Comparative results of trauma scoring systems in fatal outcomes.

BACKGROUND: Trauma scoring systems are vital tools in assessing patient injuries and determining risk of mortality. This study was designed to test which score--the Injury Severity Score (ISS), the Trauma and Injury Severity Score (TRISS), TRISS plus comorbidities (TRISSCOM) or the new International Classification of Disease (ICD-9)-Based Injury Severity Score (ICISS)--has the greatest predictive value at a Level 2 trauma center. METHODS: In this retrospective chart review, data for 39 trauma deaths over a 30-month period were collected from the Stamford Hospital Trauma Registry. RESULTS: Patients with ISS less than 15 who later died were significantly older than patients with ISS from 15 to 24 (P = 0.038) and ISS of 25 (P = 0.013). The TRISSCOM and a modification further stratifying age both produced significantly lower mean survival predictions when compared to other scores (P = 0-0.041). Only the modified TRISSCOM was highly predictive (score < 0.2) in the most severely injured patients (identified by ISS > 25). CONCLUSION: The TRISSCOM and its modification performed significantly better than the other scores assessed. Elderly patients may require special treatment when included in scoring system comparisons.