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Relationship between the Injury Severity Score and the need for life-saving interventions in trauma patients in the UK
  1. James Vassallo1,2,
  2. Gordon Fuller3,
  3. Jason E Smith1,2
  1. 1 Emergency Department, Derriford Hospital, Plymouth, UK
  2. 2 Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  3. 3 School of Health and Related Research, University of Sheffield, Sheffield, UK
  1. Correspondence to Dr James Vassallo, Emergency Department, Derriford Hospital, Plymouth PL6 8DH, UK; vassallo{at}


Introduction Major trauma is the third leading cause of avoidable mortality in the UK. Defining which patients require care in a major trauma centre is a critical component of developing, evaluating and enhancing regional major trauma systems. Traditionally, trauma patients have been classified using the Injury Severity Score (ISS), but resource-based criteria have been proposed as an alternative. The aim of this study was to investigate the relationship between ISS and the use of life-saving interventions (LSI).

Methods Retrospective cohort study using the Trauma Audit Research Network database for all adult patients (aged ≥18 years) between 2006 and 2014. Patients were categorised as needing an LSI if they received one or more interventions from a previously defined list determined by expert consensus.

Results 193 290 patients met study inclusion criteria: 56.9% male, median age 60.0 years (IQR 41.2–78.8) and median ISS 9 (IQR 9–16). The most common mechanism of injury was falls <2 m (52.1%), followed by road traffic collisions (22.2%). 15.1% received one or more LSIs. The probability of a receiving an LSI increased with increasing ISS, but only a low to moderate correlation was evident (0.334, p<0.001). A clinically significant number of cases (5.3% and 7.6%) received an LSI despite having an ISS ≤8 or <15, respectively.

Conclusions A clinically significant number of adult trauma patients requiring LSIs have an ISS below the traditional definition of major trauma. The traditional definition should be reconsidered and either lowered, or an alternative metric should be used.

  • trauma
  • emergency care systems
  • major trauma management

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  • Handling editor Caroline Leech

  • Presented at RCEM Annual Scientific Conference 2018

  • Contributors JV devised the study, conducted the initial analysis and wrote the first draft. GF conducted additional analyses and helped produce the second draft. JES oversaw the project and revised the drafts for critically important intellectual content. All authors approved the final version. JV takes responsibility for the manuscript as a whole.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The National Information Governance Board for Health and Social Care regulates the use of patient information in the UK and has previously provided ethical approval for research using anonymised TARN data (approval number: PIAG3-04(e)/2006).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Data came from the TARN database.