Introduction Purpose of scoring systems appropriate triage and classification of trauma patients predict outcomes for patient and family counseling quality assurance research extremely useful for the study of outcomes reimbursement purposes Classifications physiologic Revised Trauma Score (RTS) Acute Physiology and Chronic Health Evaluation (APACHE) Sequential Organ Failure Assessment Score (SOFA) Systemic Inflammatory Response Syndrome Score (SIRS) Emergency Trauma Score anatomic Abbreviated Injury Score (AIS) Injury Severity Score (ISS) New Injury Severity Score (NISS) Anatomic Profile (AP) Penetrating Abdominal Trauma Index (PATI) ICD-based Injury Severity Score (ICISS) Trauma Mortality Prediction Model (TMPM-ICD9) combined Trauma Score - Injury Severity Score (TRISS) A Severity Characterization of Trauma (ASCOT) International Classification of Diseases Injury Severity Score (ICISS) Ganga Hospital Open Injury Score (GHOIS) Glasgow Coma Scale Introduction quantifies severity of head injury by measuring CNS function used as initial assessment tool continual re-evaluation of head injured patients Variables Best Motor Response 6 - Obeys command 5 - Localizes pain 4 - Normal withdrawal (flexion) 3 - Abnormal withdrawal (flexion): decorticate 2 - Abnormal withdrawal (extension): decerebrate 1 - None (flaccid) Best Verbal Response 5 - Oriented 4 - Confused conversation 3 - Inappropriate words 2 - Incomprehensible sounds 1 - None Eye Opening 4 - Spontaneous 3 - To speech 2 - To pain 1 - None Calculation motor response + verbal response + eye opening Interpretation brain injury severe <9 moderate 9-12 minor 13 and above Pros reliably predicts outcomes for diffuse and focal lesions Cons does not take into account focal or lateralizing signs diffuse metabolic processes intoxication Revised Trauma Score (RTS) Introduction most widely used prehospital field triage tool Variables Glasgow Coma Scale (GCS) score 4: 13-15 3: 9-12 2: 6-8 1: 4-5 0: 3 systolic blood pressure score 4: >90 3: 76-89 2: 50-75 1: 1-49 0: 0 respiratory rate score 4: 10-29 3: >30 2: 6-9 1: 1-5 0: 0 Calculation Glasgow coma scale score + systolic blood pressure score + respiratory rate score Interpretation lower score indicates higher severity RTS <4 proposed for transfer to trauma center Pros useful during triage to determine which patients need to be transported to a trauma center Cons can underestimate injury severity in patients injured in one system Injury Severity Scale (ISS) Introduction first scoring system to be based on anatomic criteria defines injury severity for comparative purposes Variables based on scores of 9 anatomic regions head face neck thorax abdominal and pelvic contents spine upper extremity lower extremity external Calculation Abbreviated Injury Scale (AIS) grades 0 - no injury 1 - minor 2 - moderate 3 - severe (not life-threatening) 4 - severe (life-threatening, survival probable) 5 - severe (critical, survival uncertain) 6 - maximal, possibly fatal ISS ISS = sum of squares for the highest AIS grades in the three most severely injured ISS body regions ISS = A2 + B2 + C2 where A, B, C are the AIS scores of the three most severely injured ISS body regions scores range from 1 to 75 single score of 6 on any AIS region results in automatic score of 75 Interpretation ISS > 15 associated with mortality of 10% Pros integrates anatomic areas of injury in formulating a prediction of outcomes Cons difficult to calculate during initial evaluation and resuscitation in emergency room difficult to predict outcomes for patients with severe single body area injury New Injury Severity Score (NISS) overcomes this deficit Modifications Modified Injury Severity Score (MISS) similar to ISS but for pediatric trauma categorizes body into 5 areas, instead of 9 sum of the squares for the highest injury score grades in the three most severely injured body regions New Injury Severity Score (NISS) takes three highest scores regardless of anatomic area more predictive of complications and mortality than ISS Mangled Extremity Severity Score (MESS) Introduction used to predict necessity of amputation after lower extremity trauma Variables skeletal and soft tissue injury (graded 1-4) limb ischemia (graded 1-3) shock (graded 0-2) age (graded 0-2) Calculation score determined by adding scores of components in four categories Interpretation score of >7 is predictive of amputation Pros high specificity for predicting amputation Cons low sensitivity for predicting amputation Sickness Impact Profile Introduction evaluates the impact of disease on physical and emotional functioning Variables 12 categories sleep eating work home management recreation physical dimension ambulation body care movement psychosocial dimension social interaction alertness behavior emotional behavior communication Relevance to trauma lower extremity injuries psychosocial subscale does not improve with time polytrauma at 10 year follow-up after a major polytrauma, females have decreased quality-of-life scores increased PTSD rates increased absentee sick days when compared to males Systemic Inflammatory Response Syndrome (SIRS) Introduction a generalized response to trauma characterized by an increase in cytokines an increase in complement an increase in hormones a marker for an individual's generalized response to trauma that likely has a genetic predisposition associated with conditions such as disseminated intravascular coagulopathy (DIC) acute respiratory distress syndrome (ARDS) renal failure multisystem organ failure shock Variables heart rate > 90 beats/min WBC count < 4000cells/mm³ OR >12,000 cells/mm³ respiratory rate > 20 or PaCO2 < 32mm (4.3kPa) temperature less than 36 degrees or greater than 38 degrees Calculation each component (heart rate, WBC count, respiratory rate, temperature) is given 1 point if it meets the above criteria Interpretation score of 2 or more meets criteria for SIRS