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Modified Injury Severity Score

Purpose: To assess a patient following a traffic accident using the Injury Severity Score.

Description

The Modified Injury Severity Score (MISS) differs slightly from the Injury Severity Score.


Differences:

(1) The "General" category of the Injury Severity Score is deleted.

(2) There is substitution of a Glasgow Coma Scale score for the neurologic component.

 

Similarities:

(1) The chest, abdomen, and extremities sections are the same.

(2) The scoring in each section is the same.

(3) The calculation of the final score is the same.

 

Head and Neck Components Retained

 

abrasions and contusions of ocular apparatus (lids, conjunctivae, cornea, uveal injuries)

head and neck

1

vitreous or retinal hemorrhages

head and neck

1

fractures and/or dislocation of teeth

head and neck

1

undisplaced skull or facial bone fractures or compound fracture of nose

head and neck

2

laceration of the eye and appendages

head and neck

2

retinal detachment

head and neck

2

disfiguring lacerations

head and neck

2

loss of eye

head and neck

3

avulsion of optic nerve

head and neck

3

displaced facial bone fractures or those with antral or orbital involvement

head and neck

3

"blow out" fractures of orbit

head and neck

3

bony or soft tissue injury with minor destruction

head and neck

4

major airway obstruction

head and neck

5

 

where:

• (1) "blow out" fractures and (2) bony or soft tissue injury with minor destruction are not included in the injury severity score tables (above)

 

Neurologic Component of Head and Neck Section Replaced by GCS

 

cerebral injury with headache or dizziness but no loss of consciousness

head and neck

1

whiplash complaint with no anatomical or radiological evidence

head and neck

1

cerebral injury with/without skull fracture, less than 15 minutes unconsciousness, no post-traumatic amnesia

head and neck

2

whiplash severe complaints with anatomical and radiologic evidence

head and neck

2

cerebral injury with or without skull fracture, with unconsciousness more than 15 minutes, without severe neurological signs, brief post-traumatic amnesia (less than 3 hours)

head and neck

3

displaced closed skull fracture without unconsciousness or other signs of intracranial injury

head and neck

3

cervical spine fractures without cord damage

head and neck

3

cerebral injury with or without skull fracture with unconsciousness of more than 15 minutes, with definite abnormal neurological signs; post-traumatic amnesia 3-12 hours

head and neck

4

compound skull fracture

head and neck

4

cerebral injury with or without skull fracture with unconsciousness of more than 24 hours; post-traumatic amnesia more than 12 hours

head and neck

5

intracranial hemorrhage

head and neck

5

signs of increased intra-cranial pressure (decreasing state of consciousness, bradycardia under 60, progressive rise in blood pressure, or progressive pupil inequality)

head and neck

5

cervical spine injury with quadraplegia

head and neck

5

 

Glasgow Coma Score Substitution

 

Glasgow coma score 15

neurologic

1

Glasgow coma score 13-14

neurologic

2

Glasgow coma score 9-12

neurologic

3

Glasgow coma score 5-8

neurologic

4

Glasgow coma score 3-4

neurologic

5

 

Calculation

 

The highest score, indicating the most severe injury, for each region is selected. These are then ranked from the highest to lowest value. The 3 highest values are then used to calculate the injury severity score.

 

injury severity score =

= ((highest region score) ^2) + ((second highest region score) ^2) + ((third highest region score) ^2)

 

Interpretation:

• minimum score: 0

• maximum score: 75

 

The mortality rate increases:

(1) with score

(2) with age

 

MISS Score

Mortality in 1980

0 to 10

0%

11 to 20

0%

21 to 30

29%

31 to 40

60%

> 40

100%

 


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Specialty

Objective

ICD-10