Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Epidemiologic aspects and results of applying the TRISS methodology in a Spanish trauma intensive care unit (TICU)

  • 35 Accesses

  • 14 Citations



Analysis of epidemiologic aspects in a trauma intensive care unit (TICU) and assessment of predicted outcomes.


Prospective study. Samples collected over a 2-year period.


A Spanish TICU at a tertiary care centre.


A group of 404 trauma patients.


TRISS methodology was applied.

Main results

Mean age was 35.8±17 years. Mortality was 19.6% over a median ISS=17. Blunt trauma was more frequent than penetrating trauma (90.1% versus 9.9%). Car accident was the major aetiological factor (32.4%) and the highest mortality was among struck pedestrians (26.4%). The cranial region showed the highest incidence of lesion (57.9%) and the neurological complications on stage were the commonest reported on the discharge forms (49.7%). Mechanical ventilatory support (MVS) was applied in 53.2% of patients, with a relative mortality of 35.8%. Survivors differed significantly from nonsurvivors in terms of age, Glasgow Coma Scale rating, RTS, ISS, TRISS, stage and number of complications reported. The risk factors found to be associated with mortality were injury to cranial and abdominal/pelvic regions and age over 65. The TRISS total accuracy was 0.88 (sensitivity=0.67; specificity=0.93; area under the ROC curve=0.85±0.03). Forward stepwise logistic regression analysis selected age, ISS and RTS as the best predictors of survival. When our TRISS results were compared with those anticipated on the basis the MTOS, an injury severity mismatch appeared (z=0.02; M=0.78).


We found a 19.6% mortality in the TICU. Cranial and abdominal/pelvic injury and age over 65 were the main risk factors on admittance. Clinically, we finally agreed with the majority of TRISS outcome predictions. However, we could not statistically validate the apparent clinical goodness of the TRISS methodology.

This is a preview of subscription content, log in to check access.



Revised trauma score


Injury severity score


Major trauma outcome study


  1. 1.

    Schuster DP (1992) Predicting outcome after ICU admission. The art and science of assessing risk Chest 102:1861–1870

  2. 2.

    Champion HR, Frey CF, Copes WS et al (1989) A revision of the trauma score. J Trauma 29:623–629

  3. 3.

    Boyd CR, Tolson Ma, Copes WS (1987) Evaluating trauma care: the TRISS method. J Trauma 27:370–378

  4. 4.

    Baker SP, O'Neill B, Haddon W et al (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196

  5. 5.

    Phair IC, Barton DJ, Allen MJ et al (1991) Preventable deaths after head injury: a clinical audit of performance. Injury 22:353–356

  6. 6.

    Davis JW, Hoyt DB, McArdle S et al (1992) An analysis of errors causing morbidity and mortality in a trauma system: a guide for quality improvement. J Trauma 32:660–666

  7. 7.

    Knaus WA, Draper EA, Wagner DP et al (1985) Apache II: a severity of disease classification system. Crit Care Med 13:818–829

  8. 8.

    Greenspan L, McLellan BA, Grieg H (1985) Abbreviated injury scale and injury severity score. J Trauma 25:60–64

  9. 9.

    Chang RW, Jacobs S, Lee B (1986) Use of Apache II severity of disease classification to identify intensive care unit patients who would not benefit from total parenteral nutrition. Lancet I:1483–1487

  10. 10.

    Wagner AP, Knaus WA, Draper EA (1987) Identification of low-risk monitor admissions to medical-surgical ICUs. Chest 92:423–428

  11. 11.

    Silverstein MD (1988) Prediction instruments and clinical judgement in critical care. JAMA 260:1758–1759

  12. 12.

    Suárez Alvarez JR (1991) Desarrollo de un programa para el cálculo informático de la probabilidad de supervivencia en el traumatizado por metodología TRISS. Med Intensiva 15:225–228

  13. 13.

    Flora JD (1978) A method for comparing survival of burn patients to a standard survival curve. J Trauma 18:701–705

  14. 14.

    Metz C (1978) Basic principles of ROC analysis. Semin Nucl Med VIII:283–298

  15. 15.

    Hanley JA, Mcneil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36

  16. 16.

    Shackford SR, Mac Kersie RC, Davies JW et al (1989) Epidemiology and pathology of traumatic death occurring at a level I trauma center in a regionalized system. The importance of secondary brain injury. J Trauma 29:1392–1397

  17. 17.

    Shackford RS, Hollingsworth-Fridlund P, McArdle M et al (1987) Assuring quality in a trauma system. The medical audit commitee: composition, costs and results. J Trauma 2:866–875

  18. 18.

    Karmy Jones R, Copes WS, Champion HR et al (1992) Results of a multiinstitutional outcome assessment: results of a structured peer review of TRISS designated unexpected outcomes. J Trauma 32:196–203

  19. 19.

    Nadal P, Duarte R, Sarmiento J et al (1991) Analisis pronóstico en el politraumatismo grave. Med Intensiva 15:487–490

  20. 20.

    Baker CC, Openheimer L, Stephens B et al (1980) Epidemiology of trauma deaths. Am J Surg 140:144–150

  21. 21.

    Klamber RM, Marshall LF, Leursan TG et al (1989) Determinants of head injury mortality: importance of low-risk patient. Neurosurgery 24:31–36

  22. 22.

    Chol SC, Mizelaar JC, Barnen TY et al (1991) Prediction tree for severely head injured patients. J Neurosurg 75:251–255

  23. 23.

    Jennet B (1991) Diagnosis and management of head trauma. J Neurotrauma [Suppl 1] 8:15–18

  24. 24.

    Colohan ART, Alves WM, Gross CR (1989) Head injury mortality in two centers with different emergency medical services and intensive care. J Neurosurg 71:202–207

  25. 25.

    Bullock R, Teasdale GM (1990) Head injuries—surgical management of traumatic intracraneal haematomas. In: Bradman R (ed) Handbook of clinical neurology, vol 24. Head injury. Elsevier, Amsterdam, pp 249–298

  26. 26.

    Cox EF, Siegel JH (1987) Blunt trauma to the abdomen. In: Siegel JH (ed) Trauma. Emergency surgery and critical care. Churchill Livingstone, Edinburgh; pp 883–910

  27. 27.

    Robin E (1985) Psychiatric emergencies. In: Kaplan HI, Sadock BJ (eds) Comprehensive textbook of psychiatry. William & Wilkins, Baltimore, pp 1311–1330

  28. 28.

    Champion HR, Copes WS, Bayer D et al (1989) Major trauma in geriatric patients. Am J Public Health 79:1278–1282

  29. 29.

    Horst HM, Obeid FM, Sorenson et al (1986) Factors influencing survival of elderly trauma patients. Crit Care Med 14:681–684

  30. 30.

    Vassar MJ, Wilkerson CL, Duran PJ et al (1992) Comparison of Apache II, TRISS and a proposed 24 hour ICU point system for prediction of outcome in ICU trauma patients. J Trauma 32:490–500

  31. 31.

    McAneana OJ, Moore FA, Moore EE et al (1992) Invalidation of the Apache II scoring system for patients with acute trauma. J Trauma 33:504–507

  32. 32.

    Myers JP, Linnemann CC (1982) Bacteremia due to methicillin-resistantStaphylococcus aureus. J Infect Dis 145:532–536

  33. 33.

    Crawford R (1991) Trauma audit: experience in north-east Scotland. Br J Surg 78:1362–1367

  34. 34.

    Gillot AR, Copes WS, Langan E et al (1992) TRISS unexpected survivors. A statistical phenomenon or a clinical reality? J Trauma 33:743–748

Download references

Author information

Correspondence to J. R. Suárez-Alvarez.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Suárez-Alvarez, J.R., Miquel, J., Del Río, F.J. et al. Epidemiologic aspects and results of applying the TRISS methodology in a Spanish trauma intensive care unit (TICU). Intensive Care Med 21, 729–736 (1995). https://doi.org/10.1007/BF01704740

Download citation

Key Words

  • Multiple trauma
  • Intensive care
  • Mortality
  • Trauma severity indices