TRAUMA SCORE

Trauma Score - Overview

>50 scoring systems Convert the severity of an injury into a number Three main groups of trauma scores Anatomical Physiological Combined

Anatomical
Abbreviated Injury Scale (AIS) Injury Severity Score (ISS) New Injury Severity Score (NISS) Anatomic Profile (AP)

Physiological
Revised Trauma Score (RTS) Glasgow Coma Score (GCS) Acute Physiology and Chronic Health Evaluation (APACHE)

Combined
Trauma and Injury Severity Score - (TRISS) International Classification of Diseasesbased ISS - (ICISS)

Abbreviated Injury Scale - (AIS)

Stratify victims of motor vehicle crashes Six revisions since 1971 Injury severity values range from 1 to 6

Abbreviated Injury Scale - (AIS)

Injury - AIS score 1 - Minor 2 - Moderate 3 - Serious 4 - Severe 5 Critical 6 - Unsurvivable

AIS

Limitations

No comprehensive measure of severity No linear scale Not predicting patient outcomes or mortality

Injury Severity Score - ISS

Patients with multiple injuries Each injury is assigned an Abbreviated Injury Scale (AIS) score

Injury Severity Score

Six body regions Head, Face, Chest, Abdomen (including Pelvis), Extremities, External Highest AIS score - body region

Injury Severity Score

3 most severely injured body regions score squared and added Values - 0 to 75 Correlates mortality, morbidity, hospital stay and other measures of severity

Example-Injury Severity Score

Region Injury Description Head & neck Cerebral contusion Face Chest Abdomen Extremity External No injury Flail chest AIS Square Top 3 3 9 0 4 16 25

Minor contusion of Liver 2 Complex Rupture Spleen 5 Fracture femur 3 No Injury Injury Severity Score: 0

50

Limitations of Injury Severity Score

Error in AIS scoring increases ISS error Limits total number of injuries to 3 regions Description of patient injuries unknown Not a triage tool

New Injury Severity Score - NISS

Modified in 1997 from ISS The sum of the squares of the AIS of each of the patient s three most severe AIS injuries, regardless of the body region in which they occur

New Injury Severity Score - NISS

Scores >ISS values indicate multiple injuries Predicts survival Easier to calculate than ISS

Limitations of New Injury Severity Score

More accurate for penetrating injury No account for physiological variables

Anatomic Profile - (AP)

Anatomic scoring system Includes all the serious injuries Weights head and torso injuries more

Anatomic Profile
Four categories: A - Head and spinal cord B - Thorax and anterior neck C - All remaining serious injuries D - All non-serious injuries

Anatomic Profile
Square root of the sum of squares of the AIS scores of all serious injuries in each region No injury - Zero

Anatomic Profile
Mathematical complexity

Limitations

Modestly improves predictive performance

Revised Trauma Score - (RTS)

Physiologic injury severity score Components : Glasgow Coma Scale (GCS) Systolic Blood Pressure (SBP) Respiratory Rate (RR)

Revised Trauma Score

GCS, SBP and RR are given a coded value Sum of the coded values

GCS

SBP

RR

RTS

RTS as triage tool

12 11 Priority Priority
3

Triage Sort

10 or less

Priority

Revised Trauma Score

Glasgow Systolic Coma Scale Blood Pressure 13 - 15 > 89 9 - 12 6-8 4-5 3 76 - 89 50 - 75 1 - 49 0 Respiratory Coded Rate Value 10 - 29 > 29 6-9 1-5 0 4 3 2 1 0

Revised Trauma Score

Ranges 0-12 Score < 11 - transfer to trauma centre Quality assurance and outcome prediction

Limitations of Revised Trauma Score

Not practical in field Problems : Intubated patients Influence of alcohol Drugs

Trauma and Injury Severity Score Score - (TRISS)

Anatomical and physiological measures of injury severity: ISS RTS Patient age

TRISS

Limitations

Multiple injuries to same body region cannot measure Limitations of RTS , Intubated patients are excluded Physiological data, unreliable or unavailable Affected by degree of resuscitation No account of pre-existing medical conditions

International Classification of Disease based ISS - (ICISS)

Anatomical injury score based on the ICD-9 codes Uses survival risk ratios (SRRs) calculated for each ICD-9 discharge diagnosis Some advantages over ISS Allows all injuries in predictions Injuries more accurately modeled Information about all injuries

ICISS

Limitations

ICD-9 code varies from hospital to hospital Ignores physiological data Computational software is needed for calculations and predictions Claimed improvement of ICISS over ISS is not unique

Conclusion
Despite imperfections, trauma scoring remains important Existing severity scores are being used for which they are not intended Continued research will improve methodology and accurate prediction on individual patient basis