J Korean Soc Emerg Med.  2020 Dec;31(6):543-552.

Comparison of the new and conventional injury severity scoring systems for predicting mortality in severe geriatric trauma

• Ryu HW
• Ahn JY
• Seo KS
• Park JB
• Kim JK
• Lee MJ
• Ryoo HW
• Kim YJ
• Kim C
• Choe JY
• Lee DE
• Yeo IH
• Moon S
• Cho Y
• Chung HS
• Cho JW
• Jung H

Abstract

Objective
This study compared the prognostic performance of the following five injury severity scores: the Geriatric Trauma Outcome Score (GTOS), the Injury Severity Score (ISS), the New Injury Severity Score (NISS), the Revised Trauma Score (RTS), and the Trauma and Injury Severity Score (TRISS) for in-hospital mortality in severe geriatric trauma patients.
Methods
A retrospective, cross-sectional, observational study was conducted using a database of severe geriatric trauma patients (age ≥65 years and ISS ≥16) who presented to a single regional trauma center between November 2016 and October 2018. We compared the baseline characteristics between the survivor and mortality groups and the predictive ability of the five scoring systems.
Results
A total of 402 patients were included in the analysis; the in-hospital mortality rate was 25.6% (n=103). The TRISS had the highest area under the curve of 0.953 (95% confidence interval [CI], 0.927-0.971); followed by RTS, 0.777 (95% CI, 0.733-0.817); NISS, 0.733 (95% CI, 0.687-0.776); ISS, 0.660 (95% CI, 0.612-0.707); and GTOS, 0.660 (95% CI, 0.611-0.706) in severe geriatric trauma. The TRISS also had the highest area under the curve of 0.961 (0.919-0.985) among the injury severity scoring systems in polytrauma. The predictive ability of TRISS was significantly higher than the other four scores with respect to overall trauma and polytrauma (P<0.001).
Conclusion
The TRISS showed the highest prognostic performance for predicting in-hospital mortality among all the injury severity scoring systems in severe geriatric trauma.

Keyword

Wounds and injuries; Assessment; Geriatric; Mortality; Prognosis