Improving Trauma Surgeons Prospective Estimation of the Injury Severity Score

Injury Severity Score (ISS) as a prospective predictive variable is limited, as it is scored post-discharge by registrars. We followed a phase 1 pilot investigation of the feasibility of prospective ISS estimation (eISS) by trauma surgeons within 1 day of admission with an investigation of the impact of a simple educational aid on the accuracy of these estimations. Eleven surgeons evaluated 178 patients in phase 2. With the educational aid, ISS concordance improved from 74.6% to 85.1% for non-severe (abstracted ISS, aISS <16) injuries and from 78.8% to 83.1% for severe (aISS ≥16) injuries; weighted k improved from 0.53 to 0.72. Abbreviated Injury Scale (AIS) concordance similarly improved in five of seven body regions. The ability to prospectively document ISS has important clinical and research implications. There remains opportunity to refine educational aides and harness the EHR to further improve prediction accuracy and facilitate adoption in standard clinical workflows.