The Usefulness of Different Injury Scoring Systems in Trauma Patients with Altered Mental Status

Choi,  Jong Pil; Lee,  Jae Kwang; Park,  Seong Soo; Na,  Sang Jun; Park,  Joon Seok

J Korean Soc Emerg Med > Volume 17(6); 2006 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2006;17(6): 588-593.

The Usefulness of Different Injury Scoring Systems in Trauma Patients with Altered Mental Status

Jong Pil Choi, Jae Kwang Lee, Seong Soo Park, Sang Jun Na, Joon Seok Park

¹Department of Emergency Medicine, Konyang University, College of Medicine, Daejeon, Korea. mamdae@hanmail.net
²Department of Neurology, Konyang University, College of Medicine, Daejeon, Korea.

ABSTRACT

PURPOSES: The causes of altered mental status (AMS) are varied. Trauma accounts for 6.5%-36.3% of all AMS cases, and the mortality in these instances ranges from 20~80.5%. Multiple injury severity scoring systems exist to assist in the prognosing of trauma patients. We investigated the degree of correlation between injury severity scoring systems and prognoses of patients with AMS due to trauma.
METHODS:
We reviewed the medical records of 188 patients admitted to the emergency department of Konyang University Hospital who had trauma with AMS. We investigated the clinical characteristics of these patients and evaluated the usefulness of four injury severity scoring systems: revised trauma score (RTS), injury severity score (ISS), new injury severity score (NISS), and trauma and injury severity score (TRISS).
RESULTS:
The average scores of ISS and NISS were higher and RTS and TRISS were lower in the non-survivor group than in the survivor group (p<0.01). The area under the curve (AUC) for the receiver operating characteristic (ROC) curve was 0.725 for ISS and 0.733 for NISS, but these scoring systems had only a fair predictive ability. Hosmer-Lemeshow statistics showed no predictive ability differences for death between the four scoring systems. The predictive ability of all injury severity scoring systems to identify survivors was high (88.1~94.0%). In contrast, their predictive ability to identify non-survivors was low (29.6%~63.0%).
CONCLUSIONS:
In the use of RTS, ISS, NISS, and TRISS for evaluating trauma patients with AMS, none of the four systems exhibited any distinguishing predictive features. All failed to reliably predict non-survivors, but all showed good predictive value for identifying survivors.

Key words: Injury severity score