LETHAL ABDOMINAL GUNSHOT WOUNDS AT A LEVEL-I TRAUMA CENTER - ANALYSISOF TRISS (REVISED TRAUMA SCORE AND INJURY SEVERITY SCORE) FALLOUTS

Background: The TRISS methodology (composite index of the Revised Trau ma Score and the Injury Severity Score) has become widely used by trau ma centers to assess quality of care. The American College of Surgeons recommends including negative TRISS fallouts (fatally injured patient s predicted to survive by the TRISS methodology) as a filter to select patients for peer review. The purpose of this study was to analyze th e TRISS fallouts among patients with lethal abdominal gunshot wounds a dmitted to a level I trauma center. Study Design: All patients categor ized as TRISS fallouts admitted from January 1995 through December 199 6 were analyzed. Results: During the study period, 848 patients with a bdominal gunshot wounds were admitted. Of the 108 patients with any si gn of life on admission who subsequently died, 39 (36%) were TRISS fal louts. The patients were largely young (mean age, 29 years) and male ( 87%), received rapid transport (mean scene time, 11 minutes), and had an attending-led trauma-team response (<5 minutes, 87%). Major vascula r (80%) and multiple intraabdominal injuries (90%) predominated. The m ean Penetrating Abdominal Trauma Index was 40.3. The mean TRISS probab ility of survival was 89%. The peer-review process deemed the deaths t o be nonpreventable in 38 patients (97%) and potentially preventable i n one patient (3%).Conclusions: ''TRISS fallouts'' were predominantly patients who died despite receiving rapid prehospital transport, rapid senior-level trauma-team response, and surgical intervention for a se rious complex of injuries. We conclude that without regional adjustmen t of coefficients used to predict the probability of survival, the TRI SS methodology is of limited use in patients with abdominal gunshot wo unds. (J Am Coll Surg 1998;187: 123-129. (C) 1998 by the American Coll ege of Surgeons)