Relationship of injury severity score (ISS) and new injury severity score (NISS) trauma scores with 28-day mortality in patients admitted to emergency service with chest trauma

Objective: Among all trauma cases, chest traumas rank as the third entity after head-neck and extremity traumas and they cause 25% of trauma associated deaths. Scoring systems enable us to have information about the treatment and outcomes of trauma. In this study we aimed that to identify clinical and demographic specifications of patients, who applied to our emergency department, and to test trauma scoring systems and to analyze its effect on 28-day mortality. Methods and Materials: In our study, the patients who were admitted to our emergency service with thoracic trauma for one year were evaluated retrospectively. These patients were examined in terms of age, gender, type of emergency admission, mechanism of trauma, accompanying injuries, length of hospital stay and mortality. Also, the shock index, Glasgow Coma Score (GCS), Injury Severity Score (ISS) and New Injury Severity Score (NISS) scores were calculated for each patient. Results: A total of 449 cases with thoracic trauma were included in the study. Of them, 72.6% were male. While 95% of chest traumas occurred as blunt trauma, penetrating injury mechanisms was observed at the rate of only 5.6%. The most important causes of blunt thoracic traumas included motor vehicle accident (41.9%), falling from high (24.7%) and falling (13.1%). Tube thoracostomy was performed in 13.4% of the patients and thoracotomy in 0.024% of them in the emergency service. The most frequent diagnosis was rib fracture (71.5%). In the ROC analysis for 28-day mortality, AUC was determined to be 0,915 (<0,001) for shock index, 0.902 (p <0.001) for ISS and 0.892 (p <0.001) for NISS. Because the AUC was greater than 0.8, the discrimination power was evaluated as very good. Shock index, ISS and NISS scores were found to be predictive of mortality. Conclusion: Both ISS and NISS systems can be used effectively in thoracic trauma. A statistically significant relationship was found between the outcomes of ISS and NISS and 28-day mortality in our study. Further studies should be conducted in order to determine the appropriate use of ISS and NISS for specific patient status and trauma.