Major trauma and the injury severity score--where should we set the bar?

Abstract

Major trauma is commonly defined using an Injury Severity Score (ISS) threshold of 15. Since this threshold was formulated, there have been significant developments in both the Abbreviated Injury Scale underlying the ISS, and trauma management techniques, both in the preventive and acute-care phases of trauma management. This study assesses whether this ISS threshold is appropriate when evaluating both mortality, and hospital-based indicators of morbidity, in a paediatric population using a large hospital trauma registry. Other registries and datasets using ISS >15 as an inclusion criterion may exclude a substantial body of data relating to significantly morbid trauma patients.

Figure 1

Breakdown of injury mechanism for groups 1–3. Transport-related mechanisms are shaded with lines; non-transport mechanisms with dots.

Figure 2

ROC curve graphs showing sensitivity and specificity for differing ISS thresholds in evaluating a) death, and b) (surviving) patients with LOS >7 days. Calculated optimum thresholds using the two methods employed, and the common ISS >15 threshold are shown.