Injury Severity Scoring and Length of Stay in Hospital of War Casualties—Demonstration of an Association and Possible Selection Bias

Abstract

The Injury Severity Score (ISS) is a widely used measure of anatomical injury. It is the sum of squares of the highest scores on the Abbreviated Injury Scale (AIS) in each of the three most severely injured body regions. This study was designed to describe the relationship between ISS and length of stay (LOS) in hospital. The ISS was independently determined by four physicians who studied 491 war casualties, excluding dead on arrival and non-trauma patients. The study demonstrates non-linear and non-homogeneous relationships between ISS and LOS. Exclusion of fatalities resulted in biased (higher) estimates of LOS among those with ISS scores of 25-66. The patients could be grouped into five categories according to their maximal AIS (MAIS): (1) Slight injury--i.e. those with injuries appropriate for AIS scores 1 or 2 that lead to an LOS of median 5 days; (2) Moderate injury--i.e. those with injuries appropriate to AIS scores of 3, with an expected median LOS of 10 days; (3) Severe injuries--i.e. those with injuries appropriate to AIS scores of 4, with expected median LOS of about 17 days; (4) Very severe injuries--i.e. those with one injury appropriate to an AIS score of 5; and (5) Multiple severe injuries--those who are severely wounded in two or more body regions, i.e. those with two or more injuries appropriate to AIS scores of 5 and 4, with a median LOS of 39 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Which hospital-acquired conditions matter the most in trauma? An evidence-based approach for prioritizing trauma program improvement

“…All conditions are listed in Table 1. Injury severity can be associated with length of hospital stay, with higher ISS correlated to increased length of hospital stay 18 . In this study, the patient populations were nearly evenly spread across ISS groups, but a slight majority at 28.8% of the population had an ISS of 15 to 24 (Table 1).…”

Characteristics of injured children attending the emergency department: patients potentially in need of rehabilitation

“…Home and leisure accidents were the most common cause of injury in the overall study population (n = 2674, 53%), followed by sports accidents (n = 1168, 23%), traf c accidents (n = 982, 19%), intentional ISS 9-14 (serious injuries), and ISS 16 (severe injuries). 15,16 The body region of the most severe injury was de ned by the highest AIS score, the maximum AIS (MAIS), and placed in one of the following four categories: head/neck/face, thorax/abdomen, extremities, and other/unspeci ed. If a subject sustained multiple injuries with identical AIS scores, the MAIS body region was classi ed regarding the risk of death: head/neck/face > thorax/abdomen > extremities > other/unspecied.…”

Epidemiology and outcome of an acute kidney injuries in the polytrauma victims admitted at the apex trauma center in Dubai

“…Thus, it was difficult to determine whether all patients received uniform resuscitation, which is one of the determining factors for AKI after trauma. Second, outcome variables after AKI: patient’s LOS-hospital, LOS-ICU, need for mechanical ventilation, days spent on a ventilator, and mortality depend on the severity of trauma as indicated by high ISS score [ 23 , 28 , 29 ]. Similarly, AKI is also more common after severe polytrauma as indicated by the linear relationship between severe polytrauma and a high ISS score.…”