Methods Prospectively and consecutively collected 5684 trauma patients’ data over a 10-year period at a regional level I trauma centre were reviewed. Four modified TRISS (mTRISS) models using Age coefficient from reclassifications of the Age variable according to their correlation with survival by logistic regression on the local dataset were acquired. RTS and ISS coefficients were derived from the local dataset and then applied to the mTRISS models. mTRISS models were compared with the existing Major Trauma Outcome Study (MTOS)-derived TRISS (eTRISS) model. Model 1=Age effect taken as linear; Model 2=Age classified into two groups (0–54, 55+); Model 3=Age classified into four groups (0–15, 16–54, 55–79, 80+) and Model 4=Age classified into two groups (0–69, 70+). Performance measures including sensitivity, specificity, accuracy and area under the Receiver Operating Characteristic (ROC) curve were used to assess the various models. The cross-validation procedure consisted of comparing the P_S obtained from mTRISS Models 1 and 2 with the P_S obtained from the MTOS derived from eTRISS.

Results A 5147 blunt trauma patients’ dataset was reviewed. Model 1, where Age was taken as a scale variable, demonstrated a substantial improvement in the survival prediction with 91.6% accuracy in blunt injuries as compared with 89.2% in the MTOS-derived TRISS. The 95% CI for ROC derived from mTRISS Model 1 was (0.923, 0.940), when compared with the hypothesised ROC value 0.886 obtained from eTRISS, it clearly indicated a significant improvement in predicting survival at 5% level. Furthermore, ROCs have shown clearly the superiority of Model 1 over Model 2, and of Model 2 over MTOS-derived TRISS. The recategorisation of the Age variable (Models 3 and 4) also demonstrated improved performance, but their strength was not as intense as in Model 1. Overall, the results point to the adoption of Model 1 as the best model for P_S. Cross-validation analysis has further assured the validity of these findings.

Conclusions The present study has demonstrated that (1) having the Age variable being dichotomised (cut-off at 55 years) as in the eTRISS, but with the application of a local dataset-derived coefficients give better TRISS survival prediction in Asian blunt trauma patients; (2) improved performance are found with certain recategorisation of the Age variable and (3) the accuracy can further be enhanced if the Age effect is taken to be linear, with the application of local dataset-derived coefficients.