Evaluation of Probability of Survival Using Trauma and Injury Severity Score Method in Severe Neurotrauma Patients
A 67-year-old man was brought directly to our trauma center after a cultivator accident. Upon arrival at the emergency medicine department, the patient was found to have a systolic blood pressure of 150 mm Hg and a respiratory rate of 24 breaths/min and GCS of 3 (eye=1, verbal=1, motor=1). His pupils were 4/4 mm in size and did not respond to light. Also, his corneal reflex disappeared. Brain computed tomography (CT) represented a large amount of subdural hemorrhage and midline shifting from right to left (). His blood pressure (RTS coded value=4), respiratory rate (RTS coded value=4), and GCS (RTS coded value= 0) gave him an RTS of 4.09 (RTS=0.9368×0+0.7326×4+0.2908×4=4.09). His head and neck injuries, acute subdural hemorrhage (AIS=5) and his ISS was 25 (ISS=1st AIS2=52=25). Therefore, his calculated probability of survival by the TRISS methodology was 60.18%. During his hospital course, Brain swelling progressed and compressed the brain stem. He eventually died and was considered an unexpected nonsurvivor. If his AIS of the head and neck was given 6, his calculated probability of survival by the TRISS methodology would have decreased to 2.76%.