Trauma and Injury Severity Score (TRISS) has been the benchmark of mortality risk in trauma centers for over 30 years. is usually important to have an accurate benchmark of mortality risk. This benchmark serves as a predictor of mortality or expected outcome for any patient presenting with certain injuries. The expected result can then be compared to the actual outcomes in order to provide quality assurance of care provision. For many years, this benchmark has been the Trauma and Injury Severity Score (TRISS)(1C10). TRISS utilizes the patients age, type of injury, Revised Trauma Score (RTS), and the Injury Severity Score to estimate the probability of survival. It takes into account the patients physiological injury, physiological response and anatomic injury. The Injury Severity Score (ISS), 1349796-36-6 IC50 first developed by Baker et al., supplies the anatomic index for TRISS, and has been a standard tool for three decades (1). Lately, there have been new ideas about anatomic trauma scoring that have brought the ISS under a more crucial light. One main disadvantage of the ISS is usually its innate attachment to the Abbreviated Injury Scale (AIS) for severity estimates, as the AIS is usually a consensus rather than an empirically derived scale (11). Also, the ISS uses data from the top three different anatomic regions with the most severe injuries, neglecting to account for other important injuries within 1349796-36-6 IC50 a single region. In many scenarios, one region may have several severe injuries, only one of which will be accounted for, along with two less significant injuries in two other anatomic regions. In addition, because the different regions arent weighted, a severe foot injury can have the same impact on the score as a moderate head injury. Lastly, the ISS combines injury 1349796-36-6 IC50 with therapy in its calculation. Apoorly managed minor head injury allowed to progress to coma may result in the same score as a quickly and effectively managed severe head injury. However, despite these important drawbacks, the ISS has remained a strong standard of anatomic trauma scoring during these past thirty years. Past challengers to ISS such as the Anatomic Index (AI) introduced by Champion et al. (2), and the Revised Estimate Survival Probability (RESP) index introduced by Levy et al. have failed to replace the ISS. They were not shown to improve enough upon the ISS as a predictor of survival (6,12). Recently, a new system has come to the fore. In the middle of the 1990s, Osler introduced the ICD derived Injury Severity Score Rabbit polyclonal to AKT1 (ICISS), a survival score based on the ICD-9 classification of trauma injuries (13). It was also created in an attempt to address the main limitations of ISS. However, it also has the added feature of convenience, a clear advantage, as most trauma centers already collect and classify patients based on their ICD-9 1349796-36-6 IC50 injuries. Compared to ISS, it is easy to compute. To calculate the ISS score, there must be a trained individual who can correctly apply the AIS/ISS ratio. The ICISS however, is a simple likelihood value. It is based on the assumption that a patients probability of survival can be predicted based on the survival rates of prior patients with comparable injuries as classified by the ICD-9. The ICISS value is the product of survival risk ratios (SRRs) from each injury sustained. These SRRs are established based on trauma data from large patient databases, the original of which was the North Carolina State Discharge Database (13) with data from over 300 000 patients. Using these risk ratios, later studies did in 1349796-36-6 IC50 fact show that this ICISS was superior to the ISS alone as a predictor of survival (13C18). In 2006, a Canadian database was created from the National Trauma Registry (NTR) of Canada, consisting of over one million cases C the largest yet in the world (19). This benchmark database attempted to address an issue.