Injury Severity Score

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The Injury Severity Score ( ISS ) is an anatomical injury grade table for classifying the severity of injuries . The assessment is based on the severity of the individual injuries according to the simplified Abbreviated Injury Scale (AIS98). The ISS values ​​are between 0 (uninjured) and 75 (multiple trauma patients), they are calculated from AIS98.

The modern polytrauma definitions in particular are based on the AIS, which was first introduced in the USA in 1971 and the ISS trauma score developed from it and published in 1974 as a table by Susan Baker and colleagues.

calculation

The basis is the AIS grades of severity: 0 = no injury, 1 = minor, 2 = moderate, 3 = serious, 4 = severe, 5 = life-threatening, 6 = fatal injury (translation by W. Abdulla). The ISS table uses the AIS98 code with the values ​​1 to 6 as a proxy variable for the degree of injury and the so-called Anatomical Localizer of the AIS98 for assigning the injuries to a body region.

It should be noted that the definitions of the body regions of the AIS98 differ significantly from those of the ISS: the spine and spinal cord no longer form an independent body region, but are divided into the respective body region in which they are located. Injuries to the skin and subcutaneous fatty tissue (abrasions, bruises and cuts) are, in contrast to the AIS98 identifier, not related to the body region, but are coded as "external injuries". The six ISS body regions are:

  1. Head or Neck - The 'head and neck' area includes injuries to the skull (excluding the facial skull ) and the cervical spine, as well as injuries to the cerebrum and cerebellum and the cervical medulla ( medulla oblongata , cervical cord). Asphyxia (asphyxia) is also coded in this category.
  2. Face - facial injuries including the mouth, nose, eyes, ears, and facial bones.
  3. Thorax - Chest injuries, including injuries to the thoracic spine , ribs, and internal organs in the chest area, including the diaphragm . Drowning is coded as a chest injury.
  4. Abdomen / Pelvis Contents [Abdomen or Pelvis Contents] - Injuries in the abdomen (excluding the diaphragm), in the large and small pelvis and in the lumbar spine .
  5. Extremities or Pelvic Girdle - Injuries including overstretching, fracture, dislocation (dislocation) and amputation of the extremities , including injuries to the pelvis.
  6. External injuries - abrasions, also with defects, incisions, bruises and burns of the skin and the subcutaneous fatty tissue regardless of the location as well as hypothermia and injuries caused by electricity .

The maximum values ​​of the AIS codes for the 6 ISS body regions are considered. According to the initial description, the ISS is formed as the sum of the squares of the 3 highest AIS98 codes (the three most severely injured body regions) of these ISS body region values. The following are special features:

  1. If there is no injury in a body region, the corresponding AIS98 code is set to 0 for further calculation.
  2. An AIS98 code of 9 (deceased) means that no ISS value can be calculated for the injured person.
  3. If an AIS98 code of 6 is found in one of the ISS body regions, the ISS code is automatically set to 75.

Accordingly, only AIS codes from 0 to 5 are actually included in the calculation; the ISS can therefore assume numerical values ​​from 1 (for a single, very slight injury) to a maximum of 75 points (for multiple trauma patients).

ISS = (AIS a ) 2 + (AIS b ) 2 + (AIS c ) 2

with a, b, c for the three most severely injured body regions; AIS a, b, c : the highest AIS severity in each case for the region concerned.

An ISS value of over 15 is called a multiple trauma, a value of 16 to 20 characterizes a seriously injured person.

rating

The weaknesses of the ISS are that only 1 AIS code per body region and a maximum of 3 body regions are taken into account. A systematic undervaluation in the case of more than three relevantly injured body regions, in the case of severe head trauma with more than one type of injury (e.g. with simultaneous cerebral bleeding, contusion and cerebral edema) or in the case of several severe injuries to the extremities is therefore inevitable. The ISS is inferior to newer scores, but is still the most widely used score worldwide for assessing the overall severity of injury.

New Injury Severity Score (NISS)

The “New Injury Severity Score” (NISS) was proposed under the premise of a better correlation of the assessment measure with the polytrauma of the patients. Patients with an AIS code of 9 are also excluded here, but the maximum values ​​for body regions are not generated. The three largest AIS98 codes are simply squared and added together. Opinions are divided about the usefulness and superiority of the NISS over the ISS.

Remarks

  1. ↑ Walied Abdulla: Interdisciplinary Intensive Care Medicine. Urban & Fischer, Munich a. a. 1999, ISBN 3-437-41410-0 , p. 466 f.
  2. ↑ Walied Abdulla: Interdisciplinary Intensive Care Medicine. 1999, p. 467.
  3. ↑ Susan P. Baker, Brian O'Neill, William Haddon Jr., William B. Long: The Injury Severity Score . A method for describing patients with multiple injuries and evaluating emergency care. In: The Journal of Trauma . tape 14 , no. 3 . Lippincott Williams & Wilkins, March 1974, ISSN  0022-5282 , pp. 187-196 , PMID 4814394 ( journals.lww.com ).
  4. ^ The Abbreviated Injury Scale 1990 Revision Update 1998 . Association for the Advancement of Automotive Medicine (AAAM), Barrington, IL 2001.
  5. ↑ Walied Abdulla (1999), p. 467.
  6. ↑ Wayne S. Copes, Howard R. Champion, William J. Sacco, Mary M. Lawnick, Susan L. Keast, Lawrence W. Bain: The Injury Severity Score revisited . In: The Journal of Trauma . tape 28 , no. 1 , January 1988, ISSN  0022-5282 , pp. 69-77 ( journals.lww.com ).
  7. ↑ Chawda MN, Hildebrand F, Pape HC et al. (2004) Predicting outcome after multiple trauma: which scoring system? Injury 35: 347-358
  8. ↑ Turner Osler, Susan P. Baker, William B. Long: A modification of the injury severity score that both improves accuracy and simplifies scoring . In: The Journal of Trauma . tape 43 , no. 6 . Lippincott Williams & Wilkins, 1997, ISSN  0022-5282 , pp. 922-925, 925-926 , PMID 9420106 ( journals.lww.com ).
  9. ^ Seow-Yian Tay, Edward P. Sloan, Leslie Zun, and Philip Zaret: Comparison of the New Injury Severity Score and the Injury Severity Score . In: The Journal of Trauma . tape 56 , no. 1 . Lippincott, January 2004, ISSN  0022-5282 , pp. 162-164 ( journals.lww.com ).