Trauma scoring systems: a review11No competing interests declared.22Some introductory material in this article appears in Shatz D, Kirton OC, McKenney MG, Civetta JM. Manual of Trauma and Emergency Surgery, Philadelphia: WB Saunders (October).

Since West and colleagues showed clear benefits in outcomes for patients treated at specialized trauma centers in the 1970s, patients could no longer be simply transported to the nearest hospital. Scoring systems were initially created for the purposes of field triage. Of necessity these systems must be straightforward and user-friendly for prehospital personnel. Scoring systems should accurately assess severity of injury both anatomically and physiologically. The mechanism of injury is critical. Comorbid factors, age, and clinical judgment also factor into the accuracy of field triage systems. With all these factors incorporated, a scoring system should reliably predict injury severity and patient outcomes. Beside field triage, scoring systems have found a number of other uses. Because large numbers of patients are quantifiable by scoring systems, these data can be used for quality assurance. Review of records may provide details of proper care, possible areas of preventable morbidity and mortality, and treatment center specific deficiencies or strengths. Another area where scoring systems have proved valuable is in evaluating trauma care delivery and trauma research. By providing a quantifiable number for groups of trauma patients, comparisons are possible. Researchers can compare different hospitals, different regions, different practice environments, and different modes of therapy. It has become standard in all forms of trauma research to include an injury severity score in the data collection. Scoring systems can also aid in determining entry criteria for prospective research protocols. Using these systems for research has greatly advanced communication among trauma surgeons, health care workers, and researchers by enabling them to speak in similar terms. Last, trauma scoring systems have the potential to be used in reimbursement assessment. It is generally recognized that trauma and critical care are under-reimbursed. So, although the thought of controlled reimbursement is anathema for most, the era of cost-contained health care delivery is here to stay, and if a quantifiable system proves reliable, it may be that health care regulators should use it. What follows is a discussion of the current trauma severity scoring systems, and their areas of strength, weakness, and applicability.