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Erschienen in: European Journal of Trauma and Emergency Surgery 4/2014

01.08.2014 | Original Article

Proper coding of the Abbreviated Injury Scale: can clinical parameters help as surrogates in estimating blood loss?

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 4/2014

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Abstract

Purpose

The Abbreviated Injury Scale (AIS) requires the estimation of the lost blood volume for some severity assignments. This study aimed to develop a rule of thumb for facilitating AIS coding by using objective clinical parameters as surrogate markers of blood loss.

Methods

Using the example of pelvic ring fractures, a retrospective analysis of TraumaRegister DGU® data from 2002 to 2011 was performed. As potential surrogate markers of blood loss, we recorded the hemoglobin (Hb) level, systolic blood pressure (SBP), base excess (BE), Quick’s value, units of packed red blood cells (PRBCs) transfused before intensive care unit (ICU) admission, and mortality within 24 h.

Results

We identified 11,574 patients with pelvic ring fractures (Tile/OTA classification: 39 % type A, 40 % type B, 21 % type C). Type C fractures were 73.1 % AISpelvis 4 and 26.9 % AISpelvis 5. Type B fractures were 47 % AISpelvis 3, 47 % AISpelvis 4, and 6 % AISpelvis 5. In type C fractures, cut-off values of <7 g/dL Hb, <90 mmHg SBP, <−9 mmol/L BE, <35 % Quick’s value, >15 units PRBCs, and death within 24 h had a positive predictive value of 47 % and a sensitivity of 62 % for AISpelvis 5. In type B fractures, these cut-off values had poor sensitivity (48 %) and positive predictive value (11 %) for AISpelvis 5.

Conclusions

We failed to develop a rule of thumb for facilitating a proper future AIS coding using the example of pelvic ring fractures. The estimation of blood loss for severity assignment still remains a noteworthy weakness in the AIS coding of traumatic injuries.
Literatur
1.
Zurück zum Zitat Copes WS, Sacco WJ, Champion HR Bain LW. Progress in characterising anatomic injury. In: Proceedings of the 33rd Annual Meeting of the Association for the Advancement of Automotive Medicine, Baltimore, MD, October 1989, pp 205–218; 1989. Copes WS, Sacco WJ, Champion HR Bain LW. Progress in characterising anatomic injury. In: Proceedings of the 33rd Annual Meeting of the Association for the Advancement of Automotive Medicine, Baltimore, MD, October 1989, pp 205–218; 1989.
2.
Zurück zum Zitat Tile M. Acute pelvic fractures: I. Causation and classification. J Am Acad Orthop Surg. 1996;4:143–51.PubMed Tile M. Acute pelvic fractures: I. Causation and classification. J Am Acad Orthop Surg. 1996;4:143–51.PubMed
3.
Zurück zum Zitat Association for the Advancement of Automotive Medicine (AAAM). Abbreviated Injury Scale (AIS) 2005 manual. Des Plaines, IL: AAAM; 2005. Association for the Advancement of Automotive Medicine (AAAM). Abbreviated Injury Scale (AIS) 2005 manual. Des Plaines, IL: AAAM; 2005.
4.
Zurück zum Zitat Hlaing T, Hollister L, Aaland M. Trauma registry data validation: essential for quality trauma care. J Trauma. 2006;61:1400–7.PubMedCrossRef Hlaing T, Hollister L, Aaland M. Trauma registry data validation: essential for quality trauma care. J Trauma. 2006;61:1400–7.PubMedCrossRef
5.
Zurück zum Zitat Zehtabchi S, Nishijima DK, McKay MP, Mann NC. Trauma registries: history, logistics, limitations, and contributions to emergency medicine research. Acad Emerg Med. 2011;18:637–43.PubMedCrossRef Zehtabchi S, Nishijima DK, McKay MP, Mann NC. Trauma registries: history, logistics, limitations, and contributions to emergency medicine research. Acad Emerg Med. 2011;18:637–43.PubMedCrossRef
7.
Zurück zum Zitat American College of Surgeons Committee on Trauma. Resources for optimal care of the injured patient. Chicago: American College of Surgeons; 1999. American College of Surgeons Committee on Trauma. Resources for optimal care of the injured patient. Chicago: American College of Surgeons; 1999.
8.
Zurück zum Zitat Pohlemann T, Culemann U, Gänsslen A, Tscherne H. Severe pelvic injury with pelvic mass hemorrhage: determining severity of hemorrhage and clinical experience with emergency stabilization. Unfallchirurg. 1996;99:734–43.PubMedCrossRef Pohlemann T, Culemann U, Gänsslen A, Tscherne H. Severe pelvic injury with pelvic mass hemorrhage: determining severity of hemorrhage and clinical experience with emergency stabilization. Unfallchirurg. 1996;99:734–43.PubMedCrossRef
9.
Zurück zum Zitat Pohlemann T, Stengel D, Tosounidis G, Reilmann H, Stuby F, Stöckle U, Seekamp A, Schmal H, Thannheimer A, Holmenschlager F, Gänsslen A, Rommens PM, Fuchs T, Baumgärtel F, Marintschev I, Krischak G, Wunder S, Tscherne H, Culemann U. Survival trends and predictors of mortality in severe pelvic trauma: estimates from the German Pelvic Trauma Registry Initiative. Injury. 2011;42:997–1002.PubMedCrossRef Pohlemann T, Stengel D, Tosounidis G, Reilmann H, Stuby F, Stöckle U, Seekamp A, Schmal H, Thannheimer A, Holmenschlager F, Gänsslen A, Rommens PM, Fuchs T, Baumgärtel F, Marintschev I, Krischak G, Wunder S, Tscherne H, Culemann U. Survival trends and predictors of mortality in severe pelvic trauma: estimates from the German Pelvic Trauma Registry Initiative. Injury. 2011;42:997–1002.PubMedCrossRef
10.
Zurück zum Zitat Holstein JH, Culemann U, Pohlemann T; Working Group Mortality in Pelvic Fracture Patients. What are predictors of mortality in patients with pelvic fractures? Clin Orthop Relat Res. 2012;470:2090–7.PubMedCentralPubMedCrossRef Holstein JH, Culemann U, Pohlemann T; Working Group Mortality in Pelvic Fracture Patients. What are predictors of mortality in patients with pelvic fractures? Clin Orthop Relat Res. 2012;470:2090–7.PubMedCentralPubMedCrossRef
11.
Zurück zum Zitat Burkhardt M, Nienaber U, Pizanis A, Maegele M, Culemann U, Bouillon B, Flohé S, Pohlemann T, Paffrath T; The TraumaRegister DGU and the German Pelvic Injury Register of the Deutsche Gesellschaft für Unfallchirurgie. Acute management and outcome of multiple trauma patients with pelvic disruptions. Crit Care. 2012;16:R163.PubMedCentralPubMedCrossRef Burkhardt M, Nienaber U, Pizanis A, Maegele M, Culemann U, Bouillon B, Flohé S, Pohlemann T, Paffrath T; The TraumaRegister DGU and the German Pelvic Injury Register of the Deutsche Gesellschaft für Unfallchirurgie. Acute management and outcome of multiple trauma patients with pelvic disruptions. Crit Care. 2012;16:R163.PubMedCentralPubMedCrossRef
12.
Zurück zum Zitat Blackmore CC, Jurkovich GJ, Linnau KF, Cummings P, Hoffer EK, Rivara FP. Assessment of volume of hemorrhage and outcome from pelvic fracture. Arch Surg. 2003;138:504–8.PubMedCrossRef Blackmore CC, Jurkovich GJ, Linnau KF, Cummings P, Hoffer EK, Rivara FP. Assessment of volume of hemorrhage and outcome from pelvic fracture. Arch Surg. 2003;138:504–8.PubMedCrossRef
13.
Zurück zum Zitat Yücel N, Lefering R, Maegele M, Vorweg M, Tjardes T, Ruchholtz S, Neugebauer EA, Wappler F, Bouillon B, Rixen D; Polytrauma Study Group of the German Trauma Society. Trauma Associated Severe Hemorrhage (TASH)-Score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma. J Trauma. 2006;60:1228–36.PubMedCrossRef Yücel N, Lefering R, Maegele M, Vorweg M, Tjardes T, Ruchholtz S, Neugebauer EA, Wappler F, Bouillon B, Rixen D; Polytrauma Study Group of the German Trauma Society. Trauma Associated Severe Hemorrhage (TASH)-Score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma. J Trauma. 2006;60:1228–36.PubMedCrossRef
14.
Zurück zum Zitat Maegele M, Lefering R, Wafaisade A, Theodorou P, Wutzler S, Fischer P, Bouillon B, Paffrath T; Trauma Registry of Deutsche Gesellschaft für Unfallchirurgie (TR-DGU). Revalidation and update of the TASH-Score: a scoring system to predict the probability for massive transfusion as a surrogate for life-threatening haemorrhage after severe injury. Vox Sang. 2011;100:231–8.PubMedCrossRef Maegele M, Lefering R, Wafaisade A, Theodorou P, Wutzler S, Fischer P, Bouillon B, Paffrath T; Trauma Registry of Deutsche Gesellschaft für Unfallchirurgie (TR-DGU). Revalidation and update of the TASH-Score: a scoring system to predict the probability for massive transfusion as a surrogate for life-threatening haemorrhage after severe injury. Vox Sang. 2011;100:231–8.PubMedCrossRef
Metadaten
Titel
Proper coding of the Abbreviated Injury Scale: can clinical parameters help as surrogates in estimating blood loss?
Publikationsdatum
01.08.2014
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 4/2014
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-013-0335-x

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