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Correlation of trauma scoring and outcome in a Canadian trauma centre
P M King1, W S Tucker, J P Waddell
1Trauma Service, St. Michael's Hospital, University of Toronto, Ont.
Objective:
To study the effectiveness of treatment and the outcome in trauma patients, and to correlate these with trauma scoring systems.
Design:
A prospective study over 1 year of the probability of survival after trauma, based on TRISS methodology. A computerized database provided outcome statistics.
Setting:
A regional trauma centre in a Canadian university teaching hospital serving regional and referral patients.
Patients:
Three hundred consecutive patients treated at a single trauma unit. Two patients were excluded because of lack of physiologic data. Blunt injuries (94%) were most frequently from motor vehicle accidents (46%).
Interventions:
Those appropriate to multidisciplinary trauma management in a level 1 trauma centre.
Main Outcome Measures:
Survival (Z values) and injury severity (M values) for the total group and subsets were calculated for comparison of outcomes with the Multiple Trauma Outcome Study baseline and other Canadian centres for multisystem and single-system injuries.
Results:
The mean Injury Severity Score was 21.16 and the mean Revised Trauma Score was 6.75. There were 51 (17%) deaths--a Z value for the study group of 2.26. The M value was 0.78. Forty of the 51 single-system injuries were head injuries and accounted for 15 deaths. The Z value for multisystem injuries only was 0.54, and the M value was 0.77.
Conclusions:
The TRISS method for analysing blunt trauma is comparable to other trauma scoring systems. The correlation of outcome analysis with other scoring systems is affected by exclusion rates, pre-referral resuscitation and single- versus multiple-injury mix of cases.
