Trauma Scoring

Question 1

What is the AIS

Answer 1

Abbreviated injury scale
Anatomically based injury severity scoring system that classifies each injury by body region on a 6 point scale
It is used to determine the ISS

Question 2

What are the 9 AIS regions

Answer 2

1) head
2) face
3) neck
4) thorax
5) abdomen/pelvic contents
6) spine
7) upper extremities
8) lower extremities
9) external

Question 3

What is the maximum AIS score for any region and what does this mean?

Answer 3

6 - unsurvivable

Question 4

What AIS score would you give for an injury of unknown severity?

Answer 4

2 - you have to code conservatively

Question 5

From what source are the AIS scores based on? Ie where would the researcher look?

Answer 5

Patient records - so document clearly

Question 6

If you score an AIS of 6 for any region what happens?

Answer 6

Your ISS automatically defaults to 75

Question 7

What are the ISS regions?

Answer 7

Head, neck and c-spine
Face 
Chest, thoracic spine, diaphragm 
Abdo/pelvic contents, lumbar spine 
Extremities and pelvic girdle
External

Question 8

How is the ISS calculated?

Answer 8

Take the top scoring AIS injury from the 3 top scoring regions
Square them
Add them together

Question 9

Describe the revised trauma score and what it is based on

Answer 9

Physiological scoring system

GCS, SBP and RR

Question 10

Which of the parameters in the RTS has the highest weighting and what does this mean

Answer 10

GCS > SBP > RR

That chance of survival is far more dependant on GCS than others

Question 11

Does someone with a RTS of 0 or 8 have the highest chance of survival?

Answer 11

8

Question 12

State the RTS coded values for GCS

Answer 12

4 = 13-15
3 = 9-12
2 = 6-8
1 = 4-5
0 = 3

Question 13

Should you use GCS to describe a person who’s hit their head after 10 pints?

Answer 13

Nope, GCS is designed for purely head injured patients

Question 14

What is the purpose of calculating PS

Answer 14

Allows comparative outcome analyses for hospitals to be performed

Question 15

What variables were included in the TRISS model of PS

Answer 15

RTS, ISS, age and method of injury (blunt or penetrating)

Question 16

What does the coefficient b mean in the PS

Answer 16

Dependant on if the injury is blunt or penetrating

Question 17

What was wrong with the old TRISS model of PS?

Answer 17

Lots of unrecorded data for RR, SBP, and GCS
Patients transferred to another hospital for further care excluded
Patients intubated at scene were excluded
Children included in a way that isn’t statistically acceptable

Question 18

What variables are included in the updated TARN PS model?

Answer 18

GCS (not RTS)
ISS
Age 
Gender
Charlson index

Question 19

What happens if, when calculating PS, GCS is missing?

Answer 19

Intubation status is used instead

Question 20

What is the Charleston Index?

Answer 20

Adds a variable depending on patient comorbidities

Question 21

What 2 coefficients have been added to the TARN PS model in 2014?

Answer 21

Patient comorbidities

True 30 day outcome (need to know post-discharge deaths)

Question 22

What is the Ws Statistic?

Answer 22

Performance comparison graphs created for different hospitals to compare outcomes

Question 23

What is the Ws Statistic based on?

Answer 23

AIS, ISS, W statistic, unexpected deaths, unexpected survivors

Question 24

What are W, Z and M in the Ws Statistic?

Answer 24

W is actual survival rate - predicted survival rate
Z is the statistical significance of this survival rate
M coefficient is a measure of injury severity similarity

Question 25

What are some flaws of trauma scoring systems?

Answer 25

Only the 3 highest scoring injuries influence the score
Excludes total injury load
Injuries may span multiple body regions
Doesn’t take into account mechanism of injury eg shooting over stabbing
Subjective
Relies on good documentation
Tiny mistakes in records make a big difference because of the squaring and multiplication

Question 26

Give an example for each AIS severity

Answer 26

1: superficial laceration
2: fractured sternum
3: open humerus fracture
4: perforated trachea
5: ruptured liver with tissue loss
6: severed aorta

Question 27

What components make up the ABC score?

Answer 27

penetrating injury mechanism
SBP <90 in ED
HR >120 in ED
+ve FAST

Question 28

What does the ABC score indicate?

Answer 28

A score of 2 or more indicates the patient is likely to need a massive transfusion