The injury severity score: an operations perspective

Abstract

Background The statistical evaluation of aggregation functions for trauma grades, such as the Injury Severity Score (ISS), is largely based on measurements of their Pearson product-moment correlation with mortality. However, correlation analysis makes assumptions about the nature of the involved random variables (cardinality) and their relationship (linearity) that may not be applicable to ordinal scores such as the ISS. Moreover, using correlation as a sole evaluation criterion neglects the dynamic properties of these aggregation functions scores. Methods We analyze the domain and ordinal properties of the ISS comparatively to arbitrary linear and cubic aggregation functions. Moreover, we investigate the axiomatic properties of the ISS as a multicriteria aggregation procedure. Finally, we use a queuing simulation with various empirical distributions of Abbreviated Injury Scale (AIS) grades reported in the literature, to evaluate the queuing performance of the three aggregation functions. Results We show that the assumptions required for the computation of Pearson’s product-moment correlation coefficients are not applicable to the analysis of the association between the ISS and mortality. We suggest the use of Mutual Information, a information-theoretic statistic that is able to assess general dependence rather than a specialized, linear view based on curve-fitting. Using this metric on the same data set as the seminal study that introduced the ISS, we show that the sum of cubes conveys more information on mortality than the ISS. Moreover, we highlight some unintended, undesirable axiomatic properties of the ISS that can lead to bias in its use as a patient triage criterion. Lastly, our queuing simulation highlights the sensitivity of the queuing performance of different aggregation procedures to the underlying distribution of AIS grades among patients. Conclusions Viewing the ISS, and other possible aggregation functions for multiple AIS scores, as mere operational indicators of the priority of care, rather than cardinal measures of the response of the human body to multiple injuries (as was conjectured in the seminal study introducing the ISS) offers a perspective for their construction and evaluation on more robust grounds than the correlation coefficient. In this regard, Mutual Information appears as a more appropriate measure for the study of the association between injury severity and mortality, and queuing simulations as an actionable way to adapt the choice of an aggregation function to the underlying distribution of AIS scores.

The volume of infusion fluids correlates with treatment outcomes in critically ill trauma patients

“…The lack of such correlation in our study might be explained by the fact that non-survivors (with higher positive fluid balance), had the CRRT stopped prematurely, before full de-resuscitation, due to death. It should be noted that the ISS in our study is relatively high compared to other studies ( 51 , 52 ); however, this fact can be explained by the specification of the Level 3 Trauma Center in our hospital. The Trauma Center in our hospital is dedicated to a large region of southern Poland, where the most severe trauma victims are transported (mainly by the air transport—helicopters) in situations where very specialist treatment is necessary and when other, less specialist trauma centers in the region cannot handle them.…”

21st century critical care medicine: An overview

“…Recent advances have been hopeful. A retrospective study on 167 trauma patients showed that when a set of 63 genes were incorporated into the genomic score, they appeared to perform better in predicting outcomes than the Injury Severity Score and the Acute Physiology and Chronic Health Evaluation II (APACHE-II) (VSV1) metric[ 14 - 16 ]. Gene expression analyses have also been successful in distinguishing the molecularly defined subtypes of sepsis and even estimating their responses to various treatment modalities, such as corticosteroid therapy[ 11 ].…”

Five-year outcomes of trauma-specific function in patients after acute blunt popliteal artery injury: a matched cohort analysis

“…A prespecified form was used to general data from patients' medical records and outpatient interviews, including the Injury Severity Score (ISS) [ 12 ], associated injuries, surgical interventions and functional outcomes at the follow-up period. Ischemia time was defined as the time interval from trauma to blood flow restoration.…”