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Related Experiment Videos

Measuring injury severity: time for a change?

F D Brenneman1, B R Boulanger, B A McLellan

  • 1Department of Surgery, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.

The Journal of Trauma
|April 29, 1998
PubMed
Summary

The New Injury Severity Score (NISS) more accurately predicts short-term mortality in blunt trauma patients compared to the traditional Injury Severity Score (ISS). NISS accounts for multiple injuries, improving trauma severity assessment.

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Area of Science:

  • Trauma research
  • Medical scoring systems
  • Injury assessment

Background:

  • The Injury Severity Score (ISS) has limitations in assessing trauma severity, particularly with multiple injuries in the same body region.
  • The New Injury Severity Score (NISS) considers the three most severe injuries irrespective of body region, potentially offering a more accurate trauma severity measure.

Purpose of the Study:

  • To evaluate and compare the accuracy of the Injury Severity Score (ISS) and the New Injury Severity Score (NISS) in patients with blunt trauma.
  • To determine which scoring system, ISS or NISS, better predicts short-term mortality.

Main Methods:

  • A cohort of 2,328 blunt trauma patients treated between 1992 and 1996 was analyzed.
  • The ISS and NISS were calculated for each patient to identify discrepancies.

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  • Receiver operating characteristic (ROC) curves were used to compare the predictive accuracy of ISS and NISS for short-term mortality in discrepant cases.

    • Main Results:

    • The NISS (mean 33 ± 18) was higher than the ISS (mean 25 ± 13).
    • Scores were identical in 32% of patients and discrepant in 68%.
    • NISS demonstrated superior prediction of short-term mortality (Area Under Curve [AUC] 0.852 vs. 0.799; p < 0.001), with greater discrepancies correlating with higher mortality rates.

    Conclusions:

    • The NISS provides a more accurate prediction of short-term mortality in blunt trauma patients compared to the ISS.
    • While NISS offers improved accuracy, potential disadvantages include the disruption of established scoring systems.
    • Further research may explore greater improvements in trauma scoring systems.