A New Definition of Major Trauma: Overcoming the Limitations of Anatomic Injury Scoring by Incorporating Trauma-team Actions
Authors' conclusion
The novel concept of nMT is a more comprehensive definition of major trauma than the existing ISS-based standard, providing the highest overall ability to discriminate survivors from nonsurvivors.
Study context
- Population
- Trauma patients aged 18–89 y in 2021–23 NTDB files
- Participants
- 2,676,710 patients
- Exposure
- Injury severity score (ISS) >15 vs high-intensity time-sensitive (HITS)+ vs ISS >15 or HITS+ to identify major trauma
- Outcome
- Ability to identify deaths (likelihood ratios, area under the receiver operating curves (AUROCs))
- Follow-up
- 24 hours
Methodological detailsregistry (NTDB 2021-23), diagnostic performance comparison
- Registry (NTDB 2021-23)
- Diagnostic performance comparison
Main finding
As reported in the abstract
24-hour mortality
| Group | Value | Positive likelihood ratio | Negative likelihood ratio | AUROC |
|---|---|---|---|---|
| ISS>15 | 7.6% | 4.29 | 0.34 | 0.78 |
| HITS+ | 11.5% | 6.70 | 0.34 | 0.79 |
| nMT+ | 7.4% | 4.12 | 0.16 | 0.83 |
Value
ISS>157.6%
HITS+11.5%
nMT+7.4%
Positive likelihood ratio
ISS>154.29
HITS+6.70
nMT+4.12
Negative likelihood ratio
ISS>150.34
HITS+0.34
nMT+0.16
AUROC
ISS>150.78
HITS+0.79
nMT+0.83
- nMT+ vs ISS>15 and HITS+: P < 0.001 — significantly higher discriminatory power
Observational data: associations, not effects.
Further findings
Proportion of patients meeting each definition
Additional deaths identified by nMT+ vs ISS>15 or HITS+ alone
- More in-hospital deaths
- 19,851 (29%)
- More 24-hour deaths
- 9138 (26%)
Original publication
A New Definition of Major Trauma: Overcoming the Limitations of Anatomic Injury Scoring by Incorporating Trauma-team Actions. Ann Surg. Published 11 June 2026. doi:10.
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