Trauma scoring systems
To evaluate trauma management and outcome one needs to assess
- Input
- Anatomical scoring systems
- Abbreviated injury score
- Injury severity score
- Physiological scoring systems
- Glasgow coma scale
- Trauma score
- Revised trauma score
- TRISS methodology
- Treatment
- Individual patient
- System of patient care
- Outcome
Injury severity score
- Used to assess patients involved in traffic accidents
- Makes use of the Abbreviated Injury Scale (AIS)
- Its value correlates with the risk of mortality
- Patients with immediately or rapidly fatal injuries are excluded.
- Injuries are assigned to five body regions
- General
- Head & neck
- Chest,
- Abdominal,
- Extremities & pelvis
- Each type of injury encountered is assigned a value from 1 to 5, with:
- Minor injury
- Moderate injury
- Severe but not life-threatening injury
- Life-threatening but survival likely
- Critical with uncertain survival
Examples of AIS scores
| System |
Severity |
Example |
| General |
1 |
1st degree burns |
| General |
3 |
50% 3rd degree burns |
| Chest |
3 |
Haemothorax
|
| Chest |
4 |
Pericardial injury |
| Abdomen |
5 |
Ruptured liver |
- Highest score, indicating the most severe injury, for each region is selected.
- Ranked from the highest to lowest value.
- Three highest values are then used to calculate the injury severity score.
Injury severity score = (highest region score)2 + (second highest region score)2 +
(third highest region score)2
- Minimum score: 0
- Maximum score: 75
- Mortality rate increases with score and age
Morality (%) according to ISS and age
| Score |
Mortality (%) <49 |
Mortality (%) 50-69 |
Mortality (%) >70 |
| 5 |
0 |
3 |
13 |
| 10 |
2 |
4 |
15 |
| 15 |
3 |
5 |
16 |
| 20 |
6 |
16 |
31 |
| 25 |
9 |
26 |
44 |
| 30 |
21 |
42 |
65 |
| 35 |
31 |
56 |
82 |
| 40 |
47 |
62 |
92 |
| 45 |
61 |
67 |
100 |
| 50 |
75 |
83 |
100 |
| 55 |
89 |
100 |
100 |
Revised trauma score
- Used to rapidly assess patients at the scene of an accident
| Parameter |
Finding |
Points |
| Respiratory rate |
10-29 per minute |
4 |
|
> 29 per minute |
3 |
|
6-9 per minute |
2 |
|
1-5 per minute |
1 |
|
Nil |
0 |
| Systolic blood pressure |
>89 mm Hg |
4 |
|
76-89 mm Hg |
3 |
|
50-75 mm Hg |
2 |
|
1-49 mm Hg |
1 |
|
Nil |
0 |
| Glasgow Coma Score |
13-15 |
4 |
|
9-12 |
3 |
|
6-8 |
2 |
|
4-5 |
1 |
|
2 |
0 |
Revised trauma score = (points for respiratory rate) + (points for systolic blood pressure) +(points for
Glasgow coma score)
- Maximum score (indicating least affected) = 12
- Minimum score (indicating most affected) = 0
TRISS methodology
- Trauma and Injury Severity Score (TRISS) was designed to evaluate trauma care
- Calculates expected survival based on patient characteristics.
- Intended to be used to compare outcomes from different treatment centers.
Components
- Weighted Revised Trauma Score (RTS)
- Injury Severity Score (ISS)
- Score for patient's age
- Coefficients based on blunt versus penetrating trauma
Limitations
- Some researchers have found problems with the accuracy of the TRISS method.
- May be necessary to develop different coefficients for different populations of patients
Bibliography
|
Last modified:
|