A Comparative Study of Injury Severity Scales as Predictors of Mortality in Trauma Patients: Which Scale Is the Best?

Abstract

To compare the injury severity scales as predictors of mortality in trauma patients to search for the best scale. Methods: In a prospective cohort study and systematical random sampling conducted from March to September 2017, trauma patients over the age of 13 years were enrolled. The investigated variables were age, gender, systolic blood pressure, heart rate, respiratory rate, injured body region, Glasgow Coma Scale (GCS), injury severity score (ISS), revised trauma score (RTS), trauma injury severity score (TRISS) and the outcome. Results: Totally, 1410 trauma patients were followed up, out of which 68.5% were male. The participants' mean age was 43.5±20.88 years. After adjusting the confounding effects, age over 60 years (OR=7.38, CI [3.91-13.93]), GCS<8 (OR=6.5, ), RTS<7.6 (OR=6.04, CI [2-13.7]), and TRISS<0.9 (OR=3.09, CI [1.39-6.88]) were determined as the most significant predictor variables for in-hospital mortality. The results of Receiver Operating Characteristic (ROC) curve revealed that TRISS had the highest area under the curve in comparison to other tests that were evaluated. Furthermore, TRISS had the highest sensitivity and specificity for scores higher than 96.15. By contrast, the sensitivity and specificity of GCS decreased for scores higher than 5.5. Conclusion:Our results showed that TRISS, RTS, GCS, and ISS were all very effective approaches for evaluating prognosis, mortality and probable complications in trauma patients; thus, these systems of injury evaluation and scoring are recommended to facilitate treatment. TRISS, RTS, and ISS had almost the same sensitivity that was higher than GCS, but GCS had the most specificity. Finally, TRISS was selected as the most efficient scale for predicting mortality.

Prevalence and Factors Predicting Preventable Trauma Induced Mortality

“…Although male victims like other studies were dominant (77 vs. 23%), 3,6,11,15,[17][18][19][20][21] younger ages and being male or female didn't in uence on survival probability in this study. However, opponents considered whether being female or being over 60-65 years could decrease survival rate.…”

“…However, opponents considered whether being female or being over 60-65 years could decrease survival rate. 9,20,21 Post traumatic GCS ≥8 in this study was in association with better prognosis; namely patients with higher GCS than 7 had 3.3 times more chance to survive in comparison with some who had lower score(CI95%:1-10.3). Advocates declared that lower GCS was accompanied with either pre-hospital or inhospital 10 to 13 times higher mortality rate respectively.…”

“…Advocates declared that lower GCS was accompanied with either pre-hospital or inhospital 10 to 13 times higher mortality rate respectively. 20,21 The sensitivity for prediction of death in the latter study achieved to 68% for GCS≤5.5. 20 Our survey manifested that GCS≥9 was accompanied with 60% sensitivity to predict preventability of trauma related mortality.…”

“…Other authors have claimed that SBP lesser than 90 and 60 mmHg was contributed to 2.5 and 2.2 times more possibility for post traumatic death. 20,21 This study showed that respiratory rate ≥20 per minute prior to every breathing assistance increased the probability of survival 1.7 times(CI95%:1-2.9). Based on our knowledge, no identical study was found to compare for the latter nding.…”

Physiologic risk factors for early acute kidney injury in severely injured patients

“…At the last, ISS is based strictly on the degree of anatomic injury, but does not contain relevant physiologic factors contributing to AKI development in the victims of trauma. Combined scoring systems, which include both anatomic and physiologic variables indicated a higher effi ciency of these systems in predicting mortality compared to ISS (24). The positive correlation between NGALmax and ISS without a difference in ISS between the AKI and non-AKI groups could be explained by the fact that the injury severity represents a signifi cant insult for kidney function, but other factors resulting from the injury are involved in the development of clinically signifi cant AKI too.…”