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Injury Severity Scoring
Injury Severity Scoring
SCORES
BY
DR. PRATHAP AVVARU
JR, DEPT OF SURGICAL DISCIPLINES
INTRODUCTION
INJURY CODING
INJURY SEVERITY SCORES
TYPES OF INJURY SEVERITY SCORES
INTRODUCTION
following trauma.
The primary outcome of interest is usually SURVIVAL
INJURY CODING
Accurate classification of a patients injuries,
AIS
ABBREVIATED INJURY SCORE
1971,2008
TRAUMA SPECIFIC
HAS TWO COMPONENTS
An injury descriptor (pre-dot) that is unique to
each injury
a severity score (post-dot) graded FROM 1 TO 6
AIS
The actual AIS code consists of two numerical components. The
AIS
pre-dot codes include nine anatomic regions:
1, head;
2, face;
3, neck;
4, thorax;
5, abdomen and pelvic contents;
6, spine;
7, upper
extremity;
8, lower extremity;
9, unspecified
ICD
INTERNATIONAL STATISTICAL CLASSIFICATION
OF DISEASES
1983,2013
GENERAL, ALL PURPOSE DIAGNOSIS
CLASSIFICATION
CODES 800.0 TO 959.9 ARE TRAUMA SPECIFIC
TYPES
four types of risk adjustments (equally
ANATOMICAL SCORING
SYSTEMS
AIS(1971)
ISS(1974)
NISS(1997)
APS(1990)
ICDMAP-90(1990)
ICISS(1996)
TRAIS(2003)
OIS(1987)
AIS
PATIENT SURVIVAL
not only a method to classify injuries, also a validated
AIS SCORING
ISS
Patient survival
ISS divides the body into six regions: head or neck,
ISS
ISS is most widely used anatomical scoring
system
Correlates well with mortality
ISS only considers one injury in each of the
body regions and thus ignores important
injury information
NISS
Patient survival
address some of the ISS shortcomings, esp, its
APS
Patient survival
Three modified components (head/brain
OIS
GCS
PATIENT SURVIVAL AND BRAIN FUNCTION
Aggregate score of motor activity (scale of 1
RTS
Patient survival
Two foms exist : TRIAGE RTS, other for
OUTCOME RTS
Patient survival
RTS = 0.9368(GCS) +0.7326(SBP) +
0.2908(RR)
Ranges from 0 to 7.84
Lower scores more derangement
Contribution to TRISS model
APACHE-II
Patient survival and disease severity
Based on worst 12 physiological
APACHE II
Age (0 to 6 pts ), past medical h/o (0 to 5),
MORTALITY PREDICTION
BY APACHE-II
APACHE SCORE
Non op mortality
Post op mortality
0-4
5-9
10-14
15
15-19
24
12
20-24
40
30
25-29
55
35
30-34
73
73
>35
85
88
SAPS II
Simplified Acute Physiology Score
12 physiological variables and 3 disease
related variables
Ranges from 0 to 163
Greater scores high mortality
SAPS II PREDICTION
SAPS II SCORE
MORTALITY
29 pts
10%
40 pts
25%
52 pts
50%
64 pts
75%
>77 pts
90%
TRISSCOM
Patient survival
Similar to TRISS with adjustments to age and
TRISS
Patient survival
Trauma specific
Combines ISS, RTS and age
Regression coefficients from MTOS database
Different equations for penetrating and blunt
trauma
Ranges from 0(unsurvivable) to 1(high
survival)
Multiple variables, even if one is missing
TRISS cannot be calculated
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