Do Injury Severity Scores Represent Combat Injury?

Research Paper Title

All Trauma Is Not Created Equal: Redefining Severe Trauma for Combat Injuries.

Background

Injury severity scores (ISS) and shock index (SI) are popular trauma scoring systems.

Methods

The researchers assessed ISS and SI in combat trauma to determine the optimal cut-off values for mortality and trauma outcomes. Retrospective analysis of the Department of Defence Trauma Registry, 2008-2016, was performed.

Areas under receiver operating characteristic curves (AUROCs) were calculated for ISS and SI on mortality, massive volume transfusion (MVT), and emergent surgical procedure (ESP).

Optimal cut-off values were defined using the Youden index (YI).

Results

22,218 patients (97.1% male), median ages 25-29 years, ISS 9.4 ± 0.07, with 58.1% penetrating injury were studied.

Overall mortality was 3.4%. AUROCs for ISS on mortality, MVT, and ESP were 0.882, 0.898, and 0.846, while AUROCs for SI were 0.727, 0.864, and 0.711 respectively.

The optimal cut-off values for ISS on mortality, MVT, and ESP were 12.5 (YI = 0.634), 12.5 (YI = 0.666), and 12.5 (YI = 0.819), with optimal values for SI being 0.94 (YI = 0.402), 0.88 (YI = 0.608), and 0.81 (YI = 0.345) respectively.

Conclusions

Classic values for severe ISS under-represent combat injury while the SI values defined in this study are consistent with civilian data.

Reference

Lammers, D.T., Marenco, C.W., Morte, K.R., Bingham, J.R., Martin, M.J. & Eckert, M.J. (2020) All Trauma Is Not Created Equal: Redefining Severe Trauma for Combat Injuries. American Journal of Surgery. 219(5), pp.869-873. doi: 10.1016/j.amjsurg.2020.03.020. Epub 2020 Mar 26.

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