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Open Access Review

Systematic review of predictive performance of injury severity scoring tools

Hideo Tohira1*, Ian Jacobs1, David Mountain1, Nick Gibson1 and Allen Yeo2

Author Affiliations

1 School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, M516 The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia

2 Department of Surgery, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia

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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2012, 20:63  doi:10.1186/1757-7241-20-63

Published: 10 September 2012

Abstract

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.

Keywords:
ISS; NISS; TRISS; ICISS; AUROC; Outcome prediction