Quality improvement is an essential component of any trauma scoring system, and outcomes have been under constant monitoring by health professionals and health organizations. Although it is difficult to imagine predicting life or death using a mathematical formula, a common consensus was that an objective and comparable method was needed to measure the outcomes and results from different trauma centers. In the initial phase, studies on preventable trauma deaths involved panel reviews of prehospital courses and hospital charts. However, reliability and validity of agreements were under debate. After the initial phase, multidisciplinary peer-review outcome analysis was conducted. The TRISS methodology was developed by Champion and Sacco in the 1980s ¹⁾.