Description

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)


To read more or access our algorithms and calculators, please log in or register.