Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-24T19:46:00.141Z Has data issue: false hasContentIssue false
  • English
  • Français

Injury Severity Score versus New Injury Severity Score for Penetrating Injuries

Published online by Cambridge University Press:  28 June 2012

Hans Husum  and
Gino Strada
Hans Husum*
Affiliation:
Tromsoe Mine Victim Resource Center (TMC), University Hospital of Northern Norway, Norwayx
Gino Strada
Affiliation:
Emergency, Milano, Italy
*
Tromsoe Mine Victim Resource Center (TMC), PO Box 80, University Hospital, N-9038, Norway Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

The New Injury Severity Score (NISS) was introduced in 1997 to improve outcome prediction based on anatomical severity scoring in trauma victims. Studies on populations of blunt trauma victims indicate that the NISS, predicts better than the Injury Severity Score (ISS) mortality post-injury, which is why the NISS has been recommended as the new “gold standard” for severity scoring. However, so far the accuracy of the NISS for penetrating injuries has not been validated against the ISS.

Methods:

ISS and NISS scores were collected retrospectively for 1,787 war-and landmine victims in North Iraq. All victims only had penetrating injuries. The two tests were compared for prediction of short-term mortality and post-operative complications using Receiver Operating Characteristics (ROC) analysis.

Results:

Both the ISS and the NISS predicted mortality with high accuracy (ROC area under curve 0.9). There were no significant differences between the two tests. The predictive accuracy for post-operative complications was moderate for both tests (ROC-AUC <0.8), with the NISS performing significantly better than the ISS.

Conclusion:

The NISS does not perform better than the ISS in penetrating injuries. However, this study was done on a low-risk trauma population, thus the results should not be extrapolated to high severity trauma. Due to statistical shortcomings in studies previously published, studies on far larger cohorts are necessary before the NISS should be adopted as the new “gold standard” for severity scoring.

Keywords

injury severity score (ISS)landminesnew injury severity score (NISS)outcomepredictionreceiver operating curve (ROC)riskseverity scorewarNorth Iraq
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 17 , Issue 1 , March 2002 , pp. 27 - 32
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Osler, T, Baker, SP, Long, W: A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma 1997; 43: 922–925.CrossRefGoogle ScholarPubMed
2. Balogh, Z, Offner, PJ, Moore, EE, Biffl, W: NISS predicts postinjury organ failure better than the ISS. J Trauma 2000; 48: 624–627.CrossRefGoogle Scholar
3. Brenneman, FD, Boulanger, BR, McLellan, BA, Redelmeier, DA: Measuring injury severity: Time for a change. J Trauma 1998; 44: 580–582.CrossRefGoogle ScholarPubMed
4. Association for the Advancement of Automotive Medicine: The Abbreviated Injury Scale, 1990 Revision, update 98. Des Plaines, IL: 1998: ix.Google Scholar
5. World Health Organization: Epi Info [computer program]. Version 6.04b. Geneva, Switzerland: WHO; 1996.Google Scholar
6. MedCalc [computer program]. Version 5 for Windows. Mariakerke, Belgium: MedCalc Software. 1999.Google Scholar
7. Obuchowski, NA, Lieber, ML: Confidence intervals for the receiver operating characteristics area in studies with small samples. Acad Radiol 1998; 5: 561–571.Google ScholarPubMed
8. Husum, H: Effects of early prehospital life support to war injured: The Battle of Jalalabad, Afghanistan. Prehosp Disast Med 1999; 14: 75–80.CrossRefGoogle ScholarPubMed
9. Bellamy, RF: The causes of death in conventional land warfare. Milit Med 1984; 149: 55–62.CrossRefGoogle ScholarPubMed
10. Moini, M, Rezaishiraz, H, Zafarghandi, MR: Characteristics and outcome of injured patients treated in urban trauma centers in Iran. J Trauma 2000; 48: 503–507.Google ScholarPubMed
11. Altman, DG, Machin, D, Bryant, TN, Gardner, M: Statistics with Confidence. London: BMJ Books; 2000. pp 113–114.Google Scholar