Clinical Report: Evaluating NISS for Bullfighting-Related Injuries at a Level I Trauma Center

Overview

A retrospective study of 154 bullfighting trauma patients at a Level I trauma center demonstrated that the New Injury Severity Score (NISS) effectively stratifies injury severity and predicts morbidity and mortality. Most injuries were mild, with a high survival rate, but severe trauma cases had significantly worse outcomes and required more invasive interventions.

Background

Bullfighting events in Spain, particularly in Castilla y León, frequently result in high-energy trauma with a global mortality rate around 5%. Patients often present with polytrauma, necessitating reliable injury severity scoring to guide triage and treatment. The New Injury Severity Score (NISS) categorizes trauma severity and may help prioritize care in this unique patient population. This study retrospectively analyzed bullfighting-related injuries over 26 years to evaluate the utility of NISS in clinical practice.

Data Highlights

Key Findings

• The majority of bullfighting trauma patients were young males with predominantly mild injuries (NISS 1–9).
• Goring was the leading injury mechanism, especially in moderate–severe and severe trauma groups.
• Higher NISS scores correlated with older age, more abdominal injuries, and life-threatening complications such as pelvic fractures and intestinal perforations.
• Surgical intervention was required in over 90% of cases, with more invasive procedures in severe trauma patients.
• Postoperative complications occurred in 14%, mainly wound infections; mortality was low but concentrated in the severe trauma group.
• NISS effectively stratified patients by injury severity, predicting morbidity, need for surgery, and transfer to higher-level care.

Clinical Implications

The NISS scale is a valuable tool for triaging bullfighting-related trauma, enabling clinicians to identify patients at higher risk who require urgent surgical management or transfer. Early surgical intervention combined with appropriate antibiotic and tetanus prophylaxis can improve outcomes even in severe cases. Awareness of injury patterns and severity can optimize resource allocation in trauma centers managing these unique injuries.

Conclusion

This study supports the use of NISS as an effective injury severity stratification tool in bullfighting trauma, correlating with clinical outcomes and guiding management. Further multicenter prospective research is needed to validate these findings and compare NISS with other trauma scoring systems.

References

1. Martínez et al. 2023 -- Bullfighting Trauma Mortality Rates