Comparison of two different trauma assessment scores in predicting trauma outcome

We reviewed 1,455 trauma cases admitted through the Emergency Department of National Cheng Kung University Hospital from June 1988 to December 1991. Of these, 1,251 patients had Revised Trauma Scores (RTS) and 1,452 cases had Injury Severity Scores (ISS) available for analysis of final trauma outcome. Several statistical methods such as simple logistic regression, the contingency table approach, and stepwise logistic regression were adopted to obtain the critical regions of major trauma which satisfied the requirements for sensitivity and specificity with the largest probability of a correct classification. We found that RTS < or = 5.7 and ISS > or = 17 were the best critical regions for defining major trauma. These patients deserve more attention during prehospital and interhospital disposition. Moreover, RTS contributes more to the prediction of patient outcome than ISS, indicating the power of RTS at the time of field evaluation in predicting patients' survival probability. The ISS is calculated retrospectively and is of limited value in acute settings. Therefore, based on our trauma database, we recommended that the RTS be used as a triage tool to select severely ill patients. We also urge that a generalized trauma registry be established in order to validate its usefulness.