Assessment of probability of survival in penetrating injuries using the TRISS methodology

doi:10.1016/0020-1383(89)90035-1

Injury

Volume 20, Issue 1, January 1989, Pages 10-12

https://doi.org/10.1016/0020-1383(89)90035-1 Get rights and content

Abstract

By the TRISS methodology, probability of survival in injury can be estimated. It is based on a statistical analysis of outcome which is influenced by the severity of the injuries as expressed in the Injury Severity Score (ISS), the physiological function as expressed in the Trauma Score (TS) and the patient's age.

We have used the TRISS formula in 206 patients with penetrating injury. Of these patients, 149 sustained stab wounds, 32 gunshot wounds and 25 others.

ISS ranged from 2 to 38, the mean ISS being 9. The function was good (TS > 14) in 85 per cent. Estimated probability of survival ranged from 1.00 to 0.42.

Three patients (1.5 per cent) died. The probability of their survival was 0.92, 0.96 and 0.98, respectively. All the fatal cases had serious predisposing conditions: chronic pulmonary disease, alcoholism, and psychiatric illness.

In penetrating injury, the patient's functional status at the start of treatment is of greater importance for the outcome than the anatomical severity.

The concept of the methodology of TRISS for assessment of probability of survival seems useful for review and comparison in injury care.

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Cited by (14)

Trauma outcome in a Norwegian regional hospital
2005, Injury Extra
The aim of this study was to evaluate the trauma care at a Norwegian regional hospital by using the methodology of Trauma and Injury Severity Score (TRISS).
During a 2-year period 1126 patients were included in a trauma registry at Haukeland University Hospital. We estimated the excess number of survivors per 100 patients in our dataset relative to the prediction datasets from an American and a British trauma databases, respectively (W-statistics). Standardised W (W_s) was calculated to adjust for the case mix of injury severities among different datasets.
There were 2.8 (95% CI: 1.78, 3.73) more survivors per 100 trauma patients at Haukeland University Hospital compared to the predicted number of survivors in a British data base and 2.7 (95% CI: 1.54, 3.78) more survivors per 100 patients compared to an American data base. The distribution of probability of survival in our dataset and the predicting datasets showed a good match (M-values of 0.95 compared to the British database and 0.97 compared to the American database).
There was an estimated excess number of survivors at Haukeland University Hospital compared to both the British and the American databases. The distribution of probabilities of survival in the comparing datasets showed a good match.
Lethal abdominal gunshot wounds at a level I trauma center: Analysis of TRISS (Revised Trauma Score and Injury Severity Score) fallouts
1998, Journal of the American College of Surgeons
Background: The TRISS methodology (composite index of the Revised Trauma Score and the Injury Severity Score) has become widely used by trauma centers to assess quality of care. The American College of Surgeons recommends including negative TRISS fallouts (fatally injured patients predicted to survive by the TRISS methodology) as a filter to select patients for peer review. The purpose of this study was to analyze the TRISS fallouts among patients with lethal abdominal gunshot wounds admitted to a level I trauma center.
Study Design: All patients categorized as TRISS fallouts admitted from January 1995 through December 1996 were analyzed.
Results: During the study period, 848 patients with abdominal gunshot wounds were admitted. Of the 108 patients with any sign of life on admission who subsequently died, 39 (36%) were TRISS fallouts. The patients were largely young (mean age, 29 years) and male (87%), received rapid transport (mean scene time, 11 minutes), and had an attending-led trauma-team response (<5 minutes, 87%). Major vascular (80%) and multiple intraabdominal injuries (90%) predominated. The mean Penetrating Abdominal Trauma Index was 40.3. The mean TRISS probability of survival was 89%. The peer-review process deemed the deaths to be nonpreventable in 38 patients (97%) and potentially preventable in one patient (3%).
Conclusions: “TRISS fallouts” were predominantly patients who died despite receiving rapid prehospital transport, rapid senior-level trauma-team response, and surgical intervention for a serious complex of injuries. We conclude that without regional adjustment of coefficients used to predict the probability of survival, the TRISS methodology is of limited use in patients with abdominal gunshot wounds.
Predicting survival in the intensive care unit
1997, Current Problems in Surgery
Systematic review and need assessment of pediatric trauma outcome benchmarking tools for low-resource settings
2017, Pediatric Surgery International
Trauma survival prediction in Asian population: A modification of TRISS to improve accuracy
2014, Emergency Medicine Journal
Correlation of TRISS with alterations of opsonocytophagic index of injured patients
2012, Revista Cubana de Medicina Militar

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PaperAssessment of probability of survival in penetrating injuries using the TRISS methodology

Abstract

Injury

Accid. Anal. Prev.

JACEP

The Injury Severity Score: A method for describing patients with multiple injuries

J. Trauma

The injury severity score: an update

J. Trauma

Methodological considerations in the use of abbreviated injury scale in trauma epidemiology

J. Trauma

Evaluating trauma care: The TRISS method

J. Trauma

Severity indices and their implications for emergency services and research and evaluation

J. Trauma

Trauma Score

Crit. Care Med.

Paper
Assessment of probability of survival in penetrating injuries using the TRISS methodology