Edi Mustamsir
Severity of trauma
Characterization of injury severity : important in scientific study of trauma Accurate method for quantitatively summarizing injury severity Predict outcome Many scoring systems, each has its own problems & limitation
TRAUMA SCORING
Decision making Decisions for individual patients should never be based solely on injury severity score Evaluation of trauma care Trauma care research
Trauma scoring
Trauma outcome prediction : multivariate problem Outcome prediction will never be perfect
Injury severity is difficult to quantify Patients response to trauma is complex and difficult to model adequately
TRAUMA SCORING
Physiologic Scores Anatomic Scores Combined Scores
Physiologic Score
Revised Trauma Score Acute Physiology and Chronic Health Evaluation
Coded Value
4 3 2 1 0
Field triage :
RTS is determined by adding coded values together RTS ranges 0 - 12
RTS COEFFICIENT
GCS : X 0.9368 SBP : X 0.7326 RR : X 0.2908
Example
Mr.A GCS 10, SBP 80 mmHg dan RR 14/min
Coded value : GCS 3, SBP 3, RR 4 RTS= 3 X 0.9368 + 3 X 0.7326 + 4 X 0.2908 = 6.1714
Acute Physiologic Score consists of variables physiologic systems Absence of anatomic component poor performance
Anatomic Scores
Injury Severity Score (ISS) Anatomic Profile (AP) International Classification of Disease (ICD)
AIS Score 1 2
Moderate
Thorax
Abdomen
Severe not LT
Severe LT
3
4
Extremities
External
Critical
Maximum Injury
5
6
Injury Description
Cerebral contusion
No injury Flail chest Minor liver contusion Complex spleen rupt Fractured femur
AIS
3
0 4 2 5 3
16
25
Exteral
No injury
Injury Severity Score
0
50
Anatomic Profile
Limitation of ISS AP is developed All serious injuries in body regions Appropriately weights head and torso injuries Mathematical complexity & only modest improvement in redictive performance failed to gain support
Combined Scores
Trauma & Injury Severity Score (TRISS) A Severity Charavterization of Trauma (ASCOT)
Conclusion
There is no ideal scoring system Still important Prediction for trauma outcome Use the scoring system with caution