The Injury Severity Score can be used to assess patients involved in traffic accidents. It makes use of the Abbreviated Injury Scale (AIS) and its value correlates with the risk of mortality.
Patient selection:
(1) Patients are those involved in a motor vehicle accident.
(2) Patients with immediately or rapidly fatal injuries are excluded.
Patient examination:
(1) Injuries are assigned to 5 body regions (general, head & neck, chest, abdominal, extremities & pelvis)
(2) Each type of injury encountered is assigned a value from 1 to 6, with:
Injury Severity |
Abbreviated Injury Score |
---|---|
minor injury |
1 |
moderate injury |
2 |
severe but not life-threatening |
3 |
potentially life-threatening but survival likely |
4 |
critical with uncertain survival |
5 |
unsurvivable injury (maximal possible) |
6 |
severity unknown |
9 |
General
aches all over |
general |
1 |
minor laceration, contusion and abrasions (simple closure) |
general |
1 |
1st degree burns |
general |
1 |
small 2nd or 3rd degree burns |
general |
1 |
extensive contusion or abrasion |
general |
2 |
large laceration |
general |
2 |
avulsion less than 3 inches wide |
general |
2 |
2nd or 3rd degree burn involving 10-20% BSA |
general |
2 |
large lacerations involving more than 2 extremities |
general |
3 |
large avulsions, >= 3 inches wide |
general |
3 |
2nd or 3rd degree burn involving 20-30% of BSA |
general |
3 |
severe lacerations and/or avulsion with dangerous hemorrhage |
general |
4 |
2nd or 3rd degree burns involving 30-50% of BSA |
general |
4 |
2nd or 3rd degree burns involving > 50% of BSA |
general |
5 |
Head and Neck
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 |
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 |
cerebral injury with/without skull fracture, less than 15 minutes unconsciousness, no post-traumatic amnesia |
head and neck |
2 |
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 |
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 |
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 |
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 |
major airway obstruction |
head and neck |
5 |
Chest
muscle ache or chest wall stiffness |
chest |
1 |
simple rib or sternal fracture |
chest |
2 |
major contusion of chest wall without hemothorax or pneumothorax or respiratory embarrassment |
chest |
2 |
multiple rib fractures without respiratory embarrassment |
chest |
3 |
hemothorax |
chest |
3 |
pneumothorax |
chest |
3 |
rupture of diaphragm |
chest |
3 |
lung contusion |
chest |
3 |
open chest wounds |
chest |
4 |
flail chest |
chest |
4 |
pneumomediastinum |
chest |
4 |
myocardial contusion without circulatory embarrassment |
chest |
4 |
pericardial injuries |
chest |
4 |
chest injuries with major respiratory embarrassment (laceration of trachea, hemomediastinum, etc.) |
chest |
5 |
aortic laceration |
chest |
5 |
myocardial rupture or contusion, with circulatory embarrassment |
chest |
5 |
Abdomen
muscle ache |
abdominal |
1 |
seat belt abrasion |
abdominal |
1 |
major contusion of abdominal wall |
abdominal |
2 |
contusion of abdominal organs |
abdominal |
3 |
extraperitoneal bladder rupture |
abdominal |
3 |
retroperitoneal hemorrhage |
abdominal |
3 |
avulsion of ureter |
abdominal |
3 |
laceration of urethra |
abdominal |
3 |
thoracic or lumbar spine fracture without neurological involvement |
abdominal |
3 |
minor laceration of intra-abdominal contents (to include ruptured spleen, kidney and injuries to tail of pancreas) |
abdominal |
4 |
intraperitoneal bladder rupture |
abdominal |
4 |
avulsion of genitals |
abdominal |
4 |
thoracic and/or lumbar spine fracture with paraplegia |
abdominal |
4 |
rupture, avulsion or severe laceration of intra-abdominal vessels or organs, except kidney, spleen or ureter |
abdominal |
5 |
Extremities and Pelvis
minor sprains and fractures |
extremities or pelvic girdle |
1 |
dislocation of digits |
extremities or pelvic girdle |
1 |
compound fracture of digits |
extremities or pelvic girdle |
2 |
undisplaced long bone or pelvic fractures |
extremities or pelvic girdle |
2 |
major sprains of major joints |
extremities or pelvic girdle |
2 |
displaced simple long bone fractures |
extremities or pelvic girdle |
3 |
multiple hand and foot fractures |
extremities or pelvic girdle |
3 |
pelvic fracture with displacement |
extremities or pelvic girdle |
3 |
dislocation of major joints |
extremities or pelvic girdle |
3 |
multiple amputations of digits |
extremities or pelvic girdle |
3 |
laceration of the major nerves or vessels of extremities |
extremities or pelvic girdle |
3 |
multiple closed long-bone fractures |
extremities or pelvic girdle |
4 |
amputation of limbs |
extremities or pelvic girdle |
4 |
multiple open limb fractures |
extremities or pelvic girdle |
5 |
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
Score |
Mortality Rate If Age <=49 |
Mortality Rate If Age 50-69 |
Mortality Rate If Age >=70 |
---|---|---|---|
5 |
0 |
3 |
13 |
10 |
2 |
4 |
15 |
15 |
3 |
5 |
16 |
20 |
6 |
16 |
31 |
25 |
9 |
26 |
44 |
30 |
21 |
42 |
65 |
35 |
31 |
56 |
82 |
40 |
47 |
62 |
92 |
45 |
61 |
67 |
100 |
50 |
75 |
83 |
100 |
55 |
89 |
100 |
100 |
data extrapolated from Figure 4, Baker et al (1974)
Purpose: To assess a patient following a traffic accident using the Injury Severity Score.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general
Objective: criteria for diagnosis, severity, prognosis, stage, options
ICD-10: V98,