TY  - JOUR
PY  - 2016//
TI  - The military injury severity score (mISS): A better predictor of combat-mortality than injury severity score (ISS)
JO  - Journal of trauma and acute care surgery
A1  - Le, Tuan D.
A1  - Orman, Jean A.
A1  - Stockinger, Zsolt T.
A1  - Spott, Mary Ann
A1  - West, Susan A.
A1  - Mann-Salinas, Elizabeth A.
A1  - Chung, Kevin K.
A1  - Gross, Kirby R.
SP  - 114
EP  - 121
VL  - 81
IS  - 1
N2  - BACKGROUND: The military Injury Severity Score (mISS) was developed to better predict mortality in complex combat injuries, but has yet to be validated. <br><br>METHODS: U.S. combat trauma data from Afghanistan and Iraq from January 1, 2003 to December 31, 2014 from the DoD Trauma Registry (DoDTR) were analyzed. mISS, a variation of the ISS, was calculated and compared to standard ISS scores.Receiver Operator Characteristics (ROC), area under the curve (AUC) and Hosmer-Lemeshow statistics were used to discriminate and calibrate between mISS and ISS. Wilcoxon-Mann-Whitney, t-test and Chi-square tests were used and sensitivity and specificity calculated. Logistic regression was used to calculate the likelihood of mortality associated with levels of mISS and ISS overall. <br><br>RESULTS: 30,364 patients were analyzed. Most were male (96.8%). Median (IQR) age was 24 (21-29). Battle injuries comprised 65.3%. Penetrating (39.5%) and blunt (54.2%) injury types, and explosion (51%) and gunshot wound (15%) mechanisms predominated. Overall mortality was 6.0%.Median mISS and ISS were similar in survivors (5[2-10] vs. 5 [2-10]) but different in non-survivors, 30 (16-75) vs. 24 (9-23), respectively (P <0.0001). mISS and ISS were discordant in 17.6% (n= 5,352), accounting for 56.2% (n=1016) of deaths. Among cases with discordant severity scores, the median difference between mISS and ISS was 9 (7-16); range 1 to 59. mISS and ISS shared 78% variability (R=0.78).AUC was higher in mISS than ISS overall (0.82 vs. 0.79), for BI (0.79 vs. 0.76) non-BI (0.87 vs. 0.86), penetrating (0.81 vs. 0.77), blunt (0.77 vs. 0.75), explosion (0.81 vs. 0.78), and gunshot (0.79 vs. 0.73), all P < 0.001. Higher mISS and ISS were associated with higher mortality. Compared to ISS, mISS had higher sensitivity (81.2 vs. 63.9) and slightly lower specificity (80.2 vs. 85.7). <br><br>CONCLUSION: mISS predicts combat mortality better than ISS. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level III.<p />  <p>Language: en</p>
LA  - en
SN  - 2163-0755
UR  - http://dx.doi.org/10.1097/TA.0000000000001032
ID  - ref1
ER  -