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A new weighted injury severity scoring system: better predictive power for adult trauma mortality.

ABSTRACT: Background:An accurate injury severity measurement is essential in the evaluation of trauma care and in outcome research. The traditional Injury Severity Score (ISS) does not consider the differential risks of the Abbreviated Injury Scale (AIS) from different body regions, and the three AIS involved in the calculation of ISS are given equal weights. The objective of this study was to develop a weighted injury severity scoring (wISS) system for adult trauma patients with better predictive power than the traditional Injury Severity Score (ISS). Methods:The 2007-2014 National Trauma Data Bank (NTDB) Research Datasets were used. We identified adult trauma patients from the NTDB and then randomly split it into a study sample and a test sample. Based on the association between mortality and the Abbreviated Injury Scale (AIS) from each of the six ISS body regions in the study sample, we evaluated 12 different sets of weights for the component AIS scores used in the calculation of ISS and selected one best set of weights. Discrimination (areas under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value, concordance) and calibration were compared between the wISS and ISS. Results:The areas under the receiver operating characteristic curves from the wISS and ISS are all 0.83, and 0.76 vs. 0.73 for patients with ISS?=?16-74 and 0.68 vs. 0.53 for patients with ISS?=?25-74. The wISS showed higher specificity, positive predictive value, negative predictive value, and concordance when they were compared at similar levels of sensitivity. The wISS had better calibration than the ISS. Conclusions:By weighting the AIS from different body regions, the wISS had significantly better predictive power for mortality than the ISS, especially in critically injured adults.

SUBMITTER: Shi J

PROVIDER: S-EPMC6755696 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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A new weighted injury severity scoring system: better predictive power for adult trauma mortality.

Shi Junxin J Shen Jiabin J Zhu Motao M Wheeler Krista K KK Lu Bo B Kenney Brian B Nuss Kathryn E KE Xiang Henry H

Injury epidemiology 20190923

<h4>Background</h4>An accurate injury severity measurement is essential in the evaluation of trauma care and in outcome research. The traditional Injury Severity Score (ISS) does not consider the differential risks of the Abbreviated Injury Scale (AIS) from different body regions, and the three AIS involved in the calculation of ISS are given equal weights. The objective of this study was to develop a weighted injury severity scoring (wISS) system for adult trauma patients with better predictive ...[more]

PMID: 31559123

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Project description:BACKGROUND:An accurate injury severity measurement is essential for the evaluation of pediatric trauma care and outcome research. The traditional Injury Severity Score (ISS) does not consider the differential risks of the Abbreviated Injury Scale (AIS) from different body regions nor is it pediatric specific. The objective of this study was to develop a weighted ISS (wISS) system for pediatric blunt trauma patients with better predictive power than ISS. METHODS:Based on the association between mortality and AIS from each of the six ISS body regions, we generated different weights for the component AIS scores used in the calculation of ISS. The weights and wISS were generated using the National Trauma Data Bank. The Nationwide Emergency Department Sample (NEDS) was used to validate our main results. Pediatric blunt trauma patients younger than 16 years were included, and mortality was the outcome. Discrimination (areas under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value, concordance) and calibration (Hosmer-Lemeshow statistic) were compared between the wISS and ISS. RESULTS:The areas under the receiver operating characteristic curves from the wISS and ISS are 0.88 versus 0.86 in ISS of 1 to 74 and 0.77 versus 0.64 in ISS of 25 to 74 (p < 0.0001). The wISS showed higher specificity, positive predictive value, negative predictive value, and concordance when they were compared at similar levels of sensitivity. The wISS had better calibration (smaller Hosmer-Lemeshow statistic) than the ISS (11.6 vs. 19.7 for ISS = 1-74 and 10.9 vs. 12.6 for ISS = 25-74). The wISS showed even better discrimination with the Nationwide Emergency Department Sample. CONCLUSION:By weighting the AIS from different body regions, the wISS had significantly better predictive power for mortality than the ISS, especially in critically injured children. LEVEL OF EVIDENCE AND STUDY TYPE:Prognostic/epidemiological, level IV.

Project description:Many injury severity scoring tools have been developed over the past few decades. These tools include the Injury Severity Score (ISS), New ISS (NISS), Trauma and Injury Severity Score (TRISS) and International Classification of Diseases (ICD)-based Injury Severity Score (ICISS). Although many studies have endeavored to determine the ability of these tools to predict the mortality of injured patients, their results have been inconsistent. We conducted a systematic review to summarize the predictive performances of these tools and explore the heterogeneity among studies. We defined a relevant article as any research article that reported the area under the Receiver Operating Characteristic curve as a measure of predictive performance. We conducted an online search using MEDLINE and Embase. We evaluated the quality of each relevant article using a quality assessment questionnaire consisting of 10 questions. The total number of positive answers was reported as the quality score of the study. Meta-analysis was not performed due to the heterogeneity among studies. We identified 64 relevant articles with 157 AUROCs of the tools. The median number of positive answers to the questionnaire was 5, ranging from 2 to 8. Less than half of the relevant studies reported the version of the Abbreviated Injury Scale (AIS) and/or ICD (37.5%). The heterogeneity among the studies could be observed in a broad distribution of crude mortality rates of study data, ranging from 1% to 38%. The NISS was mostly reported to perform better than the ISS when predicting the mortality of blunt trauma patients. The relative performance of the ICSS against the AIS-based tools was inconclusive because of the scarcity of studies. The performance of the ICISS appeared to be unstable because the performance could be altered by the type of formula and survival risk ratios used. In conclusion, high-quality studies were limited. The NISS might perform better in the mortality prediction of blunt injuries than the ISS. Additional studies are required to standardize the derivation of the ICISS and determine the relative performance of the ICISS against the AIS-based tools.

Project description:BackgroundNumerous trauma scoring systems have been developed in an attempt to accurately and efficiently predict the prognosis of emergent trauma cases. However, it has been questioned as to whether the accuracy and pragmatism of such systems still hold in lower-resource settings that exist in many hospitals in lower- and middle-income countries (LMICs). In this study, it was hypothesized that the physiologically-based Revised Trauma Score (RTS), Mechanism/Glasgow Coma Scale/Age/Pressure (MGAP) score, and Glasgow Coma Scale/Age/Pressure (GAP) score would be effective at predicting mortality outcomes using clinical data at presentation in a representative LMIC hospital in Upper Egypt.MethodsThis was a retrospective analysis of the medical records of trauma patients at Beni-Suef University Hospital. Medical records of all trauma patients admitted to the hospital over the 8-month period from January to August 2016 were reviewed. For each case, the RTS, MGAP, and GAP scores were calculated using clinical data at presentation, and mortality prediction was correlated to the actual in-hospital outcome.ResultsThe Area Under the Receiver Operating Characteristic (AUROC) was calculated to be 0.879, 0.890, and 0.881 for the MGAP, GAP, and RTS respectively, with all three scores showing good discriminatory ability. With regards to prevalence-dependent statistics, all three scores demonstrated efficacy in ruling out mortality upon presentation with negative predictive values > 95%, while the MGAP score best captured the mortality subgroup with a sensitivity of 94%. Adjustment of cutoff scores showed a steep trade-off between optimizing the positive predictive values versus the sensitivities.ConclusionThe RTS, MGAP, and GAP all showed good discriminatory capabilities per AUROC. Given the relative simplicity and potentially added clinical benefit in capturing critically ill patients, the MGAP score should be further studied for stratifying risk of incoming trauma patients to the emergency department, allowing for more efficacious triage of patients in lower-resource healthcare settings.

Project description:BACKGROUND:Children suffering nonaccidental trauma (NAT) are at high risk of death. It is unclear whether markers of injury severity for trauma center/system benchmarking such as Injury Severity Score (ISS) adequately characterize this. Our objective was to evaluate mortality prediction of ISS in children with NAT compared with accidental trauma (AT). METHODS:Pediatric patients younger than 16 years from the Pennsylvania state trauma registry 2000 to 2013 were included. Logistic regression predicted mortality from ISS for NAT and AT patients. Multilevel logistic regression determined the association between mortality and ISS while adjusting for age, vital signs, and injury pattern in NAT and AT patients. Similar models were performed for head Abbreviated Injury Scale (AIS). Sensitivity analysis examined impaired functional independence at discharge as an alternate outcome. RESULTS:Fifty thousand five hundred seventy-nine patients were included with 1,866 (3.7%) NAT patients. Nonaccidental trauma patients had a similar rate of mortality at an ISS of 13 as an ISS of 25 for AT patients. Nonaccidental trauma patients also have higher mortality for a given head AIS level (range, 1.2-fold to 5.9-fold higher). Injury Severity Score was a significantly greater predictor of mortality in AT patients (adjusted odds rations [AOR], 1.14; 95% confidence interval [CI], 1.13-1.15; p < 0.01) than NAT patients (AOR, 1.09; 95% CI, 1.07-1.12; p < 0.01) per 1-point ISS increase, while head injury was a significantly greater predictor of mortality in NAT patients (AOR, 3.48; 95% CI, 1.54-8.32; p < 0.01) than AT patients (AOR, 1.21; 95% CI, 0.95-1.45; p = 0.12). Nonaccidental trauma patients had a higher rate of impaired functional independence at any given ISS or head AIS level than AT patients. CONCLUSION:Nonaccidental trauma patients have higher mortality and impaired function at a given ISS/head AIS than AT patients. Conventional ISS thresholds may underestimate risk and head injury is a more important predictor of mortality in the NAT population. These findings should be considered in system performance improvement and benchmarking efforts that rely on ISS for injury characterization. LEVEL OF EVIDENCE:Epidemiologic study, level III.

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A new weighted injury severity scoring system: better predictive power for adult trauma mortality.

Publications

A new weighted injury severity scoring system: better predictive power for adult trauma mortality.

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