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Different AIS Triplets: Different Mortality Predictions in Identical ISS and NISS

Aharonson-Daniel, Limor PhD; Giveon, Adi BA; Stein, Michael MD, ITG*; Peleg, Kobi PhD

Journal of Trauma-Injury Infection & Critical Care: September 2006 - Volume 61 - Issue 3 - pp 711-717
doi: 10.1097/01.ta.0000235294.32326.e6
Original Articles

Background: Previous studies demonstrated different mortality predictions for identical Injury Severity Scores (ISS) from different Abbreviated Injury Scale (AIS) triplets. This study elaborates in both scope and volume producing results of a larger magnitude, applicable to specific injury subgroups of blunt or penetrating, taumatic brain injury, various age groups, and replicated on NISS.

Methods: All patients hospitalized after trauma at 10 hospitals, with ISS/NISS (new ISS) generated by two AIS triplets, excluding patients with isolated minor or moderate injuries to a single body region were studied. Patients were separated into two groups based on the different triplets. Inpatient-mortality rates were calculated for each triplet group. Odds ratios were calculated to estimate the risk of dying in one triplet group as compared with the other. The χ2 test determined whether the difference in mortality rate between the two groups was significantly different. Differences were further explored for various subgroups.

Results: There were 35,827 patients who had ISS/NISS scores generated by two different AIS triplets. Significant differences in death rates were noted between triplet groups forming identical ISS/NISS. Odds ratio for being in the second group (always containing the higher AIS score) ranged from 2.3 to 7.4.

Conclusions: ISS and NISS that are formed by different AIS triplets have significantly different inpatient-mortality rates. The triplet with the higher AIS score has higher inpatient-mortality rates, overall and in several sub-populations of varying vulnerability. The comparison of populations and the interpretation of ISS/NISS based outcome data should take this important information into account and the components of AIS triplets creating each ISS and NISS should be reported.

From the Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.

Submitted for publication November 27, 2004.

Accepted for publication August 3, 2005.

*ITG: The Israel Trauma Group (ITG) is a study group comprised of the heads of trauma units of all hospitals belonging to the Israel Trauma Registry (ITR): Drs. R. Alficci, J. Jeroukhimov, Y Klein, Y. Kluger, M. Michaelson, A. Rivkind, G. Shaked, D. Simon, D Soffer, M. Stein.

Address for reprints: Aharonson-Daniel Limor, PhD, Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel 52621; email:

© 2006 Lippincott Williams & Wilkins, Inc.