TRISS Scores Research Articles

The Association of Total Prehospital Time to Severe Trauma Patient Outcomes in Physician Staffed Emergency Medical Teams in Sarajevo, Bosnia, and Herzegovina

Introduction:The Institute for Emergency Medical Assistance of Canton Sarajevo covers 1,777 square kilometers. All teams are physician staffed and are organized in ten geographic points. Patients are transported to a tertiary care level facility–University Clinical Center Sarajevo. Our objective was to determine the association between total prehospital time and severe trauma patient outcomes in a physician staffed emergency medical system with the hypothesis that the length of prehospital time is insignificant to patient outcome if physician treatment begins on scene.Method:This was a descriptive, retrospective, analytical study conducted from June to December 2020. The data of 153 patients with an ISS score of ≥ 16 was selected from patient registries of both facilities. According to transport duration, patients were assigned to one of four groups: <15 minutes (group 1); 16 to 30 minutes (group 2); 31-45 minutes (group 3) and > 45 minutes (group 4). Both groups according to the TRISS score were equal in mortality with an expected survival rate margin taken at 70% due to this being the approximate intrahospital survival rate of our patients. The primary outcome was in-hospital mortality, and secondary outcomes included length of hospital stay, length of ICU stay and 30-day survival rate.Results:We found no statistically significant difference to in-hospital mortality in relation to the length of pre-hospital transport when physician treatment begins on scene (p = 0,186). We ruled out any significant difference in length of stay and ICU stay (p = 0,179 and p = 0,173, respectively) among the preselected groups in relation to the length of prehospital time. Also, the 30 day survival rate was unaffected by the length of transport in physician led teams (p = 0,156).Conclusion:With strategically placed physician staffed EMS teams and physician treatment beginning on scene, patient outcome is unaffected by the length of transport.

Outcomes of traumatic extremity vascular injuries from a Malaysian level 1 trauma center

BackgroundIn Malaysia, management of traumatic vascular injuries is at the discretion of the treating surgeon (trauma or vascular surgery). This study was conducted to report on the epidemiology, mechanism of injury and outcomes of vascular injuries managed in a regional level 1 trauma center. MethodsThis is a retrospective cohort study of all patients treated for traumatic extremity vascular injuries from January 2018 to December 2020. Demography, mechanism of injury, pre-operative physiologic vital signs, vessel injured, injury severity (NISS, RTS and TRISS score), type of revascularization surgery, fasciotomy, post-operative blood investigations, operative outcomes (amputation, length of stay and ICU admission) and long-term rehabilitation follow-up were recorded and analyzed. ResultsAmongst the 35 recorded vascular injuries only 28 patients had adequate data that were included in the analysis. Majority of patients were males (23/28patients; 82%). Blunt injury to vessels was more likely in motorcycle crashes (16/28patients; 76%) than in automobile crashes (5/28patients; 24%). There were three lower limb amputees (3/3patients; 100%) that had early fasciotomy and were associated with three-fold higher post-operative median (interquartile range) CK levels of 16740 (8157 to 23116) u/l. Only two thirds (16/28 patients) had active rehabilitation follow-up and were back to work after a median duration of four months. ConclusionMale gender, blunt injury, road traffic crashes and motorcycles were the majority of vascular injuries. Lower limb vascular injuries had poorer outcome with three amputations performed after attempts at revascularization. Fasciotomy and high CK level may be related to higher risk of limb loss. Our study highlights the importance of rehabilitation and long-term follow-up in this cohort of patients.

Platelet-Lymphocyte and Neutrophil-Lymphocyte Ratio for Prediction of Hospital Outcomes in Patients with Abdominal Trauma.

Background The platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) reflect the patient inflammatory and immunity status. We investigated the role of on-admission PLR and NLR in predicting massive transfusion protocol (MTP) activation and mortality following abdominal trauma. Methods A 4-year retrospective analysis of all adult abdominal trauma patients was conducted. Patients were classified into survivors and nonsurvivors and low vs. high PLR. The discriminatory power for PLR and NLR to predict MTP and mortality was determined. Multivariate logistic regression analysis was performed for predictors of mortality. Results A total of 1199 abdominal trauma patients were included (18.7% of all the trauma admissions). Low PLR was associated with more severe injuries and greater rates of hospital complications including mortality in comparison to high PLR. On-admission PLR and NLR were higher in the survivors than in nonsurvivors (149.3 vs. 76.3 (p = 0.001) and 19.1 vs. 13.7 (p = 0.009), respectively). Only PLR significantly correlated with injury severity score, revised trauma score, TRISS, serum lactate, shock index, and FASILA score. Optimal cutoffs of PLR and NLR for predicting mortality were 98.5 and 18.5, respectively. The sensitivity and specificity of PLR were 81.3% and 61.1%, respectively, and 61.3% and 51.3%, respectively, for NLR. The AUROC for predicting MTP was 0.69 (95% CI: 0.655–0.743) for PLR and 0.55 (95% CI: 0.510–0.598) for NLR. To predict hospital mortality, the area under the curve (AUROC) for PLR was 0.77 (95% CI: 0.712–0.825) and 0.59 (95% CI: 0.529–0.650) for the NLR. On multivariate logistic regression analysis, the age, Glasgow Coma Scale, sepsis, injury severity score, and PLR were independent predictors of mortality. Conclusion On-admission PLR but not NLR helps early risk stratification and timely management and predicts mortality in abdominal trauma patients. Further prospective studies are required.

A Selection of Trauma Scores Might Not Correlate with Coagulation Factor Activity following Multiple Injuries: A Retrospective Observational Study from a Level 1 Trauma Center.

Loss and dilution of coagulation factors have been observed following multiple trauma. Timely recognition of reduced clotting factor activity might facilitate therapeutic action to restore normal coagulation function. This study investigates the potential role of some well-known trauma scores in predicting coagulation factor activity after multiple injuries. A dataset comprising the coagulation factor activities of 68 multiply injured adult patients was analyzed. The following trauma scores were evaluated: AIS, ISS, NISS, GCS, RTS, TRISS, RISC, and TASH score. To investigate the effect of trauma severity with respect to a single anatomic injury location, two groups according to the AIS (<3 vs. ≥3 points) were formed. Differences between these two groups were analyzed for five different body regions (head, thorax, abdomen, pelvis, extremities) using the Mann–Whitney U-test. Spearman's rank correlation coefficient rho was calculated to reveal possible relationships between trauma scores and clotting factor activities. The analysis showed clearly reduced clotting factor activities with a significant reduction of FII (83 vs. 50%; P = .021) and FV (83 vs. 46%; P = .008) for relevant (AIS ≥ 3 points) pelvic injuries. In contrast, traumatic brain injury according to the AIS head or the GCS does not appear to lead to a significant decrease in coagulation factor activities. Furthermore, the other scores studied show at best a fair correlation with coagulation factor activity. In this context, the RTS score seems to be the most suitable. Additionally, the predictive value of the TASH score, which was specifically developed to predict the need for mass transfusion, was also limited in this study. We would like to explicitly point out that this is not a criticism of the trauma scores, since they were developed in a completely different context.

Trauma Analysis Related Injury Severity Score (Triss) in Predicting the Prognosis of Politrauma Patients in Adam Malik General Hospital

Objective : The purposeofthis study wastoanalyzetheabilityof TRISS in predictingthe prognosis ofpolytraumapatients in the Haji Adam Malik General Hospital Medan, January 2016 toDecember 2018. Material and Method : This type of research is an analytic study with cross sectional design, which is a study by measuring independent variables and dependent variables at the same time, which aims to analyze the ability of TRISS in predicting the prognosis of patients in Haji Adam Malik General Hospital Medan January 2016 to December 2018. Results : From January 2016 - December 2018, a total 175 polytrauma patients which mostly was adult patient (&gt;18 y.o) observed. Based on sex, referral status and diagnosis, patients with polytrauma dominated in patients with male sex(143 patients), referred patient (68patients) and diagnosed with head injury (29 patients). Conclusion : There is an influence between TRISS Score on the prognosis of polytrauma patients.

PROGNOSIS OF THE ACUTE PHASE COURSE OF TRAUMATIC DISEASE AND TRANSPORTABILITY IN POLYTRAUMA PATIENTS

OBJECTIVE. The aim of the study was to substantiate the criteria for predicting of the acute phase course of traumatic disease and transportability in polytrauma patients. MATERIAL AND METHODS. The course of traumatic disease was studied in 233 patients. The prognostic value of the ISS, RTS, TRISS scores and Russian VPH-P, VPH-SP and Tsybin scores was studied using the method of binary logistic regression, Roc analysis and correlation analysis. RESULTS. RTS (AUC=0.93), TRISS (AUC=0.86) and Russian VPH-P (AUC=0.74) scores have the highest prognostic value. There is a strong correlation between the RTS and TRISS scores (r =+0.90). CONCLUSION. It is advisable to use the RTS score and Russian VPH-P score to predict the acute phase course of traumatic disease and transportability in polytrauma patients.

Trauma scores na avaliação de politraumatizados: quais e para quê?

The improvement rescue and transport of politrauma patients (PTP) increases the number of patients admitted to the Emergency departments in very severe conditions. The early prediction of later complications and bad outcomes is paramount for a good strategy. The aim of this study was to evaluate the severity of PTP in the Trauma Room (TR) of a Level 1 Hospital, using the ISS, RTS, TRISS scores and define variables associated with bad outcomes, namely ICU admission (ICU), ARDS, MODS and Death. Prospective study with data collection of demographic, clinical, laboratory and imaging parameters of all PTP admitted to the TR. The ISS was calculated by the Abbreviated Injury Scale, RTS and TRISS by Trauma.org site formulas. Statistical analysis was performed in SPSS. 278 patients were admitted in TR after Manchester screening during 6 months: 244 (185 men, 59 women) were studied, average age 39,32±19.32 years. Hospital admission- 157 patients (ICU-46, Intermediate Care Unit-29, Surgery Services-82) and 85 discharged. Submitted to Surgery-75. Scores: ISS-13,58±19,32, RTS-7,30±1,01; TRISS-92,42±15,85; Glasgow Coma Score (GCS)-13,00±3,61.Severe complications: ARDS-8%; SIRS-40%; MODS-18%; Death-14%. There is statistical correlation between Surgery Type: ICU and MODS; GCS, ISS, RTS, TRISS: ICU, ARDS, MODS and Death. Multivariate analysis shows that Surgery Type, GCS and TRISS predict ICU admission (ROC-0,884); TRISS predicts ARDS (ROC-0,844); TRISS predicts MODS (ROC-0,876); TRISS and age predicts Death (ROC-0,887). This study confirms scores validity in PTP assessment, as they are able to predict severe complications. TRISS seems to be the best score for prediction of bad outcomes.

Efficiency of RTS and TRISS Scores on Prognosis Evaluation in ICU Trauma Patients

Efficiency of RTS and TRISS Scores on Prognosis Evaluation in ICU Trauma Patients

Aortic injuries in crush trauma patients: Different mechanism, different management

BackgroundThe objective of this study is to report the clinical and radiological characteristics and early and long-term survival of a series of acute traumatic aortic injuries (ATAI) in crush trauma patients, and to compare such data with our last 30 years experience managing ATAI in deceleration non-crush trauma patients. MethodsFrom January 1980 to December 2010, 5 consecutive ATAI in crush trauma and 69 in non-crush trauma patients were admitted at our institution. ISS, RTS and TRISS scores were similar in both groups. ResultsOverall in-hospital mortality was 24.3%. There was no in-hospital mortality in crush patients and 26.1% in non-crush patients (p=0.32).All aortic-related complications occurred in non-crush patients. Median follow-up was 129 months (range 3–350 months). Non-crush group survival was 76.8% at 1 year, 73.6% at 5 years, and 71.2%% at 10 years. There was no mortality during follow-up in the crush group. Mean (SD) peak creatine phosphokinase was significantly higher in crush group than in non-crush group: 7598 (3690)IU/L vs. 3645 (2506)IU/L; p=0.041. Incidence of acute renal injury was higher in crush trauma patients (100% vs. 36.2%; p=0.018). Low-severity injuries were more common in crush trauma patients (100% in crush patients vs. 43.5% in non-crush patients, p=0.04). ConclusionsAortic injuries in crush thoracic trauma patients seem to present in a different clinical scenario from aortic injuries in high-speed thoracic trauma thus requiring distinct considerations. When planning the initial management of aortic injuries in crush trauma, the increased risk of rhabdomiolysis and subsequent acute renal failure, as well as a tendency to develop lower-risk aortic wall injuries, must be considered.

What Do Prehospital Trauma Scores Predict Besides Mortality?

Little information is available concerning the ability of prehospital triage scores to predict endpoints other than mortality. We evaluated two cohorts (a national cohort of 1,360 patients during 2002 and a single center cohort of 1,003 patients in 2003-2005) of trauma patients receiving care from a prehospital mobile intensive care unit (ICU). We tested the ability of prehospital triage scores (MGAP, Revised Trauma Score [RTS], and triage RTS [T-RTS]) to predict a severe injury, the need for a prolonged ICU period, the occurrence of massive hemorrhage, and the need for emergency procedures, and compared them with a reference score (Trauma-Related Injury Severity Score [TRISS]). The areas under the receiver operating characteristic (AUC(ROC)) curves were measured. The MGAP, RTS, and T-RTS scores were able to predict an Injury Severity Score >15 (AUC(ROC): 0.75, 0.75, and 0.74, respectively), the need for a stay in ICU >2 days or death (AUC(ROC) of 0.85, 0.83, and 0.83, respectively), and the massive hemorrhage (AUC(ROC): 0.70, 0.72, and 0.73, respectively). In contrast, MGAP, RTS, T-RTS, and TRISS scores were not predictors of the need of an emergency procedure (AUC(ROC): 0.53, 0.51, and 0.52, respectively). Four independent predictors of emergency procedure were noted: penetrating trauma, intravenous colloid administration >750 mL, systolic arterial blood pressure <100 mm Hg, and heart rate >100 bpm. Prehospital triage scores were predictors of Injury Severity Score >15, prolonged ICU stay, and massive hemorrhage but not of emergency procedure requirement.

Use of Focused Assessment with Sonography in Trauma in Emergency Department Patients for Triage, Diagnosis and Disposition: A Series of Cases

Objective: The aim of this study was to determine the effectiveness of fo cused assessment with sonography in blunt trauma (FAST) patients as an initial diagnostic and observational tool. Material and Methods: This descriptive prospective study was performed by collecting data from patients with blunt trauma who presented to our tertiary university hospital emergency department (ED) between October 2008 and December 2008 and who were evaluated with ultrasound by the treating emergency medicine physician (GE Proseries Logic 200 machine with a 3.5 MHz large curved array probe). Demographic, clinical, laboratory, and imaging data were collected prospectively and ISS, RTS, TRISS, and Glasgow scores were calculated. Results: During the study period, 28 patients presented with blunt trauma and they were evaluated with a bedside ultrasound within 10 minutes. Only one patient had splenic trauma and two had pleural fluid on FAST exam. The FAST results correlated positively with the decrease in hematocrit (Htc) values, ISS, TRISS, and duration of admission (p=0.006, 0.01, 0.034, 0.009). 96.4% (n=27) of the patients were discharged, and 3.6% (n=1) died. Conclusion: FAST was the first and an observational clue for trauma before Htc, or even physical examination. (JAEM 2011; 10: 119-22)

Linking trauma registry injury data with national injury compensation data – opportunities for public health action in New Zealand

BackgroundTrauma registries can play a key role in quality assurance and planning of trauma care. This study aimed to explore the feasibility and utility of linking data from a trauma...

A performance improvement programme aids analysis of potentially preventable death from trauma: A UK inner-city hospital experience

Aim: A core function of established trauma systems is to improve performance through peer identification and review of potentially preventable mortality. The aim of this study was to evaluate the rate and cause of excess mortality occurring in an inner-city trauma centre that has invested substantial resources in developing a dedicated trauma service. Method: Retrospective peer review of all in-hospital deaths from April 2003-April 2004. Three external international trauma authorities graded each death as not preventable, possibly preventable, probably preventable or preventable according to the American College of Surgeons guidelines. Mortalities were then assigned a preventability score of 1-4 accordingly, with an aggregate score of =7 flagged as potentially preventable. Results: One hundred and seventy seven patients with an ISS greater than 15 were admitted, of whom 32 (18%) died. Twenty-nine patients who died from burn (n = 1), penetrating (n = 4) or blunt injury (n = 25) had retrievable post-mortem reports and were referred for peer review. The median (range) ISS and TRISS scores were 29 (17-75) and 36 (0-97). Median (range) preventability score was 4 (3-7). Mean weighted Kappa co-efficient for inter-observer variability was 0.345, indicating fair agreement between panel members. No death was considered entirely preventable. Five (17%) cases were assigned as potentially preventable. The principle variances from standard of care identified in these cases included delay to surgery/angio for haemorrhage control (4 cases), and delay in evacuating intracranial haematoma (1). Other variances identified in non-preventable deaths were failure to apply damage control principles during surgery and avoidable secondary brain injury (2). Conclusion: Delay to theatre or failure to utilise damage control principles was the primary cause of potentially avoidable death in major trauma patients. Robust, peer review systems assist objective analysis and the development of a culture of safety and quality, and are essential if excess trauma mortality is to be minimised.

Assessing the Skill of Yes/No Predictions

Should healthy, middle-aged women receive precautionary mammograms? Should trauma surgeons use the popular TRISS score to predict the likelihood of patient survival? These are examples of questions confronting us when we decide whether to use a yes/no prediction. In order to trust a prediction we must show that it is more valuable than would be our best guess of the future in the absence of the prediction. Calculating value means identifying our loss should the prediction err and examining the past performance of the prediction with respect to that loss. A statistical test to do this is developed. Predictions that pass this test are said to have skill. Only skillful predictions should be used. Graphical and numerical methods to identify skill will be demonstrated. The usefulness of mammograms is explored.

Penetrating arrow injuries in Western India

Though penetrating arrow injuries are a rarity in the West, they are still seen frequently among the tribal population of India. This study was performed with the aim of documenting the clinical profile of injuries caused by arrows, the varied modes of clinical presentation and their management at a university hospital. A retrospective study of indoor records of 70 patients admitted over a period of 5 years at the Sir Sayajirao General Hospital (SSGH), Baroda, Gujarat, India, was carried out. A majority of patients were males (n=67), the median age being 36 years. The median delay in presentation to the hospital was 11 h. Median TRISS score was 98.2%. There were three mortalities. Major wound infection (n=1), intestinal fistula (n=1) and multiple organ dysfunction syndrome (n=2) were the noteworthy complications. Arrow injury and its astute management is still relevant in this century. Delay in treatment and a poor TRISS score adversely affects survival. Optimal exploration, adequate mobilisation, minimising haemorrhage and repair are the building blocks of successful treatment.

Evaluation of the Applicability, Efficacy, and Safety of a Thromboembolic Event Prophylaxis Guideline Designed for Quality Improvement of the Traumatically Injured Patient

Thromboembolic events (TE) such as deep venous thrombosis (DVT) and pulmonary embolism (PE) are common after trauma. Our Trauma Practice Management Committee developed an evidence-based DVT/PE prophylaxis guideline using a modified Delphi approach to standardize care and reduce TE rates. Our objective was to evaluate the applicability, efficacy, and safety of this guideline in the traumatized patient, especially those admitted first to the intensive care unit (ICU). We developed a risk-stratified DVT/PE prophylaxis guideline incorporating specific injuries, pertinent history, and physiologic parameters, favoring aggressive therapy in those at highest risk of dying from a PE. We prospectively collected data using this guideline in all patients admitted to the trauma or orthopedic-trauma services that were expected to stay for more than 48 hours (March-December 2003). Comparison was made with historical controls. Data collected included DVT, PE, prophylaxis level chosen, inferior vena cava filters, admission service and location, TRISS scores, length of stay, outcomes, adverse events, and specific risk factors. TE rates after implementation of the guideline were lower than historical controls for all patients (1.9% vs. 1.0%, p = 0.059) and for patients admitted first to the ICU (6.3% vs. 2%, p = 0.018). Completed sheets were collected for 46% of the targeted population. No bleeding events caused by guideline anticoagulation were noted, and one death occurred after inferior vena cava filter placement. Nine of the 12 TEs in the treatment group were in patients with spine or closed-head injury, delaying chemical prophylaxis. Form-based, risk-adjusted prophylaxis against TE leads to lower TE rates in a general and orthopedic ICU trauma population. Protocol compliance should be enforced.

Intercurrent complications in chronic alcoholic men admitted to the intensive care unit following trauma.

A chronic alcoholic group following trauma was investigated to determine whether their ICU stay was longer than that of a non-alcoholic group and whether their intercurrent complication rate was increased. Prospective study. An intensive care unit. A total of 102 polytraumatized patients were transferred to the ICU after admission to the emergency room and after surgical treatment. Of these patients 69 were chronic alcoholics and 33 were allocated to the non-alcoholic group. The chronic-alcoholic group. met the DSM-III-R and ICD-10 criteria for alcohol dependence or chronic alcohol abuse/harmful use. The daily ethanol intake in these patients was > or = 60 g. Diagnostic indicators included an alcoholism-related questionnaire (CAGE), conventional laboratory markers and carbohydrate-deficient transferrin. Major intercurrent complications such as alcohol withdrawal syndrome (AWS), pneumonia, cardiac complications and bleeding disorders were documented and defined according to internationally accepted criteria. Patients did not differ significantly between groups regarding age, TRISS and APACHE score on admission. The rate of major intercurrent complications was 196% in the chronic alcoholic vs 70% in the non-alcoholic group (p = 0.0001). Because of the increased intercurrent complication rate, the ICU stay was significantly prolonged in the chronic-alcoholic group by a median period of 9 days. Chronic alcoholics are reported to have an increased risk of morbidity and mortality. However, to our knowledge, nothing is known about the morbidity and mortality of chronic alcoholics in intensive care units following trauma. Since chronic alcoholics in the ICU develop more major complications with a significantly prolonged ICU stay following trauma than non-alcoholics, it seems reasonable to intensify research to identify chronic alcoholics and to prevent alcohol-related complications.

Validity of Applying Adult TRISS Analysis to Injured Children

Injury severity measures are becoming increasingly important for quality assurance and injury research. TRISS analysis, which uses the Revised Trauma Score (RTS) and Injury Severity Score (ISS) to predict survival, is an effective tool for comparing outcomes between trauma centers. It has been argued that blunt trauma outcome differs between children and adults, yet the Major Trauma Outcome Study (MTOS) adult data base (ages 15-54 years) regression weights have been used by others to calculate TRISS scores for injured children. This study appears to be the first to perform TRISS analysis on groups of children and adults treated by the same surgeons using the same treatment protocols to assess the validity of applying "adult" TRISS analysis to children. The charts of 346 consecutive children (ages 0-14) and 346 random adults (ages 15-54) admitted to a regional trauma center for isolated blunt trauma over a 30-month period were reviewed for demographics, mechanism of injury, RTS, ISS, and survival. Statistical evaluation included TRISS survival analysis and calculation of the Z statistic. The median ISS was 10 for both children and adults. The Z statistics for children and adults were similar (1.85 and 1.81). Analysis demonstrated the groups to be statistically identical with a nonsignificant trend toward improved survival compared with the MTOS baseline group. These data support the use of existing TRISS analysis for evaluation of pediatric trauma care.

Trauma Outcome Analysis of Two Canadian Centres Using the TRISS Method

In this retrospective study, the TRISS method of trauma care analysis is used to compare trauma care at the Hamilton General Hospital (HGH) and the Ottawa Civic Hospital (OCH) with the standards reported in the Major Trauma Outcome Study (MTOS). A total of 274 adult patients with multiple-system injuries were studied; their demographic data, Trauma Scores (TS) on arrival to the Emergency Room, and Injury Severity Scores (ISS) were reviewed. The TRISS scores and Z and M statistics were then calculated. In the Hamilton group, 106 consecutive patients from April through July 1987 were studied. The majority of patients (72%) were male, and the median age was 26 years. The majority of patients (96.2%) sustained blunt trauma, with motor vehicle accidents (MVA) being the most common (76.4%) mechanisms of injury. Fifty-four (51%) of the patients were transferred from outlying hospitals. The Z and M statistics were −0.05 and 0.92, respectively. In the Ottawa group, 168 consecutive patients from April 1987 through October 1988 were studied. The majority of patients (73%) were male, and the median age was 39 years. Blunt trauma accounted for the majority (91.7%) of injuries, with MVAs being responsible for 58% of injuries. Most patients (63.5%) were transferred from regional hospitals. The Z and M statistics were 1.20 and 0.56, respectively. We conclude that the survival statistics of trauma patients treated at both centres are comparable to those of trauma patients in the MTOS.

Trauma Outcome Analysis of Two Canadian Centres Using the TRISS Method

In this retrospective study, the TRISS method of trauma care analysis is used to compare trauma care at the Hamilton General Hospital (HGH) and the Ottawa Civic Hospital (OCH) with the standards reported in the Major Trauma Outcome Study (MTOS). A total of 274 adult patients with multiple-system injuries were studied; their demographic data, Trauma Scores (TS) on arrival to the Emergency Room, and Injury Severity Scores (ISS) were reviewed. The TRISS scores and Z and M statistics were then calculated. In the Hamilton group, 106 consecutive patients from April through July 1987 were studied. The majority of patients (72%) were male, and the median age was 26 years. The majority of patients (96.2%) sustained blunt trauma, with motor vehicle accidents (MVA) being the most common (76.4%) mechanisms of injury. Fifty-four (51%) of the patients were transferred from outlying hospitals. The Z and M statistics were -0.05 and 0.92, respectively. In the Ottawa group, 168 consecutive patients from April 1987 through October 1988 were studied. The majority of patients (73%) were male, and the median age was 39 years. Blunt trauma accounted for the majority (91.7%) of injuries, with MVAs being responsible for 58% of injuries. Most patients (63.5%) were transferred from regional hospitals. The Z and M statistics were 1.20 and 0.56, respectively. We conclude that the survival statistics of trauma patients treated at both centres are comparable to those of trauma patients in the MTOS.