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NISS Predicts Postinjury Multiple Organ Failure Better than the ISS

Balogh, Zsolt MD; Offner, Patrick J. MD, MPH; Moore, Ernest E. MD; Biffl, Walter L. MD

Journal of Trauma and Acute Care Surgery: April 2000 - Volume 48 - Issue 4 - p 624-628
Annual Meeting Articles

Background: The Injury Severity Score (ISS) has been observed consistently to be a robust predictor of postinjury multiple organ failure (MOF). However, the ISS fails to account for multiple injuries to the same body region. Recently, the “new” ISS (NISS) has been proposed to address this shortcoming. Preliminary studies suggest the NISS is superior to the ISS in predicting trauma mortality. Our purpose was to determine whether the NISS is a better predictor of postinjury MOF than the ISS.

Methods: A total of 558 patients admitted to our Level I trauma center with ISS > 15, age > 15 years, and survival > 48 hours were prospectively identified; 101 (18%) developed postinjury MOF. Data characterizing postinjury MOF were collected, and the NISS was calculated retrospectively. The ISS and NISS were compared as univariate predictors of MOF. Multivariate analysis was used to determine whether substitution of NISS for ISS resulted in a superior predictive model.

Results: In 295 patients (53%), the NISS was greater than the ISS. This subgroup of patients experienced a greater frequency of MOF (26.7% vs. 8.3%, p < 0.0001), a higher mortality (12.8% vs. 4.9%, p < 0.001), and a higher early transfusion requirement (6.7 U vs. 3.6 U, p < 0.0001) compared with the group in which NISS equaled ISS. Moreover, the NISS yielded better separation between patients with and without MOF reflected by the greater difference in median NISS scores compared with ISS scores. The multivariate predictive model, including NISS, showed a better goodness of fit compared with the same model that included ISS.

Conclusions: The NISS is superior to the ISS in the prediction of postinjury MOF. This measure of tissue injury severity should replace the ISS in trauma research.

From the Department of Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, Denver, Colorado.

Address for reprints: Patrick J. Offner, MD, MPH, Department of Surgery, MC 0206, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204; email:

Submitted for publication September 25, 1999.

Accepted for publication December 23, 1999.

Presented at the 59th Annual Meeting of the American Association for the Surgery of Trauma, September 16–18, 1999, Boston, Massachusetts,.

© 2000 Lippincott Williams & Wilkins, Inc.