The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services

R Russell, T Hodgetts, J McLeod, K Starkey, P Mahoney, K Harrison, Elaine Bell

    Research output: Contribution to journalArticlepeer-review

    55 Citations (Scopus)


    This paper discusses mathematical models of expressing severity of injury and probability of survival following trauma and their use in establishing clinical governance of a trauma system. There are five sections: (i) Historical overview of scoring systems-anatomical, physiological and combined systems and the advantages and disadvantages of each. (ii) Definitions used in official statistics-definitions of 'killed in action' and other categories and the importance of casualty reporting rates and comparison across conflicts and nationalities. (iii) Current scoring systems and clinical governance-clinical governance of the trauma system in the Defence Medical Services (DMS) by using trauma scoring models to analyse injury and clinical patterns. (iv) Unexpected outcomes-unexpected outcomes focus clinical governance tools. Unexpected survivors signify good practice to be promulgated. Unexpected deaths pick up areas of weakness to be addressed. Seventy-five clinically validated unexpected survivors were identified over 2 years during contemporary combat operations. (v) Future developments-can the trauma scoring methods be improved? Trauma scoring systems use linear approaches and have significant weaknesses. Trauma and its treatment is a complex system. Nonlinear methods need to be investigated to determine whether these will produce a better approach to the analysis of the survival from major trauma.

    Original languageEnglish
    Pages (from-to)171-191
    Number of pages21
    JournalPhilosophical Transactions of the Royal Society of London Series B: Biological Sciences
    Issue number1562
    Publication statusPublished - 27 Jan 2011


    • A severity characterization of trauma
    • Clinical governance
    • Complex system
    • Trauma
    • Trauma scoring
    • TRISS


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