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7
2%
37/1685
9
16%
278/1685
25
19%
324/1685
29
60%
1012/1685
30
1%
20/1685
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The MISS for children categorizes injuries into five body areas: 1) neurologic, 2) face & neck, 3) chest, 4) abdomen & pelvic contents, 5) extremities & pelvic girdle. Each of these are scored 1-5 with 1 being minor, 2 moderate, 3 severe but not life threatening, 4 severe with probable survival, and 5 critical with uncertain survival. The total score for the MISS, like the Injury Severity Score (ISS), is the sum of the squares for the highest injury score grades in the three most severely injured body regions. Therefore, in this case: chest (3x3) + abdomen (2x2) + face/neck (4x4) = 9+4+16 = 29. The Glasgow coma scale would be 1, which is less than the scores of 3 of the other areas so it is excluded. Loder in 1987 showed that in 78 polytrauma pediatric patients, no deaths were seen when the MISS is <40. Mortality was 50% for scores >40 and 75% for scores >50. The Mayer article is a good overview of the MISS.
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