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Comparison of Current Injury Scales for Survival Chance Estimation: An Evaluation Comparing the Predictive Performance of the ISS, NISS, and AP Scores in a Dutch Local Trauma Registration

Frankema, Sander P. G.; Steyerberg, Ewout W.; Edwards, Michael J. R.; van Vugt, Arie B.

Journal of Trauma-Injury Infection & Critical Care: March 2005 - Volume 58 - Issue 3 - pp 596-604
Original Articles

Background: Prediction of survival chances for trauma patients is a basic requirement for evaluation of trauma care. The current methods are the Trauma and Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOT). Scales for scoring injury severity are part of these methods. This study compared three injury scales, the Injury Severity Score (ISS), the New ISS (NISS), and the Anatomic Profile (AP), in three otherwise identical predictive models.

Methods: Records of the Rotterdam Trauma Center were analyzed using logistic regression. The variables used in the models were age (as a linear variable), the corrected Revised Trauma Score (RTS), a denominator for blunt or penetrating trauma, and one of the three injury scales. The original TRISS and ASCOT models also were evaluated. The resulting models were compared in terms of their discriminative power, as indicated by the receiver–operator characteristic (ROC), and calibration (Hosmer–Lemeshow [HL]) for the entire range of injury severity.

Results: For this study, 1,102 patients, with an average ISS of 15, met the inclusion criteria. The TRISS and ASCOT models, using original coefficients, showed excellent discriminative power (ROC, 0.94 and 0.96, respectively), but insufficient fits (HL, p = 0.001 and p = 0.03, respectively). The three fitted models also had excellent discriminative abilities (ROC, 0.95, 0.97, and 0.96, respectively). The custom ISS model was unable to fit the entire range of survival chances sufficiently (p = 0.01). Models using the NISS and AP scales provided adequate fits to the actual survival chances of the population (HL, 0.32 and 0.12, respectively).

Conclusions: The AP and NISS scores particularly both managed to outperform the ISS score in correctly predicting survival chances among a Dutch trauma population. Trauma registries stratifying injuries by the ISS score should evaluate the use of the NISS and AP scores.

From the Departments of Anesthesiology (S.P.G.F.) and Public Health (E.W.S.), Erasmus MC Rotterdam, and the Department of General Surgery and Traumatology, University Medical Center Nijmegen (M.J.R., A.B.vV), The Netherlands.

Submitted for publication September 7, 2002.

Accepted for publication October 8, 2004.

Address for reprints: S. P. G. Frankema, MD, Trauma Centre TCZWN, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; email: s.frankema@erasmusmc.nl.

© 2005 Lippincott Williams & Wilkins, Inc.