Practice ABC of Major Trauma, 4th Edition

Scoring Systems for Trauma

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1142 (Published 21 March 2014) Cite this as: BMJ 2014;348:bmj.g1142
  1. Maralyn Woodford
  1. University of Manchester Manchester, UK

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OVERVIEW

  • Trauma scoring systems include measurements of host vulnerability (age, gender), anatomical severity and physiological derangement.

  • In Europe, the TRISS methodology has been superseded.

  • Any assessment of the effectiveness of a trauma system should be based on casemix standardised outcomes.

  • Process measures are equally important in evaluating trauma systems.

Trauma care systems deal with patients who have an almost infinite variety of injuries requiring complex treatment. The assessment of such systems is a major challenge in clinical measurement and audit. Which systems are most effective in delivering best outcomes? Implementing recommendations for improved procedures will often incur additional costs: will the expense be worthwhile? Clearly, casemix-adjusted outcome analysis must replace anecdote and dogma. Outcome prediction in trauma is a developing science which enables the assessment of trauma system effectiveness. An improvement in trauma care is essential; audit is one of the tools that can be used.

The effects of injury can be defined in terms of input (an anatomical component and the physiological response) and outcome (mortality and morbidity) (Box 1). These must be coded numerically before we can comment with confidence on treatment or process of care. Elderly people survive trauma less well than others, so age must be taken into account and the association between gender and age is also considered to be important. Most recent work has been concerned with measurement of injury severity and its relation to mortality. Assessment of morbidity has been largely neglected, yet for every person who dies as a result of trauma, there …

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