Contemporary New Zealand coefficients for the trauma injury severity score: TRISS(NZ)

Schluter, Philip J., Cameron, Cate, Davey, Tamzyn, Civil, Ian, Orchard, Jodie, Dansey, Rangi, Hamill, James, Naylor, Helen, James, Carolyn, Dorrian, Jenny, Christey, Grant, Pollard, Cliff and McClure, Rod (2009) Contemporary New Zealand coefficients for the trauma injury severity score: TRISS(NZ). The New Zealand Medical Journal, 122 1302: 54-64.

Author Schluter, Philip J.
Cameron, Cate
Davey, Tamzyn
Civil, Ian
Orchard, Jodie
Dansey, Rangi
Hamill, James
Naylor, Helen
James, Carolyn
Dorrian, Jenny
Christey, Grant
Pollard, Cliff
McClure, Rod
Title Contemporary New Zealand coefficients for the trauma injury severity score: TRISS(NZ)
Journal name The New Zealand Medical Journal   Check publisher's open access policy
ISSN 0028-8446
Publication date 2009-09-11
Year available 2009
Sub-type Article (original research)
Volume 122
Issue 1302
Start page 54
End page 64
Total pages 12
Editor Frank Frizelle
Place of publication Christchurch, New Zealand
Publisher New Zealand Medical Association
Collection year 2010
Language eng
Subject 111706 Epidemiology
920409 Injury Control
Formatted abstract
To develop local contemporary coefficients for the Trauma Injury Severity Score in New Zealand, TRISS(NZ), and to evaluate their performance at predicting survival against the original TRISS coefficients.

Retrospective cohort study of adults who sustained a serious traumatic injury, and who survived until presentation at Auckland City, Middlemore, Waikato, or North Shore Hospitals between 2002 and 2006. Coefficients were estimated using ordinary and multilevel mixed-effects logistic regression models.

1735 eligible patients were identified, 1672 (96%) injured from a blunt mechanism and 63 (4%) from a penetrating mechanism. For blunt mechanism trauma, 1250 (75%) were male and average age was 38 years (range: 15–94 years). TRISS information was available for 1565 patients of whom 204 (13%) died. Area under the Receiver Operating Characteristic (ROC) curves was 0.901 (95%CI: 0.879–0.923) for the TRISS(NZ) model and 0.890 (95% CI: 0.866–0.913) for TRISS (P<0.001). Insufficient data were available to determine coefficients for penetrating mechanism TRISS(NZ) models.


Both TRISS models accurately predicted survival for blunt mechanism trauma. However, TRISS(NZ) coefficients were statistically superior to TRISS coefficients. A strong case exists for replacing TRISS coefficients in the New Zealand benchmarking software with these updated TRISS(NZ) estimates.
References 1. Traub M, Cass D. Trauma Systems. In: McClure RJ, Stevenson M, McEvoy S, eds. The Scientific Basis of Injury Prevention and Control. East Hawthorn, Vic: IP Communications; 2004:233–245. 2. Davey TM, Pollard CW, Aitken LM, et al. Tackling the burden of injury in Australasia: developing a binational trauma registry. Med J Aust. 2006;185(9):512–514. 3. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987;27(4):370–378. 4. McDermott FT, Cooper GJ, Hogan PL, et al. Evaluation of the prehospital management of road traffic fatalities in Victoria, Australia. Prehosp Disaster Med. 2005;20(4):219–227. 5. Ministry of Health. Our Health, Our Future: The Health of New Zealanders. Wellington: Ministry of Health; 1999. 6. Chiara O, Cimbanassi S, Pitidis A, Vesconi S. Preventable trauma deaths: from panel review to population based-studies. World J Emerg Surg. 2006;1:12. 7. Findlay G, Martin IC, Carter S, et al. Trauma: Who cares? London: National Confidential Enquiry into Patient Outcome and Death; 2007. 8. Sugrue M, Caldwell E, D'Amours S, et al. Time for a change in injury and trauma care delivery: a trauma death review analysis. ANZ J Surg. 2008;78(11):949–954. 9. Cameron PA, Gabbe BJ, McNeil JJ, et al. The trauma registry as a statewide quality improvement tool. J Trauma. 2005;59(6):1469–1476. 10. Gabbe BJ, Cameron PA, Wolfe R. TRISS: does it get better than this? Acad Emerg Med. 2004;11(2):181–186. 11. Joosse P, Soedarmo S, Luitse JS, Ponsen KJ. Trauma outcome analysis of a Jakarta University Hospital using the TRISS method: validation and limitation in comparison with the major trauma outcome study. Trauma and Injury Severity Score. J Trauma. 2001;51(1):134–140. 12. Kilgo PD, Meredith JW, Hensberry R, Osler TM. A note on the disjointed nature of the injury severity score. J Trauma. 2004;57(3):479–485. 13. Glance LG, Osler T. Beyond the major trauma outcome study: benchmarking performance using a national contemporary, population-based trauma registry. J Trauma. 2001;51(4):725–727. 14. Bergeron E, Rossignol M, Osler T, et al. Improving the TRISS methodology by restructuring age categories and adding comorbidities. J Trauma. 2004;56(4):760–767. 15. Talwar S, Jain S, Porwal R, et al. Trauma scoring in a developing country. Singapore Med J. 1999;40(6):386–388. 16. Millham FH, LaMorte WW. Factors associated with mortality in trauma: re-evaluation of the TRISS method using the National Trauma Data Bank. J Trauma. 2004;56(5):1090–1096. 17. Congdon P. Bayesian Statistical Modelling. Chichester: Wiley & Sons; 2002. 18. Bouamra O, Wrotchford A, Hollis S, et al. A new approach to outcome prediction in trauma: A comparison with the TRISS model. J Trauma. 2006;61(3):701–710. 19. Rutledge R, Osler T, Emery S, Kromhout-Schiro S. The end of the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS): ICISS, an International Classification of Diseases, ninth revision-based prediction tool, outperforms both ISS and TRISS as predictors of trauma patient survival, hospital charges, and hospital length of stay. J Trauma. 1998;44(1):41–49. 20. Osler TM, Rogers FB, Badger GJ, et al. A simple mathematical modification of TRISS markedly improves calibration. J Trauma. 2002;53(4):630–634. 21. Champion HR, Copes WS, Sacco WJ, et al. Improved predictions from a severity characterization of trauma (ASCOT) over Trauma and Injury Severity Score (TRISS): results of an independent evaluation. J Trauma. 1996;40(1):42–48. 22. DiRusso SM, Sullivan T, Holly C, et al. An artificial neural network as a model for prediction of survival in trauma patients: validation for a regional trauma area. J Trauma. 2000;49(2):212–220. 23. Gabbe BJ, Cameron PA, Finch CF. Is the revised trauma score still useful? ANZ J Surg. 2003;73(11):944–948. 24. Moore L, Lavoie A, Abdous B, et al. Unification of the revised trauma score. J Trauma. 2006;61(3):718–722. 25. Skaga NO, Eken T, Hestnes M, et al. Scoring of anatomic injury after trauma: AIS 98 versus AIS 90 – do the changes affect overall severity assessment? Injury. 2007;38(1):84–90. 26. Burd RS, Ouyang M, Madigan D. Bayesian logistic injury severity score: a method for predicting mortality using international classification of disease-9 codes. Acad Emerg Med. 2008;15(5):466–475.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

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