Introduction
The Injury Severity Score (ISS) is the most commonly used measure of injury severity.
The score has been shown to have excellent predictive capability for trauma mortality
and has been validated in multiple data sets. However, the score has never been tested
to see if its discriminatory ability is affected by differences in race and gender.
Objective
This study is aimed at validating the ISS in men and women and in three different
race/ethnic groups using a nationwide database.
Methods
Retrospective analysis of patients age 18–64 y in the National Trauma Data Bank 7.0
with blunt trauma was performed. ISS was categorized as mild (<9,) moderate (9–15),
severe (16–25), and profound (>25). Logistic regression was done to measure the relative
odds of mortality associated with a change in ISS categories. The discriminatory ability
was compared using the receiver operating characteristics curves (ROC). A P value testing the equality of the ROC curves was calculated. Age stratified analyses
were also conducted.
Results
A total of 872,102 patients had complete data for the analysis on ethnicity, while
763,549 patients were included in the gender analysis. The overall mortality rate
was 3.7%. ROC in Whites was 0.8617, in Blacks 0.8586, and in Hispanics 0.8869. Hispanics
have a statistically significant higher ROC (P value < 0.001). Similar results were observed within each age category. ROC curves
were also significantly higher in females than in males.
Conclusion
The ISS possesses excellent discriminatory ability in all populations as indicated
by the high ROCs.
Key Words
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Article info
Publication history
Published online: May 10, 2010
Received:
January 9,
2010
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
