Probability of death – a guesstimate or an estimate? Recommendation for a more accurate prediction

Introduction The estimation of the probability of death in an injured victim is a crucial duty of the judicial medical officer in Sri Lanka. Several instruments can be used to approximately predict the probability of death/or survival. To the authors’ knowledge, so far no instrument has been used or proposed to predict the probability of death for medico-legal purposes in Sri Lanka. As such there is low inter - rater reliability with possible confusion in a criminal trial. We propose that it is the need of the hour to use such instruments in view of the current controversies around the concept “endangering life”. These instruments can also be used to categorize injuries as “fatal in the ordinary course of nature” , which are terminology used in criminal trials to categorise the severity of injuries following trauma in Sri Lanka. Description The simplest instrument, Abbreviated injury scale (AIS), an anatomical scoring system ranks each injury individually from 01 to 06. Using the AIS, Injury severity score (ISS) which takes multiple injuries into consideration is calculated which predicts the probability of death. The Revised trauma scale (RTS)is a physiologic scoring system which has a high inter - rater reliability and demonstrated accuracy. The Trauma score – Injury Severity Score (TRISS) determines the probability of survival of a patient with a formula using both ISS and RTS. Conclusion and recommendation Four injury scales/scores would be described with outlines of their usefulness and limitations. The predictive value of each code can be identified by performing multi centre studies to identify which code was more accurate in predicting the probability of death for trauma victims. This would ensure uniform expression of opinions regarding the percentage probability of death; an opinion crucial to express whether an injury is endangering life or fatal in the ordinary course of nature. Medico-Legal Journal of Sri Lanka 2014; 2(1) : 11-14