[Prognosis for patients involved in traffic injuries]

The outcome in trauma is influenced by the anatomical severity of the injuries as expressed in the Injury Severity Score (ISS), the physiological function as expressed in the Trauma Score (TS) and the patient's age. Based on a statistical analysis, it is possible to estimate the probability of survival. All 202 patients admitted urgently to Ullevål Hospital, Oslo, after traffic accidents in 1987 were assessed. ISS averaged 15 (one to 75). Mean ISS for the dead was 44 (25 to 75). 17 patients (8%) died. When ISS greater than or equal to 16 ('severe injury') mortality was 25%. Patients with TS less than 5 had 100% mortality. Probability of survival was mean 0.95 in survivors and 0.23 for dead. ISS, TS and probability of survival were significantly correlated to death in hospital (p less than 0.0001). Three of 181 patients with probability of survival greater than 0.5 ('avoidable deaths') died, one from an undiscovered aortic rupture, and another from a head/face injury. The third was 83 years old with thoracic injury and died from pneumonia. Two out of three patients with probability of survival between 0.5 and 0.25 ('possibly avoidable deaths') died, while six of 18 patients with probability of survival less than 0.25 ('unavoidable deaths') survived. Risk of dying in hospital was higher in patients with systolic blood pressure below 90 mmHg upon admission. In this case the odd ratio was 40.5, as compared with persons with a systolic blood pressure of 90 mmHg or above. The routines in initial trauma care can be further improved and must include rapid reversal of any hypoperfusion, parallel with quick and complete diagnostic workup.