Nationwide Evaluation of the Validity of the Trauma and Injury Severity Score Method in Korean Regional Trauma Centers Using Multi-Institutional Large-Scale Data

Background: The Trauma and Injury Severity Score (TRISS) method is a widely used tool for assessing patient severity and predicting survival probability in trauma care. However, its accuracy and applicability in the Korean context, particularly for neurotrauma patients, have not been thoroughly validated yet. Previous studies at a single institution have identified significant discrepancies between TRISS predictions and actual outcomes, particularly in severe neurotrauma cases. This study aimed to evaluate the accuracy of the TRISS method on a national scale using data from multiple regional trauma centers (RTCs) in Korea. Methods: We utilized data from the Korea Trauma Data Bank collected from January 1, 2017 to December 31, 2021. A total of 70,785 patients were selected based on specific inclusion and exclusion criteria. The probability of survival was calculated using the TRISS method. Patients were categorized into neurotrauma and non-neurotrauma groups. Misclassification rate (MR) was measured by comparing the predicted survival or death using the TRISS method with the actual outcomes to assess the predictive validity of the TRISS method. Results: This study included 28,285 neurotrauma patients and 42,503 non-neurotrauma patients. The neurotrauma group had higher actual deaths (2,401) than the non-neurotrauma group (809). The neurotrauma group also had a significantly higher mortality rate per 100,000 population (8,489.50 vs. 1,903.40). MR was significantly higher in neurotrauma patients (8.07%) than in non-neurotrauma patients (1.92%). Patients with severe head injuries (Glasgow Coma Scale <= 8) had the highest MR (32.27%). Conclusion: Our study confirms that the TRISS method's misclassification issues observed at a single institution are prevalent across multiple RTCs in Korea. The accuracy of the TRISS method decreases with increasing injury severity, particularly in neurotrauma patients. These findings highlight the need to revise evaluation criteria and develop more accurate prediction models tailored to the Korean trauma care system. Implementing these changes will enhance the reliability of trauma care assessments and ensure more equitable support for RTCs, ultimately improving the quality and equity of trauma care in Korea.