Degrees of Injury Severity

Injury Deaths

Hospitalization

Emergency Dept.

Physician Visit

Households
 OUTPUT PARAMETERS
Risk of Death
Risk of Hospital Admission
Risk of “Serious” Injury
Risk of “Slight” Injury
The Abbreviated Injury Scale (AIS)
AIS by body regions (Head, Neck,
etc.
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WHAT LEVEL OF INJURY IS
ACCEPTABLE?
Prevent Death?
Prevent Permanent Disabilities?
Prevent AIS 3+ Injuries?
Prevent AIS 3+ to X% of
Population?
Prevent AIS 2+ to Y% of
Population?
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Impact of the Injury will depend
on...

™ Extent of tissue damage

™ Physiological response to the
injury
™ Host factors that mediate the
response
Aspects of Injury Severity
Anatomic Physiological
al Injury Measurement
s

Age
Blunt/Penetrating

Probability of survival of individual patients

Comparisons between groups

Abbreviated Injury Scale (AIS)

™ Anatomical measure that

addresses the extent of
tissue damage

™ ICD-based classifications
Abbreviated Injury Scale

1 MINOR
2 MODERATE
3 SERIOUS
4 SEVERE
5 CRITICAL
6 MAXIMUM

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Abbreviated Injury Scale
BODY REGIONS
‰ HEAD
‰ FACE
‰ NECK
‰ THORAX
‰ ABDOMEN
‰ SPINE
‰ UPPER EXTREMITY
‰ LOWER EXTREMITY

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 INJURY SEVERITY SCORE
SUM OF SQUARES OF THE HIGHEST AIS CODE IN THREE
MOST SEVERELY INJURED ISS REGIONS

‰ HEAD OR NECK
‰ FACE
‰ THORAX
‰ ABDOMEN
‰ ALL EXTREMITIES AND PELVIS
‰ EXTERNAL
(SPINAL INJURIES INCLUDED IN RESPECTIVE REGION)

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Severity scores are subjective
assessments assigned by
experts

Implicitly based on four criteria:

™ Threat to life
™ Permanent Impairment
™ Treatment Period
™ Energy Dissipation
 Addressing Multiple Injuries
for predicting survival

¾Injury Severity Score (ISS)

¾The New Injury Severity Score
(NISS)
¾The Anatomic Profile (AP)
 The Injury Severity Score (ISS)

™ Sum of squares of the highest AIS in

each
of 3 most severely injured body regions
™ ISS Body Regions:
– Head or neck - Face
– Abdominal - Chest
– Extremities - External
 INJURY SEVERITY SCORE
Example

AIS
Score
Small subdural haematoma 4
Parietal lobe swelling 3
Major liver laceration 4
Upper tibial fracture (displaced) 3

ISS = 42 + 42 + 32 = 41
 Criticisms of the ISS

™ Does not take into account multiple

injuries within a body system

™ Equal weights across body regions;

underscores severe head injuries