Comparison of Trauma and Injury Severity Score model with alternative approach in outcome prediction in trauma using National Trauma Database in Malaysia

Abstract

Objective The coefficients for the Trauma and Injury Severity Score are derived from the Major Trauma Outcome Study (MTOS) in North America, so the applicability of the MTOS-Trauma and Injury Severity Score (TRISS) in different populations remains challenging. This study proposed an alternate TRISS model called National Trauma Database-TRISS, where the coefficients were derived from the National Trauma Database (NTrD) in Malaysia. Methods This study utilised data derived from the National Trauma Database in Malaysia with 70% of the cases being used to develop the NTrD-TRISS model, while model validation was conducted based on the remaining 30% of cases. Fractional polynomial method was applied to correct the non-linearity in the logit of Injury Severity Score (ISS) and New Injury Severity Score (NISS). The predictive validity of the NTrD-TRISS model was compared with the MTOS-TRISS model. The predictive validity of these models was further examined with ISS and NISS. Results A total of 5857 major trauma cases reported to 13 trauma centres located throughout Malaysia for patients aged 16 and above were included in the study. The outcome prediction in trauma from NTrD-TRISS model was found to be more accurate compared to the MTOS-TRISS model. Conclusions This study has ascertained the applicability of the MTOS-TRISS model in Malaysia. The outcome prediction in trauma from the NTrD-TRISS was found to outperform the MTOS-TRISS model. Given the complex computational nature of ISS, the MTOS-TRISS and NTrD-TRISS models with NISS were recommended for future practical usage.