Trauma severity scores
Keywords:
Trauma severity indices, Prognosis, Anesthesia, Severity of illness index, Wounds and injuries
Abstract
Introduction: Throughout the years, several methods have been developed to help determine injury severity and obtain accurate prognoses in trauma patients. Trauma scores that have been used for more than 40 years are extremely useful in clinical practice as well as in research.
Objective: To conduct a review of the most relevant literature on trauma and to make a description of each of the scoring tools, focusing on their limitations and their application in clinical trials.
Materials and methods: Narrative review conducted in different databases such as PubMed, ScienceDirect and OVID. A manual search was also conducted of articles on the subject in both English and Spanish.
Results: The review articles provided an adequate description of each of the scores, the way they are calculated, the main limitations in their application, and the most relevant findings in the literature.
Conclusion: There is a wide range of severity scores used in trauma patients for anticipating clinically significant outcomes with varying degrees of accuracy. Creating and validating a single, universally valid score is a huge challenge; consequently, the selection of the scoring tool is based, to a large extent, on experience, the context and the available evidence.
References
1. McDougal JL. Trauma scoring systems In: Eastman AL, Rosenbaum DA, Thal E, editors. The parkland trauma handbook: mobile medicine series, 3, 3rd ed. Philadelphia: Elsevier Health Sciences; 2008. p. 560.3, 18-23.
2. Mikhail JN, Harris YD, Sorensen VJ. Injury severity scoring: influence of trauma surgeon involvement on accuracy. J Trauma Nurs. 2003;10:43-7.
3. Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187-96.
4. Lefering R. Trauma scoring systems. Curr Opin Crit Care. 2012;18:637-40.
5. Copes WS, Champion HR, Sacco WJ, Lawnick MM, Gann DS, Gennarelli T, et al. Progress in characterizing anatomic injury. J Trauma 1990;30:1200-7.
6. Subed N, Yadav B, Jha S. Application of abbreviated injury scale and injury severity score in fatal cases with abdominopelvic injuries. Am J Forensic Med Pathol. 2014;35:275-7.
7. Glance LG, Osler TM, Mukamel DB, Meredith W, Wagner J, Dick AW. TMPM-ICD9: a trauma mortality prediction model based on ICD-9-CM codes. Ann Surg. 2009;249:1032-9.
8. Haider AH, Villegas CV, Saleem T, Efron DT, Stevens KA, Oyetunji TA, et al. Should the IDC-9 Trauma Mortality Prediction Model become the new paradigm for benchmarking trauma outcomes? J Trauma Acute Care Surg. 2012;72:1695-701.
9. Rowell SE, Barbosa RR, Diggs BS, Schreiber MA, Holcomb JB, Wade CE, et al. Specific abbreviated injury scale values are responsible for the underestimation of mortality in penetrating trauma patients by the injury severity score. J Trauma. 2011;71:S384-8.
10. Camilloni L, Giorgi Rossi P, Farchi S, Chini F, Borgia P, Guasticchi G. Triage and Injury Severity Scores as predictors of mortality and hospital admission for injuries: a validation study. Accid Anal Prev. 2010;42:1958-65.
11. Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma. 1997;43:922-5.
12. Stevenson M, Segui-Gomez M, Lescohier I, Di Scala C, McDonald-Smith G. An overview of the injury severity score and the new injury severity score. Inj Prev. 2001;7:10-3.
13. Husum H, Strada G. Injury Severity Score versus New Injury Severity Score for penetrating injuries. Prehosp Disaster Med. 2002;17:27-32. [ Links ]
14. Kilgo PD, Osler TM, Meredith W. The worst injury predicts mortality outcome the best: rethinking the role of multiple injuries in trauma outcome scoring. J Trauma. 2003;55:599-606.
15. Moore L, Lavoie A, Le Sage N, Liberman M, Bergeron E. Two worst injuries in different body regions are associated with higher mortality than two wors injuries in the same body region. J Trauma. 2006;60:802-5.
16. Mica L, Rufibach K, Keel M, Trentz O. The risk of early mortality of polytrauma patients associated to ISS, NISS, APACHE II values and prothrombin time. J Trauma Manag Outcomes. 2013;7:6.
17. Osler T, Glance L, Buzas JS, Mukamel D, Wagner J, Dick A. A trauma mortality prediction model based on the anatomic injury scale. Ann Surg. 2008;247:1041-8.
18. Cook A, Weddle J, Baker S, Hosmer D, Glance L, Friedman L, et al. A comparison of the Injury Severity Score and the Trauma Mortality Prediction Model. J Trauma Acute Care Surg. 2014;76:47-52.
19. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2:81-1.
20. Barlow P. A practical review of the Glasgow Coma Scale and Score. Surgeon. 2012;10:114-9.
21. Teasdale G, Jennett B. Assessment and prognosis of coma after head injury. Acta Neurochir (Wien). 1976;34:45-55.
22. Teasdale G, Knill-Jones R, van der Sande J. Observer variability in assessing impaired consciousness and coma. J Neurol Neurosurg Psychiatry. 1978;41:603-10.
23. Marshall LF, Becker DP, Bowers SA, Cayard C, Eisenberg H, Gross CR, et al. The National Traumatic Coma Data Bank. Part 1: Design, purpose, goals, and results. J Neurosurg. 1983;59:276-84.
24. Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA. Disability caused by minor head injury. Neurosurgery. 1981;9:221-8.
25. Rimel RW, Giordani B, Barth JT, Jane JA. Moderate head injury: completing the clinical spectrum of brain trauma. Neurosurgery. 1982;11:344-51.
26. Fischer J, Mathieson C. The history of the Glasgow Coma Scale: implications forpractice. Crit Care Nurs Q. 2001;23:52-8.
27. Davis DP, Vadeboncoeur TF, Ochs M, Poste JC, Vilke GM, Hoyt DB. The association between field Glasgow Coma Scale score and outcome in patients undergoing paramedic rapid sequence intubation J Emerg Med. 2005;29:391-7.
28. Teasdal G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G. The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurol. 2014;13:844-54.
29. Muñana-Rodríguez JE, Ramírez-Elías A. Escala de coma de Glasgow: origen, análisis y uso apropiado. Enfermería Universitaria. 2014;11:24-35.
30. Kim YJ. Injury severity scoring systems: a review of application to practice. Nurs Crit Care. 2012;17:138-50.
31. Kung WM, Tsai SH, Chiu WT, Hung KS, Wang SP, Lin JW, et al. Correlation between Glasgow coma score components and survival in patients with traumatic brain injury. Injury. 2011;42:940-4.
32. Champion HR. Trauma scoring. Scand J Surg. 2002;91:12-22.
33. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989;29:623-9.
34. Moore L, Lavoie A, Abdous B, Le Sage N, Liberman M, Bergeron E, et al. Unification of the revised trauma score. J Trauma. 2006;61:718-22.
35. Watts HF, Kerem Y, Kulstad EB. Evaluation of the revised trauma and injury severity scores in elderly trauma patients. J Emerg Trauma Shock. 2012;5:131-4.
36. Lefering R. Development and validation of the revised injury severity classification score for severely injured patients. Eur J Trauma Emerg Surg. 2009;35:437-47.
37. Champion HR, Sacco WJ, Carnazzo AJ, Copes W, Fouty WJ. Trauma score. Crit Care Med. 1981;9:672-6.
38. Rapsang AG, Shyam DC. Scoring systems of severity in patients with multiple trauma. Cirugía Española (English Edition). 2015;93:213-21.
39. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987;27:370-8.
40. Lefering R. Trauma score systems for quality assessment. EurJ Trauma. 2002;28:52-63.
41. Champion HR, Copes WS, Sacco WJ, Lawnick MM, Keast SL, Bain LW, et al. The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma. 1990;30: 1356-65.
42. Rutledge R, Osler T, Emery S, Kromhout-Schiro S. The end of the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS): ICISS, an International Classification of Diseases, ninth revision-based prediction tool, outperforms both ISS and TRISS as predictors of trauma patient survival, hospital charges, and hospital length of stay. J Trauma. 1998;44:41-9.
43. Woodford M. Scoring systems for trauma. BMJ. 2014;21.
44. Brooks SE, Mukherjee K, Gunter OL, Guillamondegui OD, Jenkins JM, Miller RS, et al. Do models incorporating comorbidities outperform those incorporating vital signs and injury pattern for predicting mortality in geriatric trauma? J Am Coll Surg. 2014;219:1020-7.
45. Bouamra O, Wrotchford A, Hollis S, Vail A, Woodford M, Lecky F. A new approach to outcome prediction in trauma: a comparison with the TRISS model. J Trauma. 2006;61:701-10.
46. Champion HR, Copes WS, Sacco WJ, Lawnick MM, Bain LW, Gann DS, et al. A new characterization of injury severity. J Trauma. 1990;30:539-45.
47. Chawda MN, Hildebrand F, Pape HC, Giannoudis PV. Predictin outcome after multiple trauma: which scoring system? Injury. 2004;35:347-58.
48. Champion HR, Copes WS, Sacco WJ, Frey CF, Holcroft JW, Hoyt DB, et al. Improved predictions from a severity characterization of trauma (ASCOT) over Trauma and Injury Severity Score (TRISS): results of an independent evaluation. J Trauma. 1996;40:42-8.
49. Russell RJ, Hodgetts TJ, McLeod J, Starkey K, Mahoney P, Harrison K, et al. The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services. Philos Trans R Soc Lond B Biol Sci. 2011;366:171-91.
50. Raj R, Brinck T, Skrifvars MB, Kivisaari R, Siironen J, Lefering R, et al. Validation of the revised injury severity classification score in patients with moderate-to-severe traumatic brain injury. Injury. 2015;46:86-93.
2. Mikhail JN, Harris YD, Sorensen VJ. Injury severity scoring: influence of trauma surgeon involvement on accuracy. J Trauma Nurs. 2003;10:43-7.
3. Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187-96.
4. Lefering R. Trauma scoring systems. Curr Opin Crit Care. 2012;18:637-40.
5. Copes WS, Champion HR, Sacco WJ, Lawnick MM, Gann DS, Gennarelli T, et al. Progress in characterizing anatomic injury. J Trauma 1990;30:1200-7.
6. Subed N, Yadav B, Jha S. Application of abbreviated injury scale and injury severity score in fatal cases with abdominopelvic injuries. Am J Forensic Med Pathol. 2014;35:275-7.
7. Glance LG, Osler TM, Mukamel DB, Meredith W, Wagner J, Dick AW. TMPM-ICD9: a trauma mortality prediction model based on ICD-9-CM codes. Ann Surg. 2009;249:1032-9.
8. Haider AH, Villegas CV, Saleem T, Efron DT, Stevens KA, Oyetunji TA, et al. Should the IDC-9 Trauma Mortality Prediction Model become the new paradigm for benchmarking trauma outcomes? J Trauma Acute Care Surg. 2012;72:1695-701.
9. Rowell SE, Barbosa RR, Diggs BS, Schreiber MA, Holcomb JB, Wade CE, et al. Specific abbreviated injury scale values are responsible for the underestimation of mortality in penetrating trauma patients by the injury severity score. J Trauma. 2011;71:S384-8.
10. Camilloni L, Giorgi Rossi P, Farchi S, Chini F, Borgia P, Guasticchi G. Triage and Injury Severity Scores as predictors of mortality and hospital admission for injuries: a validation study. Accid Anal Prev. 2010;42:1958-65.
11. Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma. 1997;43:922-5.
12. Stevenson M, Segui-Gomez M, Lescohier I, Di Scala C, McDonald-Smith G. An overview of the injury severity score and the new injury severity score. Inj Prev. 2001;7:10-3.
13. Husum H, Strada G. Injury Severity Score versus New Injury Severity Score for penetrating injuries. Prehosp Disaster Med. 2002;17:27-32. [ Links ]
14. Kilgo PD, Osler TM, Meredith W. The worst injury predicts mortality outcome the best: rethinking the role of multiple injuries in trauma outcome scoring. J Trauma. 2003;55:599-606.
15. Moore L, Lavoie A, Le Sage N, Liberman M, Bergeron E. Two worst injuries in different body regions are associated with higher mortality than two wors injuries in the same body region. J Trauma. 2006;60:802-5.
16. Mica L, Rufibach K, Keel M, Trentz O. The risk of early mortality of polytrauma patients associated to ISS, NISS, APACHE II values and prothrombin time. J Trauma Manag Outcomes. 2013;7:6.
17. Osler T, Glance L, Buzas JS, Mukamel D, Wagner J, Dick A. A trauma mortality prediction model based on the anatomic injury scale. Ann Surg. 2008;247:1041-8.
18. Cook A, Weddle J, Baker S, Hosmer D, Glance L, Friedman L, et al. A comparison of the Injury Severity Score and the Trauma Mortality Prediction Model. J Trauma Acute Care Surg. 2014;76:47-52.
19. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2:81-1.
20. Barlow P. A practical review of the Glasgow Coma Scale and Score. Surgeon. 2012;10:114-9.
21. Teasdale G, Jennett B. Assessment and prognosis of coma after head injury. Acta Neurochir (Wien). 1976;34:45-55.
22. Teasdale G, Knill-Jones R, van der Sande J. Observer variability in assessing impaired consciousness and coma. J Neurol Neurosurg Psychiatry. 1978;41:603-10.
23. Marshall LF, Becker DP, Bowers SA, Cayard C, Eisenberg H, Gross CR, et al. The National Traumatic Coma Data Bank. Part 1: Design, purpose, goals, and results. J Neurosurg. 1983;59:276-84.
24. Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA. Disability caused by minor head injury. Neurosurgery. 1981;9:221-8.
25. Rimel RW, Giordani B, Barth JT, Jane JA. Moderate head injury: completing the clinical spectrum of brain trauma. Neurosurgery. 1982;11:344-51.
26. Fischer J, Mathieson C. The history of the Glasgow Coma Scale: implications forpractice. Crit Care Nurs Q. 2001;23:52-8.
27. Davis DP, Vadeboncoeur TF, Ochs M, Poste JC, Vilke GM, Hoyt DB. The association between field Glasgow Coma Scale score and outcome in patients undergoing paramedic rapid sequence intubation J Emerg Med. 2005;29:391-7.
28. Teasdal G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G. The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurol. 2014;13:844-54.
29. Muñana-Rodríguez JE, Ramírez-Elías A. Escala de coma de Glasgow: origen, análisis y uso apropiado. Enfermería Universitaria. 2014;11:24-35.
30. Kim YJ. Injury severity scoring systems: a review of application to practice. Nurs Crit Care. 2012;17:138-50.
31. Kung WM, Tsai SH, Chiu WT, Hung KS, Wang SP, Lin JW, et al. Correlation between Glasgow coma score components and survival in patients with traumatic brain injury. Injury. 2011;42:940-4.
32. Champion HR. Trauma scoring. Scand J Surg. 2002;91:12-22.
33. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989;29:623-9.
34. Moore L, Lavoie A, Abdous B, Le Sage N, Liberman M, Bergeron E, et al. Unification of the revised trauma score. J Trauma. 2006;61:718-22.
35. Watts HF, Kerem Y, Kulstad EB. Evaluation of the revised trauma and injury severity scores in elderly trauma patients. J Emerg Trauma Shock. 2012;5:131-4.
36. Lefering R. Development and validation of the revised injury severity classification score for severely injured patients. Eur J Trauma Emerg Surg. 2009;35:437-47.
37. Champion HR, Sacco WJ, Carnazzo AJ, Copes W, Fouty WJ. Trauma score. Crit Care Med. 1981;9:672-6.
38. Rapsang AG, Shyam DC. Scoring systems of severity in patients with multiple trauma. Cirugía Española (English Edition). 2015;93:213-21.
39. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987;27:370-8.
40. Lefering R. Trauma score systems for quality assessment. EurJ Trauma. 2002;28:52-63.
41. Champion HR, Copes WS, Sacco WJ, Lawnick MM, Keast SL, Bain LW, et al. The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma. 1990;30: 1356-65.
42. Rutledge R, Osler T, Emery S, Kromhout-Schiro S. The end of the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS): ICISS, an International Classification of Diseases, ninth revision-based prediction tool, outperforms both ISS and TRISS as predictors of trauma patient survival, hospital charges, and hospital length of stay. J Trauma. 1998;44:41-9.
43. Woodford M. Scoring systems for trauma. BMJ. 2014;21.
44. Brooks SE, Mukherjee K, Gunter OL, Guillamondegui OD, Jenkins JM, Miller RS, et al. Do models incorporating comorbidities outperform those incorporating vital signs and injury pattern for predicting mortality in geriatric trauma? J Am Coll Surg. 2014;219:1020-7.
45. Bouamra O, Wrotchford A, Hollis S, Vail A, Woodford M, Lecky F. A new approach to outcome prediction in trauma: a comparison with the TRISS model. J Trauma. 2006;61:701-10.
46. Champion HR, Copes WS, Sacco WJ, Lawnick MM, Bain LW, Gann DS, et al. A new characterization of injury severity. J Trauma. 1990;30:539-45.
47. Chawda MN, Hildebrand F, Pape HC, Giannoudis PV. Predictin outcome after multiple trauma: which scoring system? Injury. 2004;35:347-58.
48. Champion HR, Copes WS, Sacco WJ, Frey CF, Holcroft JW, Hoyt DB, et al. Improved predictions from a severity characterization of trauma (ASCOT) over Trauma and Injury Severity Score (TRISS): results of an independent evaluation. J Trauma. 1996;40:42-8.
49. Russell RJ, Hodgetts TJ, McLeod J, Starkey K, Mahoney P, Harrison K, et al. The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services. Philos Trans R Soc Lond B Biol Sci. 2011;366:171-91.
50. Raj R, Brinck T, Skrifvars MB, Kivisaari R, Siironen J, Lefering R, et al. Validation of the revised injury severity classification score in patients with moderate-to-severe traumatic brain injury. Injury. 2015;46:86-93.
How to Cite
1.
Restrepo-Álvarez CA, Valderrama-Molina CO, Giraldo-Ramírez N, Constain-Franco A, Puerta A, León AL, et al. Trauma severity scores. Colomb. J. Anesthesiol. [Internet]. 2016 Oct. 1 [cited 2024 Apr. 19];44(4):317–323. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/609
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Published
2016-10-01
How to Cite
1.
Restrepo-Álvarez CA, Valderrama-Molina CO, Giraldo-Ramírez N, Constain-Franco A, Puerta A, León AL, et al. Trauma severity scores. Colomb. J. Anesthesiol. [Internet]. 2016 Oct. 1 [cited 2024 Apr. 19];44(4):317–323. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/609
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Section
Narrative review
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