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Which AIS Based Scoring System is the Best Predictor of Outcome in Orthopaedic Blunt Trauma Patients?

Harwood, Paul J. MBChB; Giannoudis, Peter V. MD; Probst, Christian MD; Van Griensven, Martijn MD; Krettek, Christian MD; Pape, Hans-Christoph MD; The Polytrauma Study Group of the German Trauma Society

Journal of Trauma-Injury Infection & Critical Care: February 2006 - Volume 60 - Issue 2 - pp 334-340
doi: 10.1097/01.ta.0000197148.86271.13
Original Articles

Background: Abbreviated Injury Scale (AIS)-based systems—the Injury Severity Score (ISS), New Injury Severity Score (NISS), and AISmax—are used to assess trauma patients. The merits of each in predicting outcome are controversial.

Methods: A large prospective database was used to assess their predictive capacity using receiver operator characteristic curves.

Results: In all, 10,062 adult, blunt-trauma patients met the inclusion criteria. All systems were significant outcome predictors for sepsis, multiple organ failure (MOF), length of hospital stay, length of intensive care unit (ICU) admission and mortality (p < 0.0001). NISS was a significantly better predictor than the ISS for mortality (p < 0.0001). NISS was equivalent to the AISmax for mortality prediction and superior in patients with orthopaedic injuries. NISS was significantly better for sepsis, MOF, ICU stay, and total hospital stay (p < 0.0001).

Conclusions: NISS is superior or equivalent to the ISS and AISmax for prediction of all investigated outcomes in a population of blunt trauma patients. As NISS is easier to calculate, its use is recommended to stratify patients for clinical and research purposes.

From the Academic Department Orthopaedic Trauma Surgery, Leeds University (P.J.H., P.V.G.), United Kingdom; Department of Trauma Surgery, Hannover Medical School (C.P., M.V.G., C.K.), Germany; Division of Trauma, Department of Orthopaedic Surgery (H-C.P.), Pittsburg, Pennsylvania.

Submitted for publication May 22, 2004.

Accepted for publication October 26, 2005.

Address for reprints: H. C. Pape, MD, Department of Orthopaedic Surgery, Division Chief-Traumatology, Suite 911, Kaufmann Med. Building, 3471 Fifth Avenue, Pittsburg, PA 15213; email:

© 2006 Lippincott Williams & Wilkins, Inc.