Trauma and Injury Severity Score (TRISS) coefficients 2009 revision

Schluter, Philip J., Nathens, Avery, Neal, Melanie L., Goble, Sandra, Cameron, Cate M., Davey, Tamzyn M. and McClure, Roderick J. (2010) Trauma and Injury Severity Score (TRISS) coefficients 2009 revision. The Journal of Trauma: Injury, Infection and Critical Care, 68 4: 761-770. doi:10.1097/TA.0b013e3181d3223b

Author Schluter, Philip J.
Nathens, Avery
Neal, Melanie L.
Goble, Sandra
Cameron, Cate M.
Davey, Tamzyn M.
McClure, Roderick J.
Title Trauma and Injury Severity Score (TRISS) coefficients 2009 revision
Journal name The Journal of Trauma: Injury, Infection and Critical Care   Check publisher's open access policy
ISSN 0022-5282
Publication date 2010-04
Sub-type Article (original research)
DOI 10.1097/TA.0b013e3181d3223b
Open Access Status
Volume 68
Issue 4
Start page 761
End page 770
Total pages 10
Place of publication Baltimore, Maryland, U.S.A.
Publisher Lippincott Williams & Wilkins
Collection year 2011
Language eng
Subject C1
920409 Injury Control
110305 Emergency Medicine
Formatted abstract
Background: Currently used Trauma and Injury Severity Score (TRISS) coefficients, which measure probability of survival (PS), were derived from the Major Trauma Outcome Study (MTOS) in 1995 and are now unlikely to be optimal. This study aims to estimate new TRISS coefficients using a contemporary database of injured patients presenting to emergency departments in the United States; and to compare these against the MTOS coefficients.

Methods: Data were obtained from the National Trauma Data Bank (NTDB) and the NTDB National Sample Project (NSP). TRISS coefficients were estimated using logistic regression. Separate coefficients were derived from complete case and multistage multiple imputation analyses for each NTDB and NSP dataset. Associated PS over Injury Severity Score values were graphed and compared by age (adult ≥15 years; pediatric <15 years) and injury mechanism (blunt; penetrating) groups. Area under the Receiver Operating Characteristic curves was used to assess coefficients’ predictive performance.

Results: Overall 1,072,033 NTDB and 1,278,563 weighted NSP injury events were included, compared with 23,177 used in the original MTOS analyses. Large differences were seen between results from complete case and imputed analyses. For blunt mechanism and adult penetrating mechanism injuries, there were similarities between coefficients estimated on imputed samples, and marked divergences between associated PS estimates and those from the MTOS. However, negligible differences existed between area under the receiver operating characteristic curves estimates because the overwhelming majority of patients had minor trauma and survived. For pediatric penetrating mechanism injuries, variability in coefficients was large and PS estimates unreliable.

Conclusions: Imputed NTDB coefficients are recommended as the TRISS coefficients 2009 revision for blunt mechanism and adult penetrating mechanism injuries. Coefficients for pediatric penetrating mechanism injuries could not be reliably estimated.
Keyword Trauma and injury severity score
References 1. Gabbe BJ, Cameron PA, Wolfe R. TRISS: does it get better than this? Acad Emerg Med. 2004;11:181–186. 2. Champion HR, Sacco WJ, Copes WS. Injury severity scoring again. J Trauma. 1995;38:94 –95. 3. Kilgo PD, Meredith JW, Hensberry R, Osler TM. A note on the disjointed nature of the injury severity score. J Trauma. 2004;57:479–485. 4. Hannan EL, Mendeloff J, Farrell LS, Cayten CG, Murphy JG. Validation of TRISS and ASCOT using a non-MTOS trauma registry. J Trauma. 1995;38:83– 88. 5. The American College of Surgeons. National Trauma Data Bank Reference Manual: Background, Caveats, and Resources. Chicago, IL: The American College of Surgeons; 2005. 6. Glance LG, Osler T. Beyond the major trauma outcome study: benchmarking performance using a national contemporary, population-based trauma registry. J Trauma. 2001;51:725–727. 7. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987; 27:370 –378. 8. Champion HR, Copes WS, Sacco WJ, et al. The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma. 1990;30: 1356–1365. 9. Kirkham JJ. A comparison of hospital performance with non-ignorable missing covariates: an application to trauma care data. Stat Med. 2008; 27:5725–5744. 10. The American College of Surgeons. National Trauma Data Bank (NTDB) Research Data Set v. 7.1: User Manual. Chicago, IL: The American College of Surgeons; 2008. 11. Clark DE, Winchell RJ. Risk adjustment for injured patients using administrative data. J Trauma. 2004;57:130 –140. 12. The American College of Surgeons. National Trauma Data Bank (NTDB) National Sample Project: ED Admission Years 2003–2006. Chicago, IL: The American College of Surgeons; 2008. 13. SAS Institute Inc. SAS Help and Documentation: The MI Procedure: Overview. Cary, NC: SAS Institute Inc.; 2003. 14. Bennett DA. How can I deal with missing data in my study? Aust N Z J Public Health. 2001;25:464–469. 15. Donders AR, van der Heijden GJ, Stijnen T, Moons KG. Review: a gentle introduction to imputation of missing values. J Clin Epidemiol. 2006;59:1087–1091. 16. Noland RB, Quddus MA. Improvements in medical care and technology and reductions in traffic-related fatalities in Great Britain. Accid Anal Prev. 2004;36:103–113. 17. MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354:366–378. 18. Rothman KJ, Greenland S, Lash TL. Modern Epidemiology. 3rd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2008. 19. The American College of Surgeons. Trauma Programs: National Trauma Data Bank (NTDB) Reports and Publications. Available at: Accessed 13 June, 2009. 20. Senkowski CK, McKenney MG. Trauma scoring systems: a review. J Am Coll Surg. 1999;189:491–503. 21. 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;78:949 –954. 22. Traub M, Cass D. Trauma systems. In: McClure RJ, Stevenson M, McEvoy S, eds. The Scientific Basis of Injury Prevention and Control. East Hawthorn, Victoria: IP Communications;2004:233–245.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Nursing, Midwifery and Social Work Publications
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Created: Sun, 02 May 2010, 00:04:06 EST