Introduction: Several scoring systems including APACHE II, the Sequential Organ Failure Assessment, the Systemic Inflammatory Response Syndrome, and the Injury Severity Score have been developed to grade the severity of illness in critically ill trauma patients with the goal of predicting clinical outcomes in these patients. These systems have been studied independently, or in comparison with another system, in their ability to predict clinical outcome. However, a study comparing all 4 systems simultaneously has not yet been reported. Our objective was to prospectively evaluate the ability of these 4 scoring systems in predicting 5 primary outcomes (mortality, nosocomial infection, ICU days, hospital days, and ventilator days) and to determine which scoring system is best at predicting a specific outcome in the first week.

Methods: Prospective data were analyzed on trauma patients admitted to the ICU of the primary adult trauma center in the state of Maryland over a 2-year period. APACHE II, SOFA, and SIRS scores were calculated for each patient on admission and then daily for 1 week. An ISS score was calculated at time of discharge. Each scoring system was evaluated as an independent predictor of the mentioned outcomes on the day of admission up to day 7. Additionally, each of the 5 outcomes were analyzed to determine which scoring system was a better predictor for the specific outcome.

Results: The prospective study cohort consisted of 816 patients. Table 1 displays the scoring systems that significantly (p<0.05) predicted a particular outcome on a specific day (Odds Ratio, p-value). On the day of admission, SIRS and ISS scores significantly predicted infection, ICU days, ventilator days, and hospital days. APACHE II, SOFA, and ISS scores were better predictors of mortality than the SIRS score at admission. Between days 2 – 6, no scoring system was significantly better than another in predicting clinical outcomes. On day 7, APACHE II, SOFA, and SIRS scores significantly predicted infection, ventilator days, hospital days, and ICU days while APACHE II and SOFA scores significantly predicted mortality.

Conclusion: In general, all scoring systems were better at predicting clinical outcomes at the time of admission and on day 7. On admission, SIRS and ISS scores are best used to predict infection, ventilator days, hospital days, and ICU days, while the APACHE II, SOFA, and ISS scoring systems are better at predicting mortality. With regards to infection, SIRS score appears to be superior, particularly on days 1, 6, and 7. The use of these scoring systems between days 2 to 5 appears to demonstrate little utility in predicting outcome in critically injured trauma patients. Further research is warranted for better prediction models during this period.