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
QUESTIONS 1 of 8 1 2 3 4 5 6 7 8 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ12.79) At long term follow-up, a male who sustains multiple traumatic injuries compared with a premenopausal female, who sustained similar polytrauma, is most likely to have which of the following? QID: 4439 Type & Select Correct Answer 1 Higher quality-of-life scores than females 57% (3477/6107) 2 Increased rates of complex regional pain syndrome 3% (198/6107) 3 Require more psychiatric counseling and pharmacologic management than females 11% (664/6107) 4 Take more absentee days at work as a result of illness than females 26% (1614/6107) 5 Decreased incidence of lower extremity amputation 2% (114/6107) L 4 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ09.205) A patient sustains a severe lower extremity injury. What can be said about his outcome at 2 years if he chooses reconstruction over amputation? QID: 3018 Type & Select Correct Answer 1 He has a higher risk of rehospitalization 75% (2518/3348) 2 He has a higher chance of returning to work 4% (130/3348) 3 He will have a higher overall SIP (Sickness Impact Profile) score 14% (469/3348) 4 His psychosocial SIP score will improve with time 6% (192/3348) 5 He will have a better SIP score if he did not complete high school 1% (35/3348) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ07.106) A child in a MVA has a Glasgow Coma Scale score of 14. His injuries have been graded as severe but not life-threatening injury to the chest (3 points), moderate injury to the abdomen (2 points), and severe injuries but with probable survival injury to the the face or neck (4 points) using the criteria for the Modified Injury Severity Score (MISS). There are no injuries to extremities/pelvis . Based on this information, what is the child’s total MISS score? QID: 767 Type & Select Correct Answer 1 7 2% (33/1509) 2 9 16% (243/1509) 3 25 20% (295/1509) 4 29 61% (914/1509) 5 30 1% (14/1509) L 3 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ05.175) What is the Injury Severity Score (ISS) for a patient with an open chest wound (Abbreviated Injury Scale, AIS=4), colon transection (AIS=4), femoral fracture (AIS=3), shoulder dislocation (AIS=2), and a thyroid gland contusion (AIS=1) QID: 1061 Type & Select Correct Answer 1 11 3% (30/888) 2 13 11% (94/888) 3 41 68% (600/888) 4 45 11% (96/888) 5 46 7% (59/888) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ05.121) The mangled extremity severity score (MESS) utilizes all of the following variables EXCEPT: QID: 1007 Type & Select Correct Answer 1 Limb ischemia 1% (10/1044) 2 Shock 6% (65/1044) 3 Patient age 17% (174/1044) 4 Skeletal and soft tissue injury 2% (18/1044) 5 Time from admission to surgery 74% (772/1044) L 3 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic
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