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Invited Commentary

Edward E. Cornwell III, MD
Arch Surg. 1994;129(8):805. doi:10.1001/archsurg.1994.01420320027004.
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This fine report by Norwood and Myers not only articulates the commitment necessary to achieve excellent results in the care of injured patients in a rural level I trauma center but highlights the value of using objective scores of injury severity (TRISS) and an accepted standard of comparison (MTOS) to avoid the subjectivity associated with self-review. A highly desirable z-statistic (negative score, absolute value >1.96) was produced, suggesting that the 94.4% survival rate exceeds that which would be predicted by the TRISS method. In Table 6 of the article, the m-statistic of less than 0.88 in each category of stratified injury severity reflects a distribution that differs from the baseline study population of the MTOS and typically detracts from the validity of the z-statistic within that category.1 However, the overall excellent results described by Norwood and Myers (z=−3.30, m=0.99) demonstrate the top priority of


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