The definition of major trauma using different revisions of the abbreviated injury scale

Abstract

Background A threshold Injury Severity Score (ISS) ≥ 16 is common in classifying major trauma (MT), although the Abbreviated Injury Scale (AIS) has been extensively revised over time. The aim of this study was to determine effects of different AIS revisions (1998, 2008 and 2015) on clinical outcome measures. Methods A retrospective observational cohort study including all primary admitted trauma patients was performed (in 2013–2014 AIS98 was used, in 2015–2016 AIS08, AIS08 mapped to AIS15). Different ISS thresholds for MT and their corresponding observed mortality and intensive care (ICU) admission rates were compared between AIS98, AIS08, and AIS15 with Chi-square tests and logistic regression models. Results Thirty-nine thousand three hundred seventeen patients were included. Thresholds ISS08 ≥ 11 and ISS15 ≥ 12 were similar to a threshold ISS98 ≥ 16 for in-hospital mortality (12.9, 12.9, 13.1% respectively) and ICU admission (46.7, 46.2, 46.8% respectively). AIS98 and AIS08 differed significantly for in-hospital mortality in ISS 4–8 (χ2 = 9.926, p = 0.007), ISS 9–11 (χ2 = 13.541, p = 0.001), ISS 25–40 (χ2 = 13.905, p = 0.001) and ISS 41–75 (χ2 = 7.217, p = 0.027). Mortality risks did not differ significantly between AIS08 and AIS15. Conclusion ISS08 ≥ 11 and ISS15 ≥ 12 perform similarly to a threshold ISS98 ≥ 16 for in-hospital mortality and ICU admission. This confirms studies evaluating mapped datasets, and is the first to present an evaluation of implementation of AIS15 on registry datasets. Defining MT using appropriate ISS thresholds is important for quality indicators, comparing datasets and adjusting for injury severity. Level of evidence Prognostic and epidemiological, level III.

Injury severity score as a predictor of mortality in adult trauma patients by injury mechanism types in the United States: A retrospective observational study

“…[25] Van Ditshuizen et al recently observed equivalent in-hospital mortality and ICU admission rates using a threshold of ISS98 ≥ 16 and thresholds of ISS08 ≥ 11 and ISS15 ≥ 12. [22] Our results point toward a difference in the discriminatory ability of ISS across the different penetrating injury mechanisms. The discriminatory ability of ISS was moderate in injury by cutting and piercing (AUROC above 0.70), which was the most prevalent penetrating injury mechanism in this study.…”

Association between prehospital fluid resuscitation with crystalloids and outcome of trauma patients in Asia by a cross-national multicenter cohort study

“…The Dutch National Trauma Registry (DNTR) was nationally coordinated to 11 trauma regions. Annually, among approximately 80,000 included participants, approximately 5% are considered to suffer major trauma 18 . Additionally, in our study, in-hospital mortality accounted for 1.6% of the propensity-matched cohort.…”

Closed loop communication in the trauma bay: identifying opportunities for team performance improvement through a video review analysis

“…The T-NOTECHS tool (Online Resource 1), as described by Steinmann et al [ 11 ], was used to collect primary outcome data. Final data collection metrics included: (1) Patient demographics [age; male sex; Injury Severity Score (ISS) as a measure of trauma severity (ISS ≥ 16 was considered more severe at SHSC, a threshold commonly used to define major trauma [ 17 ]); impaired airway, breathing, and/or circulation as determined by the trauma team; mechanism of injury]; (2) Primary outcome: team performance as assessed across the five domains of T-NOTECHS (Leadership; Cooperation and resource management; Communication and interaction; Assessment and decision making; Situation awareness/coping with stress) on a five-point Likert scale; (3) Secondary outcomes (Number of callouts during patient assessment and management; number of times closed loop communication was properly completed; number of times closed loop communication was initiated and not properly completed; number of times parallel conversations occurred; number of times the charting nurse had to ask a team member to repeat themselves; number of times the trauma team leader or other team member had to reinforce the crowd and noise control during patient care).…”