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  • Collecting reliable, accurate, and timely data on injury care is central to injury research and surveillance.

  • Injury severity score (ISS) selection should be based on a clear sense of what one wants to measure and why and on a good understand of the score’s strengths and limitations.

  • Combination injury severity models attempt to combine the three concepts of risk: (1) preinjury physiologic reserve (eg, age, comorbidities); (2) physiologic status of the injured patient (eg, Glasgow Coma Scale [GCS]); and (3) anatomic injury severity (eg, ISS). The optimal injury severity model will depend on the data available, the study population, the exposure of interest, and, in particular, the outcome under evaluation.

  • Injury outcomes research aims to improve our understanding of the determinants of optimal injury outcomes with the ultimate goal of reducing the societal burden of injury. Scientific ethics require a demonstration that addressing the research question will sigadvance current knowledge.

  • Researchers are increasingly looking to assess outcomes that are important to patients. For hemorrhagic shock, that may be mortality, but for brain, spinal cord, and orthopedic injuries, function in daily activities and quality of life are more likely to be meaningful.

  • Outcomes research must be based on a comprehensive, integrated, and end-of-grant knowledge-translation strategy. Practitioners, policymakers, decision makers, and patient/family advocates should be involved in all phases of research projects, and results should be distributed to all stakeholders, not just in the form of scientific articles but as policy briefs, clinical guides, and decision rules. We should also work to strengthen international collaborations to pool resources, avoid duplicating research projects, and generate results with maximum impact.

  • To improve our understanding of the complex associations underlying the burden of injury, we need to improve the quality and coverage of injury data; employ more sophisticated analytical methods; improve the knowledge translation-to-action cycle of research results; look toward comparing outcomes across health care systems in high-, middle-, and low-income countries; and adapt our methods to the changing demographics of trauma populations.


Injuries have long been classified in terms of severity. The world’s oldest known surgical document, the Edwin Smith Surgical Papyrus (ca. 17th century BC), classified 48 traumatic injuries from ancient Egyptian battlefields and construction sites as successfully treatable, possibly curable, or untreatable.1 Such predictions about patient outcomes, and attempts to quantify the severity of injury, are today the realm of more than 50 published injury severity scores, scales, and models.

Injury severity scoring quantifies the risk of an outcome following trauma and provides metrics based on elements of clinical acumen and statistical and mathematical modeling to describe aspects of the patient condition after injury. The primary outcome of interest is commonly survival or a measure of morbidity (eg, complications) or resource use (eg, hospital or intensive care unit [ICU] length of stay [LOS]) but may be any primary end point of interest (eg, compliance to an evidence-based ...

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