TRISS as a Predictor of Trauma Patient Outcomes (TRISS/ER)

March 3, 2026 updated by: Abdulillah R. Khamees, Al-Nahrain University

Prospective Validation of the Trauma and Injury Severity Score (TRISS) for Predicting Mortality and Major Outcomes: Bridging the Regional Evidence Gap in Trauma Outcomes Prediction From Iraq

The goal of this prospective observational study is to evaluate the predictive utility of the Trauma and Injury Severity Score (TRISS) in determining patient outcomes, including survival and mortality, among trauma patients admitted to the trauma and emergency department of Kadhimiya Educational Hospital, Iraq.

The main questions it aims to answer are:

How accurately does TRISS predict survival and mortality outcomes in trauma patients? What is the performance of TRISS in predicting secondary outcomes, such as the need for intensive care, surgical interventions, and length of hospital stay?

Participants will:

Be assessed using the TRISS score upon their admission to the emergency department.

Have their clinical outcomes, including survival, need for intensive care, surgery, and hospital stay, monitored throughout their hospitalization.

Study Overview

Status

Completed

Conditions

Detailed Description

Trauma is a significant cause of mortality and morbidity around the world. Approximately 10% of the burden of disease in adults is due to traumatic injuries. Trauma can lead to serious consequences, including disabilities, psychosocial burdens, and increased mortality among the actively working population. Cardiopulmonary arrest, unplanned admissions to intensive care units, and nosocomial infections are some complications faced by trauma patients admitted to trauma centers. The estimated mortality rate for hospitalized trauma patients is 11%. The in-hospital mortality rate for trauma patients who undergo cardiopulmonary resuscitation (CPR) is 92.7%. Trauma-related mortality and morbidity depend on injury severity, diagnostic delays, and the time taken to reach a medical facility.Timely evaluation, effective post-trauma care, and appropriate triage can significantly reduce long-term mortality and morbidity among trauma patients, with rapid assessment of trauma severity being crucial for the primary triage of multiple trauma patients.

Trauma scoring systems are valuable tools for quickly assessing the severity of injuries and predicting patient outcomes. By utilizing these scoring systems, healthcare providers can enhance the organization of trauma patient triage, optimize resource allocation, and conduct immediate evaluations of potential complications. Several scoring systems have been developed to assess trauma cases. These trauma scores are classified into three categories: anatomical (such as the Abbreviated Injury Scale and Injury Severity Score), physiological (like the Revised Trauma Score), and combined (such as the Trauma and Injury Severity Score). Physiological scores can be determined during the initial clinical assessment of the patient, while anatomical scoring can be performed later after the patient has been stabilized. This makes it easier to stratify trauma patients effectively. On the other hand, combined scores that include both anatomical and physiological criteria are more useful for patient prognosis. One such combined score is the Trauma and Injury Severity Score (TRISS), which was designed by the Major Trauma Outcome Study (MTOS) in the United States to predict the outcome in polytrauma patients and includes the Injury Severity Score (ISS) and Revised Trauma Score (RTS).

Trauma is thus now a significant health challenge in Iraq. Through the long fight in Iraq, more and more people are experiencing violence-related injuries, such as from firearms and attacks. The work also demonstrates that violence is one of the primary determinants of public health because it leads to complications with injuries and the psychological development of the survivors in the course of their lives. The Iraqi healthcare system has documented a significant rise in RTAs (road traffic accidents), particularly since the escalation of conflict around 2013. Trauma care system is not well established, and few protocols are followed clinically, and no scientific method is well established to predict the outcome in trauma patients in Iraq. This is made worse by scarce resources, inadequate staffing and educational preparedness of medical personnel, and the overall lack of formalized trauma registry databases that could well monitor patient results. In the Iraqi context, only a few studies have demonstrated the use of different trauma scores to predict outcomes in patients with trauma.

There is a significant research gap regarding the use of trauma scoring systems, especially TRISS, in Iraq. Most studies focus on descriptive outcomes rather than evaluating global trauma scores in the unique Iraqi context. Resource limitations, inconsistent pre-hospital care, and conflict-related injuries complicate the application of these systems. The lack of standardized trauma registries and data collection further limits the ability to improve trauma care and emergency services in Iraq.

Study Type

Observational

Enrollment (Actual)

204

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Iraq
      • Baghdad, Iraq, 10001
        • College of Medicine - Al-Nahrain University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

The study population will consist of trauma patients presenting to the Emergency Department of Al-Kadhmia Teaching Hospital during the study period. These patients represent a diverse demographic and clinical profile, encompassing individuals with varying injury mechanisms, severities, and outcomes.

The study specifically targets patients for whom trauma scoring systems, including the Trauma and Injury Severity Score (TRISS), can be applied reliably. This includes both blunt and penetrating trauma cases.

Description

Inclusion Criteria:

  • Trauma patients admitted to the emergency department of Al-Kadhimiya Teaching Hospital.
  • Patients with adequate documentation of physiological and anatomical data are required for TRISS calculation.
  • Trauma scoring (TRISS) completed within the first 6 hours of hospital arrival to ensure timely assessment.

Exclusion Criteria:

  • Patients under 18 years, pregnant women, or those with conditions that alter standard trauma scoring or management.
  • Non-trauma cases (e.g., medical emergencies, terminal illnesses) to ensure focus on trauma-specific outcomes.
  • Patients with incomplete or missing data required for TRISS calculation.
  • Patients declared dead on arrival or those not treated in the trauma and emergency department.
  • Individuals refusing participation or withdrawing consent at any stage of the study.
  • Patients transferred to or from another facility or enrolled in other studies that might affect scoring accuracy or outcomes.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Accuracy Assessment of TRISS in Predicting In-Hospital Mortality
Time Frame: From admission to hospital discharge or death, up to 30 days.
This outcome evaluates the ability of the Trauma and Injury Severity Score (TRISS), which generates a probability of survival ranging from 0% to 100%, to predict in-hospital mortality among trauma patients. Lower TRISS survival probabilities are expected to correlate with increased observed mortality.
From admission to hospital discharge or death, up to 30 days.
Accuracy Assessment of TRISS in Predicting the Need for Intervention
Time Frame: From admission to hospital discharge or death, up to 30 days.
This outcome examines the predictive value of TRISS (range: 0-100% survival probability) in determining the likelihood of trauma patients requiring major interventions (such as surgical procedures, blood transfusion, or invasive monitoring). Lower TRISS survival probabilities are expected to correlate with increased intervention requirements.
From admission to hospital discharge or death, up to 30 days.
Accuracy Assessment of TRISS in Predicting the Need for Endotracheal Intubation
Time Frame: From emergency department admission to intubation, discharge, or in-hospital death, up to 30 days.
This outcome assesses the predictive performance of TRISS (range: 0-100% survival probability) in identifying trauma patients requiring endotracheal intubation during hospitalization. Lower TRISS survival probabilities are expected to be associated with an increased likelihood of intubation.
From emergency department admission to intubation, discharge, or in-hospital death, up to 30 days.
Accuracy Assessment of TRISS in Predicting Length of Hospitalization
Time Frame: From hospital admission to discharge, up to 30 days.
This outcome evaluates the ability of TRISS (range: 0-100% survival probability) to predict hospitalization duration. Patients with higher TRISS survival probabilities are expected to have shorter hospital stays, while those with lower probabilities are more likely to require prolonged hospitalization.
From hospital admission to discharge, up to 30 days.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Length of Hospitalization
Time Frame: Up to discharge, an average of 7-10 days
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.
Up to discharge, an average of 7-10 days
Number of Participants Requiring ICU Admission
Time Frame: Up to discharge, an average of 7-10 days
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.
Up to discharge, an average of 7-10 days
Need for Surgical Intervention
Time Frame: Up to discharge, an average of 7-10 days
need for surgical intervention during a trauma patient's hospital stay.
Up to discharge, an average of 7-10 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Al-Nahrain University

Investigators

  • Study Director: Anees K Nile, Professor of general surgery, College Of Medicine - Nahrain University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

November 15, 2024

Primary Completion (Actual)

July 1, 2025

Study Completion (Actual)

July 15, 2025

Study Registration Dates

First Submitted

November 23, 2024

First Submitted That Met QC Criteria

November 28, 2024

First Posted (Actual)

December 2, 2024

Study Record Updates

Last Update Posted (Actual)

March 6, 2026

Last Update Submitted That Met QC Criteria

March 3, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • UNCOMIRB20241134

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Trauma, Multiple

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Kenya

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Subscribe