ArticleBMJ open2026
Comparison of the revised Shock Index multiplied by the Glasgow Coma Scale and the Trauma and Injury Severity Score for predicting survival in paediatric patients with trauma: a nationwide retrospective cohort study in Japan.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThe Trauma and Injury Severity Score (TRISS) is widely used to predict survival in patients with trauma; however, its predictive accuracy in paediatric populations remains suboptimal. In contrast, the revised Shock Index multiplied by the Glasgow Coma Scale (rSIG), a simple physiological marker, has shown potential utility in adults and children. Therefore, we aimed to compare the predictive performance of rSIG and TRISS in paediatric patients with trauma.
designRetrospective cohort study.
settingJapan Trauma Data Bank.
participantsPaediatric patients with trauma aged ≤17 years who were registered in the Japan Trauma Data Bank between 2009 and 2021. PRIMARY AND SECONDARY OUTCOME MEASURES: The optimal cut-off value for rSIG was determined using the derivation cohort (2009-2018). In the validation cohort (2019-2021), the predictive accuracy of rSIG and TRISS for in-hospital survival was compared using the area under the receiver operating characteristic curve (AUC).
resultsIn the derivation cohort, the optimal cut-off value for rSIG was 10.13. In the validation cohort, the overall AUC for rSIG was 0.857 (95% CI 0.796 to 0.918) compared with 0.740 (95% CI 0.661 to 0.820) for TRISS, demonstrating the significantly superior predictive accuracy of rSIG (p=0.006). Age-stratified analyses revealed that rSIG significantly outperformed TRISS in the 7-12 and 13-17 age groups.
conclusionsThe rSIG demonstrated higher predictive accuracy for in-hospital survival among paediatric patients with trauma than TRISS. These findings suggest that rSIG is a more effective prognostic tool for paediatric trauma care. Validation and the establishment of age-specific cut-off values are warranted to enhance its clinical applicability.
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