The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services.

Research output: Contribution to journalArticle


  • Robert Russell
  • TJ Hodgetts
  • J McLeod
  • K Starkey
  • P Mahoney
  • E Bell

Colleges, School and Institutes


This paper discusses mathematical models of expressing severity of injury and probability of survival following trauma and their use in establishing clinical governance of a trauma system. There are five sections: (i) Historical overview of scoring systems--anatomical, physiological and combined systems and the advantages and disadvantages of each. (ii) Definitions used in official statistics--definitions of 'killed in action' and other categories and the importance of casualty reporting rates and comparison across conflicts and nationalities. (iii) Current scoring systems and clinical governance--clinical governance of the trauma system in the Defence Medical Services (DMS) by using trauma scoring models to analyse injury and clinical patterns. (iv) Unexpected outcomes--unexpected outcomes focus clinical governance tools. Unexpected survivors signify good practice to be promulgated. Unexpected deaths pick up areas of weakness to be addressed. Seventy-five clinically validated unexpected survivors were identified over 2 years during contemporary combat operations. (v) Future developments--can the trauma scoring methods be improved? Trauma scoring systems use linear approaches and have significant weaknesses. Trauma and its treatment is a complex system. Nonlinear methods need to be investigated to determine whether these will produce a better approach to the analysis of the survival from major trauma.


Original languageEnglish
Pages (from-to)171-91
Number of pages21
JournalRoyal Society of London. Philosophical Transactions B. Biological Sciences
Issue number1562
Publication statusPublished - 27 Jan 2011