Predictive capability of the injury severity score versus the new injury severity score in the categorization of the severity of trauma patients: a cross-sectional observational study

  • Rebeca Abajas Bustillo
  • Francisco José Amo Setién
  • María del Carmen Ortego Mate
  • María Seguí Gómez
  • María Jesús Durá Ros
  • César Leal CostaEmail author
Original Article



The AIS scale is a measurement tool for single injuries. The ISS is considered the gold standard for determining the severity of injured patients, and the NISS was developed to improve the ISS with respect to loss of information, as well as to facilitate its calculation. The aim of this study was to analyse what injury severity measure, calculated according to the Abbreviated Injury Scale (AIS), 1998 and 2005 (update 2008) versions, performs better with mortality, cost and hospital length of stay healthcare indicators.


This cross-sectional observational study was carried out between February 1st 2012 and February 1st 2013. Inclusion criteria were injured patients due to external causes admitted to trauma service through the emergency department. Manual coding of all injuries was performed and ISS and NISS scores were calculated for both versions of the AIS scale. Severity was then compared to mortality (in-hospital and at 30 days), healthcare cost, and length of hospital stay.


The index with the best predictive capability for in-hospital mortality was NISS 05 (AUC = 0.811). There was a significant increase in hospital stay and healthcare cost in the most severe patients in all indexes, except for ISS 05.


NISS is found to be an index with higher predictive capability for in-hospital mortality and correlates better to length of hospital stay and healthcare cost.


Abbreviated injury scale Clinical coding Injury severity score Patient acuity Trauma severity indexes 



The authors are grateful to doctors Fernando Rojo and Tomás Belzunegui for providing access to data, to the members of the Nursing School of the University of Cantabria for their support and to Montse Ruiz for the translation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that we have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.112 Emergency Center of Castilla y León, School of NursingUniversity of CantabriaSantanderSpain
  2. 2.School of NursingUniversity of CantabriaSantanderSpain
  3. 3.Johns Hopkins Bloomberg School of Public Health, University of Virginia School of MedicineCharlottesvilleUSA
  4. 4.University of MurciaMurciaSpain

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