ConclusionThe results from the present study showed that the SOFA score was not different from APACHE II scoring system and TRISS in predicting the outcomes for ICU trauma patients. However, the method for calculating SOFA scores is easier and simpler than APACHE II and TRISS.

Evaluation of trauma and prediction of outcome using TRISS method

Introduction:Trauma and injury severity score (TRISS), introduced in 1981 is a combination index based on revised trauma score (RTS), injury severity score (ISS) and patient's age. In this study we have used TRISS method to predict the outcome in trauma cases.Materials and Methods:1000 consecutive cases of trauma of adult age group admitted in casualty of Dayanand Medical College and Hospital Ludhiana, from 1/7/2000 onwards. Revised Trauma Score, Injury Severity Score and Age Index were recorded from which TRISS was determined. The performance of TS, ISS and TRISS as predictors of survival was evaluated using the misclassification rate, the information gain and the relative information gain.Results:The majority of the patients were men (83.7%) and in the age group of 20-50 years. Road traffic collisions (72%) were the most common cause of trauma. The mortality rate was 4.1%. Using PER method, the TRISS method was found to have information gain of 0.049 and a relative information gain of 0.41.Conclusions:The revised trauma score (RTS) ranged from 2.746 to 7.8408.There was a graded increase in mortality with decreasing RTS score.

質評価としての同僚評価―外傷の救急医療の質の研究委員会EMSQの方法―

Education, resident training, guidelines, and evaluation are necessary to improve health care quality. Changing the resident system, re-organizing medical associations and Evidenced-Based Medicine (EBM) are becoming popular, and clinical practice using guidelines has been stressed in recent years in Japan. However, clinical evaluation is generally not so popular, except within internal conferences, and during short discussions at medical societies, although evaluation of the hospital services is on going by the Japanese Council for Quality Health Care (JCQHC). In contrast, the Joint Commission on Healthcare Accreditation Organization (JCAHO) is generally used for evaluation of hospitals in the US. The TRISS (Trauma and Injury Severity Score) method has offered a standardized approach to the evaluation of the outcome of trauma care. All trauma cases admitted to emergency centers in Japan were reviewed using the TRISS methodology in 2001 to assess preventable trauma death (PTD). There are big discrepancies regarding PTD among hospitals. The Emergency Medicine Study Group for Quality (EMSQ), organized by 14 emergency centers in the Kanto area, has developed a peer review (PR) system using explicit standards together with the TRISS methodology, in order to promote accuracy in the evaluation of PTD. Definitions of trauma, PTD, and a set of standards consisting of 20 items for determining PTD, were proposed. The optimal quality level of medical care for the patients was the criterion against which decisions regarding PTD were made. All death cases whose probability of survival (Ps) value exceeded 50% were reviewed using a PR method based on explicit standards. The PR process found that only 11.2% of all deaths were preventable, although 25.3% were considered preventable by the TRISS method. The PR process, using explicit standards, provided an excellent method of evaluation of PTD. The PR process also serves an educational purpose in improving the quality of care in emergency trauma cases. PR, by applying uniform standards at the optimal level of quality for the patients, offers not only more precise assessment, but also a means of case identification for quality assurance review on a local basis. Outcome reviews will offer the opportunity to assess comparability with national standards and norms. Trauma registry and evaluation are recommended for all emergency centers in Japan. These evaluation processes may be useful for systematic improvement of the emergency medical field.

Characteristics and outcome of injured patients treated in urban trauma centers in Iran.

Because of the need to improve the quality of care of trauma patients in our country, we decided to evaluate the epidemiology and find the most powerful tool for prediction of survival. The Trauma and Injury Severity Score (TRISS) has been known as conventional method for this purpose. We planned to test its ability for prediction of survival of our trauma patients, and also we wanted to compare its ability with the New Injury Severity Score (NISS) in combination with Revised Trauma Score (RTS) and age. We used the most suitable model to evaluate the trauma care in our centers. From the Tehran University data registry on trauma patients of three different hospitals during 1 year, we selected trauma patients admitted to hospital for at least 1 day and all those patients who were declared dead at the emergency department. Epidemiologic description of patients has been given and evaluation of TRISS and (NISS + RTS + age) for prediction of survival has been performed. We determined factors affecting mortality and morbidity, evaluated hospitals, and analyzed patients admitted directly and the patients transferred from other hospitals. A total of 2,662 patients had complete data necessary for the calculation of probability of survival based on the TRISS method. The population at risk for trauma was the young, especially students and industrial workers. The major mechanisms of trauma were road traffic crashes and falls. The time expenditure and means of transportation as well as the time of stay in emergency department all seemed to be far less than optimal. We found that TRISS has higher performance than (NISS + RTS + age). Based on our descriptive findings, we proposed some suggestions that seem to be necessary for improvement of trauma care in our centers. Among them were improved measures for prehospital service, and emergency department and other health care units of our centers. The findings of this study suggest that conducting trauma surgery training programs and direct transportation to trauma centers can improve the outcome of trauma patients. We conclude that small sample size, mixing penetrating trauma cases with blunt trauma cases, and differences in the mechanism of trauma between study populations may be responsible for the difference between our results and others.

Firearm Injuries in Southern Taiwan: A Single Hospital's Experience

Firearm injuries in Taiwan have become more common in recent years. To determine the incidence of firearm injuries and the types of firearms involved, we conducted a hospital-based study of gunshot wounds (GSWs) treated in the emergency department of National Cheng Kung University Hospital. MATERIALS and METHODS: This retrospective obtained data from the medical records of firearm-related injuries treated at our hospital between May 1989 to April 1997. The severity of firearm injury was coded utilizing RTS (Revised Trauma Score) and ISS (Injury Severity Score). TRISS (Trauma and Injury Severity Score) method was adopted to predict patient survivability. All the data were analyzed by SPSS using Mann-Whitney statistics. RESULTS: One hundred and twenty two subjects (117 men, 5 women) with a mean age of 31.4±9.9 years (range: 4-68 years) were enrolled in our study. Intentional incidents, including assault and suicide, accounted for 85% of the injuries. Handguns were the leading causes of penetrating trauma in this series. The extremity was the major site of firearm injury (48%), however, the head and chest wounds were associated with the highest mortality and had significantly lower RTS (Mann-Whitney statistics, p＜0.001) on arrival. The case-fatality ratio (CFR) for firearm injury was 1:16 (non-survivor: survivor), which was lower than other countries. CONCLUSION: We suggest that an island-wide Trauma Registry should be established as soon as possible. With this Trauma Registry, the incidences of firearm injuries across Taiwan could be tracked. In addition treatment methods and outcomes could be evaluated and improvements made.