Injury Scoring Assigning an ISS. AIS and... · 2020. 3. 25. · 2 additional localiser codes, allow...
Transcript of Injury Scoring Assigning an ISS. AIS and... · 2020. 3. 25. · 2 additional localiser codes, allow...
Injury Scoring &
Assigning an ISS
The Trauma Audit & Research Network (TARN)
TARN
Injury coding performed centrally at TARN
Ensuring coding uniformity
Coders check injury descriptions & imaging reports
Abbreviated Injury Scale dictionary (AIS2005) currently used
Every submission assigned an Injury Severity Score (ISS)
85,000+ submissions approved per year
Injury Coding
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Abbreviated Injury Scale: AIS
THE Internationally recognised system for injury scoring
Produced by AAAM (Association for the Advancement of Automotive Medicine) in U.S.A
Introduced in 1970, originally for Vehicle Crash investigators
AIS2005 version >2000 injury descriptors
Anatomically based system, ranking injuries according to severity on a 6 point ordinal scale
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AIS: 6 point severity scale AIS
(Severity)Grade Injury example
1 Minor Bruise to abdomen
2 Moderate Small Liver laceration
3 Serious Liver laceration with >1 litre of blood loss
4 Severe Ruptured liver
5 Critical Liver laceration involving hepatic vessels
6 Maximum Avulsed liver
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AIS Severity indicates
The relative risk of “threat to life”in an average person
who sustains the coded injury as his or her only injury
It’s not a disability scale
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AIS code structure: 7 digits
Code Injury Numerical identifier
Severity Score
853271.3 Comminuted Femoral Shaft # 853271 .3
140656.5 Large Subdural haemorrhage 140656 .5
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Abbreviated Injury Scale: Sections
Skin DeglovingPenetrating HypothermiaCrush Asphyxia: Hanging/StrangulationTraumatic Amputation DrowningNerve FrostbiteVessel BurnsJoint InhalationSkeletal Electrocution
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AIS: Spinal Injuries
Cervical Spine (C1-C7) Thoracic Spine (T1-T12) Lumbar spine (L1-L5)
Severity can be affected by location of spinal injury
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AIS: Confirmed injuries only
Suspected injuries
Possible injuries
Probable injuries
Ruled out injuries
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AIS: Not Coded
Infections Pneumonia Death BlindnessMiscarriage Epilepsy following head injury Pulmonary embolism following skeletal injury
Don’t affect Severity score
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NFS: Not Further Specified
This appears throughout the AIS dictionary & allows the coding of injuries when detailed
information is lacking
Example:Injury description = Liver laceration
Coded as: 541820.2 (Liver laceration NFS)
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Most used NFS codeswhich affect data accreditation
Most used NFS codes Information needed
Cerebrum/cerebellum contusionDiameter of the contusion or a description of the size e.g.
tiny, small, large, extensive.
Cerebrum/cerebellum subdural/extradural The depth of the haematoma or a description of the size e.g. tiny, small, large, extensive confirmed in imaging
Cerebrum/cerebellum intracerebral haematomaDiameter of the ICH or a description of the size e.g. tiny,
small, large, extensive.
Brain swellingSeverity of the swelling e.g mild; sulcal effacement,
moderate; compressed or partially effaced ventricles, major; effaced ventricles
Multiple rib fractures Number of ribs fractured and which side the fracture are on
Long bone fractures e,g clavicle, femur & fibular Location of the fracture e.g. proximal, shaft, distal.
Facial fractures e.g. zygoma, orbit Location of the fracture
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AIS 6: Maximum score
AIS 6 not used just because a patient dies!
Has to be documented medical evidence of an AIS 6 injury
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AIS 6: Maximum score Head or Neck
Brain stem: laceration, crush, penetrating or transectionC3 or higher complete cord transection or contusionSigmoid or Transverse sinus or Internal carotid artery: Bilateral lacerations
Thorax Heart: rupture, multiple lacerations or avulsion Total chest crush Aortic rupture + haemorrhage not confined to mediastinum Bilateral pulmonary artery or vein transection Severe inhalation
Abdominal & Pelvic contents Liver avulsion
External 2nd or 3rd degree burns > 90% Total Body SurfaceMassive Whole body Explosion type injury
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AIS: Localisers2 additional localiser codes, allow coding of:
Localiser 1 Side or aspect of an injury e.g. Right, left, Upper, Temporal, Frontal
Localiser 2 Actual Site of an injury e.g. 5th rib, 12th Thoracic vertebrae, 2nd toe
Numerical identifier Severity Localiser 1 Localiser 2
• Don’t affect ISS• Used mainly in Research
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AIS dictionary
Available only from: www.aaam.org
• Latest Version: AIS 2015 recently released • $225 each + shipping• TARN currently using AIS2005, but will move to AIS2015 • All existing codes will be mapped over • All Trusts notified well in advance
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Injury Coding exerciseTARN
Spiral fracture Shaft of Femur 147
Open complete articular fracture to distal Radius 127
Open book fracture to pelvis with blood loss >20% 159
3 ribs fractured on left 82
Extensive bilateral cerebral contusion 44
Skull vault fracture 49
Grade III (OIS grade) Spleen laceration 96
853251.3
752372.3
856164.5
450203.3
140626.5
150400.2
544224.3
EXAMPLE SUBMISSION 1: INJURIES Page AIS code
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Calculating the ISSInjury Severity Score
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Calculating the ISS: Step 1
Determine the scores of the individual injuries using the
Abbreviated Injury Scale
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Calculating the ISS: Step 2
Identify the highest severity score in each body areaTARN
Injury Severity Score: 6 body areas
1. Head & Neck & Cervical spine
2. Face
3. Chest & Thoracic spine
4. Abdomen & pelvic contents & Lumbar spine
5. Extremities & bony pelvis
6. External (incl. Skin injuries and Burns)
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Head Extensive bilateral cerebral contusion 140626.5
Skull vault fracture 150400.2
Thorax 3 ribs fractured on left 450203.3
Abdomen Grade III Spleen laceration 544224.3
Extremities Open complete articular fracture to distal Radius 752372.3
Open book fracture to pelvis with blood loss >20% 856164.5
Spiral Shaft of Femur 853251.3
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Calculating the ISS: Step 3
Square the highest score in each body area
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Head Extensive bilateral cerebral contusion 140626.5
Skull vault fracture 150400.2
Thorax 3 ribs fractured on left 450203.3
Abdomen Grade III Spleen laceration 544224.3
Extremities Open complete articular fracture to distal Radius 752372.3
Open book fracture to pelvis with blood loss >20%856164.5
Spiral Shaft of Femur 853251.3
5² =25
3² =9
3² =9
5² = 25
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Calculating the ISS: Step 4
Code individual injuries
Identify the highest score in each body area
Square the highest score in each body area
Add together the highest AIS2 from 3 different body areas
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Head Extensive bilateral cerebral contusion 140626.5
Skull vault fracture 150400.2
Thorax 3 ribs fractured on left 450203.3
Abdomen Grade III Spleen laceration 544224.3
Extremities Open complete articular fracture to distal Radius 752372.3
Open book fracture to pelvis with blood loss >20%856164.5
Spiral Shaft of Femur 853251.3
5² =25
3² =9
3² =9
5² = 25
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Injury Severity Score(ISS) = 59
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Body area Injury AIS code
Head Closed vault fracture 150402.2
Thorax 5+6 ribs fractured on left 450202.2
ISS = 8
Injury Severity Score (ISS)
2² = 4
2² = 4TARN
Body area Injury AIS code
Head Closed vault fracture 150402.2
Thorax 5+6 ribs fractured on left 450202.2
External Lower limb – skin laceration 810600.1
ISS = 9
Injury Severity Score (ISS)
2² = 4
2² = 4
1² = 1TARN
Injury Severity Score (ISS)
Ranges from 1 to 75
Maximum 75 achieved in 2 ways:
1. Severity 5 in 3 different body areas52 + 52 + 52 = 75
2. ISS convention:AIS = 6 in any body area, ISS = 75
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Importance of Injury Detail Length, depth or Grade of lacerations (especially to internal organs)
Depth, size and location of haemorrhages and contusions (especially in the brain)
Open or Closed fracturesStability & site of Fractures (e.g. Comminuted/Displaced Shaft/Proximal/Distal fracture)
Articular (joint) involvement (e.g. Intra-articular, extra-articular)
Blood loss Vessel damageLocation & number of rib fractures Compression or effacement of ventricles/brain stem cisternsNeurology associated with spinal cord injuries Grade, Instability, Blood loss or Vascular damage associated with Pelvic Fractures Cardiac arrest associated with asphyxia or drowning
Ensure all injuries are documentedInclude imaging reports or Post Mortems for every submission.
Jan 17: Grade now requested for pelvic ring fixations
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Probability of SurvivalOnce ISS is assigned
Probability of Survival (Ps) calculated eachsubmission
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Ps19 Importance of accurate injury detail
Age: 40 Gender: Male ISS: 59 GCS: 5 PMC:Nil
Ps19 calculation
Ps: 58%
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Ps19 Importance of accurate injury detail
Full injury detail Code
Spiral Shaft of Femur 853251.3
Open complete articular fracture to distal Radius 752372.3
Open book fracture to pelvis with blood loss >20% 856164.5
3 ribs fractured on left 450203.3
Extensive bilateral cerebral contusion 140626.5
Skull vault fracture 150400.2
Grade III (OIS grade) Spleen laceration 544224.3
Incomplete injury detail Code
Spiral Shaft of Femur 853251.3
Fracture to distal Radius 752371.2
Fracture to pelvis 856151.2
Multiple ribs fractured on left 450210.2
Cerebral contusion 140604.3
Skull vault fracture 150400.2
Spleen laceration 544220.2
Accurate ISS Accurate Ps
59 58%
Incomplete ISS
22
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Ps19 Importance of accurate injury detail
Age: 40 Gender: Male ISS: 22 GCS: 5 PMC:Nil
Ps19 calculation
Ps: 86% Inaccurate Ps
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Summary
Inclusion Criteria
Identifying Cases
Data Entry
System Features
Quality Assurance: Case ascertainment & Data Accreditation
Injury scoring & calculating the ISS
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1600 lives saved since launch of Major Trauma Networks
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