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The idea of publishing a risk adjustment equation to enable trauma centers to compare their mortality to a reference database originated with the Major Trauma Outcome Study (MTOS) coordinated by the ACS more than 20 years ago (Champion et al.
In agreement with the Major Trauma outcome Study (MTOS), ISS increments were associated with increased mortality (31), which was not a linear function of the ISS (Figure 1), a finding similar to the modelled effect of the acute physiological and chronic health evaluation III score on mortality outcome (32).