• H J Oestern and K Kabus.
• Klinik für Unfall- und Wiederherstellungschirurgie, Allgemeines Krankenhaus Celle.
• Unfallchirurg. 1994 Apr 1;97(4):177-84.

AbstractAmong the more than 50 scoring systems available for quantitative evaluation of injury severity, only a few have proved effective in clinical practice. In particular, the Revised Trauma Score (RTS), referring to physiological variables, has proved effective in preclinical use and otherwise, the Injury Severity Score (ISS), referring to anatomical data. There is a tendency in the development of new scoring systems to aim at higher predictive accuracy, forfeiting practicability. The initial purpose of scoring--an early assessment of the risks--is being pushed into the background. The TRISS method, which includes the RTS, ISS, patient's age, and mechanism of injury, is regarded as the international standard. However, it has the disadvantage of a low sensitivity of 60% for blunt trauma, resulting in a high rate of unexpected deaths. Reasons for this are underestimation of head injuries, multiple injuries to one body region, and failure to take full account of the individual patient's age. The new ASCOT method, in which the ISS is replaced by the Anatomic Profile, and the age of the patient is given more consideration, hardly brings better results--in spite of quite time-consuming methods. When the scoring systems currently available are applied their specific deficiencies and limited evidence must be borne in mind. Nevertheless, they are an important scientific instrument for comparative examinations, and indispensable for quality assurance and economic analyses. To improve the predictive accuracy, biochemical parameters and chronic diseases should be considered, in addition to existing scores.

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