Keywords:
Trauma, Quality assurance, Education and training, Outcomes analysis, Audit and standards, CT, Emergency
Authors:
S. Sinha, B. Owen, S. Beattie, A. Kraus, L. Dykes; Bangor/UK
DOI:
10.1594/ecr2013/C-1636
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 by 5 (from 18 to 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 |
24 |
6 |
13 |
13 |
7 |
18 |
25 |
8 |
10 |
20 |
9 |
9 |
9 |
10 |
9 |
9 |
11 |
9 |
16 |
12 |
24 |
29 |
13 |
29 |
29 |
14 |
20 |
20 |
15 |
18 |
13 |
16 |
34 |
45 |
17 |
4 |
18 |
18 |
13 |
13 |
19 |
9 |
9 |
20 |
9 |
16 |
ISS results comparing original scores to the study scores.
The changes in score occurred where more descriptive details regarding injuries were required by the AIS to give an accurate ISS e.g.
multiple rib fractures would score only 2 whereas a flail chest would score 4 (Fig. 1; Fig. 2; Fig. 3).
Another region with frequent discrepancies in initial scoring and the study scoring were the description of pulmonary contusions.
The AIS is quite specific with regards to the number,
location and lobes affected (Fig. 5).
The sidebar shows further examples where a more detailed description of the injuries would have led to a higher ISS score (Fig. 4; Fig. 6; Fig. 7; Fig. 8).