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The exponential function transforms the Abbreviated Injury Scale, which both improves accuracy and simplifies

M D Wang1, W H Fan2, W S Qiu3

  • 1Department of Emergency Medicine, Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Gongshu District, Hangzhou, 310015, Zhejiang, People's Republic of China. Wang_Xu@hz.cn.

European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society
|January 28, 2016
PubMed
Summary

The new Exponential Injury Severity Score (EISS) significantly outperforms older trauma scoring systems like NISS and ISS in predicting patient mortality. This advanced trauma score offers improved accuracy for assessing injury severity and patient outcomes.

Keywords:
Abbreviated Injury ScaleExponential Injury Severity ScoreInjury Severity ScoreNew Injury Severity ScorePrediction of mortality

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Area of Science:

  • Trauma scoring systems
  • Injury severity assessment
  • Mortality prediction in trauma

Background:

  • The Abbreviated Injury Scale (AIS) is a foundational system for injury coding.
  • Existing trauma scores like the Injury Severity Score (ISS) and New Injury Severity Score (NISS) have limitations in accurately predicting mortality.
  • There is a need for a more robust and accurate method to quantify trauma severity.

Purpose of the Study:

  • To introduce and validate the Exponential Injury Severity Score (EISS), a novel exponential transformation of AIS.
  • To compare the predictive performance of EISS against NISS and ISS for mortality in trauma patients.
  • To establish EISS as a potentially superior standard for summarizing human trauma severity.

Main Methods:

  • The EISS was calculated by applying an exponential function to AIS values (AIS severity score raised to the power of 3, minus 2) and summing the three highest injury scores.
  • EISS and NISS values were computed for two large, independent datasets of trauma patients (3,911 and 4,129) from Chinese tertiary hospitals over six years.
  • Statistical comparison of EISS and NISS predictive accuracy for mortality was performed using receiver operating characteristic (ROC) curves and the Hosmer-Lemeshow test.

Main Results:

  • The EISS demonstrated significantly higher predictive accuracy for survival compared to NISS in both datasets (Zhejiang: AUC 0.949 vs. 0.932; Liaoning: AUC 0.942 vs. 0.924).
  • Statistical significance was confirmed with P-values of 0.0115 (Zhejiang) and 0.0139 (Liaoning).
  • The EISS provided a better overall fit for mortality prediction across the entire range, as indicated by lower Hosmer-Lemeshow statistics (Zhejiang: 13.52 vs. 21.86; Liaoning: 15.55 vs. 23.27).

Conclusions:

  • The Exponential Injury Severity Score (EISS) is a more effective predictor of mortality than existing scores like NISS and ISS.
  • The EISS demonstrates superior performance in assessing trauma severity and predicting patient outcomes.
  • The study suggests that EISS has the potential to become the standard measure for summarizing human trauma.