The performance of our proposed BISS model was superior to that of the TRISS model in the populations under investigation. Nevertheless, given the ease of assessment and the objective value of the base deficit, it may be considered as a good method to predict outcome and evaluate care of trauma patients. Whether this can be translated to trauma patients in general needs further investigation.

We prospectively evaluated the care of all acutely trauma patients admitted to the St. Elisabeth Hospital, Tilburg, the Netherlands, during 3 consecutive years (1996 through 1998). Data were compiled in a physician operating round the clock available electronic medical record. A total of 2849 patients were included (60% male). More than 95% suffered from a blunt trauma. Out of 2849 admitted patients 115 died.Compared with the Major Trauma Outcome Study (MTOS), the survival rates revealed at St. Elisabeth Hospital suggest a negative difference (98.1% vs. 96%). However, evaluating population differences between MTOS and our population reveals a less severely traumatized population comparing survival probabilities based upon ISS/AIS (Injury Severity Score/Abbreviated Injury Score) and RTS (Revised Trauma Score), making comparison hazardous. The evaluation of our deceased patients showed that 56% of deaths is due to severe head injury, whereas 22% of the deceased patient population consisted of patients with femoral neck fractures and minimal physiological reserve.We conclude that TRISS (Trauma Injury Severity Score) method provides a good basis for evaluation of trauma care also in a non-US environment. However, due to population differences, care should be taken drawing overall conclusions. Obvious differences of results revealed at first sight should be submitted to further meticulous evaluation. Eur J Trauma 2000;26:248-55 Introduction During the last decades there has been an increased interest in registration of the results of trauma care. Different scoring systems have been introduced in order to stratify the severity of trauma and predict its outcome. Once the severity of trauma has been stratified, evaluation of the quality of care can take place. A prospective registration of all admitted trauma patients in a hospital or trauma center provides the most important basis for a reliable trauma evaluation. Comparing the results of trauma care of sequential years in one and the same hospital can lead to insight in the aspects in which the trauma care can or should be improved. Moreover, a national or European database is needed as a reliable reference in order to get a better understanding of the epidemiology of our trauma population and to provide a basis for improvement of national and international trauma care. Key Words Trauma registration · Prediction of survival · TRISS · Quality of trauma care