Trauma Mortality: Using Injury Severity Score (ISS) for Survival Prediction in East of Iran


1 Department of Research and Education, Razavi Hospital, Mashhad, IR Iran

2 department of New Sciences and Technology, Mashhad University of Medical Sciences, Mashhad, IR Iran

3 Orthopedic and Trauma Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran

4 Department of Cardiology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran


ackground: Numerous scoring systems have been proposed, and there is an inaccuracy in the anatomical and physiological differences between patients. Injury severity scoring (ISS) is a process by which the complexity of traumatic patients will be reduced to a single number. Objectives: The objective of this study was to determine whether ISS scoring along with the sub-categories of the mechanism of injury, age and place where hospital traumatic deaths occurred are able to predict the clinical outcome. Patients and Methods: The database registered accidents (DRAs) were gathered from Trauma Centre of Kamyab Hospital, Mashhad, East of Iran from March 2011 to April 2012. ISS was used to define the major trauma. Results: 15496 traumatic patients referred to the hospital and traumatic deaths occurred in 289 patients. Blunt trauma accounted for 286 (99%) of death and penetrating trauma for only 1%. Our findings concerning the injury pattern, correlation between ISS and time of death suggest that patients who die in the first hour after admission have the highest ISS (average of 70.2); whereas those who die after 72 hours have the lowest ISS. Conclusions: With regards to the predictive strength of the combination of GCS and ISS, a predictive system for analyzing the clinical outcome may be provided.


1.Steyerberg EW, Mushkudiani N, Perel P, Butcher I, Lu J, McHugh GS, et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med. 2008;5(8).
2. Rowley G, Fielding K. Reliability and accuracy of the Glasgow Coma Scale with experienced and inexperienced users. Lancet. 1991;337(8740):535–8.
3. Baker SP, O'Neill B, Haddon W, Jr., Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.
4. Ehsaei M, Bahadorkhan G, Samini F, Kheradmand H. Pediatric Spine Injuries after Trauma: A Review of 43 Cases. Med J Islam Repub Iran. 2008;68(22):86–92.
5. Ehsaei MR, Zare E, Hushmandi F. Epidemiologic Evaluation of Traumatic Spinal Injury. Neurosurg Q. 2012;22(2):141–3.
6. Hukkelhoven CW, Steyerberg EW, Habbema JD, Farace E, Marmarou A, Murray GD, et al. Predicting outcome after traumatic brain injury: development and validation of a prognostic score based on admission characteristics. J Neurotrauma.2005;22(10):1025–39.
7. Bahadorimonfared A, Soori H, Mehrabi Y, Delpisheh A, Esmaili A, Salehi M, et al. Trends of fatal road traffic injuries in Iran (2004-2011). PLoS One. 2013;8(5).
8. Leijdesdorff HA, Siegerink B, Sier CF, Reurings MC, Schipper IB. Injury pattern, injury severity, and mortality in 33,495 hospitaladmitted victims of motorized two-wheeled vehicle crashes in
The Netherlands. J Trauma Acute Care Surg. 2012;72(5):1363–8.
9. Copes WS, Champion HR, Sacco WJ, Lawnick MM, Keast SL, Bain LW. The Injury Severity Score revisited. J Trauma.
10. Bilello JF, Davis JW, Cagle KM, Kaups KL. Predicting extubation failure in blunt trauma patients with pulmonary contusion. J Trauma Inj Inf Crit Care. 2013;75(2):229–33.
11. Demetriades D, Murray J, Charalambides K, Alo K, Velmahos G, Rhee P, et al. Trauma fatalities: time and location of hospital deaths. J Am Coll Surg. 2004;198(1):20–6.
12. Karimiani EG, Day P. Personalised treatment of haematological malignancies through systems medicine based on single molecules in single cells. Integr Biol (Camb). 2013;5(5):759–67.
13. Demetriades D, Murray J, Sinz B, Myles D, Chan L, Sathyaragiswaran L, et al. Epidemiology of major trauma and trauma deaths in Los Angeles County. J Am Coll Surg. 1998;187(4):373–83.
14. Moazzez Lesko M, Jenks T, O'Brien SJ, Childs C, Bouamra O, Woodford M, et al. Comparing Model Performance for Survival
Prediction Using Total Glasgow Coma Scale and Its Components in Traumatic Brain Injury. J Neurotrauma. 2013;30(1):17–22.
15. Healey C, Osler TM, Rogers FB, Healey MA, Glance LG, Kilgo PD, et al. Improving the Glasgow Coma Scale score: motor score alone is a better predictor. J Trauma. 2003;54(4):671–8.