Skip to main content
SpringerLink
Log in

Scoring systems in trauma

  • Review
  • Published:
Irish Journal of Medical Science Aims and scope Submit manuscript

Abstract

Background

Trauma is a major cause of mortality and morbidity worldwide. Methods of assessing outcome have evolved with management of trauma victims.

Results and Discussion

The wide variety of scoring instruments available to assess the injured patient may be divided into three groups: anatomical, physiological and combined systems. Anatomical systems depend on an accurate description of the injuries sustained. Physiological systems measure the effects of injury on the patient’s physiological reserves. Combined systems contain elements of both anatomical and physiological scores. Prospectively, scoring systems help in description, triage, treatment decisions and estimating outcome. Retrospective scoring is helpful in audit, in quality control, in comparing treatment methods or centres, and in identifying unexpected outcomes. Limitations may be inherent in the system or may reflect inaccurate or incomplete data collection.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Champion HR, Copes WS, Sacco WJ, et al. The Major Trauma Outcome Study: establishing national norms for trauma care.J Trauma 1990; 30: 1356–65,

    Article  PubMed  CAS  Google Scholar 

  2. Baker SP, Injuries: the neglected epidemic: Stone Lecture, 1985, America Trauma Society Meeting.J Trauma 1987; 27: 343–8.

    PubMed  CAS  Google Scholar 

  3. Oakes AR. Trauma: twentieth century epidemic.Heart Lung 1979; 8: 918–22,

    PubMed  CAS  Google Scholar 

  4. Lane PL, Doig G, Mikrogianakis A, Charyk ST, Stefanits T. An evaluation of Ontario trauma outcomes and the development of regional norms for trauma and injury severity score (TRISS) analysis.J Trauma 1996; 41: 731–4.

    Article  PubMed  CAS  Google Scholar 

  5. Murphy JG, Cayten CG, Stahl WM. Controlling for the severity of injuries in emergency medicine research.Am J Emerg Med 1990; 8: 484–91.

    Article  PubMed  CAS  Google Scholar 

  6. Esposito TJ, Offner PJ, Jurkovich GJ, Griffith J, Maier RV. Do pre-hospital trauma center triage criteria identify major trauma victims?Arch Surg 1995; 130: 171–6.

    PubMed  CAS  Google Scholar 

  7. Champion HR, Sacco WJ, Copes WS, Gann DS, Gcnnarelli TA, Flanagan ME. A revision of the trauma score.J Trauma 1989; 29: 623–9.

    Article  PubMed  CAS  Google Scholar 

  8. Carley S. Evaluating performance of the revised trauma score as a triage instrument in the pre-hospital setting.Injury 1996; 27: 756–7.

    Article  PubMed  CAS  Google Scholar 

  9. Fisher RB, Dearden CH. Improving the care of patients with major trauma in the accident and emergency department.BMJ 1990; 300: 1560–3.

    Article  PubMed  CAS  Google Scholar 

  10. Gilpin DA, Nelson PG. Revised trauma score: a triage tool in the accident and emergency department.Injury 1991; 22: 35–7.

    Article  PubMed  CAS  Google Scholar 

  11. Ryan JM, Gaudry PL, McDougall PA, McGrath PJ. Implementation of a two-tier trauma response.Injury 1998; 29: 677–83.

    Article  PubMed  CAS  Google Scholar 

  12. Kaplan LJ, Santora TA, Blank-Reid CA, Trooskin SZ. Improved emergency department efficiency with a three tier trauma triage system.Injury 1997; 28: 449–53.

    Article  PubMed  CAS  Google Scholar 

  13. Pillgram-Larsen J, Marcus M, Svennevig JL. Assessment of probability of survival in penetrating injuries using the TRISS methodology.Injury 1989; 20: 10–2.

    Article  PubMed  CAS  Google Scholar 

  14. Wong DT, Barrow PM, Gomez M, McGuire GP. A comparison of the acute physiology and chronic health evaluation (APACHE) II score and the trauma and injury severity score (TRISS) for outcome assessment in intensive care unit trauma patients.Crit Care Med 1996; 24: 1642–8.

    Article  PubMed  CAS  Google Scholar 

  15. Burdett-Smith P, Airey M, Franks A. Improvements in trauma survival in Leeds.Injury 1996; 26: 455–8.

    Article  Google Scholar 

  16. Petrie D, Lane P, Stewart TC. An evaluation of patient outcomes comparing trauma team activated versus trauma team not activated using TRISS analysis. Trauma and Injury Severity Score.J Trauma 1996; 41: 870–5.

    Article  PubMed  CAS  Google Scholar 

  17. Eastridge BJ, Burgess AR. Pedestrian pelvic fractures: five year experience of a major urban trauma center.J Trauma 1997; 42: 695–700.

    Article  PubMed  CAS  Google Scholar 

  18. Chong KH, DeCoster T, Osler T, Robinson B. Pelvic fractures and mortality.Iowa Orthop J 1997; 17: 110–4.

    PubMed  CAS  Google Scholar 

  19. Copeland CE, Mitchell KA, Bramback RJ, Gens DR, Burgess AR, Mortality in patients with bilateral femoral fractures.J Orthop Trauma 1998; 12: 315–9.

    Article  PubMed  CAS  Google Scholar 

  20. Baker SP, O’Neill B, Haddon WJ, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care.J Trauma 1974; 14: 187–96.

    Article  PubMed  CAS  Google Scholar 

  21. Committee on Injury Scaling. The abbreviated injury scale, 1990 revision. 1990; Association for the Advancement of Automotive Medicine.

  22. Adams VI, Carrubba C. The abbreviated injury scale: application to autopsy data.Am J Forensic Med Pathol 1998; 19: 246–51.

    Article  PubMed  Google Scholar 

  23. Streat SJ, Civil ID. Injury scaling at autopsy: the comparison with premortem clinical data.Accid Anal Prev 1990; 22: 241–52.

    Article  PubMed  CAS  Google Scholar 

  24. Greenspan L, McLellan BA, Greig H. Abbreviated injury scale and injury severity score: a scoring chart.J Trauma 1985; 25: 60–4.

    Article  PubMed  CAS  Google Scholar 

  25. Civil ID, Schwab CW. The Abbreviated Injury Scale, 1985 revision: a condensed chart for clinical use.J Trauma 1988; 28: 87–90.

    Article  PubMed  CAS  Google Scholar 

  26. Rodenburg H. The Florida trauma system: assessment of a statewide data base.Injury 1996; 27: 205–8.

    Article  Google Scholar 

  27. Long WB, Sacco WJ, Copes WS, Lawnick MM, Proctor SM, Sacco JB. An evaluation of expert human and automated abbreviated injury scale and ICD-9-CM injury coding.J Trauma 1994; 36: 499–503.

    PubMed  CAS  Google Scholar 

  28. Moore EE, Shackford SR, Pacher HL et al. Organ injury scaling: spleen, liver and kidney.J Trauma 1989; 29: 1664–6.

    Article  PubMed  CAS  Google Scholar 

  29. Helfet DL, Howey T, Sanders R, Johansen K. Limb salvage versus amputation. Preliminary results of the mangled extremity severity score.Clin Orthop 1990; 256: 80–6.

    PubMed  Google Scholar 

  30. Robertson PA. Prediction of amputation after severe lower limb trauma.J Bone Joint Surg (Br) 1991; 73: 816–8.

    CAS  Google Scholar 

  31. O’Sullivan ST, O’Sullivan M, Pasha N, O’Shaughnessy M, O’Connor TP. Is it possible to predict limb viability in complex Gustilo IIIB and IIIC tibial fractures? A comparison of two predictive indices.Injury 1997; 28: 639–42.

    Article  PubMed  Google Scholar 

  32. Coupland R. The Red Cross classification of war wounds: the EXCFVM scoring system.World J Surg 1992; 16: 910–7.

    Article  PubMed  CAS  Google Scholar 

  33. Bowyer GW, Stewart MP, Ryan JM. Gulf War wounds: application of the Red Cross wound classification.Injury 1993; 24: 597–600.

    Article  PubMed  CAS  Google Scholar 

  34. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale.Lancet 1974; 2: 81–4.

    Article  PubMed  CAS  Google Scholar 

  35. Grossman J, Bankes M, Bhan A, Crockard HA. The Glasgow coma score: reliable evidence?Injury 1998; 29: 435–7.

    Article  Google Scholar 

  36. Buechler CM, Blostein PA, Koestner A, Hurt K, Schaars M, McKeman J. Variation among trauma centres’ calculation of Glasgow coma scale score: results of a national survey.J Trauma 1998; 45: 429–32.

    Article  PubMed  CAS  Google Scholar 

  37. Meredith W, Rutledge R, Pakhry SM, Emery S, Kromhout-Schiro S. The conundrum of the Glasgow coma scale in intubated patients: a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores.J Trauma 1998; 44: 839–5.

    Article  PubMed  CAS  Google Scholar 

  38. Rudedge R, Lentz CW, Fakhry S, Hunt J. Appropriate use if the Glasgow coma scale in intubated patients: a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores.J Trauma 1996; 41: 514–22.

    Article  Google Scholar 

  39. Feuerman T, Wackym PA, Gade GF, Becker DP. Value of skull radiography, head computed tomographic scanning, and admission for observation in cases of minor head injury.Neurosurgery 1988; 22: 449–53.

    Article  PubMed  CAS  Google Scholar 

  40. Gomez PA, Lobato ED, Ortega JM, De La Cruz J. Mild head injury: differences in prognosis among patients with a Glasgow coma scale score of 13 to 15 and analysis of factors associated with abnormal CT findings.Br J Neurosurgery 1996; 10: 453–60.

    Article  CAS  Google Scholar 

  41. Gennarelli TA, Champion HR, Copes WS, Sacco WJ. Comparison of mortality, morbidity, and severity of 59,713 head injured patients with 114,447 patients with extracranial injuries.J Trauma 1994; 37: 962–8.

    Article  PubMed  CAS  Google Scholar 

  42. Gray A, Goyder EC, Goodacre SW, Johnson GS. Trauma triage: a comparison of CRAMS and TRTS in UK population.Injury 1997; 28: 97–101.

    Article  PubMed  CAS  Google Scholar 

  43. Roorda J, van Beeck EF, Stapert JW, ten Wolde W. Evaluating performance of the revised trauma score as a triage instrument in the prehospital setting.Injury 1996; 27: 163–7.

    Article  PubMed  CAS  Google Scholar 

  44. Le Gai JR, Loirat P, Alperovitch A et al. A simplified acute physiology score for ICU patiente.Crit Care Med 1984; 12: 975–7

    Google Scholar 

  45. Le Gall JR, Lemeshow S, Saulnier F, A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study.JAMA 1993; 270: 2957–63.

    Article  PubMed  Google Scholar 

  46. Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system.Crit Care Med 1981; 9: 591–7.

    Article  PubMed  CAS  Google Scholar 

  47. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system,Crit Care Med 1985; 13: 818–29.

    Article  PubMed  CAS  Google Scholar 

  48. Knaus WA, Wagner DP, Draper EA, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults.Chest 1991; 100: 1619–36.

    Article  PubMed  CAS  Google Scholar 

  49. Kruse JA, Thill-Baharozian MC, Carlson RW. Comparison of clinical assessment with APACHE II for predicting mortality risk in patiente admitted to a medical intensive care unit.JAMA 1988; 260: 1739–42.

    Article  PubMed  CAS  Google Scholar 

  50. Boyd CR, Toison MA, Copes WS. Evaluating trauma care: the TRISS method, trauma score and the injury severity score.J Trauma 1987; 27: 370–8.

    Article  PubMed  CAS  Google Scholar 

  51. Hill DA, Lennox AF, Neil MJ, Sheehy JP, Evaluation of TRISS as a means of selecting trauma deaths for clinical peer review.Aust N Z J Surg 1992; 62: 204–8.

    Article  PubMed  CAS  Google Scholar 

  52. Gorman DF, Teanby DN, Sinha MP, Wotherspoon J, Boot DA, Molokhia A. Preventable deaths among major trauma patients in Mersey Region, North Wales and the Isle of Man.Injury 1996; 27: 189–92.

    Article  PubMed  CAS  Google Scholar 

  53. Champion HR, Copes WS, Sacco WJ, et al. A new characterization of injury severity.J Trauma 1990; 30: 539–6.

    Article  PubMed  CAS  Google Scholar 

  54. Champion HR, Copes WS, Sacco WJ, et al. Improved predictions from a severity characterization of trauma (ASCOT) over trauma and injury severity score (TRISS): results of an independent evaluation.J Trauma 1996; 40: 42–9.

    Article  PubMed  CAS  Google Scholar 

  55. Markle J, Cayten CG, Byrne DW, Moy F, Murphy JG. Comparison between TRISS and ASCOT methods in controlling for injury severity.J Trauma 1992; 33: 326–32.

    Article  PubMed  CAS  Google Scholar 

  56. Teasdale GM, Pettigrew LE, Wilson JT, Murray G, Jennett B. Analyzing outcome of treatment of severe head injury: a review and update on advancing the use of the Glasgow outcome scale.J Neurotrauma 1998; 15: 587–97.

    Article  PubMed  CAS  Google Scholar 

  57. Hellawell DJ, Signorini DF. The Edinburgh extended Glasgow outcome scale (EEGOS): rationale and pilot studies.Int J Rehabil Res 1997; 20: 345–54.

    Article  PubMed  CAS  Google Scholar 

  58. States JD, Viano DC. Injury impairment and disability scales to assess the permanent consequences of trauma.Accid Anal Prev 1990; 22: 151–60.

    Article  PubMed  CAS  Google Scholar 

  59. MacKenzie EJ, Damiano A, Miller T, Luchter S. The development of the functional capacity index.J Trauma 1996; 41: 799–807.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Adelaide and Meath Hospital, Tallaght, Dublin

    R. Kingston & S. J. O’Flanagan

Authors
  1. R. Kingston
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. J. O’Flanagan
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kingston, R., O’Flanagan, S.J. Scoring systems in trauma. Ir J Med Sci 169, 168–172 (2000). https://doi.org/10.1007/BF03167688

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03167688

Keywords

Search

Navigation