6.1 General trauma severity measures

10.1055/b-0034-98161

6.1 General trauma severity measures

1 Introduction to general trauma classification systems

There are a variety of general trauma severity measures in use today. Their primary goals vary from identifying individual injuries to categorizing their severity or predicting mortality. Three of the most commonly used General Trauma Severity measures are the Injury Severity Score (ISS), Glasgow Coma Scale (GCS), and Abbreviated Injury Score (AIS).

The Abbreviated Injury Score

The AIS is an individual number given to each specific injury that a patient sustains. The numbers range from one (mild injury) to five (severe injury). Each anatomic injury is assigned to one of seven regions (head, abdomen, extremity). The number is often derived or mapped from the current iteration of the International Classification Diagnosis (ICD) manual.

The AIS is used to ensure that all injuries get a severity rating and has been extensively reviewed and revised by the Association for the Advancement of Automotive Medicine as part of an international effort to increase motor vehicle safety.

The Injury Severity Score

The ISS was developed by Baker in 1974 to take the individual AIS and create an overall severity score. This score is calculated by taking the highest AIS scores from each different region, squaring the score in the region, and then summing the highest three numbers. This number ranges from three to 75 with three representing minimal injury and 75 representing massive injury [1].

The ISS which is used by many researchers (with over 4,000 citations in Pub Med) i s widely considered to be flawed as a measure of severity when used in relation to the multiply injured patient. The ISS allows only one injury per region to be considered so patients with bilateral femur fractures or severe spleen and liver injuries are given the same severity score as a patient with a unilateral femur or spleen injury. This limitation has been addressed by the development of the New Injury Severity Score (NISS) [3]. This score, developed in 2003, allows for the three highest AIS values to be part of the ISS calculation regardless of region. While not as widely used as the ISS it appears to be getting increased use in the literature either as a replacement or in conjunction with the ISS.

The Glasgow Coma Scale

The GCS is a score designed to quantify the level of consciousness of a given patient. This well-accepted scale is widely used to monitor change of cognitive function over time [2].

2 Summary

In general, publications dealing with spine trauma typically concern injuries within its realm as having occurred in isolation. While there are no clear statistics on the occurrence of isolated spinal injuries compared to those in a multisystem trauma setting or as concurrent multilevel injuries, it seems eminently clear that spinal injuries are preferably seen in the context of the overall injury setting both in a clinical and research setting. The overall injury burden has been shown to impact patient survival and may, in fact, dictate timing and type of surgical care chosen [4]. The paucity in which studies on spine trauma address the general injury angle remains an oversight as far as discussion of outcomes and complications are concerned. Hopefully future publications will address the general trauma burden more consistently. At the same time aspects of spine care, such as the importance of spinal cord injury and type of coexistent conditions, such as ankylosing spine conditions, which are associated with much higher morbidity, remain under-represented from a proportional purview. Closer interactions of the trauma and spine communities in bridging this present gap seem desirable.

3 References

1. Baker SP, O’Neill B, Haddon W, Jr., et al (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma; 14:187–196. 2. Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet; 2:81–84. 3. Balogh ZJ, Varga E, Tomka J, et al (2003) The new injury severity score is a better predictor of extended hospitalization and intensive care unit admission than the injury severity score in patients with multiple orthopaedic injuries. J Orthop Trauma; 17:508–512. 4. McHenry TP, Mirza SK, Wang J, et al (2006) Risk factors for respiratory failure following operative stabilization of thoracic and lumbar spine fractures. J Bone Joint Surg Am; 88:997–1005.

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