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Comparative results of trauma scoring systems in fatal outcomes.

BACKGROUND
Trauma scoring systems are vital tools in assessing patient injuries and determining risk of mortality. This study was designed to test which score--the Injury Severity Score (ISS), the Trauma and Injury Severity Score (TRISS), TRISS plus comorbidities (TRISSCOM) or the new International Classification of Disease (ICD-9)-Based Injury Severity Score (ICISS)--has the greatest predictive value at a Level 2 trauma center.


METHODS
In this retrospective chart review, data for 39 trauma deaths over a 30-month period were collected from the Stamford Hospital Trauma Registry.


RESULTS
Patients with ISS less than 15 who later died were significantly older than patients with ISS from 15 to 24 (P = 0.038) and ISS of 25 (P = 0.013). The TRISSCOM and a modification further stratifying age both produced significantly lower mean survival predictions when compared to other scores (P = 0-0.041). Only the modified TRISSCOM was highly predictive (score < 0.2) in the most severely injured patients (identified by ISS > 25).


CONCLUSION
The TRISSCOM and its modification performed significantly better than the other scores assessed. Elderly patients may require special treatment when included in scoring system comparisons.