title: Validating the Injury Severity Score (ISS) in different populations: ISS predicts mortality better among Hispanics and females.
abstract: BACKGROUND
  The Injury Severity Score (ISS) is the most commonly used measure of injury severity. The score has been shown to have excellent predictive capability for trauma mortality and has been validated in multiple data sets. However, the score has never been tested to see if its discriminatory ability is affected by differences in race and gender.
  
  
  OBJECTIVE
  This study is aimed at validating the ISS in men and women and in three different race/ethnic groups using a nationwide database.
  
  
  METHODS
  Retrospective analysis of patients age 18-64 y in the National Trauma Data Bank 7.0 with blunt trauma was performed. ISS was categorized as mild (<9,) moderate (9-15), severe (16-25), and profound (>25). Logistic regression was done to measure the relative odds of mortality associated with a change in ISS categories. The discriminatory ability was compared using the receiver operating characteristics curves (ROC). A P value testing the equality of the ROC curves was calculated. Age stratified analyses were also conducted.
  
  
  RESULTS
  A total of 872,102 patients had complete data for the analysis on ethnicity, while 763,549 patients were included in the gender analysis. The overall mortality rate was 3.7%. ROC in Whites was 0.8617, in Blacks 0.8586, and in Hispanics 0.8869. Hispanics have a statistically significant higher ROC (P value < 0.001). Similar results were observed within each age category. ROC curves were also significantly higher in females than in males.
  
  
  CONCLUSIONS
  The ISS possesses excellent discriminatory ability in all populations as indicated by the high ROCs.
authors.affiliation: Trauma Outcomes Research Group, Department of Surgery Howard University College of Medicine, Washington, DC, USA.
authors.forename: O B
authors.initials: OB
authors.lastname: Bolorunduro
authors.forename: C
authors.initials: C
authors.lastname: Villegas
authors.forename: T A
authors.initials: TA
authors.lastname: Oyetunji
authors.forename: E R
authors.initials: ER
authors.lastname: Haut
authors.forename: K A
authors.initials: KA
authors.lastname: Stevens
authors.forename: D C
authors.initials: DC
authors.lastname: Chang
authors.forename: E E
authors.initials: EE
authors.lastname: Cornwell
authors.forename: D T
authors.initials: DT
authors.lastname: Efron
authors.forename: A H
authors.initials: AH
authors.lastname: Haider
mesh_terms: D000293:Adolescent; D000328:Adult; D016208:Databases, Factual / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D017678:Sex Distribution; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality; D055815:Young Adult