ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026
The accuracy of the injury severity score in patients below the age of 18 years, a trauma registry data study.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThe Injury Severity Score (ISS) is an anatomical score that estimates both severity of trauma and risk of mortality in adults. Although widely used, its applicability in pediatric trauma remains uncertain. This retrospective cohort study evaluated the predictive value of ISS for pediatric mortality and clinically relevant outcomes.
methodsPatients (< 18 years) treated at a level-1 trauma centre with traumatic injury between 2015 and 2023 were included in the Dutch National Trauma Registry. Receiver operating characteristic (ROC) analyses were used to assess the discriminative performance of ISS for mortality, prehospital advanced care, emergency interventions, imaging, length of stay, surgical burden, and functional outcome.
results1733 patients were included. ISS showed excellent discrimination for mortality (AUC 0.97) and good performance for emergency interventions, prehospital advanced care, functional outcome, and admission to higher levels of care, but limited value for predicting number of surgeries. Optimal thresholds for ISS were 16 or higher, except for CT imaging (ISS ≥ 10).
conclusionISS reliably predicts mortality and several clinically relevant outcomes in children. While ISS ≥ 16 remains appropriate for identifying severe injury, optimal thresholds vary by outcome. These findings emphasize the need for outcome-specific interpretation of ISS, for benchmarking and resource allocation.
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