Anatomical Scoring System Research Articles

Health status after traumatic injury

This study explored the relationships between health-related quality of life and postacute factors such as patients' perceived access to information and support, perceptions of illness and ability to provide self-care after traumatic injury. Adults (18 years or older) admitted to hospital for ≥ 24 hours for the acute treatment of trauma in two hospitals in Queensland, Australia, were enrolled in a prospective cohort study. Questionnaires completed at hospital discharge and 3 months and 6 months incorporated the following: demographic data; psychological factors (Revised Illness Perception Questionnaire, Information, Autonomy and Support Scale, and Therapeutic Self-Care Scale); and outcome data (medical short form-36). Data on injury and hospital stay were obtained from health care records and the Queensland Trauma Registry. One hundred ninety-four patients with a median Injury Severity Score 9 (interquartile range, 5-14) were enrolled, with 125 (64%) completing questionnaires at 6 months. More than half the cohort reported symptoms of pain, fatigue, stiff joints, sleep difficulties, and loss of strength. All subscale scores on the short form-36 were below Australian norms 6 months after injury. Predictors of poor physical health included older age, lower extremity injury, and increased perceived consequences of their injuries, whereas predictors of poor mental health included younger age, female gender, and lower perceived control over their environment. Patients with minor to moderate injury based on anatomic injury scoring systems have ongoing challenges with recovery including problematic symptoms and low quality of life. Interventions aimed toward assisting recovery should not be limited to trauma patients with major injury. Prognostic study, level III.

A report of the injuries sustained in Iran Air Flight 277 that crashed near Urmia, Iran.

On January 9, 2011 Iran Air Flight 277 crashed during approach to Urmia, Iran. Out of 105 passengers, 27 survived. This brief report presents a perspective of the passengers' sustained injuries. We reviewed the recorded injuries of all passengers as provided by the Legal Medicine Organization authorities. The Injury Severity Score (ISS), an anatomical scoring system, was used to provide an overall code for those who survived with multiple anatomical injuries. There were a total of 96 ISS body region injuries among those who survived. Facial injuries (83%) were the most frequent injuries noted among fatalities, which was statistically significant (P = 0.000). In those who survived, injuries to the head and neck (37%) and facial (33%) regions were relatively less frequent than other anatomical regions. The most serious injuries among survivors belonged to the extremity (85%) region, particularly lower limb fractures (62%). Differences in extremity injuries between the survivors and fatalities were not statistically significant. The findings of this study were similar to other studies where the most frequent serious injuries were fractures of the extremities, particularly the lower limbs.

Minimally Invasive Plate Osteosynthesis for Tibial Plateau Fractures

To evaluate radiological and clinical outcome of minimally invasive plate osteosynthesis (MIPO) for tibial plateau fractures. 35 men and 6 women aged 19 to 75 (mean, 40; standard deviation [SD], 14) years underwent MIPO for displaced tibial plateau fractures. According to the Schatzker system, the tibial plateau fractures were classified as types I (n=3), II (n=9), III (n=11), IV (n=6), V (n=7), and VI (n=5). Six patients had open fractures; 2 of them underwent debridement before MIPO. 10 patients needed additional bone grafting. Radiological (at immediate postoperation) and clinical (at the 12-month follow-up) assessments based on the Rasmussen anatomic and functional scoring system were recorded using a proforma. Patients with acceptable and unacceptable outcomes were compared in terms of age. The mean Rasmussen anatomic score was 15.1 (SD, 2.2; range, 10-18); the mean Rasmussen functional score was 25.3 (SD, 3.2; range, 14-29); and the mean range of knee motion was 118 (SD, 10; range, 90-140) degrees. Anatomic outcome was excellent in 10, good in 28, and unacceptable in 3 patients (one each had Schatzker type-I, -II, and -III fractures). 27 (71%) of the 38 patients with acceptable anatomic outcome were aged 45 years or younger, whereas 2 (67%) of the 3 patients with unacceptable anatomic outcome were aged 60 years or older (p=0.001). Functional outcome was excellent in 18, good in 19, and unacceptable in 4 patients (2 had Schatzker type-III and another 2 had Schatzker type-I or -II fractures). 37 of the patients had a range of knee motion of 120 degrees or more; 27 (73%) of them were aged 45 years or younger, whereas 3 (75%) of the 4 patients with unacceptable functional outcome were aged 60 years or older (p=0.001). MIPO for tibial plateau fractures achieved good outcome with minimal soft-tissue complications. Older age was the predictor of unacceptable outcome.

Tumour necrosis factor blockade for the treatment of erosive osteoarthritis of the interphalangeal finger joints: a double blind, randomised trial on structure modification

BackgroundAdalimumab blocks the action of tumor necrosis factor-α and reduces disease progression in rheumatoid arthritis and psoriatic arthritis. The effects of adalimumab in controlling progression of structural damage in erosive...

Diagnostic Value of the Glasgow Coma Scale for Traumatic Brain Injury in 18,002 Patients with Severe Multiple Injuries

Although patients with severe multiple injuries may have other reasons for unconsciousness, traumatic brain injury (TBI) in these patients is frequently defined by the Glasgow Coma Scale (GCS). Nevertheless, the diagnostic value of GCS for severe TBI in the multiple-injured patient is unknown. Therefore, we investigated the diagnostic value of GCS to identify severe TBI in multiple-injured patients. The records of 18,002 severely injured adult (ISS >16) patients from the Trauma Register of the German Society for Trauma Surgery were analyzed and initial GCS and Abbreviated Injury Scale (head) (AIS(head)) were recorded. A severe TBI was defined by an AIS(head) ≥ 3. On the other hand, unconsciousness was defined by an initial GCS ≤ 8. By these criteria, 6546 patients (36.3%) were unconscious, and 8746 patients (48.6%) had severe TBI. Nine percent of all cases (n=1643) had a GCS ≤ 8 without severe TBI. Only 56.1% of patients with severe TBI (n=4903) had been unconscious. Decreasing levels of unconsciousness (as defined by GCS) showed consistent rising prevalence of severe TBI (correlation coefficient r=-0.52). Approximately 20% of all multiple-injured patients arriving in the emergency department with an initial GCS of 15 had severe TBI (AIS(head) ≥ 3). The diagnostic value of GCS ≤ 8 for severe TBI in patients with multiple injuries has low sensitivity (56.1%) but higher specificity (82.2%). Our study indicates that the GCS (as defined ≤ 8) in unconsciousness patients with multiple injuries shows only a moderate correlation with the diagnosis of severe TBI. Nevertheless, the main reason for unconsciousness in patients with multiple injuries is TBI, since only 9% of these patients had another reason for unconsciousness. However, due to the poor sensitivity of GCS, we suggest the use of the anatomical scoring system with AIS(head) ≥ 3 to define severe TBI in patients with multiple injuries.

Postmortem Hesaplanan ISS ve NISS Puanı Önlenebilir Ölümlere İşaret Edebilir mi

Travmalı hastalarm değerlendirilebilmesi için birçok fizyolojik ve anatomik skor sistemleri geliştirilmiştir. Anatomik skor sistemleri arasında en sık kullanılan Abreviated Injury Scale (AIS) ve onun türevleri ile Injury Severity Score (ISS)’dur. ISS, 1997’de Osler ve ark. tarafından New Injury Severity Score (NISS) olarak modifiye edilmiştir. Bu çalışmada, travma nedeniyle ölen ve otopsileri yapılan olguların ISS ve NISS puanlarına göre değerlendirilmeleri amaçlanmıştır. Osmangazi Üniversitesi Tıp Fakültesi Adli Tıp Ana-bilim Dalında 2001-2007 yılları arasında travmatik sebeplerle ölen ve otopsileri yapılan 157 olgunun, retrospektif olarak değerlendirilip yaralarının AIS puanları ışığında ISS ve NISS hesaplamaları yapılmıştır. Olguların %67,5’inde penetran yaralanma, %32,5’inde künt yaralanma mevcuttur. Hem ISS hem de NISS puanı 14 ve altında olan olgu sayısı 12’dir (%7,6). Penetran yaralanmak grupta hem ISS hem de NISS puanı 75 olan olgu sayısı künt yaralanmak gruba göre istatistiksel olarak daha fazla iken, künt yaralanmak grupta ISS ve NISS puanı küçük olmasına rağmen ölümle sonuçlanan olgu sayısı penetran yaralanmak olgulara göre istatistiksel olarak daha fazla bulunmuştur. ISS puanı 50’den küçük olan olgularda baş-boyun ve göğüs bölgelerinde çoklu yara oranı, ISS puanı 50’den büyük olgulara göre daha fazla bulunmuştur. 157 olgunun 29’unda (%18,5) NISS değerinin ISS değerine göre daha yüksek grupta yer aldığı görülmüştür. Kişinin ölümünde fizyolojik mekanizmaların rolü olup anatomik olarak bunların gösterilemediği künt travmalı olgular ile aynı vücut bölgesinde çoklu yaralanması olan ve hastanede bir süre yatarak tedavi görüp enfeksiyon vb. komplikasyonların gelişme ihtimali olan olgularda, ISS ve NISS’nin önlenebilir ölümleri belirlemede yetersiz kaldığı düşünülmektedir. Ayrıca, adli nitelikli ölümlerde, yaralanma saati, yaralanma ile ölüm arasmda geçen süreç, olay yerinde ölmeyen ve hastanede ölen olgularm ne kadar sürede ilk yardım ve hastaneye ulaştırıldığının çok net olarak bilinememesi de bu tür çalışmaların güvenirliğini etkileyen hususlardır.Anahtar kelimeler: Önlenebilir ölüm, otopsi, travma skoru, ISS, NISS

Morbid anatomy of ‘erosive osteoarthritis’ of the interphalangeal finger joints: an optimised scoring system to monitor disease progression in affected joints

ObjectivesTo develop and validate a quantitative radiographic scoring system, the Ghent University Scoring System (GUSS), with better ability to detect progression over a shorter period of time in erosive osteoarthritis...

ANALYSIS OF COMPLICATIONS IN PATIENTS TREATED WITH THE X-STOP INTERSPINOUS PROCESS DECOMPRESSION SYSTEM

The X-Stop Interspinous Process Decompression System (St. Francis Medical Technologies, Concord, CA) is an interspinous device used with increasing frequency in the treatment of degenerative lumbar spine conditions. To date, limited data are available on complications observed in association with X-Stop procedures, and even less information exists on their underlying causes. The aim of this study was to analyze a series of complications occurring at a single institution and their potential causes and propose an anatomic scoring system that may help to classify patients and prevent complications. Sixty-nine patients were treated with the X-Stop. Forty-six single-level and 23 double-level operations (92 devices) were performed according to recommended indications. The mean follow-up duration was 23 months. Eight complications were recorded: 4 device dislocations and 4 spinous process (SP) fractures, including 2 spontaneous fractures of the L4 SP in patients treated at L3-L4 and L4-L5. The following anatomic variants were demonstrated: markedly decreased interspinous distance (kissing spine-like), with concomitant facet joint hypertrophy, a posterior V-shaped interspinous area, limited accessibility of the space between the base and the tip of the SP because of facet joint hypertrophy and variations in the shape of the inferior surface of the cranial SP. This is the first study focusing on interspinous distractor complications and the anatomic features of the SP and interspinous areas of the patients, which could potentially be the underlying causes for those complications. The X-Stop can be an effective treatment option, but it is not a panacea for all patients with degenerative lumbar spine conditions. Not only do the clinical indications deserve attention, but also, and most importantly, the patient's anatomic characteristics.

A Genomic Score Prognostic of Outcome in Trauma Patients

Traumatic injuries frequently lead to infection, organ failure, and death. Health care providers rely on several injury scoring systems to quantify the extent of injury and to help predict clinical outcome. Physiological, anatomical, and clinical laboratory analytic scoring systems (Acute Physiology and Chronic Health Evaluation [APACHE], Injury Severity Score [ISS]) are utilized, with limited success, to predict outcome following injury. The recent development of techniques for measuring the expression level of all of a person's genes simultaneously may make it possible to develop an injury scoring system based on the degree of gene activation. We hypothesized that a peripheral blood leukocyte gene expression score could predict outcome, including multiple organ failure, following severe blunt trauma. To test such a scoring system, we measured gene expression of peripheral blood leukocytes from patients within 12 h of traumatic injury. cRNA derived from whole blood leukocytes obtained within 12 h of injury provided gene expression data for the entire genome that were used to create a composite gene expression score for each patient. Total blood leukocytes were chosen because they are active during inflammation, which is reflective of poor outcome. The gene expression score combines the activation levels of all the genes into a single number which compares the patient's gene expression to the average gene expression in uninjured volunteers. Expression profiles from healthy volunteers were averaged to create a reference gene expression profile which was used to compute a difference from reference (DFR) score for each patient. This score described the overall genomic response of patients within the first 12 h following severe blunt trauma. Regression models were used to compare the association of the DFR, APACHE, and ISS scores with outcome. We hypothesized that patients with a total gene response more different from uninjured volunteers would tend to have poorer outcome than those more similar. Our data show that for measures of poor outcome, such as infections, organ failures, and length of hospital stay, this is correct. DFR scores were associated significantly with adverse outcome, including multiple organ failure, duration of ventilation, length of hospital stay, and infection rate. The association remained significant after adjustment for injury severity as measured by APACHE or ISS. A single score representing changes in gene expression in peripheral blood leukocytes within hours of severe blunt injury is associated with adverse clinical outcomes that develop later in the hospital course. Assessment of genome-wide gene expression provides useful clinical information that is different from that provided by currently utilized anatomic or physiologic scores.

Brain maturation is delayed in infants with complex congenital heart defects

Small head circumferences and white matter injury in the form of periventricular leukomalacia have been observed in populations of infants with severe forms of congenital heart defects. This study tests the hypothesis that congenital heart defects delay in utero structural brain development. Full-term infants with hypoplastic left heart syndrome or transposition of the great arteries were prospectively evaluated with preoperative brain magnetic resonance imaging. Patients with independent risk factors for abnormal brain development (shock, end-organ injury, or intrauterine growth retardation) were excluded. Outcome measures included head circumferences and the total maturation score on magnetic resonance imaging. Total maturation score is a previously validated semiquantitative anatomic scoring system used to assess whole brain maturity. The total maturation score evaluates 4 parameters of maturity: (1) myelination, (2) cortical infolding, (3) involution of glial cell migration bands, and (4) presence of germinal matrix tissue. The study cohort included 29 neonates with hypoplastic left heart syndrome and 13 neonates with transposition of the great arteries at a mean gestational age of 38.9 +/- 1.1 weeks. Mean head circumference was 1 standard deviation below normal. The mean total maturation score for the cohort was 10.15 +/- 0.94, significantly lower than reported normative data in infants without congenital heart defects, corresponding to a delay of 1 month in structural brain development. Before surgery, term infants with hypoplastic left heart syndrome and transposition of the great arteries have brains that are smaller and structurally less mature than expected. This delay in brain development may foster susceptibility to periventricular leukomalacia in the preoperative, intraoperative, and postoperative periods.

The systemic inflammatory response induced by trauma is reflected by multiple phenotypes of blood neutrophils

Secondary morbidity and mortality after trauma are mainly due to a dysfunctional immune system. Severe injury can trigger a systemic inflammatory response, which is characterised by pre-activation or priming of neutrophils in peripheral blood. Signals initiated as result of local tissue damage can further activate these neutrophils leading to post-injury inflammatory complications. Additional trauma caused by surgical intervention can worsen the inflammatory response, thereby increasing the risk of these inflammatory complications. Limiting surgical procedures through damage control principles can reduce the risk of secondary morbidity. Inflammatory complications after injury cannot adequately be predicted using the current anatomical and physiological-based scoring systems. In this review we propose a methodology focussing on the activation state of the systemic inflammatory response with focus on neutrophils to aid in the risk assessment of secondary morbidity after trauma. Neutrophils are essential effector cells during the post-injury systemic inflammatory response. Neutrophils differentially express an array of surface receptors by which the cells can respond and adapt to changing environmental signals. The determination of specific expression profiles of neutrophil receptors can aid in phenotyping and quantifying the systemic inflammatory response. This article reviews the application of these specific signatures of neutrophil receptors as a consequence of severe injury.

The Abbreviated Injury Scale and its Correlation with Preventable Traumatic Accidental Deaths: A study from South Delhi

Anatomic trauma scoring systems are fundamental to trauma research. The Abbreviated Injury Scale (AIS) and its derivative, the Injury Severity Score (ISS), are the most frequently used scales. In a prospective study, 400 autopsies of road traffic accident victims performed between January 2002 and December 2003 were coded according to the AIS and ISS methods. All the cases were classified into different injury groups according to the Injury Severity Scale. Fifty-eight cases (14.5%) were assigned an ISS value of <25; 244 (61%) cases were valued between 25-49; 38 cases (9.5%) were valued between 50-74 and 60 (15%) cases had a value of 75. On analysis of medical care, in cases with ISS<50, about 96% of the victims did not receive optimal care quickly enough with a lack of pre-hospital resuscitation measures and lengthy transportation time to hospital being of major importance.

Hand radiology characteristics of patients carrying the T303M mutation in the gene for matrilin‐3

Objective: To determine whether the recently described hand osteoarthritis (HOA)‐associated T303M mutation in the gene for matrilin‐3 (MATN3) is associated with specific radiological changes on hand radiographs.Method: Standard hand radiographs from 26 HOA patients carrying the T303M missense mutation in the MATN3 gene (T303M patients) were compared with those from 52 HOA controls matched for sex, age, and clinical disease severity. Two blinded readers scored the radiographs, using the Verbruggen–Veys anatomical scoring system for the interphalangeal and metacarpophalangeal joints and the OARSI atlas scoring system for the first carpometacarpal (CMC1) joints. A scoring system based on the latter was used for the scaphoid–trapezoid–trapezoideum (STT) joints.Results: No particular distinguishing features were found in the T303M patients and the prevalence of erosive and cystic changes was similar to the control group. As a group, however, the T303M patients had more severe thumb‐base affection, particularly in the STT joint. Thus, definite radiological OA in both CMC1 and STT joints and higher STT scores compared with CMC1 were significantly more common in patients carrying the T303M mutation. Radiological scores for joint‐space narrowing (CMC1 and STT) and osteophytes (STT) were also significantly higher in the T303M patients.Conclusion: Patients carrying the T303M mutation in the gene for matrilin‐3 express a form of HOA that is radiologically indistinguishable from idiopathic HOA in individual patients but they have more severe thumb‐base involvement, particularly in the STT joint. This is the first described genetic mutation that is associated with a common form of osteoarthritis.

Predictive effect of the injury severity score on the development of multiple organ failure among young adults and elderly patients

Study objectives: Multiple organ failure is a major cause of mortality in the injured patient, representing a significant financial burden to the health care system. Recent studies have demonstrated the importance of early prediction and early resuscitation for multiple organ failure to improve outcome. The objective of this study is to determine the correlation between Injury Severity Score (ISS) and multiple organ failure among severely injured young (aged 18 to 54 years) and elderly (aged 55 years) patients. Methods: This was a cross-sectional observational study from a hospital-based trauma registry. Data from 1997 were collected. All adult cases (>18 years) with acute trauma as defined by International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes and E-codes were included. Descriptive statistics were used to present group characteristics. For significance testing, χ 2 and Fisher's exact test were used for categorical variables. Severe injuries were defined by an ISS greater than 15. Presence of multiple organ failure was based on the definitions proposed by Knaus and Fry. Results: Six hundred forty-two adult trauma patients were included, with 469 classified as young and 173 as elderly. Among the 469 young adults, 193 had ISS greater than 15 (41.2%), and 35 of these developed multiple organ failure (35 of 193, or 18.1%). Among the 173 elderly patients, 88 had an ISS greater than 15 (50.9%), and 51 met the definition for multiple organ failure (51 of 173, or 29.5%). Severely injured (ISS >15) young and elderly groups were more likely to develop multiple organ failure compared with those with an ISS less than 15 ( P P P Conclusion: This study demonstrated a direct relationship between ISS greater than 15 and the development of multiple organ failure. We also observed a fivefold increase in the development of multiple organ failure among severely injured elderly patients. Future studies should focus on early resuscitative interventions based on prompt emergency department severity estimates calculated from anatomic and physiologic scoring systems. Limitations of this study are primarily related to the retrospective data collection process and the subsequent accuracy of the medical records.

Incidence of asymptomatic pulmonary embolism in moderately to severely injured trauma patients.

Chest computed tomographic (CT) scanning is used frequently to evaluate symptomatic patients for pulmonary embolus (PE). The incidence of PE diagnosed by helical CT scanning in asymptomatic patients is unknown. Asymptomatic trauma patients with an Injury Severity Score > or = 9 were studied with contrast-enhanced helical CT images of the chest, pelvis, and lower extremities. Clot burden was assessed using an anatomic scoring system. Patients not receiving anticoagulation were followed. Twenty-two of 90 patients had a PE. Four had major clot burden, including one patient with a saddle embolus. Risk factors for asymptomatic PE include age (odds ratio [OR], 1.04), head injury (OR, 6.78), chest injury (OR, 4.51), lower extremity injury (OR, 5.03), and transfusion (OR, 3.42). Thirty percent of patients receiving pharmacologic prophylaxis had a PE. Asymptomatic PE occur in 24% of moderately to severely injured patients. Age, head, chest, and lower extremity injury are associated with an increased risk. Standard thromboembolic prophylaxis is not reliably protective.

Prediction of survival in stage iv colorectal cancer by a computed tomographic scoring system for hepatic metastasis

To assess the relation between the burden of hepatic metastasis on initial CT scan and survival. A simple scoring system to quantify the degree of hepatic involvement was utilized by a single staff radiologist who retrospectively reviewed the CT scans obtained on admission of 48 patients who presented to the study institution with stage IV colon and rectal cancer between 1991 and 1998. The radiologist was blinded to the clinical presentation and survival of the patients. The scoring system separated patients into five groups depending on the radiologist’s visual calculation of the hepatic involvement by metastatic disease: 0% (stratum 1), 1–25% (stratum 2), 25–50% (stratum 3), 50–75% (stratum 4) and more than 75% (stratum 5). (Patients with 0% hepatic involvement had known metastatic disease at another site.) The results of this scoring system were then correlated with survival data. Kaplan-Meier curves demonstrated a statistically significant difference in survival between the different groups (p = 0.02). During the first four months after presentation, 91% (95% CI: 59%–100%) of patients in stratum 1 survived and 87% (95% CI: 60–98%) of patients in stratum 2 survived, while only 43% (95%:CI 10–82%), 40% (95% CI: 10–82%) and 22% (95% CI: 3–60%) of patients in Strata 3, 4 and 5 survived, respectively. Kruskal-Wallis testing also showed a significant difference across the five groups (p = 0.007). Strata 1 and 2, with lower hepatic tumor burdens, showed longer survival times with median survival of 312 days [IQR:143–739] and 293 days [IQR: 225–706]. As the amount of hepatic involvement increased, the median survival decreased with strata 3, 4, and 5 demonstrating a progressive decrease in survival time with median values of 100 days [IQR:38–375], 54 days [IQR:43–139] and 22 days [IQR:11–56], respectively. We have developed a simple anatomical CT-based scoring system which significantly correlates with survival of stage IV colorectal cancer patients. Most clinically important, a significant difference in survival was seen in the first few months after presentation. Assessing the volume of hepatic involvement is a useful adjunct to the clinician in providing optimal care to patients with advanced colon and rectal cancer.

Trauma scoring systems explained

Objective: To list, describe and classify the extant trauma scoring systems found in the English language literature from the vantage of utility to emergency medicine. Each system is illustrated by a table and a hypothetical case study. Data Sources: Medline citations provided the data. The systems are classified as physiological, anatomical and combined trauma scoring systems. Results: We reviewed the Glasgow Coma Scale, the Paediatric Glasgow Coma Scale, the Trauma Score and Revised Trauma Score, the Circulation, Respiration, Abdominal/Thoracic, Motor and Speech Scale, the Acute Physiology and Chronic Health Evaluation System, Abbreviated Injury Scale, the Injury Severity Score, the Anatomical Profile, A Severity Characterization of Trauma, Revised Trauma Score and Injury Severity Score and its revisions, the Paediatric Trauma Score and the Drug‐Rock Injury Severity Score. Conclusions: This compendium should help emergency physicians become familiar with trauma scoring systems which evaluate the extent and severity of injuries, facilitate inter‐institutional comparisons and facilitate trauma research.

Trauma Scoring Systems Explained

Objective: To list, describe and classify the extant trauma scoring systems found in the English language literature from the vantage of utility to emergency medicine. Each system is illustrated by a table and a hypothetical case study. Data Sources: Medline citations provided the data. The systems are classified as physiological, anatomical and combined trauma scoring systems. Results: We reviewed the Glasgow Coma Scale, the Paediatric Glasgow Coma Scale, the Trauma Score and Revised Trauma Score, the Circulation, Respiration, Abdominal/Thoracic, Motor and Speech Scale, the Acute Physiology and Chronic Health Evaluation System, Abbreviated Injury Scale, the Injury Severity Score, the Anatomical Profile, A Severity Characterization of Trauma, Revised Trauma Score and Injury Severity Score and its revisions, the Paediatric Trauma Score and the Drug-Rock Injury Severity Score. Conclusions: This compendium should help emergency physicians become familiar with trauma scoring systems which evaluate the extent and severity of injuries, facilitate inter-institutional comparisons and facilitate trauma research.

The Abbreviated Injury Scale. A valuable tool for forensic documentation of trauma.

Anatomic trauma scoring systems are fundamental to trauma research. The Abbreviated Injury Scale (AIS) and its derivative, the Injury Severity Score (ISS), are the most frequently used scales. We assessed the applicability of the AIS and the ISS systems for postmortem forensic documentation of trauma. In a prospective study, all trauma autopsies performed between January 1 and June 30, 1993, were coded according to the AIS and ISS method. All cases were reviewed by a consultant in forensic medicine and a traumatologist. Cases were grouped in three categories according to ISS values: 0-14, 16-66, and 75. These categories represent minor, major, and incompatible-with-life injuries, respectively. All autopsy findings in which ISS was < or = 14 were peer-reviewed to establish mechanism and cause of death. In the 6-month period, 279 trauma-related autopsies were studied. Age at death averaged 37.1 +/- 18.7 (mean +/- SD). Eighty-six percent of the victims were male. Penetrating trauma was the mechanism of injury in 67%. ISS was 0-14 in 19 cases, 16-66 in 150 cases, and 75 in 110 cases. In conclusion, AIS and ISS scoring systems are applicable to trauma forensic documentation. Using these methods for coding postmortem findings may help in establishing a database for trauma research, and this information could constitute a major part of continuous quality improvement of trauma management. Low ISS values may serve as a warning, sometimes indicating preventable death.