2. • Outcome of any injury are:
complete recovery
Recovery with residual effect
disability
death.
Outcome depends on:
• Timing of hospital care
• Mechanism of injury
• Vital signs in field and on arrival
• Outcome measures-ICU days, ventilator days

3. It has been suggested that trauma(commonest cause of
unnatural death) follows tri-modal distribution:
Immediate: severe head injury, aorta dissection.
dealt only by prevention and public education.
Early :epidural, subdural hematoma, hemothorax etc.
Correctable injury, pre hospital coordinated care
and definitive t/t can benefit these pt.
Late: sepsis, consequences of initial management

4. Morbidity and mortality
• Hypoxia
• Microatelectasis
• Hypovolemia
• Chest injury
• Head injury

5. • Physiological status
Glasgow coma scale
Revised trauma score
• Anatomical scores
Abbreviated injury scale
Injury severity score
System used to : ∞ stratify injury pattern
∞ assess injuries to predict pt. survival
∞ predict functional outcome of injuries
• ∞ resource utilization

6. Glasgow coma scale
Eye opening :
spontaneously 4
verbal command 3
pain 2
no response 1
Best motor response:
to verbal command: obeys 6
painful stimulus: localized pain 5
withdrawal / flexion 4
abnormal flexion 3
extension decerebrate 2
none 1
Best verbal response:
oriented 5
disoriented 4
inappropriate words 3
incomprehensible words 2
nil 1
total 3—15

7. • Head injuries GCS score
Minor 13 – 15
Majority recover fully
Moderate 9 – 12
Severe <8
degree of eventual recovery depends on initial brain injury

8. Revised trauma score <RTS>
GCS score
13 -15 4
9 -12 3
6 -8 2
4 -5 1
3 0
Systolic BP
>90 4
76 -89 3
50 -75 2
1 - 49 1
o 0
Respiratory rate
10 -29 4
>29 3
6 -9 2
1 -5 1
0 0
total score 0 – 12
used for pre-hospital emergency room triage or for
comparative reassessment
during and after resuscitation without need for accurate
diagnosis

9. • As score diminishes --------- progressively probability
of survival decreases
• A score >4 for any variable --- survival rate of <90%
• A score <4 --------------------a survival rate of just over
45%

10. ABBREVIATED INJURY SCALE
o Developed to rate and compare injuries.
o Scores based on t/t period, life threatening injuries,
expected permanent impairment & energy dissipation.
o Coding is done for
anatomical site
nature
severity
1 minor
2 moderate
3 serious
4 severe
5 critical
6 fatal

11. Score <10: death rare in pt under age of
50
Score 10-15: response to t/t
Score 10-20: mortality 4-30% depending on
age
Score >50: only rare survival

12. INJURY SEVERITY SCORE
BODY IS DIVIDED INTO 6 PARTS:
Head
Face
Chest
Abdomen
Extremities (including pelvis)
External structures
ISS=A2+B2+C2
The total ISS score is calculated from the sum of the squares of
the three worst regional values
Generally, multiple trauma patient are defined as patient with
iss≥16.
ISS<30 good prognosis, unless associated with head injury.
ISS>60 usually fatal.
The score gives a correlation between ISS and mortality

13. ISS is the most frequently used injury scoring methodology
• Has major limitation i.e.
• Can underestimate injury severity of patient with multiple
injuries in same body region.
• When used as predictor of survival ISS tends to
overweigh combined non lethal injuries, like
Isolated severe head injury ,AIS=5,ISS=25
Liver laceration AIS=4 & femur fracture AIS=3 ,ISS=25
Despite equal ISS, mortality, short and long term
complication rate, resource utilization in these 2 injuries
are probably very different.

14. Prognostic factors in head injury
• Increasing age • Diffuse B/L CT lesions
• Pupil abnormalities • Multiple injuries resulting
in hypovolaemia
• Massive lesions
• Immediate coma/lucid
• Increasing ICP interval

15. Prognostic factors in thoracic trauma:
• Mechanical ventilation
• High PEEP(flial chest)
• Pulmonary contusion –progressive hypoxia
due to edematous lung leading to v-p
mismatch.
• Emergency surgery
• Hemodynamic instability

16. Immediately life threatning conditions
• Tension pneumothorax
• Sucking chest wound
• Flial chest
• Cardiac tamponade
• Massive hemothorax
Early interventions by trained personnel (paramedics,fire
fighters,police) and well equipped transport system and
emergency team are likely to modify the outcome
Complications like ARDS, fat embolism syndrome, DIC,
crush syndrome, multi system organ failure have less
favourable outcome.

17. NEPAL TRAUMA INDEX (NTI)
For trauma scoring in developing countries
(Multifactoral scoring system)
factors criteria score
Age < 12 years of > 55 years 2
12-55 years 1
Time gap after sustaining trauma and > 12 hours 3
6-12 hours 2
reporting to hospital
< 6 hours 1
Med. t/t received elsewhere after none 2
some 1
trauma
Pulse pulse less 3
100 – 120 per minute 2
100 per minute 1
b.P not recordable 3
< 100 syst. 2
> 100 syst 1
respiration cyanosis / gasping 3
tachypnoea 2
none 1
Level of consciousness no response to verbal commands 3
reposed but irritable or incoherent 2
normal response 1
Areas of suspected injuries - Viscera head face open arterial, associated burns long 3
bone fracture, fracture spine 2
- more than 2 long bone fractures, open or closed or 1
dislocations (no visceral injuries)
- one long bone injury or dislocation or closed soft tissue
injury
Hb. At first sample < 8 grams % 3
8-10 grams % 2
> 10 grams % 1

18. • Maximum (worst score)- 25
• Safest score-10 for extremes of age groups
9 for 12 – 55 years of age groups
.

19. • Rock wood n Green`s
fractures in adults, vol. 1
• Appley’s system of orthopedics n fracture
• Orthopedics' principle and their
applications Samuel L turek

20. THANK YOU