### Literature Review
#### Injury Severity and Trauma Scoring for Prediction of Survival Based on Physiological Parameters
A high NEWS score (NEWS \(\geq\) 7) should prompt an emergency assessment by a critical care staff with critical-care skills and competencies, and in such cases, the patient has to be transferred to higher critical care settings for diagnosis and treatment [6; 7; 10]. The use of physiologic scoring systems for identifying high-risk patients for mortality detection has been considered using the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiologic Score (SAPS II) models, and they are currently used in a large number of hospitals worldwide. Although these scores are not very exact or perfect, they do enable the estimation of the health status of a patient who has had a recent episode of trauma or a similar condition. Patients brought to the accident and emergency wards may have suffered multiple injuries, in which case the Injury Severity Score (ISS) is used to assess the trauma levels. Such patients who have been injured may have one or multiple injuries, and the ISS is an anatomical scoring method that provides estimates and measures of the overall severity of injured patients. All injuries are assigned an Abbreviated Injury Scale (AIS) score, and the codes of injuries have been derived from an internationally recognized and accepted dictionary that describes over 2000 injuries, and ranges from 1 (minor injury) to 6 (an extreme life threatening injury). Patients with multiple injuries are scored by adding the squares of the three injuries with the highest AIS scores in predetermined regions of the body, and in the order of the severity of injuries. The ISS score can range from 1 to 75, and a score of 75 represents an extreme condition. The maximum score is 75 (25 + 25 + 25), as the maximum severity is 5 for each anatomical part. By convention, a patient with an AIS 6 in one body region is given an ISS of 75. The injury severity score is non-linear, and scores of 9 and 16 are common, while scores of 14 and 22 unusual. The AIS grades are 0--no injury, 1--minor, 2--moderate, 3--severe (not life-threatening), 4--severe (life-threatening, survival probable), 5--severe (critical, survival uncertain), 6--maximal, possibly fatal. ISS \(>\) 15 has been associated with a mortality of 10%. The advantage of using ISS is that it uses anatomical areas of injury to help in formulating a prediction of survival, though at the same time it is difficult to calculate this during the initial evaluation when the patient arrives at the emergency ward, and during resuscitation. In addition, it is difficult to predict the outcomes for patients with a severe single body area injury, though the New Injury Severity Score (NISS), which takes the three highest scores regardless of anatomic area, overcomes this deficit [11; 21]. The injury severity scoring can be classified as the following:  
1. Physiologic: RTS, APACHE, Emergency Trauma Score
2. Anatomical: AIS, ISS, NISS
3. Combined: TRISS, A Severity Characterization of Trauma (ASCOT), the International Classification of Diseases Injury Severity Score (ICISS)  
The composite device in this research can calculate the early warning scores and injury severity scores in real time, when the individual has had an episode of trauma. The NEWS, RTS, and TRISS models have been considered in this research presented in Table 1. In the Materials and Methods section, these scores have been calculated and discussed, along with the severity levels that are associated with these scores. The statistical scores associated with these scores have been compared, and the analytical results have been presented. The correlation and regression scores between the NEWS and RTS scores have been studied and are later discussed. The measurements of the physiological parameters associated with these trauma scores have been measured in real time, and the scores have been calculated and presented in real time. In the calculation of injury severity, the TRISS score [22] remained the most commonly used tool for benchmarking trauma fatality outcome.