Quality assessment of multiple trauma management: ISS, TRISS or ASCOT?

Objectives: Scores have been developed to assess the quality of trauma trea tment. Our objective was to investigate prospectively whether there is a si gnificant difference between the predicted survival and mortality rates wit h ISS, TRISS and ASCOT and observed rates in our patients. If the answer is affirmative, we also wished to evaluate whether the difference is signific ant enough to justify the greater data collection effort required for ASCOT as opposed to TRISS, and for TRISS as opposed to ISS. Patients and methods: Charts from 470 of 484 blunt multiple trauma patients with an ISS of 8 or more documented as part of a National Fund Study betwe en June 1990 and June 1996 were reviewed. We compared the survival and mort ality rates calculated by ISS, TRISS and ASCOT with the observed survival a nd death rates. Results: Only the predicted survival and death rates calculated by ISS diff ered significantly from the observed rates. There were also significant dif ferences between ISS and TRISS, and ISS and ASCOT, with regard to the predi cted rates. Conclusions: In our unit ISS, which is simple to use, is not suitable for q uality assessment. TRISS and ASCOT are of equal value. We prefer TRISS unti l a better, internationally recognised score is available, since it involve s less effort and is less error-prone. General recommendations for Switzerl and cannot be made until further results from other national accident and e mergency units are available.