Purpose
Trauma scores are widely used to quantify severity of injury of trauma patients for research and audit purposes.
With increasing use of CT for evaluation of major trauma,
radiologists play a crucial role in supporting accurate trauma scoring.
Unfortunately,
most have no idea this is the case.
The Injury Severity Score (ISS) is ananatomical score,
derived from the Abbreviated Injury Scale (AIS) that is concerned with injuries to the 6 body areas below and was first described by Susan Baker in 1974.
Head and neck...
Methods and Materials
We identified a convenience sample of 20 consecutive major trauma patients whose CT scan demonstrated injuries.
We initially calculated the AIS of all injuries on the CT examinations (and thence the ISS) from the original radiological reports that were all reported by consultant radiologists at our institution.
A separate radiologist,
either a consultant or senior trainee,
then re-reported the injuries identified on the original CT scans using the descriptors of injury contained in the AIS manual.
The ISS was then re-calculated for each case.
Results
10/20 ISS values rose on re-coding,
by a mean of 7 (range 2-14,
median 7).
9/20 ISS values remained the same on re-coding.
1/20 ISS values fell by5 (from 18to 13).
Overall,
the re-coded ISS mean score rose from 15 to 18.4.
In one case,
an ISS was revised up from 34 to 45,
reclassifying the patient into the category of 'massive trauma'.
Original report
Study report
Trauma Patient
ISS
ISS
1
16
18
2
9
16
3
13
13
4
13
13
5
22...
Conclusion
Traditional free-text CT reports by consultant radiologists in our institution are insufficiently precise to generate a reliable ISS.
This impacts upon both research and audit:
TARN may actually be auditing the precision of radiology reports,
rather than the quality of major trauma care in the UK
Comparison of different countries' trauma systems and trauma literature,
which often utilises the ISS,
may reflect differences in custom and practice of radiology reporting
On a national,
European and international scale,
the impact of this effect may be substantial....
References
1.
Trauma Audit and Research Network (TARN).
www.tarn.ac.uk.
2.
Abbreviated Injury Scale (AIS) Manual 2005.
Association for the Advancement of Automotive Medicine.
3.
Yates DW.
Scoring Systems for Trauma.BMJ 1990;301:1090-1094.
4.Mehdi Moazzez Lesko,
Maralyn Woodford,
Laura White,
Sarah J O’Brien,
Charmaine Childs,
Fiona Lecky.
Using Abbreviated Injury Scale (AIS) codes to classify Computed Tomography (CT) features in the Marshall System.BMC Medical Research Methodology 2010,
10:72
5.
Omar Bouamra,
Alan Wrotchford,
Sally Hollis,
Andy Vail,
Maralyn Woodford,
Fiona Lecky.
Outcome Prediction in Trauma.Injury 2006; 37: 1092-1097....
Personal Information
Dr.
Shrilay Sinha BSc MB ChB MRCSEd FRCR,
Department of Radiology,
Ysbyty Gwynedd,
Betsi Cadwaladr University Health Board,
Bangor,
Wales,
UK;
[email protected]
Dr.Bethan Owen BM,
Department of Emergency Medicine,Ysbyty Gwynedd,
Betsi Cadwaladr University Health Board,
Bangor,
Wales,
UK.
Dr.
Scott Beattie BSc MB ChB MCEM DipIMC,
formerlyDepartment of Emergency Medicine,Ysbyty Gwynedd,
Betsi Cadwaladr University Health Board,
Bangor,
Wales,
UK.
Dr.
Alexandra Kraus FRCR,Department of Radiology,
Ysbyty Gwynedd,
Betsi Cadwaladr University Health Board,
Bangor,
Wales,
UK.
Dr.
Linda Dykes MBBS FCEM,
Department of Emergency Medicine,Ysbyty Gwynedd,...