Predicting outcome after multiple trauma: which scoring system?

We have undertaken a review of the commonly used scoring systems to identify advantages and possible pitfalls involved in their use. Currently, there is a variety of systems available for scoring trauma severity. Some of them are based on the anatomical description of the injuries, whilst others are based on physiological parameters. The most widely used systems for the purpose of predicting outcome after trauma are based on combined anatomical and physiological parameters. Systems such as the Injury Severity Score (ISS) and the Trauma Injury Severity Score (TRISS) have served some useful purposes and have proved popular over time, but it now seems that there is no ideal scoring system available. The task of incorporating various factors such as pre-existing morbidity, age, immunological differences and different genetic predispositions has made the prospect of creating a universally acceptable and applicable trauma-scoring system extremely arduous, if not impossible. Therefore caution should be exercised when using any of the existing scoring systems until an ideal one becomes available.