Improved prediction from a severity characterization of trauma (ascot) over trauma and injury severity score (triss): Results of an independent evaluation

TRISS calculated norms as an outcomes predictor has been used in trauma quality improvement programs since approximately 1986. Injury predictability and probabilities of survival with TRISS focus predominantly on motor vehicle crashes and have been limited due to poor calculations for penetrating injury and adjustment for age factors. In 1990, an additional scoring system was introduced, A Severity Characterization of Trauma (ASCOT), to potentially present a more accurate predictability scoring system. Utilizing the data from four Level I Trauma Centers from 1987 to 1989, a comparative analysis was conducted on the accuracy of scoring systems. The findings indicate that for blunt injured adults, ASCOT had a higher sensitivity than TRISS, and for penetrating adult injuries, ASCOT and TRISS sensitivities had an equally low accuracy. For pediatric patients, TRISS and ASCOT sensitivities were comparable. Overall, the ASCOT scoring system accounted for age differential and severity of injury differential more accurately in four categories, allowing for a more accurate calibration. The ASCOT model seemed better for predicting survival than the TRISS model in that it had a higher sensitivity and met the Hosmer-lemeshow criterion for calibration, whereas the TRISS did not.