Development of a modified trauma and injury severity score to predict disability in acute trauma patients

Abstract

Objective: The Trauma and Injury Severity Score (TRISS) has been used to predict trauma patient mortality and to assess the quality of trauma care systems. The goal of this investigation was to develop a modified trauma-related injury severity score (termed the TRISS-D) for predicting disability in acute trauma patients.

Methods: We used data collected by emergency medical services and entered into the Korea Centers for Disease Control and Prevention severe trauma database. The TRISS-D was based on age category (0-14, 15-54, ≥55 years), the Revised Trauma Score, and the Injury Severity Score. The outcome measures were severe disability and worsening disability. Worsening disability was defined as a lower Glasgow Outcome Scale score at hospital discharge than before the traumatic incident. Two types of cases were examined: those with penetrating or blunt injuries (group 1) and those with severe head injuries (group 2). We assessed the discriminatory power of the TRISS-D by calculating the area under a receiver operating characteristic curve (AUROC).

Results: The database comprised 14,791 patients; overall, 3,757 (25%) had severe disability and 6,018 (41%) had worsening disability. For severe disability, the AUROC (95% confidence interval) for the TRISS-D was 0.948 (0.944-0.952) in group 1 and 0.950 (0.946-0.954) in group 2. The corresponding values for worsening disability were 0.810 (0.803-0.817) and 0.816 (0.809-0.823), respectively.

Conclusion: The TRISS-D showed excellent discriminatory power for severe disability and very good discriminatory power for worsening disability.

Keywords: Disability evaluation; Injury severity score; Trauma.

Fig. 1.

Selection of the study population. EMS, emergency medical service; TRISS-D, Trauma and Injury Severity Score model predicting disability