### Literature Review
#### Injury Severity and Trauma Scoring for Prediction of Survival Based on Physiological Parameters  
The scoring measures, such as the NEWS, the GCS, the ISS, the TRISS, the SAPS II/III, and Ps have been successfully used to identify high health risks in patients that have suffered injury and trauma, and who have been admitted to ICU. The trauma scores used in this research, and the physiological parameters involved, have been presented in Table 1 for comparison. In the case of emergency, it would be a great advantage if the early warning scores could be calculated in time, and if the healthcare units could be made aware of these scores as soon as possible, to prepare for emergency, even before the patient arrives. The NEWS score is based on an aggregate scoring system in which a score is calculated using physiological measurements, recorded in a routine check-up in a hospital or under prehospital settings. Six simple physiological parameters that are used for NEWS calculations are: the respiration rate, the oxygen saturation, the systolic blood pressure, the pulse rate, the level of consciousness or confusion, and the body temperature. In the case that the patient is in a confused state of mind or disoriented, where the patient may respond to the questions, but is confused, a score of 3 or 4 is assigned to the GCS scale. The normal GCS score equals 5 for a verbal response. NEWS scoring takes the GCS score into consideration, and in the case of trauma, the GCS scores can be very low, which can affect the NEWS scoring. A score is allocated to each measured parameter, with the magnitude reflecting how the parameter varies from the normal values. These act as weights for each measured parameter. Two additional points are added for people requiring supplemental oxygen to maintain \begin{table}
\begin{tabular}{c l l l} \hline  & \multicolumn{1}{c}{**NEWS**} & \multicolumn{1}{c}{**RTS**} & \multicolumn{1}{c}{**TRISS**} \\ \hline \multirow{6}{*}{Parameters} & Respiratory Rate & \multirow{2}{*}{Glasgow Coma Scale (GCS):} & \multirow{2}{*}{Uses RTS and ISS} \\  & Oxygen Saturations & & \\  & Supplemental Oxygen (Y/N) & Eye + Verbal + Motor response & & ISS: (Anatomical injury \\  & Temperature & & score & scores for Head + Face + \\  & Systolic Blood Pressure & Systolic BP & Chest + Abdomen injury) \\  & Heart Rate & Respiratory Rate & Severity of injury \\  & AVPU Score & & \\ \hline \multirow{6}{*}{Interpretation} & NEWS 1-4: escalation of clinical care & \multirow{2}{*}{GCS of \(<\)15 warrants close attention} & \multirow{2}{*}{ISS of 75 and higher is critical with less chance of survival.} \\  & NEWS of 5-6 or a RED score: & & \\ \cline{1-1}  & escalation to critical care & & \\ \cline{1-1}  & NEWS \(\geq\) 7: escalation to critical care & & \\ \cline{1-1}  & with maximum competency & & \\ \cline{1-1}  & NEWS, RTS, and TRISS scoring schemes used in the research. & & \\ \hline \end{tabular}
\end{table} 
Table 1: Trauma scores and physiological parameters. oxygen saturation in blood. There is also an AVPU score (Alert, Voice, Pain, Unresponsive) that can be added to the calculation, depending on the alertness of the patient. The interpretation of the NEWS score: A low score (NEWS 1-4) would ideally require assessment by a competent registered nurse who would further decide how often clinical monitoring would be required, and whether the case should be referred to the next level of diagnosis. A medium score (i.e., NEWS of 5-6 or a RED score) would prompt an urgent review by a clinician that was skilled with the relevant competencies for the assessment of the kind of illness that the patient is suffering from, which would usually be a ward-based doctor or an acute team nurse, who would further assess the patient's health, and if required, would refer the patient to the critical care team. A RED score refers to an extreme condition in one of the physiological parameter (e.g., a score of 3 on the NEWS chart in any one physiological parameter).