The injury severity score or the new injury severity score for predicting mortality, intensive care unit admission and length of hospital stay: experience from a university hospital in a developing country

Injury. 2008 Jan;39(1):115-20. doi: 10.1016/j.injury.2007.06.007. Epub 2007 Sep 18.


Introduction: Limited research has been performed to compare the predictive abilities of the injury severity score (ISS) and the new ISS (NISS) in the developing world.

Patients and methods: From January 2001 until January 2003 all trauma patients admitted to the American University of Beirut Medical Centre were enrolled. The statistical performance of the ISS/NISS in predicting mortality, admission to the intensive care unit (ICU) and length of hospital stay (LOS dichotomised as <10 or > or =10 days) was evaluated using receiver operating characteristic and the Hosmer-Lemeshow calibration statistic.

Results: A total of 891 consecutive patients were enrolled. The ISS and NISS were equivalent in predicting survival, and both performed better in patients younger than 65 years of age. However, the ISS predicted ICU admission and LOS better than the NISS. However, these predictive abilities were lower for the geriatric trauma patients aged 65 years and above compared to the other age groups.

Discussion: There are conflicting results in the literature about the abilities of ISS and NISS to predict mortality. However, this is the first study to report that ISS has a superior ability in predicting both LOS and ICU admission.

Conclusion: The scoring of trauma severity may need to be individualised to different countries and trauma systems.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Critical Care / statistics & numerical data*
  • Developing Countries*
  • Female
  • Hospitals, University
  • Humans
  • Infant
  • Injury Severity Score*
  • Lebanon
  • Length of Stay / statistics & numerical data*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Survival Analysis
  • Wounds and Injuries / diagnosis*
  • Wounds and Injuries / mortality