[Do we need trauma scoring in emergency medicine?]

Abstract

Trauma scores in emergency medicine quantitatively characterise the severity of trauma victims' injuries and physiologic derangements. They are used to detect and assess patients and have applications in guiding patient care and early therapeutic decisions. In the pre-clinical setting, an effective trauma index meets the following criteria: It is highly reliable with regard to identifying high- and low-risk patients. It has high face-validity. It has high inter- and intra-rater reliability. It is easy to use and allows rapid, accurate measurements. The most widely accepted injury severity index is probably the Injury Severity Score (ISS). It is calculated as the sum of the squares of the three most severely injured body regions, and was originally developed as a means to standardise the description of injuries sustained in motor vehicle accidents. The Trauma Score (TS) represents the gold standard of physiologic scoring of injury severity. It summarises the numerical assessments of the central nervous and cardiopulmonary system functions. The recently developed Mainz Emergency Evaluation Score (MEES) is based upon numerical specification of the vital signs, including a pain scale, and has been designed as a dynamic score. Nevertheless, limitations of the established trauma score systems have been described. Mortality and patient outcome do not strictly correlate with injury severity scoring. In addition, intubated or paralysed patients were excluded from outcome studies since the scoring systems lacked options for evaluation of pathophysiological conditions after therapeutic interventions. Thus, therapeutic efficacy could hardly be assessed, and subsequent scoring during time periods was impossible.(ABSTRACT TRUNCATED AT 250 WORDS)