Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 100104

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : June | Volume : 17 | Issue : 6 | Page : PC10 - PC13 Full Version

Revised Trauma Score, Injury Severity Score, New Injury Severity Score and Trauma Revised Injury Severity Score among Trauma Patients in a Tertiary Care Hospital: A Comparative Study


Published: June 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/60767.18020
K Srinidhi, R Jai Vinod Kumar, M Reegan Jose

1. Postgraduate, Department of General Surgery, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India. 2. Professor, Department of General Surgery, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India. 3. Assistant Professor, Department of General Surgery, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India.

Correspondence Address :
Dr. K Srinidhi,
Postgraduate, Department of General Surgery, SRM Medical College Hospital and Research Centre, Chennai-603211, Tamil Nadu, India.
E-mail: kalyansrinidhi@gmail.com

Abstract

Introduction: Injury severity scoring can provide objective correlations with resource utilisation, such as length of stay and treatment costs, and inform clinical decisions regarding managing injuries of specific severity. The ability to predict survival after trauma is perhaps the most fundamental use of injury severity scoring.

Aim: To compare the efficacy of the Injury Severity Score (ISS), Revised Trauma Score (RTS), New Injury Severity Score (NISS), and Trauma Revised Injury Severity Score (TRISS) in the prediction of mortality in trauma patients.

Materials and Methods: The present prospective observational study was conducted in the Department of General Surgery, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India from April 2021 to September 2022 in 400 trauma patients who were clinically assessed and managed as per the latest Advanced Trauma Life Support (ATLS) guidelines (10th edition). After the stabilisation of the patient, RTS, ISS, NISS and TRISS were obtained from the trauma chart, imaging studies and intraoperative findings. Statistical analysis was done using the statistical software Statistical Package for the Social Sciences (SPSS) version 16.0.

Results: Most trauma patients showed more blunt injuries 284 (71.0%) than penetrating injuries 116 (29.0%). The major trauma region was external 161 (40.3%), followed by extremity 124 (31.0%). The mortality rate in the present study was 17 (4.3%). The cut-off points for predicting mortality in trauma patients in ISS, RTS, NISS and TRISS systems were 22, 6.8, 28.5, 87.95 with sensitivity of 94.12%, 88.24%, 88.24%, 100.00% and specificity of 94.78%, 94.52%, 92.95%, 95.56%, respectively.

Conclusion: According to the current study’s findings, TRISS was a more accurate prognosticator among trauma patients.

Keywords

Anatomical, Mortality rate, Physiological, Prognosticator, Receiver operating curve

Injury severity grading, regarded as a fundamental prerequisite for trauma management and clinical tests, is the primary determinant in determining the degree of an injury. The observed statistical discrepancies in the rate of long term disability after trauma between various healthcare facilities can highlight the variations in injury severity grading and patient management standards in each population under study. It is crucial to have a suitable technique or index for traumatic patient evaluation to manage these patients accurately (1). The number of lives saved and the quality of the outcomes have improved due to advancements in trauma prevention and quality control of treatment systems for trauma patients (2). Through quality improvement programmes, databases contain trauma records with severity scores, the outcomes of care systems for trauma patients can be managed most successfully (3). Severity scores in trauma are predictive screening or evaluation methods based on the patient’s physiological changes and anatomical injuries. When examining the level of service delivered, evaluating these scores enables the computation and study of the patient’s survival Probability (Ps) and comparing results within or between care services (4).

The most popular trauma severity scores currently available are divided into three categories based on the patient’s information: anatomical scores, such as the Abbreviated Injury Scale (AIS) (5) and the ISS (6); physiological scores, like the RTS (7), and mixed scores, which combine anatomical and physiological scores, like the TRISS (8).

To give numerical values to anatomical lesions and physiological changes following an accident, trauma scores were first presented more than 30 years ago. According to changes in vital signs and consciousness, physiological scores translate alterations brought on by trauma. All injuries that have been identified by a clinical examination, imaging, surgery, or autopsy are given anatomical scores. Anatomical scores are utilised once the diagnosis is made, usually following the patient’s discharge or postmortem, if physiological scores are used at the time of the patient’s initial contact (for triage) and then again to track the patient’s progress. They are used in trauma patients to categorise and to predict the severity of the lesion. For predicting a patient’s prognosis, mixed scores- scores that consider both morphological and physiological criteria- are helpful (9).

The scores have problems especially in the evaluation of penetrating trauma, such as a patient with multiple injuries in an area. An effective tool is needed to assess the prognosis of the patient in trauma. Given the significance of evaluating the prognosis of trauma patients, the present study was conducted to evaluate the prediction of mortality in trauma patients. The study aimed to compare the efficacy of the ISS, RTS, NISS, and TRISS in the prediction of mortality in trauma patients.

Material and Methods

This comparative prospective observational study was conducted in the Department of General Surgery SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, from April 2021 to September 2022 in patients admitted with the clinical diagnosis of “TRAUMA” under General Surgery care. Institutional Ethical Committee (IEC) gave permission to conduct the study with approval number: 2357/IEC/2021.

Inclusion criteria: All patients older than 13 years with clinical/radiological evidence of trauma and who gave informed consent were included in the study.

Exclusion criteria: Patients/Attendants of patients who were unwilling to participate were excluded from the study.

Sample size calculation: Sample size was calculated considering the RTS score of survivors to be 7.60±0.48 (10); d=0.05 Z=1.96, ((Z^2)*(0.48^2))/(0.05^2)=368.64. Considering loss of data, 30 patients were added and the final sample size was 400.

Study Procedure

Patients history including demographics, general examination data were collected. Patients were clinically assessed and managed per the latest ATLS guidelines (10th edition) (11). After stabilising the patient, detailed history was recorded, and a general physical/systemic examination was done. After the stabilisation of the patient, the RTS (<7.108), ISS (>15), NISS (>17) and TRISS (<91.6) was obtained from the trauma chart, imaging studies and intraoperative findings (10).

Statistical Analysis

The statistical analysis was done using the statistical software SPSS for windows (version 16). The Student’s t-test was used to compare the mean value. Receiver Operating Characteristics (ROC) curve was plotted to find the cut-off points. A p-value <0.05 was stated as statistically significant.

Results

Four hundred patients who experienced trauma were included in the study. The mean age of the trauma patients was 37.07±12.7 years. Most trauma patients were 344 men (86.0%) and 56 women (14.0%). The most common mode of injury was road traffic accidents 268 (67.0%), followed by assault 132 (33.0%) (Table/Fig 1). Most trauma patients showed blunt injuries 284 (71.0%) than penetrating injuries 116 (29.0%). The major common trauma region was external 161 (40.3%), followed by extremity 124 (31.0%). The mortality rate in this study was 4.3% (n=17) (Table/Fig 2).

The cut-off points for predicting mortality in trauma patients in ISS, RTS, NISS and TRISS systems were 22, 6.8, 28.5, 87.95 with sensitivity of 94.12%, 88.24%, 88.24%, 100.00% and specificity of 94.78%, 94.52%, 92.95%, 95.56%, respectively. All these values were found to be statistically significant (p≤0.001) (Table/Fig 3),(Table/Fig 4).

Discussion

The outcomes of trauma patients can be improved with appropriate training and application of these principles at trauma centres. Following that, the various ISS come into play. These standardised instruments are used to compare the severity of injuries with regard to clinical outcomes as well as for triaging trauma patients. Physiologic, anatomic, and mixed anatomic and physiologic scoring systems are among the many trauma scores that are utilised. The anatomic scores are ISS and NISS. Both rely on the AIS, although their methods of calculation are different. NISS is better than ISS for evaluating injured individuals. The most popular and effective physiological trauma severity scoring method is RTS. Rapid characterisation of neurologic, circulatory, and respiratory injuries is possible using the RTS system. RTS has been decried as little more than a triage tool, though (12),(13).

The present study included only the basic parameters for all the scores which includes the type of injury and the site of injury, Glasgow coma scale, systolic blood pressure, respiratory rate and using formulas the scores were calculated. In most of the cases, the most influential parameter was age and in TRISS score the age included along with the RTS and ISS score and calculated using formula.

ISS permits documenting one injury per body region (the most severe damage). To get over some of the drawbacks of ISS and make it possible to take into account severe injuries in numerous body locations, the NISS was created. Regardless of body part, the NISS only squares and adds the scores associated with the three most serios injuries.

The mean ISS in patients who died was 39.05±7.25 and in patients who survived was 6.59±6.57 with 22 being a cut-off, 94.12% sensitivity, and 94.78% specificity. The study by Javali RH et al., which had 15 as ISS cut-off, had 91% sensitivity and 89% specificity, being consistent with the findings of researcher (10). Another study by Samin OA and Civil ID revealed that the ISS score, 91% sensitivity and 90% specificity, cut-off point 38 has been utilised (14).

The mean RTS in patients died was 4.67±1.19 and in patients who have survived are 7.58±0.49, with 6.8 as a cut-off point, 88.24% sensitivity, and 94.52% specifity and AUC of 0.99. The RTS score could not be utilised to predict death. The sensitivity and specificity of 11 studies (total trauma patients=20,631) that evaluated RTS by Mansour DA et al., were 82% and 91%, respectively. The study had been carried out in six different nations. Most of the samples (76.68%) were of men (15). In the study by Javali RH et al., the average RTS score was 7.108 (97% sensitivity, 98% specificity) (10).

With a cut-off point of 28.5, the mean NISS was 43.35±8.24 in patients who passed away and 8.72±8.33 in those who survived. Mortality was predicted with a sensitivity of 88.24% and a specificity of 92.95%. Unlike Javali RH et al., the NISS cut-off value was 17 (91% sensitivity, 93% specificity), and the mean NISS value for patients who passed away was 27.657.49 and 8.806.19 for survivors (10). The average NISS for non-survivors was reported by Orhon R et al., to be 27.62±12.85 (16).

The mean TRISS was 35.07±23.98 in patients who died and 94.28±3.25 in patients who survived, with a cut-off point of 87.95 with a mortality prediction sensitivity of 100.0% and 95.56% specificity. The TRISS score can be used to predict mortality in the study population. With a sensitivity of 97% and a specificity of 88%. Javali RH et al., reached the cut-off value of 91.6. The mean TRISS for those who passed away was 58.48±25.58, and 95.49±4.41 for those who survived (10). The mean TRISS rate in the group that passed away in Orhon R et al., was greater, coming in at 72.80±19.35 and 98.34±6.58 for those treated (16). Accordingly, the TRISS score had a sensitivity of 97.1% and a specificity of 76.7% for predicting mortality among the 426 trauma cases included in the study by Höke MH et al., (17).

The prognosis of trauma victims can be accurately predicted using the TRISS grading system, according to a 2007 study by Mitchell AD et al., in Canada (18). In a study done in India, Hariharan S et al., concluded that the TRISS method can be used to predict morbidity and death in older patients after falls (19).

The sensitivity and specificity of TRISS, ISS, and RTS were found to be 87%, 68%, 81%, and 60%, respectively, in studies conducted by Milton M et al., in Africa. In polytrauma population using these scores mortality was calculated, and found that TRISS had the highest sensitivity among all these scores (20). ISS and NISS scores for the recovered were considerably lower than those who died, although the RTS and TRISS scores of survivors were greater than those of the deceased. Javali RH et al., also looked at the statistically significant difference between ISS, NISS, RTS, and TRISS with p>0.0001 (10).

Several variables could have an impact on TRISS’s ability to predict death. The score cannot consider several injuries to the same body part. Second, the score cannot consider systemic co-morbidities, which also affected the patient’s prognosis. Third, because the score is based on the patient’s breathing rate, it cannot be used to evaluate intubated patients (21). Other unique situations must be considered, including trauma epidemiology, emergency care, referral networks, and medical care. The intensity of the trauma, the presence of co-morbid conditions, emergency professionals, and the trauma treatment system all have a role in the polytrauma patient’s final prognosis. TRISS can predict survival following trauma. Recalculating the TRISS coefficients increased prediction accuracy; however, models that took co-morbidity data into account did not show any further gains. In addition, there may be diversity in trauma depending on several variables, such as the patient’s co-morbidities and injury severity, how the doctor treats each patient, and how the trauma centre’s particular system is handled (22).

Limitation(s)

The study was a single-centred study and was conducted during the COVID-19 pandemic, hence, could not follow-up the patients.

Conclusion

The present study was carried out to study the efficacy of ISS, RTS, NISS and TRISS in predicting mortality in trauma patients. According to the current study’s findings, TRISS was a more accurate prognosticator among trauma patients. This rating system can determine a patient’s prognosis and the need for early, intensive treatment. Trauma patients’ mortality and morbidity may be decreased if structured care is started as soon as possible.

References

1.
Aydin SA, Bulut M, Ozgüç H, Ercan I, Türkmen N, Eren B, et al. Should the new injury severity score replace the injury severity score in the trauma and injury severity score? Ulus Travma Acil Cerrahi Derg. 2008;14(4):308-12.
2.
Stewart TC, Lane PL, Stefanits T. An evaluation of patient outcomes before and after trauma center designation using trauma and injury severity score analysis. J Trauma. 1995;39(6):1036-40. [crossref][PubMed]
3.
World Health Organization; International Association for Trauma Surgery and Intensive Care. Guidelines for trauma quality improvement programmes. Geneva: WHO; 2009.
4.
Pereira Junior GA, Scarpelini S, Basile Filho A, Andrade JI. Trauma indices. Medicina (Ribeirão Preto). 1999;32:237-50. [crossref]
5.
Association for the Advancement of Automotive Medicine (AAAM). The Abbreviated Injury Scale (AIS): 1990 revision, update 1998. Illinois: Des Plaines; 1998.
6.
Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187-96. [crossref][PubMed]
7.
Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the trauma score. J Trauma. 1989;29(5):623-29. [crossref][PubMed]
8.
Champion HR, Copes WS, Sacco WJ, Lawnick MM, Keast SL, Bain LW, et al. The major trauma outcome study: Establishing national norms for trauma care. J Trauma. 1990;30(11):1356-65. [crossref][PubMed]
9.
Beuran M, Negoi I, Pun S, Runcanu A, Gaspar B, Vartic M. Trauma scores: A review of the literature. Chirurgia (Bucur). 2012;107(3):291-97.
10.
Javali RH, Patil A, Srinivasarangan M. Comparison of injury severity score, new injury severity score, revised trauma score and trauma and injury severity score for mortality prediction in elderly trauma patients. Indian J Crit Care Med. 2019;23(2):73. [crossref][PubMed]
11.
ACS. ATLS student course manual: Advanced trauma life support. 10th ed. American College of Surgeons; 2018.
12.
Kortbeek JB. Buckley R. Trauma-care systems in Canada. Injury. 2003;34:658-63. [crossref][PubMed]
13.
Chawda MN, Hildebrand F, Pape HC, Giannoudis PV. Predicting outcome aftermultiple trauma: Which scoring system? Injury. 2004;35:347-58. [crossref][PubMed]
14.
Samin OA, Civil ID. The new injury severity score versus the injury severity score in predicting patient outcome: A comparative evaluation on trauma service patients of the Auckland hospital. Annu Proc Assoc Adv Automot Med. 1999;43:01-15. PMCID: PMC3400229.
15.
Mansour DA, Abou Eisha HA, Asaad AE. Validation of revised trauma score in the emergency department of Kasr Al Ainy. The Egyptian J Surg. 2019;38(4):679-84.
16.
Orhon R, Eren SH, Karadayi S, Korkmaz I, Cos¸kun A, Eren M, et al. Comparison of trauma scores for predicting mortality and morbidity on trauma patients. Ulus Travma Acil Cerrahi Derg. 2014;20(4):258-64.[crossref][PubMed]
17.
Höke MH, Usul E, Özkan S. Comparison of Trauma Severity Scores (ISS, NISS, RTS, BIG Score, and TRISS) in multiple trauma patients. J Trauma Nurs. 2021;28(2):100-06. [crossref][PubMed]
18.
Mitchell AD, Tallon JM, Sealy B. Air versus ground transport of major trauma patients to a tertiary trauma centre: A province-wide comparison using TRISS analysis. Can J Surg. 2007;50(2):129-33.
19.
Hariharan S, Chen D, Parker K, Figari A, Lessey G, Absolom D, et al. Evaluation of trauma care applying TRISS methodology in a Caribbean developing country. J Emerg Med. 2009;37(1):85-90. [crossref][PubMed]
20.
Milton M, Engelbrecht A, Geyser M. Predicting mortality in trauma patients-A retrospective comparison of the performance of six scoring systems applied to polytrauma patients from the emergency centre of a South African central hospital. Afr J Emerg Med. 2021;11:453-58. [crossref][PubMed]
21.
Gunawan B, Dumastoro R, Kamal AF. Trauma and injury severity score in predicting mortality of polytrauma patients. eJournal Kedokteran Indonesia. 2018 Jan 17. [crossref]
22.
Siritongtaworn P, Opasanon S. The use of Trauma Score-Injury Severity Score (TRISS) at Siriraj hospital: How accurate is it? J Med Assoc Thai. 2009;92(8):1016-21.

DOI and Others

DOI: 10.7860/JCDR/2023/60767.18020

Date of Submission: Oct 13, 2022
Date of Peer Review: Jan 04, 2023
Date of Acceptance: Apr 05, 2023
Date of Publishing: Jun 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 14, 2022
• Manual Googling: Mar 25, 2023
• iThenticate Software: Mar 30, 2023 (14%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com