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    Parnil Singh
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    16 ISS Baker Haddon 1974

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    23 просмотров10 страниц

    16 ISS Baker Haddon 1974

    Загружено:

    Parnil Singh
    16 ISS Baker Haddon 1974

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    ‘Twp Jovmeat op Texvs Copyright © 174 by The Wiliams & Wilkins Co. Vol, Nod Printed in OSA. ‘THE INJURY SEVERITY SCORE: A METHOD FOR DESCRIBING PATIENTS WITH MULTIPLE INJURIES AND EVALUATING EMERGENCY CARE SUSAN P. BAKER, MPH, BRIAN O'NEILL, BSc, WILLIAM HADDON, Ja, MD., ‘oxo WILLIAM B, LONG, MD. From the Division of Porensic Pathology, The Johns Hopkins University School oj Hygiene ‘and Public Health, Baltimore, Maryland; Ineurance Institute for Highway Safety, Wash ‘ington, D.C.; and Maryland Institute for Emergency Medicine, University of Maryland, Baltimore Injuries are a serious problem common to all societies. Yet even within a single community, groups of injured persons differ es to the nature and severity of their injuries. The difficulty of adjusting for such variation las hampered sci- entific study of injured persons. Nevertheless, it is essential to take differences in severity of in- jury into account when comparing the morbidity and mortality of various groups for purposes of evaluating their emergency and subsequent, care a), ‘Two basic research approsches ean be used in dealing with this problem. The first is to com- pare only persons with similar injuries, When Feasible this is often the best approach, but the numbers of injuries of each specific type and severity are often too small to support statisti- cally sound conclusions. The second approach is to compare persons whose injuries, although not necessarily the same anatomically, are of the same severity, Combining patients into groups on the basis of severity of injury requires the use of seales such as the Abbreviated Injury Seale (AIS) (4, 12) and the Comprehensive Research Injury Seale (CRIS) (5,12), which were developed to provide a method for rating and comparing. injuries incurred in automotive crashes, The widely used AIS is the simpler of the two scales; the CRIS is 9 detailed extension of the AIS. These two seales were baced primarily on the professional experience and judgment of the physicians who constructed them, The degree to which they re- late to morbidity and mortality has remained conjectural, despite the medical reasonableness of the ecales themselves, Address for reprinfs: William Haddon, Jr, MD., Insurance Institute for Highway Safety, Watergate ‘600, Washington, D.C. 20087. ‘The AIS and CRIS pertain to individual injuries. Even though most deaths following sutomotive crashes involve injury to more than cone part of the body, a scale for describing ‘multiply injured patients has been lacking. The present study was undertaken to deter- mine the extent to which AIS ratings correlate ‘with mortality. The analysis led to development of a simple method—based on the AIS—of ad- justing for multiple injuries. This method, the “Injury Severity Score,” makes possible a valid numerical description of the overall severity of injury in persons who have sustained injury to ‘more than one area of the body. METHODS ‘The study group included 2,128 motor vehicle ocenpents, pedestrians, and other road users ‘whose injuries resulted in hospitalization or caused death. All such patients at eight Balti- ‘more hospitals during the 2-year period 1968 1969 were included. The cight hospitals were selected on the basis of having record systems that mado it feasible to identify patients ad- mitted because of vehicle-related injuries. Seven of the hospitals wero participants in the Professional Activity Study (PAS), and at these hospitals the eoded PAS data were used. At the cighth hospital data were obtained irom patients’ charts, Patients transferred to other hospitals or extended care facilities were followed to deter- ‘mine their status as of March 1971. ‘Records from the Office of the Chief Medical ‘Examiner of Maryland provided a second source of information for persons who died following hospital admission, and also made it possible to include persons who were dead on arrival (DOA) cor who died in emergency rooms prior to admis- 187 ‘TABLE 1 ‘The Abbreviated Injury Seale Examples of Codes for Chest Injuries AIS Code Tnjery Deseipion ‘Muscle ache or cheat wall stiffness ‘Simple rib or sternal fractures ‘Multiple rib fractures without res- piratory embarrassment Flail chest Aortic luceration sion—deaths that might not appear in hospital adinission or discharge records, Injuries were categorized according to the AIS (Table I) modified for the present study in ‘wo respecte. First and most important, we did not use the AIS codes 6 through 9, which are normally assigned to any fatality occurring within 24 br, irrespective of injury severity, All such fatalities were coded as if the outcome ‘were not known. Thus all injuries were rated by severity, irrespective of outcome, and the most severe injury code used was 5. Use of the fatal codes 6 to @ would have made it impossible to compute mesningful death rates for the various severity codes, and in addition some details of ‘the injuries themselves would have been lost, Second, facial injuries were separated from cranial and neck injuries—in part because facial injuries, being common in antomobile crashes, might otherwise have overshadowed other head injuries, and in part because the disfigurement often associated with facial injuries may have in- fluenced their AIS rating. With the ATS, each injury was eategorized by Doody area (head or neck, face, chest, abdominal or pelvie contents, extremities or pelvie girdle, and general) and severity (1, minor; 2, moder- ate; 3, severe, not life-threstening; 4, severe, life-threatening, survival probable; 5, critial, survival uncertain). For injuries coded by the International Classification of Diseases, Adapted (ICDA) at the PAS hospitals, each ICDA code ‘was translated into an AIS grade, For example, the ICDA code 835, denoting dislocation of the hip, was converted to “grade 3 injury, ex- tremity.” After grading of all injuries for a given pa- tient, each body area was categorized by the most severe injury in that area. For example, if a ‘THE JOURNAL OF TRAUMA, March 1974 person had two chest injuries graded 1 and 3, his grade for chest injury was 3. Autopsies had been performed on 74% of all persons who died. When information was avail- able from both hospital and autopsy data, severity grading was based on the autopsy. RESULTS ‘The overall ratio of hospital admissions to deaths (including DOA’s) was 8:1. The ratios of admissions to deaths ranged from approxi- mately 5:1 to 60:1 in individual hospitals—re- fleeting, in general, differences in the proportion of severely injured patients each received, ‘There were large differences between hospitals in the proportion of children and elderly pa- tients. There were also differences between hos- pitals in the proportion of patients who had sustained injury to specific body areas, such as the face; but at all eight hospitals the ex- tremities and pelvic girdle were the most fre- quently injured perts of the body. Forty-nine percent of all pationts eustained injuries to ex- tremities or the pelvie girdle, and in 35% of all patients this was the most severely injured area. Table shows the distribution of injury severity. (It is important to remember that this distribution does not represent the entire spec- trum of highway injuries, since many injuries, ‘especially minor ones, do not result in admission to hospitals.) In approximately half (49%) of all patients in the study, the most severe injury was grade 3 ‘The percentage of patients who died inereased, with the AIS grade of the most severe injury (Fig. 1), as did the proportion of deaths that were DOA. Patients im each of these five AIS severity groups hed a wide spectrum of additional in- juries, For instance, some patients whose most sovere injury was grade 4 had no injury else- where, while others had minor to severe in- juries in other parts of the body. Figure 2A. shows that for persons whose most severe in- jury was grade 4, the death rate increased with injury severity in the second area, ranging from 6% in persons with no injury or only a grade 1 injury in a second area to 60% of those with a second grade 4 injury. Similarly, Figure 2B shows tbat for persons Whose most severe injury Vol. 14, No. $ / XNaURY SeVERETY SCORE 180 TABLE I Outcome by ATS Grade of Most Severe Injury AISGrole Mestad on Ava

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