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

Objectives: This study tests the accuracy of the Injury Severity Score (ISS), New Injury Severity Score (NISS), Revised Trauma Score (RTS) and Trauma and Injury Severity Score (TRISS) in prediction of mortality in cases of geriatric trauma.Design: Prospective observational study Materials and methods: This was a prospective observational study on two hundred elderly trauma patients who were admitted to JSS Hospital, Mysuru over a consecutive period of 18 months between December 2016 to May 2018.On the day of admission, data were collected from each patient to compute the ISS, NISS, RTS, and TRISS.Results: Mean age of patients was 66.35 years.Most common mechanism of injury was road traffic accident (94.0%) with mortality of 17.0%.The predictive accuracies of the ISS, NISS, RTS and the TRISS were compared using receiver operator characteristic (ROC) curves for the prediction of mortality.Best cutoff points for predicting mortality in elderly trauma patient using TRISS system was a score of 91.6 (sensitivity 97%, specificity of 88%, area under ROC curve 0.972), similarly cutoff point under the NISS was score of 17(91%, 93%, 0.970); for ISS best cutoff point was at 15(91%, 89%, 0.963) and for RTS it was 7.108(97%,80%,0.947).There were statistical differences among ISS, NISS, RTS and TRISS in terms of area under the ROC curve (p <0.0001).Conclusion: TRISS was the strongest predictor of mortality in elderly trauma patients when compared to the ISS, NISS and RTS.