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

TARN

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

TARN

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

TARN

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

TARN

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)

TARN

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

TARN

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

TARN

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

TARN

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

TARN

http://www.aaam.org/

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

TARN

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

TARN


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)

TARN

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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Square the highest score in each body area

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Open book fracture to pelvis with blood loss >20%856164.5


5² =25

3² =9

3² =9

5² = 25

TARN


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

TARN






Open book fracture to pelvis with blood loss >20%856164.5


5² =25

3² =9

3² =9

5² = 25

TARN

Injury Severity Score(ISS) = 59

TARN

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


2² = 4

2² = 4

1² = 1TARN


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

TARN

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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Full injury detail Code


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


Grade III (OIS grade) Spleen laceration 544224.3

Incomplete injury detail Code


Fracture to distal Radius 752371.2

Fracture to pelvis 856151.2

Multiple ribs fractured on left 450210.2

Cerebral contusion 140604.3


Spleen laceration 544220.2

Accurate ISS Accurate Ps

59 58%

Incomplete ISS

22

TARN


Age: 40 Gender: Male ISS: 22 GCS: 5 PMC:Nil

Ps19 calculation

Ps: 86% Inaccurate Ps

TARN

Summary

Inclusion Criteria

Identifying Cases

Data Entry

System Features

Quality Assurance: Case ascertainment & Data Accreditation

Injury scoring & calculating the ISS

TARN

1600 lives saved since launch of Major Trauma Networks

TARN

injury scoring assigning an iss. ais and... · 2020. 3. 25. · 2 additional localiser codes, allow...

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