Diagnostic accuracy of shock index, revised trauma score, and injury severity score for mortality prediction in trauma: A hierarchical meta-analysis.
Abbas Ali Raza, Muhammad Ahmad, Neha Choudhary et al.
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In 30 seconds
This systematic review and hierarchical meta-analysis compared the accuracy of Shock Index (SI), Revised Trauma Score (RTS), and Injury Severity Score (ISS) for predicting in-hospital mortality in adult trauma patients. Across 12 studies involving 234,129 patients, pooled AUCs were 0.747 for SI, 0.852 for RTS, and 0.855 for ISS. In six studies that assessed RTS and ISS in the same cohorts, their diagnostic accuracy did not differ significantly (likelihood-ratio test, p = 0.91). The authors conclude that the scores have complementary roles across the trauma timeline, but neither reliably rules in or rules out death at realistic trauma prevalence.
Key findings
- Pooled sensitivity/specificity were 0.679/0.763 for SI, 0.788/0.801 for RTS, and 0.788/0.796 for ISS.
- AUCs were 0.747 for SI, 0.852 for RTS, and 0.855 for ISS.
- In paired studies, RTS and ISS did not differ significantly in diagnostic accuracy (likelihood-ratio test, p = 0.91).
Why it matters
Mortality prediction in trauma depends on when information becomes available: SI and RTS can inform acute triage, whereas ISS requires anatomical injury characterization and is generally available later. The findings caution against treating these scores as interchangeable competitors or relying on any one of them alone to rule in or rule out death.
What to keep in mind
The pooled estimates draw on different numbers of studies for each score, and the direct RTS–ISS comparison was limited to six studies reporting both in the same cohort.