COMPARISON OF DIFFERENT TRAUMA SCORING SY STEMS - A REVIEW

Among the more than 50 scoring systems available for quantitative eval uation of injury severity, only a few have proved effective in clinica l practice. In particular, the Revised Trauma Score (RTS), referring t o physiological variables, has proved effective in preclinical use and otherwise, the Injury Severity Score (ISS), referring to anatomical d ata. There is a tendency in the development of new scoring systems to aim at higher predictive accuracy, forfeiting practicability. The init ial purpose of scoring - an early assessment of the risks - is being p ushed into the background. The TRISS method, which includes the RTS, I SS, patient's age, and mechanism of injury, is regarded as the interna tional standard. However, it has the disadvantage of a low sensitivity of 60% for blunt trauma, resulting in a high rate of unexpected death s. Reasons for this are underestimation of head injuries, multiple inj uries to one body region, and failure to take full account of the indi vidual patient's age. The new ASCOT method, in which the ISS is replac ed by the Anatomic Profile, and the age of the patient is given more c onsideration, hardly brings better results - in spite of quite time-co nsuming methods. When the scoring systems currently available are appl ied their specific deficiencies and limited evidence must be borne in mind. Nevertheless, they are an important scientific instrument for co mparative examinations, and indispensable for quality assurance and ec onomic analyses. To improve the predictive accuracy, biochemical param eters and chronic diseases should be considered, in addition to existi ng scores.