The Military Injury Severity Score (mISS): A better predictor of combat mortality than Injury Severity Score (ISS)

Tuan D. Le, Jean A. Orman, Zsolt T. Stockinger, Mary Ann Spott, Susan A. West, Elizabeth A. Mann-Salinas, Kevin K. Chung, Kirby R. Gross

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: TheMilitary Injury Severity Score (mISS) was developed to better predict mortality in complex combat injuries but has yet to be validated. METHODS: US combat trauma data from Afghanistan and Iraq from January 1, 2003, to December 31, 2014, from the US Department of Defense Trauma Registry (DoDTR) were analyzed.Military ISS, a variation of the ISS, was calculated and compared with standard ISS scores. Receiver operating characteristic curve, area under the curve, and Hosmer-Lemeshow statisticswere used to discriminate and calibrate between mISS and ISS. Wilcoxon-Mann-Whitney, t test and X2 tests were used, and sensitivity and specificity calculated. Logistic regression was used to calculate the likelihood of mortality associated with levels of mISS and ISS overall. RESULTS: Thirty thousand three hundred sixty-four patients were analyzed. Most were male (96.8%). Median age was 24 years (interquartile range [IQR], 21-29 years). Battle injuries comprised 65.3%. Penetrating (39.5%) and blunt (54.2%) injury types and explosion (51%) and gunshot wound (15%) mechanisms predominated. Overall mortality was 6.0%. Median mISS and ISS were similar in survivors (5 [IQR, 2-10] vs. 5 [IQR, 2-10]) but different in nonsurvivors, 30 (IQR, 16-75) versus 24 (IQR, 9-23), respectively (p < 0.0001). Military ISS and ISS were discordant in 17.6% (n = 5,352), accounting for 56.2% (n = 1,016) of deaths. Among cases with discordant severity scores, the median difference between mISS and ISS was 9 (IQR, 7-16); range, 1 to 59. Military ISS and ISS shared 78% variability (R2 = 0.78). Area under the curve was higher in mISS than in ISS overall (0.82 vs. 0.79), for battle injury (0.79 vs. 0.76), non-battle injury (0.87 vs. 0.86), penetrating (0.81 vs. 0.77), blunt (0.77 vs. 0.75), explosion (0.81 vs. 0.78), and gunshot (0.79 vs. 0.73), all p < 0.0001. Higher mISS and ISS were associated with higher mortality. Compared with ISS, mISS had higher sensitivity (81.2 vs. 63.9) and slightly lower specificity (80.2 vs. 85.7). CONCLUSION: Military ISS predicts combat mortality better than does ISS.

Original languageEnglish (US)
Pages (from-to)114-121
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume81
Issue number1
DOIs
StatePublished - 2016
Externally publishedYes

Fingerprint

Injury Severity Score
Mortality
Wounds and Injuries
Explosions
Area Under Curve
United States Department of Defense

Keywords

  • Combat mortality
  • mAIS
  • Military Abbreviated Injury Scale
  • Military Injury Severity Score
  • mISS

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Le, T. D., Orman, J. A., Stockinger, Z. T., Spott, M. A., West, S. A., Mann-Salinas, E. A., ... Gross, K. R. (2016). The Military Injury Severity Score (mISS): A better predictor of combat mortality than Injury Severity Score (ISS). Journal of Trauma and Acute Care Surgery, 81(1), 114-121. https://doi.org/10.1097/TA.0000000000001032

The Military Injury Severity Score (mISS) : A better predictor of combat mortality than Injury Severity Score (ISS). / Le, Tuan D.; Orman, Jean A.; Stockinger, Zsolt T.; Spott, Mary Ann; West, Susan A.; Mann-Salinas, Elizabeth A.; Chung, Kevin K.; Gross, Kirby R.

In: Journal of Trauma and Acute Care Surgery, Vol. 81, No. 1, 2016, p. 114-121.

Research output: Contribution to journalArticle

Le, TD, Orman, JA, Stockinger, ZT, Spott, MA, West, SA, Mann-Salinas, EA, Chung, KK & Gross, KR 2016, 'The Military Injury Severity Score (mISS): A better predictor of combat mortality than Injury Severity Score (ISS)', Journal of Trauma and Acute Care Surgery, vol. 81, no. 1, pp. 114-121. https://doi.org/10.1097/TA.0000000000001032
Le, Tuan D. ; Orman, Jean A. ; Stockinger, Zsolt T. ; Spott, Mary Ann ; West, Susan A. ; Mann-Salinas, Elizabeth A. ; Chung, Kevin K. ; Gross, Kirby R. / The Military Injury Severity Score (mISS) : A better predictor of combat mortality than Injury Severity Score (ISS). In: Journal of Trauma and Acute Care Surgery. 2016 ; Vol. 81, No. 1. pp. 114-121.
@article{052816735ed04de4bf5b2776ce326432,
title = "The Military Injury Severity Score (mISS): A better predictor of combat mortality than Injury Severity Score (ISS)",
abstract = "Background: TheMilitary Injury Severity Score (mISS) was developed to better predict mortality in complex combat injuries but has yet to be validated. METHODS: US combat trauma data from Afghanistan and Iraq from January 1, 2003, to December 31, 2014, from the US Department of Defense Trauma Registry (DoDTR) were analyzed.Military ISS, a variation of the ISS, was calculated and compared with standard ISS scores. Receiver operating characteristic curve, area under the curve, and Hosmer-Lemeshow statisticswere used to discriminate and calibrate between mISS and ISS. Wilcoxon-Mann-Whitney, t test and X2 tests were used, and sensitivity and specificity calculated. Logistic regression was used to calculate the likelihood of mortality associated with levels of mISS and ISS overall. RESULTS: Thirty thousand three hundred sixty-four patients were analyzed. Most were male (96.8{\%}). Median age was 24 years (interquartile range [IQR], 21-29 years). Battle injuries comprised 65.3{\%}. Penetrating (39.5{\%}) and blunt (54.2{\%}) injury types and explosion (51{\%}) and gunshot wound (15{\%}) mechanisms predominated. Overall mortality was 6.0{\%}. Median mISS and ISS were similar in survivors (5 [IQR, 2-10] vs. 5 [IQR, 2-10]) but different in nonsurvivors, 30 (IQR, 16-75) versus 24 (IQR, 9-23), respectively (p < 0.0001). Military ISS and ISS were discordant in 17.6{\%} (n = 5,352), accounting for 56.2{\%} (n = 1,016) of deaths. Among cases with discordant severity scores, the median difference between mISS and ISS was 9 (IQR, 7-16); range, 1 to 59. Military ISS and ISS shared 78{\%} variability (R2 = 0.78). Area under the curve was higher in mISS than in ISS overall (0.82 vs. 0.79), for battle injury (0.79 vs. 0.76), non-battle injury (0.87 vs. 0.86), penetrating (0.81 vs. 0.77), blunt (0.77 vs. 0.75), explosion (0.81 vs. 0.78), and gunshot (0.79 vs. 0.73), all p < 0.0001. Higher mISS and ISS were associated with higher mortality. Compared with ISS, mISS had higher sensitivity (81.2 vs. 63.9) and slightly lower specificity (80.2 vs. 85.7). CONCLUSION: Military ISS predicts combat mortality better than does ISS.",
keywords = "Combat mortality, mAIS, Military Abbreviated Injury Scale, Military Injury Severity Score, mISS",
author = "Le, {Tuan D.} and Orman, {Jean A.} and Stockinger, {Zsolt T.} and Spott, {Mary Ann} and West, {Susan A.} and Mann-Salinas, {Elizabeth A.} and Chung, {Kevin K.} and Gross, {Kirby R.}",
year = "2016",
doi = "10.1097/TA.0000000000001032",
language = "English (US)",
volume = "81",
pages = "114--121",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - The Military Injury Severity Score (mISS)

T2 - A better predictor of combat mortality than Injury Severity Score (ISS)

AU - Le, Tuan D.

AU - Orman, Jean A.

AU - Stockinger, Zsolt T.

AU - Spott, Mary Ann

AU - West, Susan A.

AU - Mann-Salinas, Elizabeth A.

AU - Chung, Kevin K.

AU - Gross, Kirby R.

PY - 2016

Y1 - 2016

N2 - Background: TheMilitary Injury Severity Score (mISS) was developed to better predict mortality in complex combat injuries but has yet to be validated. METHODS: US combat trauma data from Afghanistan and Iraq from January 1, 2003, to December 31, 2014, from the US Department of Defense Trauma Registry (DoDTR) were analyzed.Military ISS, a variation of the ISS, was calculated and compared with standard ISS scores. Receiver operating characteristic curve, area under the curve, and Hosmer-Lemeshow statisticswere used to discriminate and calibrate between mISS and ISS. Wilcoxon-Mann-Whitney, t test and X2 tests were used, and sensitivity and specificity calculated. Logistic regression was used to calculate the likelihood of mortality associated with levels of mISS and ISS overall. RESULTS: Thirty thousand three hundred sixty-four patients were analyzed. Most were male (96.8%). Median age was 24 years (interquartile range [IQR], 21-29 years). Battle injuries comprised 65.3%. Penetrating (39.5%) and blunt (54.2%) injury types and explosion (51%) and gunshot wound (15%) mechanisms predominated. Overall mortality was 6.0%. Median mISS and ISS were similar in survivors (5 [IQR, 2-10] vs. 5 [IQR, 2-10]) but different in nonsurvivors, 30 (IQR, 16-75) versus 24 (IQR, 9-23), respectively (p < 0.0001). Military ISS and ISS were discordant in 17.6% (n = 5,352), accounting for 56.2% (n = 1,016) of deaths. Among cases with discordant severity scores, the median difference between mISS and ISS was 9 (IQR, 7-16); range, 1 to 59. Military ISS and ISS shared 78% variability (R2 = 0.78). Area under the curve was higher in mISS than in ISS overall (0.82 vs. 0.79), for battle injury (0.79 vs. 0.76), non-battle injury (0.87 vs. 0.86), penetrating (0.81 vs. 0.77), blunt (0.77 vs. 0.75), explosion (0.81 vs. 0.78), and gunshot (0.79 vs. 0.73), all p < 0.0001. Higher mISS and ISS were associated with higher mortality. Compared with ISS, mISS had higher sensitivity (81.2 vs. 63.9) and slightly lower specificity (80.2 vs. 85.7). CONCLUSION: Military ISS predicts combat mortality better than does ISS.

AB - Background: TheMilitary Injury Severity Score (mISS) was developed to better predict mortality in complex combat injuries but has yet to be validated. METHODS: US combat trauma data from Afghanistan and Iraq from January 1, 2003, to December 31, 2014, from the US Department of Defense Trauma Registry (DoDTR) were analyzed.Military ISS, a variation of the ISS, was calculated and compared with standard ISS scores. Receiver operating characteristic curve, area under the curve, and Hosmer-Lemeshow statisticswere used to discriminate and calibrate between mISS and ISS. Wilcoxon-Mann-Whitney, t test and X2 tests were used, and sensitivity and specificity calculated. Logistic regression was used to calculate the likelihood of mortality associated with levels of mISS and ISS overall. RESULTS: Thirty thousand three hundred sixty-four patients were analyzed. Most were male (96.8%). Median age was 24 years (interquartile range [IQR], 21-29 years). Battle injuries comprised 65.3%. Penetrating (39.5%) and blunt (54.2%) injury types and explosion (51%) and gunshot wound (15%) mechanisms predominated. Overall mortality was 6.0%. Median mISS and ISS were similar in survivors (5 [IQR, 2-10] vs. 5 [IQR, 2-10]) but different in nonsurvivors, 30 (IQR, 16-75) versus 24 (IQR, 9-23), respectively (p < 0.0001). Military ISS and ISS were discordant in 17.6% (n = 5,352), accounting for 56.2% (n = 1,016) of deaths. Among cases with discordant severity scores, the median difference between mISS and ISS was 9 (IQR, 7-16); range, 1 to 59. Military ISS and ISS shared 78% variability (R2 = 0.78). Area under the curve was higher in mISS than in ISS overall (0.82 vs. 0.79), for battle injury (0.79 vs. 0.76), non-battle injury (0.87 vs. 0.86), penetrating (0.81 vs. 0.77), blunt (0.77 vs. 0.75), explosion (0.81 vs. 0.78), and gunshot (0.79 vs. 0.73), all p < 0.0001. Higher mISS and ISS were associated with higher mortality. Compared with ISS, mISS had higher sensitivity (81.2 vs. 63.9) and slightly lower specificity (80.2 vs. 85.7). CONCLUSION: Military ISS predicts combat mortality better than does ISS.

KW - Combat mortality

KW - mAIS

KW - Military Abbreviated Injury Scale

KW - Military Injury Severity Score

KW - mISS

UR - http://www.scopus.com/inward/record.url?scp=84960156627&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84960156627&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000001032

DO - 10.1097/TA.0000000000001032

M3 - Article

C2 - 26958797

AN - SCOPUS:84960156627

VL - 81

SP - 114

EP - 121

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 1

ER -