Considering the patient's perspective in the injury severity score

Background: The injury severity score (ISS) assesses anatomical threat to life, but does not correlate with severity perceived by the patient. The purpose of this study was to assess how and why patients assign perceived injury severity.

Methods: One hundred twenty consecutive patients were asked "Would you say your injury is mild, moderate, severe or very severe?" and "Why do you rate your injury that way?" Explanations were categorized and compared by age, perceived injury severity, and injury mechanism. Categories were pain, injury assessment, injury description, and others. The age groups used were <55 and ≥ 55 y old. The data were analyzed with Wilcoxon rank sum, Spearman's correlation coefficient, and Mantel-Haenszel tests.

Results: The ISS was not significantly correlated with perceived injury severity scores (r(2) = 0.177, P = 0.0535, Spearman's correlation), and most patients reported a higher injury severity. Patients with penetrating injuries significantly overestimated their injury severity (P = 0.014, Wilcoxon rank sum). Patients with mild and moderate injuries gave more assessment explanations, whereas patients with severe or very severe injuries gave more description explanations (P = 0.0220, Mantel-Haenszel).

Conclusions: Patients based perceived severity on their injuries, but it did not correlate with ISS, likely because ISS considers injuries graded events, while the patient considers them all or none events. Assessment responses suggested relief, whereas description responses indicated more distress. It is important to ask patients about their injury severity to help them better cope with their experience, which will likely improve quality of life outcomes.