Trauma, MultipleNCT06709547
Mortality Prediction Using Trauma Scores
An observational study of Trauma, Multiple, run by Al-Nahrain University at 1 site in Iraq.
Trial summary
The goal of this prospective cohort study is to compare the predictive utility of the Injury Severity Score (ISS), New Injury Severity Score (NISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) in determining mortality outcomes among trauma patients admitted to the trauma and emergency… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Trauma, Multiple
- How many people
- 150 participants
- Where
- 1 siteIraq
- Study dates
- 28 Nov 2025to 15 Dec 2027
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: The study population consists of adult trauma patients (≥18 years) presenting to the trauma and emergency department at Kadhimiya Educational Hospital in Baghdad. It includes individuals with acute injuries, such as blunt or penetrating trauma, who require trauma severity scoring. Data will be gathered through standardized clinical assessments and trauma scoring within the emergency department setting, ensuring a representative sample of the trauma population at the hospital.
Who may be able to join
- Trauma patients admitted to the emergency room (ER).
- Documented injury data sufficient to calculate both the New Injury Severity Score (NISS) and the Injury Severity Score (ISS).
- Trauma scores (ISS, NISS, Revised Trauma Score [RTS], and Trauma and Injury Severity Score [TRISS]) calculated within 12 hour of arrival to ensure timely predictions.
- Informed consent provided by the patient or a legal guardian in cases of incapacity.
Who cannot join
- Under 18 years of age and pregnant women, due to differences in trauma management and scoring applicability.
- Non-trauma cases, including patients with terminal illnesses or severe cognitive impairments, to maintain focus on trauma outcomes.
- Incomplete trauma scoring, missing or incomplete medical records, and
- patients not treated in the trauma or emergency department.
- Patients who refuse participation or withdraw consent to ensure ethical participation.
- Transferred patients and those enrolled in other research studies that could interfere with trauma scoring.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Iraq1 site, 1 recruiting
- Recruiting
College of Medicine - Al-Nahrain University
Baghdad
dr.rawaaasattar@nahrainuniv.edu.iq
Abdulillah R. Khamees
About this study
Official title: Which Trauma Severity Score (ISS, NISS, RTS, or TRISS) Best Predicts Mortality in Trauma Patients? A Prospective Observational Study
The goal of this prospective cohort study is to compare the predictive utility of the Injury Severity Score (ISS), New Injury Severity Score (NISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) in determining mortality outcomes among trauma patients admitted to the trauma and emergency department at Kadhimiya Educational Hospital in Baghdad.
The main questions it aims to answer are:
Read more
Which trauma scoring system provides the most accurate prediction of mortality? Are there specific trauma patient subgroups where one scoring system outperforms the others?
Participants will:
Be assessed using all four trauma scoring systems (ISS, NISS, RTS, and TRISS) upon admission to the trauma and emergency department.
Have their clinical outcomes, including mortality, length of hospital stay, ICU admission, and discharge status, monitored throughout their hospital stay to evaluate the accuracy and utility of each scoring system in predicting patient outcomes.
Read the detailed description
Trauma remains a leading cause of morbidity and mortality worldwide, with millions of individuals affected annually. The severity of trauma injuries can vary widely, ranging from minor to life-threatening, and effective management often hinges on the ability to quickly assess the severity of injury and predict patient outcomes, including mortality. Accurate and timely prognostication is essential for prioritizing care, guiding treatment decisions, and allocating resources in trauma care settings. Trauma severity scoring systems have been developed to assist in these assessments, with the most commonly used being the Injury Severity Score (ISS), the New Injury Severity Score (NISS), the Revised Trauma Score (RTS), and the Trauma and Injury.
Injury Severity Score (ISS) The Injury Severity Score (ISS) was developed in the 1970s as a way to quantify the severity of trauma-related injuries based on anatomic regions of injury. The ISS assigns scores to the most severe injuries in six body regions, and the sum of the squares of the highest AIS (abbreviated Injury Score) from each of the three most severely injured regions determines the total score. ISS is widely used for risk stratification in trauma patients and has been validated as a predictor of mortality in various populations.
New Injury Severity Score (NISS) The New Injury Severity Score (NISS), introduced in the 1990s, improves upon the ISS by utilizing the three most severe injuries across any body region rather than restricting it to the highest injuries from three predefined regions. Research has shown that NISS is more predictive of mortality than ISS, particularly in patients with polytrauma or multiple severe injuries across different body regions. Despite its advantages, Revised Trauma Score (RTS) The Revised Trauma Score (RTS) is a physiological scoring system based on three clinical parameters: Glasgow Coma Scale (GCS), systolic blood pressure (SBP), and respiratory rate (RR). Unlike ISS and NISS, RTS focuses on the immediate physiological status of the patient rather than the anatomical severity of the injuries. The RTS has been widely used in trauma centers, especially for triage purposes, as it can be quickly assessed in the pre-hospital setting. However, RTS does not account for the type, distribution, or severity of injuries, which can limit its ability to predict mortality in more complex trauma cases.
Trauma and Injury Severity Score (TRISS) The Trauma and Injury Severity Score (TRISS) combines the ISS (or NISS), the RTS, and the patient's age to estimate the probability of survival. TRISS has been widely validated and used in trauma registries as a comprehensive scoring system, considering both injury severity and physiological status. It has been shown to predict trauma-related mortality with good accuracy and is often used to assess trauma system performance and to guide clinical decision-making. However, TRISS may be less accurate in certain populations, such as older adults or those with significant comorbidities, as it primarily relies on injury-related factors and may not fully capture the complex interplay of clinical variables affecting outcomes.
Need for Comparative Studies While individual trauma scoring systems have demonstrated utility in predicting mortality, no single scoring system is universally superior. In clinical practice, there is a need to evaluate and compare these scoring systems across different populations and settings, particularly to determine which system is most reliable in predicting mortality for various trauma mechanisms.
injury patterns, and patient characteristics. Some studies have suggested that combining these systems may improve predictive accuracy, but evidence supporting the superiority of one over the others is inconclusive.
Additionally, while many studies have focused on the predictive validity of these scores in large datasets, fewer studies have compared them head-to-head within the same cohort of trauma patients. This gap in the literature necessitates a comprehensive, cohort-based study that directly compares the performance of the ISS, NISS, RTS, and TRISS for predicting mortality across a broad spectrum of trauma patients.
- Conditions
- Trauma, Multiple
- Keywords
- ISS, NISS, RTS, TISS
- Medical subject headings
- Multiple Trauma
What is being measured
The primary outcome is the main question the study is designed to answer.
In hospital mortality
Mortality (death) during hospitalization
Measured: In-Hospital Phase (average of 7 days through discharge)
Accuracy Assessment of Injury Severity Score (ISS)
Range: 0 to 75 Higher values indicate worse outcomes, reflecting greater injury severity.
Measured: the first 12 hours after ER admission
Accuracy Assessment of New Injury Severity Score (NISS)
Range: 0 to 75. Higher values indicate worse outcomes, reflecting greater injury severity.
Measured: the first 12 hours after ER admission
Accuracy Assessment of Trauma Injury Severity Score (TISS)
Range: 0 (represents a 0% probability of survival) to 1 (represents a 100% probability of survival), with higher scores indicating greater trauma severity.
Measured: the first 12 hours after ER admission
Accuracy Assessment of the Revised Trauma Score (RTS)
The total RTS score ranges from 0 to approximately 12, with lower scores indicating more severe injuries and a higher risk of mortality.
Measured: the first 12 hours after ER admission
Secondary outcomes (3)
Length of Hospitalization
The total duration of a patient's stay in the hospital, measured from the date of admission to the date of discharge. This includes all days spent in general wards, intensive care units (ICU), and other hospital departments as part of their treatment course.
Measured: Up to discharge, an average of 7 days
Number of Participants Requiring ICU Admission
The requirement for admission to the intensive care unit (ICU) is determined by the presence of severe clinical deterioration, significant complications, or the need for advanced monitoring and life-support measures.
Measured: Up to discharge, an average of 7 days
Number of Participants Requiring Surgical Intervention
need for surgical intervention during a trauma patient's hospital stay.
Measured: Up to discharge, an average of 7 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 Nov 2024
- Study start28 Nov 2025
- Primary completion1 Dec 2027 (estimated)
- Study completion15 Dec 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (6)Papers the sponsor has linked to this study.
- Other trials for Trauma, MultipleStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 150 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Al-Nahrain University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Abdulillah R. Khamees, Al-Nahrain University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06709547
- Sponsor's protocol ID
- UNCOMIRB20241123
- Status last verified
- Sep 2026
- First submitted
- 23 Nov 2024
- Last updated
- 17 Sep 2026
- Results posted
- No
- Data monitoring committee
- Yes
- Individual data sharing
- No
Publications
Senkowski CK, McKenney MG. Trauma scoring systems: a review. J Am Coll Surg. 1999 Nov;189(5):491-503. doi: 10.1016/s1072-7515(99)00190-8. No abstract available.
PubMed 10549738Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989 May;29(5):623-9. doi: 10.1097/00005373-198905000-00017.
PubMed 2657085Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974 Mar;14(3):187-96. No abstract available.
PubMed 4814394Hoke MH, Usul E, Ozkan S. Comparison of Trauma Severity Scores (ISS, NISS, RTS, BIG Score, and TRISS) in Multiple Trauma Patients. J Trauma Nurs. 2021 Apr-Jun 01;28(2):100-106. doi: 10.1097/JTN.0000000000000567.
PubMed 33667204Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987 Apr;27(4):370-8.
PubMed 3106646Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma. 1997 Dec;43(6):922-5; discussion 925-6. doi: 10.1097/00005373-199712000-00009.
PubMed 9420106
Study at a glance
From the registry record, last updated by the sponsor on 17 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Which Trauma Severity Score (ISS, NISS, RTS, or TRISS) Best Predicts Mortality in Trauma Patients? A Prospective Observational Study
- ClinicalTrials.gov ID
- NCT06709547
- Acronym / sponsor ID
- UNCOMIRB20241123
- Conditions
- Trauma, Multiple
- Keywords
- ISS, NISS, RTS, TISS
- Study type
- Observational
- Recruitment status
- Recruiting
- Enrolment
- 150 participants (estimated)
- Lead sponsor
- Al-Nahrain UniversityUniversity, hospital or other
- Study start
- 28 Nov 2025 (actual)
- Primary completion
- 1 Dec 2027 (estimated)
- Study completion
- 15 Dec 2027 (estimated)
- First posted
- 29 Nov 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this prospective cohort study is to compare the predictive utility of the Injury Severity Score (ISS), New Injury Severity Score (NISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) in determining mortality outcomes among trauma patients admitted to the trauma and emergency department at Kadhimiya Educational Hospital in Baghdad.
The main questions it aims to answer are:
Which trauma scoring system provides the most accurate prediction of mortality? Are there specific trauma patient subgroups where one scoring system outperforms the others?
Participants will:
Be assessed using all four trauma scoring systems (ISS, NISS, RTS, and TRISS) upon admission to the trauma and emergency department.
Have their clinical outcomes, including mortality, length of hospital stay, ICU admission, and discharge status, monitored throughout their hospital stay to evaluate the accuracy and utility of each scoring system in predicting patient outcomes.
Detailed description
Trauma remains a leading cause of morbidity and mortality worldwide, with millions of individuals affected annually. The severity of trauma injuries can vary widely, ranging from minor to life-threatening, and effective management often hinges on the ability to quickly assess the severity of injury and predict patient outcomes, including mortality. Accurate and timely prognostication is essential for prioritizing care, guiding treatment decisions, and allocating resources in trauma care settings. Trauma severity scoring systems have been developed to assist in these assessments, with the most commonly used being the Injury Severity Score (ISS), the New Injury Severity Score (NISS), the Revised Trauma Score (RTS), and the Trauma and Injury.
Injury Severity Score (ISS) The Injury Severity Score (ISS) was developed in the 1970s as a way to quantify the severity of trauma-related injuries based on anatomic regions of injury. The ISS assigns scores to the most severe injuries in six body regions, and the sum of the squares of the highest AIS (abbreviated Injury Score) from each of the three most severely injured regions determines the total score. ISS is widely used for risk stratification in trauma patients and has been validated as a predictor of mortality in various populations.
New Injury Severity Score (NISS) The New Injury Severity Score (NISS), introduced in the 1990s, improves upon the ISS by utilizing the three most severe injuries across any body region rather than restricting it to the highest injuries from three predefined regions. Research has shown that NISS is more predictive of mortality than ISS, particularly in patients with polytrauma or multiple severe injuries across different body regions. Despite its advantages, Revised Trauma Score (RTS) The Revised Trauma Score (RTS) is a physiological scoring system based on three clinical parameters: Glasgow Coma Scale (GCS), systolic blood pressure (SBP), and respiratory rate (RR). Unlike ISS and NISS, RTS focuses on the immediate physiological status of the patient rather than the anatomical severity of the injuries. The RTS has been widely used in trauma centers, especially for triage purposes, as it can be quickly assessed in the pre-hospital setting. However, RTS does not account for the type, distribution, or severity of injuries, which can limit its ability to predict mortality in more complex trauma cases.
Trauma and Injury Severity Score (TRISS) The Trauma and Injury Severity Score (TRISS) combines the ISS (or NISS), the RTS, and the patient's age to estimate the probability of survival. TRISS has been widely validated and used in trauma registries as a comprehensive scoring system, considering both injury severity and physiological status. It has been shown to predict trauma-related mortality with good accuracy and is often used to assess trauma system performance and to guide clinical decision-making. However, TRISS may be less accurate in certain populations, such as older adults or those with significant comorbidities, as it primarily relies on injury-related factors and may not fully capture the complex interplay of clinical variables affecting outcomes.
Need for Comparative Studies While individual trauma scoring systems have demonstrated utility in predicting mortality, no single scoring system is universally superior. In clinical practice, there is a need to evaluate and compare these scoring systems across different populations and settings, particularly to determine which system is most reliable in predicting mortality for various trauma mechanisms.
injury patterns, and patient characteristics. Some studies have suggested that combining these systems may improve predictive accuracy, but evidence supporting the superiority of one over the others is inconclusive.
Additionally, while many studies have focused on the predictive validity of these scores in large datasets, fewer studies have compared them head-to-head within the same cohort of trauma patients. This gap in the literature necessitates a comprehensive, cohort-based study that directly compares the performance of the ISS, NISS, RTS, and TRISS for predicting mortality across a broad spectrum of trauma patients.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- The study population consists of adult trauma patients (≥18 years) presenting to the trauma and emergency department at Kadhimiya Educational Hospital in Baghdad. It includes individuals with acute injuries, such as blunt or penetrating trauma, who require trauma severity scoring. Data will be gathered through standardized clinical assessments and trauma scoring within the emergency department setting, ensuring a representative sample of the trauma population at the hospital.
Key inclusion criteria (4 listed)
- Trauma patients admitted to the emergency room (ER).
- Documented injury data sufficient to calculate both the New Injury Severity Score (NISS) and the Injury Severity Score (ISS).
- Trauma scores (ISS, NISS, Revised Trauma Score [RTS], and Trauma and Injury Severity Score [TRISS]) calculated within 12 hour of arrival to ensure timely predictions.
- Informed consent provided by the patient or a legal guardian in cases of incapacity.
Key exclusion criteria (6 listed)
- Under 18 years of age and pregnant women, due to differences in trauma management and scoring applicability.
- Non-trauma cases, including patients with terminal illnesses or severe cognitive impairments, to maintain focus on trauma outcomes.
- Incomplete trauma scoring, missing or incomplete medical records, and
- patients not treated in the trauma or emergency department.
- Patients who refuse participation or withdraw consent to ensure ethical participation.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
In hospital mortality
Time frame: In-Hospital Phase (average of 7 days through discharge)
Mortality (death) during hospitalization
Accuracy Assessment of Injury Severity Score (ISS)
Time frame: the first 12 hours after ER admission
Range: 0 to 75 Higher values indicate worse outcomes, reflecting greater injury severity.
Accuracy Assessment of New Injury Severity Score (NISS)
Time frame: the first 12 hours after ER admission
Range: 0 to 75. Higher values indicate worse outcomes, reflecting greater injury severity.
Accuracy Assessment of Trauma Injury Severity Score (TISS)
Time frame: the first 12 hours after ER admission
Range: 0 (represents a 0% probability of survival) to 1 (represents a 100% probability of survival), with higher scores indicating greater trauma severity.
Accuracy Assessment of the Revised Trauma Score (RTS)
Time frame: the first 12 hours after ER admission
The total RTS score ranges from 0 to approximately 12, with lower scores indicating more severe injuries and a higher risk of mortality.
3 secondary outcomes
Length of Hospitalization
Time frame: Up to discharge, an average of 7 days
Number of Participants Requiring ICU Admission
Time frame: Up to discharge, an average of 7 days
Number of Participants Requiring Surgical Intervention
Time frame: Up to discharge, an average of 7 days
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 17 Sep 2026.
- Background: PubMed 10549738Senkowski CK, McKenney MG. Trauma scoring systems: a review. J Am Coll Surg. 1999 Nov;189(5):491-503. doi: 10.1016/s1072-7515(99)00190-8. No abstract available.
- Background: PubMed 2657085Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989 May;29(5):623-9. doi: 10.1097/00005373-198905000-00017.
- Background: PubMed 4814394Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974 Mar;14(3):187-96. No abstract available.
- Results publication: PubMed 33667204Hoke MH, Usul E, Ozkan S. Comparison of Trauma Severity Scores (ISS, NISS, RTS, BIG Score, and TRISS) in Multiple Trauma Patients. J Trauma Nurs. 2021 Apr-Jun 01;28(2):100-106. doi: 10.1097/JTN.0000000000000567.
- Results publication: PubMed 3106646Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987 Apr;27(4):370-8.
- Results publication: PubMed 9420106Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma. 1997 Dec;43(6):922-5; discussion 925-6. doi: 10.1097/00005373-199712000-00009.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Trauma, Multiple, run by Al-Nahrain University at 1 site in Iraq.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 17 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Iraq. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Abdulillh R. Khamees (+9647838571013, allaabed987@ced.nahrainuniv.edu.iq), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
In hospital mortality (time frame: In-Hospital Phase (average of 7 days through discharge)). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06709547, which also lists 6 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Sep 2026.