Publication:

Evaluation of trauma outcomes using the trauma and injury severity score at a tertiary care centre: a prospective observational study

Background Trauma is a leading cause of death among young, economically active people. The trauma and injury severity score (TRISS) combines anatomical injury, physiological status and age to estimate probability of survival (Ps). We assessed its ability to predict in-hospital mortality at a tertiary care centre.

Methods In this prospective study, 180 adults (≥18 years) with trauma admitted and treated for at least 24 hours over 18 months were evaluated. Glasgow coma scale (GCS), revised trauma score (RTS), injury severity score (ISS) and TRISS Ps were calculated using standard Boyd coefficients and compared with observed outcomes. Discrimination was assessed using the area under the receiver-operating-characteristic curve (AUROC).

Results The cohort was predominantly young and male (85.6%), with road traffic accidents (60.5%) and blunt trauma (88.9%) predominating. Overall survival was 91.1% and mortality 8.9%. Non-survivors had lower GCS (7.88±3.28 versus 14.52±0.76), higher ISS (35.19±13.24 versus 12.98±7.61), lower RTS (4.60±1.40 versus 7.64±0.46) and lower TRISS Ps (48.1±28.9% versus 98.0±4.0%; all p<0.001). TRISS showed excellent discrimination (AUROC 0.994), with 56.3% sensitivity, 100% specificity, 100% positive predictive value, 95.9% negative predictive value and 96.1% accuracy.

Conclusions TRISS demonstrated excellent discrimination for in-hospital mortality and may be useful for trauma outcome assessment and audit. Its modest sensitivity suggests potential limitations in identifying some patients at risk of death and supports local validation and recalibration.