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Incorporating Recent Advances To Make the TRISS Approach Universally Available

Kilgo, Patrick D. MS; Meredith, J Wayne MD; Osler, Turner M. MD

Journal of Trauma and Acute Care Surgery: May 2006 - Volume 60 - Issue 5 - p 1002-1009
doi: 10.1097/01.ta.0000215827.54546.01
Original Articles

Background: The Trauma and Injury Severity Score (TRISS), used to garner predictions of survival from the Injury Severity Score (ISS), the Revised Trauma Score (RTS, for physiologic reserve), and age is difficult for many trauma facilities to compute because it requires 8 to 10 variables and ISS depends on the specialized Abbreviated Injury Scale (AIS) scale rather than the International Classification of Diseases scale (ICD-9). It has been shown that metrics describing a patient’s worst injury (WORSTSRR) are a powerful predictor of survival (regardless of coding type, AIS versus ICD-9) and that the Glasgow Coma Scale (GCS) motor component contains the majority of the information found in the full GCS score. This study hypothesized that the TRISS approach could be made more predictive and efficient with fewer variables by incorporating these advances.

Methods: A total of 310,958 patients with nonmissing TRISS variables were subset from the National Trauma Data Bank (NTDB). Logistic regression was used to model mortality as a function of anatomic, physiologic and age variables. A traditional TRISS model was computed (with NTDB-derived coefficients) that uses ISS, RTS, age index, and mechanism to predict survival. Four smaller three- or four-variable models employed the ICD-9 WORSTSRR, the GCS motor component, and age (both continuously and dichotomously). Two of the four models also use mechanism. These models were compared using the concordance index (c-index, a measure of model discrimination) and the pseudo-R2 statistic (estimates proportion of variance explained).

Results: Each experimental model (two models with 3 variables and two models with 4 variables) have superior discrimination and explain more variance than the traditional TRISS model that employs 8–10 variables.

Conclusions: Recent advances in anatomic and physiologic scoring markedly simplify TRISS-type models at no cost to prediction. This approach uses routinely available data, requires up to seven fewer terms, and predicts at least as well as the original TRISS. These findings could increase the availability of accurate trauma scoring tools to smaller trauma facilities.

From the Department of Biostatistics, Emory University School of Public Health; the Department of General Surgery, Wake Forest University School of Medicine; and the Department of General Surgery, University of Vermont School of Medicine.

Submitted for publication October 21, 2004.

Accepted for publication February 16, 2006.

Presented at the 63rd Annual Meeting of the American Association for the Surgery of Trauma, September 29–October 2, 2004, Maui, Hawaii.

Address for reprints: Patrick Kilgo, MS, Emory University School of Public Health, Department of Biostatistics, 1518 Clifton Rd, Atlanta GA 30322; email:

© 2006 Lippincott Williams & Wilkins, Inc.