A modification of the injury severity score that both improves accuracy and simplifies scoring

J Trauma. 1997 Dec;43(6):922-5; discussion 925-6. doi: 10.1097/00005373-199712000-00009.


Objectives: The Injury Severity Score (ISS) has served as the standard summary measure of anatomic injury for more than 20 years. Nevertheless, the ISS has an idiosyncrasy that both impairs its predictive power and complicates its calculation. We present here a simple modification of the ISS called the New Injury Severity Score (NISS), which significantly outperforms the venerable but dated ISS as a predictor of mortality.

Design: Retrospective calculation of NISS and comparison of NISS with prospectively calculated ISS.

Materials and methods: The NISS is defined as the sum of the squares of the Abbreviated Injury Scale scores of each of a patient's three most severe Abbreviated Injury Scale injuries regardless of the body region in which they occur. NISS values were calculated for every patient in two large independent data sets: 3,136 patients treated during a 4-year period at the American College of Surgeons' Level I trauma center in Albuquerque, New Mexico, and 3,449 patients treated during a 4-year period at the American College of Surgeons' Level I trauma center at the Emanuel Hospital in Portland, Oregon. The power of NISS to predict mortality was then compared with previously calculated ISS values for the same patients in each of the two data sets.

Measurements and main results: We find that NISS is not only simple to calculate but more predictive of survival as well (Albuquerque: receiver operating characteristic (ROC) ISS = 0.869, ROC NISS = 0.896, p < 0.001; Portland: ROC ISS = 0.896, ROC NISS = 0.907,p < 0.004). Moreover, NISS provides a better fit throughout its entire range of prediction (Hosmer Lemeshow statistic for Albuquerque ISS = 29.12, NISS = 8.88; Hosmer Lemeshow statistic for Portland ISS = 83.48, NISS = 19.86).

Conclusion: NISS should replace ISS as the standard summary measure of human trauma.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Abbreviated Injury Scale
  • Adult
  • Algorithms
  • Bias
  • Humans
  • Injury Severity Score*
  • Middle Aged
  • Multiple Trauma / classification*
  • Multiple Trauma / mortality*
  • New Mexico
  • Oregon
  • Predictive Value of Tests
  • Registries
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity
  • Survival Rate
  • Trauma Centers / statistics & numerical data*