A Comparative Analysis of the Trauma and Injury Severity Score (TRISS) and the Injury Severity Score (ISS) in Predicting High-Value Care Outcomes in Children with Traumatic Brain Injury

Introduction: Predicting high-value care outcomes is crucial in the management of pediatric traumatic brain injuries (TBI), where timely and accurate prognostication can significantly influence treatment decisions and resource allocation. This study was designed to enhance our understanding of how well scoring systems, such as the Trauma and Injury Severity Score (TRISS), can forecast high-value care outcomes. Furthermore, we compared the predictive power of TRISS with the conventionally used Injury Severity Score (ISS).

Methods: We conducted a retrospective analysis of pediatric patients in our mid-Atlantic urban pediatric emergency department from June 2016 to June 2023, identifying TBI cases using pertinent ICD-10 codes. Prolonged length of stay (LOS) was defined as a hospital stay falling in the upper quarter of hospital stay durations. Non-routine discharge disposition was defined as discharge to inpatient rehab facility, acute care hospital, foster care, and death. Standard multivariate regressions were utilized. DeLong test was used to compare the discriminative abilities of the TRISS and ISS by evaluating the differences in the areas under their respective receiver operating characteristic (AUROC) curves.

Results: This study included 2787 children with TBI with an average age of 7.3 ± 5.4 years. 62% of patients were male. 40% were white, %43 was African American, and 15% categorized as other races. 28.1% experienced prolonged LOS, while 7.2% had non-routine discharge disposition. On adjusted multivariate models both TRISS and ISS were correlated with higher odds of non-routine discharge disposition and prolonged LOS (both P< 0.001). TRISS had significantly greater AUROC than ISS for non-routine discharge disposition (0.874 vs. 0.840, P< 0.001), but this result was not significant in prolonged LOS (0.868 vs. 0.874, P=0.252).

Conclusion : TRISS and ISS are effective tools for predicting high-value care outcomes in pediatric TBI. Utilizing these resources can assist healthcare providers in conveying informed, risk-adjusted predictions.