Evaluation of the Revised Trauma Score in Predicting Outcomes of Trauma Patients

Abstract

Introduction

The revised trauma score (RTS) was developed more than 20 years ago. Few studies investigated its usefulness in predicting trauma outcomes. This is especially true for the weighted version of RTS (RTS-w). The aim of this study was to test the predicting power of RTS-w for the trauma outcomes including mortality, admission to intensive care unit (ICU), hospital length of stay and ICU length of stay through a comparison with Injury Severity Score (ISS).

Methods

Descriptive data, variables related to the trauma scores and outcomes were collected. The statistical performance of RTS-w and ISS in predicting the trauma outcomes using receiver operating characteristics (ROC) curves and the area under the curve (AUC) with 95% confidence interval and p value were calculated. The Hosmer-Lemeshow chi-squared statistic was performed to measure its calibration.

Results

A total of 3323 patients were enrolled in the study. RTS-w was significantly better than ISS in predicting mortality of trauma patients (AUC: 0.934 vs.0.880, p<0.0001). However, for the other three outcomes, i.e. admission to ICU, hospital length of stay and intensive care unit length of stay, the performance of RTS-w was inferior to ISS.

Conclusions

The RTS-w is a better predictor of mortality than ISS. But its ability to predict other trauma outcomes is not as good as ISS. More studies are needed to identify the predictive ability of RTS-w for the outcomes other than mortality. Besides, updating the coefficients of the formula may make RTS-w more accurate.

Keywords

Injury Severity Score intensive care utilization length of stay mortality survival analysis

References

Baue

A.E.

What's the Score?

J Trauma 2008; 65(5): 1174–9.

Yates

D.W.

ABC of major trauma. Scoring systems for trauma. BMJ 1990; 301(6760): 1090–4.

Chawda

M.N.

, Hildebrand

, Pape

H.C.

, Giannoudis

P.V.

Predicting outcome after multiple trauma: which scoring system?

Injury 2004; 35(4): 347–58.

Champion

H.R.

, Sacco

W.J.

, Carnazzo

A.J.

, Copes

, Fouty

W.J.

Trauma score. Crit Care Med 1981; 9(9): 672–6.

Gabbe

B.J.

, Cameron

P.A.

, Finch

C.F.

Is the revised trauma score still useful?

ANZ J Surg 2003; 73(11): 944–8.

Champion

H.R.

, Sacco

W.J.

, Copes

W.S.

, Gann

D.S.

, Gennarelli

T.A.

, Flanagan

M.E.

A revision of the Trauma Score. J Trauma 1989; 29(5): 623–9.

Lichtveld

R.A.

, Spijkers

A.T.

, Hoogendoorn

J.M.

, Panhuizen

I.F.

, van der Werken

Triage Revised Trauma Score change between first assessment and arrival at the hospital to predict mortality. Int J Emerg Med 2008; 1(1): 21–6.

Tamim

, Al

H.A.

, Mahfoud

, Atoui

, El-Chemaly

The injury severity score or the new injury severity score for predicting mortality, intensive care unit admission and length of hospital stay: experience from a university hospital in a developing country. Injury 2008; 39(1): 115–20.

Kuwabara

, Matsuda

, Imanaka

, Fushimi

, Hashimoto

, Ishikawa

K.B.

Injury severity score, resource use, and outcome for trauma patients within a Japanese administrative database. J Trauma 2010; 68(2): 463–70.

10.

Bulut

, Koksal

, Korkmaz

, Turan

, Ozguc

Childhood falls: characteristics, outcome, and comparison of the Injury Severity Score and New Injury Severity Score. Emerg Med J 2006; 23(7): 540–5.

11.

Bilgin

N.G.

, Mert

, Camdeviren

The usefulness of trauma scores in determining the life threatening condition of trauma victims for writing medical-legal reports. Emerg Med J 2005; 22(11): 783–7.

12.

Moore

, Lavoie

, Abdous

, Le Sage

, Liberman

, Bergeron

Unification of the revised trauma score. J Trauma 2006; 61(3): 718–22; discussion 722.

13.

Oyetunji

, Crompton

J.G.

, Efron

D.T.

, Haut

E.R.

, Chang

D.C.

, Cornwell

E.R.

Simplifying physiologic injury severity measurement for predicting trauma outcomes. J Surg Res 2010; 159(2): 627–32.

14.

Osler

, Baker

S.P.

, Long

A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma 1997; 43(6): 922–5; discussion 925-6.

15.

Harwood

P.J.

, Giannoudis

P.V.

, Probst

, Van Griensven

, Krettek

, Pape

H.C.

Which AIS based scoring system is the best predictor of outcome in orthopaedic blunt trauma patients?

J Trauma 2006; 60(2): 334–40.

16.

Laupland

K.B.

, Kirkpatrick

A.W.

, Kortbeek

J.B.

, Zuege

D.J.

Long-term mortality outcome associated with prolonged admission to the ICU. Chest 2006; 129(4): 954–9.

17.

Williams

T.A.

, Ho

K.M.

, Dobb

G.J.

, Finn

J.C.

, Knuiman

, Webb

S.A.

Effect of length of stay in intensive care unit on hospital and long-term mortality of critically ill adult patients. Br J Anaesth 2010; 104(4): 459–64.

18.

Trottier

, McKenney

M.G.

, Beninati

, Manning

, Schulman

C.I.

Survival after prolonged length of stay in a trauma intensive care unit. J Trauma 2007; 62(1): 147–50.

19.

Rimachi

, Vincent

J.L.

, Brimioulle

Survival and quality of life after prolonged intensive care unit stay. Anaesth Intensive Care 2007; 35(1): 62–7.

20.

Martin

C.M.

, Hill

A.D.

, Burns

, Chen

L.M.

Characteristics and outcomes for critically ill patients with prolonged intensive care unit stays. Crit Care Med 2005; 33(9): 1922–7; quiz 1936.

21.

Schluter

P.J.

The Trauma and Injury Severity Score (TRISS) revised. Injury 2011; 42(1): 90–6.

22.

Bouillon

, Lefering

, Vorweg

, Tiling

, Neugebauer

, Troidl

Trauma score systems: Cologne Validation Study. J Trauma 1997; 42(4): 652–8.