The injury severity score—Importance and uses - ScienceDirect

Annals of Epidemiology

Volume 5, Issue 6, November 1995, Pages 440-446

Annals of Epidemiology

https://doi.org/10.1016/1047-2797(95)00059-3 Get rights and content

Abstract

The development and attributes of the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) are reviewed. The ISS was proved to be an excellent method for retrospective comparison of overall injury data between populations differing in time or space. Its strengths, purpose, and appropriate uses are emphasized, together with specific comments on statistical analyses and combined scales of anatomic and physiologic injury.

References (64)

JP Bull
The Injury Severity Score of road traffic casualties in relation to mortality, time of death, hospital treatment time and disability
Accid Anal Prev
(1975)
JP Bull
Measures of severity of injury
Injury
(1978)
DE Beverland et al.
An assessment of the validity of the injury severity score when applied to gunshot wounds
Injury
(1983)
EJ MacKenzie
Injury severity scales: Overview and directions for future research
Am J Emerg Med
(1984)
T Osler
Injury severity scoring: Perspectives in development and future directions
Am J Surg
(1993)
JP Bull et al.
Injury scoring by TRISS and ISS/age
Injury
(1991)
WG Baxt et al.
The lack of full correlation between the Injury Severity Score and the resource needs of injured patients
Ann Emerg Med
(1990)
SP Baker et al.
The Injury Severity Score: A method for describing patients with multiple injuries and evaluating emergency care
J Trauma
(1974)
SP Baker et al.
The Injury Severity Score: An update
J Trauma
(1976)
Committee on Medical Aspects of Automotive Safety
Rating the severity of tissue damage. I. The Abbreviated Scale
JAMA
(1971)

Committee on Medical Aspects of Automotive Safety

Rating the severity of tissue damage. II. The Comprehensive Scale

JAMA

(1972)

Joint Committee of the Society of Automotive Engineers

The Abbreviated Injury Scale-(AIS) (revision, including dictionary)

(1976)

Committee on Injury Scaling

Abbreviated Injury Scale

(1980)

Committee on Injury Scaling

Abbreviated Injury Scale

(1985)

The Abbreviated Injury Scale

(1990)

JL Semmlow et al.

Utility of the injury severity score: A confirmation

Health Serv Res. Spring

(1976)

HR Champion et al.

An anatomic index of injury severity

Trauma

(1980)

RF Bellamy et al.

Assessment of penetrating injury severity

Adv Trauma

(1988)

WS Copes et al.

The Injury Severity Score revisited

J Trauma

(1988)

JP Krischer

Indexes of severity: Underlying concepts

Health Serv Res

(1976)

JP Krischer

Indexes of severity: Conceptual development

Health Serv Res

(1979)

B O'Neill et al.

Indexes of severity: Underlying concepts—a reply

Health Serv Res

(1979)

JP Bull

RH Cale

Injury severity determination: Requirements, approaches and applications

Ann Emerg Med

(1986)

RJA Goris

The Injury Severity Score

World J Surg

(1983)

LS Robertson

Injury Epidemiology

(1992)

JA Moylan et al.

Evaluation of the quality of hospital care for major trauma

J Trauma

(1976)

CW Schwab et al.

DRG reimbursement for trauma: The demise of the trauma center (the use of ISS grouping as an early predictor of total hospital cost)

J Trauma

(1988)

EJ MacKenzie et al.

The Abbreviated Injury Scale and the Injury Severity Score: Levels of inter and intrarater reliability

Med Care

(1985)

WS Copes et al.

Progress in characterizing anatomic injury

J Trauma

(1990)

LH Wolff et al.

Timelag and multiplicity factors in abdominal injuries

HR Champion et al.

A new characterization of injury severity

J Trauma

(1990)

Cited by (156)

The new injury severity score underestimates true injury severity in a resource-constrained setting
2024, African Journal of Emergency Medicine
The new injury severity score (NISS) is widely used within trauma outcomes research. NISS is a composite anatomic severity score derived from the Abbreviated Injury Scale (AIS) protocol. It has been postulated that NISS underestimates trauma severity in resource-constrained settings, which may contribute to erroneous research conclusions. We formally compare NISS to an expert panel's assessment of injury severity in South Africa.
This was a retrospective chart review of adult trauma patients seen in a tertiary trauma center. Randomly selected medical records were reviewed by an AIS-certified rater who assigned an AIS severity score for each anatomic injury. A panel of five South African trauma experts independently reviewed the same charts and assigned consensus severity scores using a similar scale for comparability. NISS was calculated as the sum of the squares of the three highest assigned severity scores per patient. The difference in average NISS between rater and expert panel was assessed using a multivariable linear mixed effects regression adjusted for patient demographics, injury mechanism and type.
Of 49 patients with 190 anatomic injuries, the majority were male (n = 38), the average age was 36 (range 18–80), with either a penetrating (n = 23) or blunt (n = 26) injury, resulting in 4 deaths. Mean NISS was 16 (SD 15) for the AIS rater compared to 28 (SD 20) for the expert panel. Adjusted for potential confounders, AIS rater NISS was on average 11 points (95 % CI: 7, 15) lower than the expert panel NISS (p < 0.001). Injury type was an effect modifier, with the difference between the AIS rater and expert panel being greater in penetrating versus blunt injury (16 vs. 7; p = 0.04). Crush injury was not well-captured by AIS protocol.
NISS may under-estimate the ‘true’ injury severity in a middle-income country trauma hospital, particularly for patients with penetrating injury.
Comparison Between Orthopaedic Trauma Versus Arthroplasty Fellowship Training on Outcomes of Total Hip Arthroplasty for Femoral Neck Fracture
2023, Journal of Arthroplasty
This study aimed to identify differences in patient characteristics, perioperative management methods, and outcomes for total hip arthroplasty (THA) for femoral neck fracture (FNF) when performed by orthopaedic surgeons who have arthroplasty versus orthopaedic trauma training.
This study was a multicenter retrospective review of 636 patients who underwent THA for FNF between 2010 and 2019. There were 373 patients who underwent THA by an arthroplasty surgeon, and 263 who underwent THA by an orthopaedic trauma surgeon. Comorbidities, management methods, and outcomes were compared between patients operated on by orthopaedic surgeons who had arthroplasty versus trauma training.
Arthroplasty-trained surgeons had shorter operative times (102 versus 128 minutes, P < .0001) and utilized tranexamic acid more frequently than trauma-trained surgeons (48.8 versus 18.6%, P < .0001). Orthopaedic trauma surgeons more frequently utilized an anterior approach. Patients of arthroplasty-trained surgeons had lower rates of complications including pulmonary embolism (1.6 versus 6.5%, P = .0019) and myocardial infarction (1.6 versus 11.0%, P < .0001). Similarly, patients of arthroplasty-trained surgeons were discharged faster (5.3 versus 7.9 days, P < .0001) with greater ambulation capacity (92.2 versus 57.2 feet, P < .0001). Dislocation, periprosthetic joint infection, and revision were similar between both groups. When adjusted for covariates, there was no difference in 90-day, 1-year, or 2-year mortality.
A THA performed for FNF by arthroplasty surgeons was associated with lower in-hospital morbidities and improved functional statuses at discharge. However, mortalities and complications after discharge were similar between both specialties when adjusted for confounding variables. Optimization of protocols may further improve outcomes for THA for FNF.
Atlanto-occipital dislocation with concomitant severe traumatic brain injury: A retrospective study at a level 1 trauma center
2023, Neurocirugia
Traumatic atlanto-occipital dislocation (AOD) is a life-threatening injury. Although traumatic brain injury (TBI) is associated with increased mortality in AOD patients, a detailed individual analysis of these patients is lacking in the literature.
Patients ≥16 years old who were diagnosed of AOD with concomitant severe TBI from 2010 to 2020 were included in this retrospective study. We examined the epidemiology, injury mechanisms, associated injuries, and outcomes of these patients.
Eight patients were included. Six patients died before any intervention could be performed, and two patients underwent an occipito-cervical fixation, showing a notorious neurologic improvement on follow-up. Cardiorespiratory arrest (CRA) was a strong predictor of subsequent death. CT signs of diffuse axonal injury (DAI) were present in most patients and were confirmed by magnetic resonance imaging (MRI) in survivors. Although TBI was not the main cause of death, it was responsible for the delayed neurological improvement and deferred stabilization. The average sensitivity of the different used methodologies for AOD diagnosis ranged from 0.50 to 1.00, being the Basion Dens Interval (BDI) and the Condyle-C1 interval (CCI) sum the most reliable criteria. Non-survivors tended to show greater distraction measurements. The high incidence of condylar avulsion fractures suggests that their visualization on the initial CT study should heighten the suspicion for AOD.
Our data suggest that patients with AOD and concomitant severe TBI might be salvageable patients. In those who survive beyond the first hospital days and show neurological improvement, surgical treatment should be performed as they can achieve an important neurologic recovery.
La luxación atlantooccipital (AOD) traumática es una lesión potencialmente mortal. Aunque el traumatismo craneoencefálico (TCE) se asocia con un aumento de la mortalidad en los pacientes con AOD, no existe en la literatura un análisis individual detallado de estos pacientes.
En este estudio retrospectivo se incluyeron pacientes mayores de 16 años que fueron diagnosticados de AOD con TCE grave concomitante durante el periodo 2010-2020. Estudiamos la epidemiología, los mecanismos lesionales, así como las lesiones asociadas y los resultados de estos pacientes.
Se incluyeron ocho pacientes. Seis pacientes fallecieron antes de que se pudiera realizar cualquier intervención y dos pacientes fueron sometidos a una fijación occipitocervical, mostrando una notoria mejoría neurológica durante el seguimiento. La parada cardiorrespiratoria fue un predictor de muerte. En la TC inicial, signos de lesión axonal difusa estaban presentes en la mayoría de los pacientes y se confirmaron mediante imágenes de resonancia magnética en los supervivientes. Aunque el TCE no fue la principal causa de muerte, fue responsable de una mejoría neurológica tardía y por ello una estabilización diferida. La sensibilidad de las diferentes metodologías utilizadas para el diagnóstico de AOD osciló entre 0,50 y 1,00, siendo el intervalo Basion Dens y la suma del intervalo Condylo-C1 los criterios más fiables. Además, los no supervivientes presentaban mayores medidas de distracción. La alta incidencia de fracturas de cóndilo por avulsión sugiere que su visualización en el estudio de TC inicial debería aumentar la sospecha de AOD.
Nuestros datos sugieren que los pacientes con AOD y TCE grave concomitante podrían ser pacientes salvables. En aquellos que sobreviven más allá de los primeros días de hospitalización y presentan mejoría neurológica, se debe considerar realizar un tratamiento quirúrgico ya que pueden lograr una importante recuperación neurológica.
Macro-level literature analysis on pedestrian safety: Bibliometric overview, conceptual frames, and trends
2022, Accident Analysis and Prevention
Citation Excerpt :
This worrisome issue highlights the need for evaluating causes and improving safety measures in pedestrian injuries and fatalities. Pedestrian injury severity researches have generally used four types of injury severity representatives: (1) Abbreviated Injury Score (AIS) as an anatomic injury severity score (Atkins et al., 1988; Decker et al., 2016; Lefler and Gabler, 2004; MacKenzie et al., 1985; Roudsari et al., 2004); (2) Injury Severity Score (ISS) which is based on AIS for summarizing multiple AIS scores (Demetriades et al., 2004; Jehle and Cottington, 1988; Linn, 1995); (3) Binary variable (Ballesteros et al., 2004; Batouli et al., 2020; Holubowycz, 1995; Jensen, 1999; Li et al., 2021b; Mohamed et al., 2013; Sze and Wong, 2007); (4) Ordinal variable (Al-Ghamdi, 2002; Aziz et al., 2013; Kim et al., 2008; Lee and Abdel-Aty, 2005). Moreover, numerous risk factors considered in pedestrian crash studies could be categorized in seven areas: (1) pedestrian features like age, gender, race (Bajada and Attard, 2021; Harruff et al., 1998; Rosén and Sander, 2009); (2) driver’s features like age, gender (Batouli et al., 2020; Kim et al., 2010; Li et al., 2021b); (3) vehicle features like vehicle type, speed (Harruff et al., 1998; Rosén and Sander, 2009; Song et al., 2021; Zajac and Ivan, 2003); (4) road and environmental features like weather, road type, traffic control devices, lighting condition (Kim et al., 2008; Pour-Rouholamin and Zhou, 2016; Song et al., 2021); (5) crash features like collision type and pre-crash movements (Behnood and Mannering, 2016); (6) built environment like network connectivity, accessibility, and land use (Clifton et al., 2009; Munira et al., 2020; Su et al., 2021); (7) spatial and temporal patterns (Alogaili and Mannering, 2022; Toran Pour et al., 2018; Zamani et al., 2021).
Due to the high volume of documents in the pedestrian safety field, the current study conducts a systematic bibliometric analysis on the researches published before October 3, 2021, based on the science-mapping approach. Science mapping enables us to present a broad picture and comprehensive review of a significant number of documents using co-citation, bibliographic coupling, collaboration, and co-word analysis. To this end, a dataset of 6311 pedestrian safety papers was collected from the Web of Science Core Collection database. First, a descriptive analysis was carried out, covering whole yearly publications, most-cited papers, and most-productive authors, as well as sources, affiliations, and countries. In the next steps, science mapping was implemented to clarify the social, intellectual, and conceptual structures of pedestrian-safety research using the VOSviewer and Bibliometrix R-package tools. Remarkably, based on intellectual structure, pedestrian safety demonstrated an association with seven research areas: “Pedestrian crash frequency models”, “Pedestrian injury severity crash models”, “Traffic engineering measures in pedestrians’ safety”, “Global reports around pedestrian accident epidemiology”, “Effect of age and gender on pedestrians’ behavior”, “Distraction of pedestrians”, and “Pedestrian crowd dynamics and evacuation”. Moreover, according to conceptual structure, five major research fronts were found to be relevant, namely “Collision avoidance and intelligent transportation systems (ITS)”, “Epidemiological studies of pedestrian injury and prevention”, “Pedestrian road crossing and behavioral factors”, “Pedestrian flow simulation”, and “Walkable environment and pedestrian safety”. Finally, “autonomous vehicle”, “pedestrian detection”, and “collision avoidance” themes were identified as having the greatest centrality and development degrees in recent years.
Toward better measurement of traffic injuries – Comparison of anatomical injury measures in predicting the clinical outcomes in motorcycle crashes
2022, Journal of Safety Research
Introduction: Little evidence exists in the literature regarding the discrimination power of better anatomical injury measures in differentiating clinical outcomes in motorcycle crashes. Furthermore, multiple injuries to different body parts of the rider are seldom analyzed. This study focuses on comparing anatomical injury measures such as the injury severity score (ISS) and the new injury severity score (NISS) in capturing injuries of multiple injured riders and examining the discriminatory capabilities of the ISS and NISS in predicting clinical outcomes post motorcycle crash. Methods: The study harnessed unique and comprehensive injury data on 322 riders from the US DOT Federal Highway Administration’s Motorcycle Crash Causation Study (MCCS). Detailed exploratory analysis is performed and discrete/ordered statistical models are estimated for three clinical outcomes: mortality risk, trauma risk, and trauma status. Results: Around 9% of the riders died and 45% of the riders had injuries. Around 36% of the riders were hospitalized, disabled, or institutionalized. While a very strong dependence was found between ISS and NISS, ISS underestimated injuries sustained by riders. Statistical models for mortality risk revealed that a unit increase in the ISS and NISS was correlated with a 1.18 and 1.17 times increase in the odds of mortality, respectively. Moreover, a unit increase in ISS and NISS values was correlated with a higher trauma risk by 1.48 and 1.36 times, respectively. Our analysis reveals that the probability of a rider being hospitalized or disabled/institutionalized increases with an increase in the NISS. Conclusions and practical applications: The NISS exhibits significantly better calibration and discriminatory ability in differentiating survivors and non-survivors and in predicting trauma status – underscoring the importance of accounting for microscopic body-part-level injury data in motorcycle crashes. We consider that compared with the KABCO scale, the ISS and NISS are more nuanced scores that can better measure the overall injury intensity and can lead to more targeted countermeasures.
Internal and external validation of an updated ICD-10-CA to AIS-2005 update 2008 algorithm
2024, Journal of Trauma and Acute Care Surgery

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^☆: This study was supported by the Social Science Research Council-MacArthur Foundation (605 Third Avenue, New York, NY 10158) and the Israel Ministry of Defence, Office of Rehabilitation.

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