The document discusses various trauma scoring systems used to classify and predict outcomes in trauma patients. It describes anatomical scoring systems like the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) that evaluate individual injuries and their severity. It also discusses physiological scoring systems such as the Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS) that assess physiological derangements. Combined scoring systems like TRISS and ASCOT incorporate both anatomical and physiological factors. The document provides details on the components and calculations of several common trauma scoring systems.

1. TRAUMA SCORING
SYSTEMS
BY
MITHUN BENJAMIN
SURGERY PG
MES

3. Purpose of scoring systems
• Appropriate triage and classification of trauma patients
• Predict outcomes (for patient and family counseling)
• Quality assurance

4. CLASSIFICATION OF SCORING SYSTEMS IN
TRAUMA
• ANATOMICAL SCORES :
• Abbreviated Injury Scale (AIS)
• Injury Severity Score (ISS)
• Organ Injury Scale
• Anatomic Profile (AP)
• Penetrating Abdominal Trauma Index (PATI)

5. PHYSIOLOGICAL SCORES
• Glasgow Coma Scale (GCS)
• Revised Trauma Score (RTS)
• Acute Physiology and Chronic Health Evaluation
(APACHE)

6. COMBINED SCORES:
• Trauma Score - Injury Severity Score (TRISS)
• A Severity Characterization of Trauma (ASCOT)
• International Classification of Diseases Injury Severity Score (ICISS)
• CRAMS Score

7. ANATOMICAL SCORES

8. ABBREVIATED INJURY SCALE
• The Association for the Advancement of Automotive Medicine
• Injuries are characterized by a six-digit taxonomy that describes the
body region, type of anatomic structure, and specific anatomic
detail of the injury
• This seventh digit describes the severity and potential risk of death
for each injury in the AIS system

9. • The score describes three aspects of the injury using 7 numbers written as
12(34)(56).7[4]
• Each number signifies
• 1- body region
• 2- type of anatomical structure
• 3,4- specific anatomical structure
• 5,6- level
• 7- Severity of score

11. Injury Severity Score (ISS)
• ISS = sum of squares for the highest AIS grades in the three most
severely injured ISS body regions
• ISS = A2 + B2 + C2
• where A, B, C are the AIS scores of the three most severely injured
ISS body regions
• Range from 1-75
• Minor<9, moderate 9-16, serious 16-25, sever injury >25

12. • Calculation is based upon the Abbreviated Injury Scale (AIS) grades
• 0 - no injury
• 1 - minor
• 2 - moderate
• 3 - severe (not life-threatening)
• 4 - severe (life-threatening, survival probable)
• 5 - severe (critical, survival uncertain)
• 6 - maximal, possibly fatal

13. New Injury Severity Score (ISS)
• The 3 most severe injuries regardless of body region is
used

14. ORGAN INJURY SCALE
• Here individual organ is graded according to severity of injury
• Splenic injury scale
• The spleen is the most commonly injured abdominal organ with abdominal
trauma.
• Direct compression of the spleen with parenchymal fracture is a common
pathophysiologic mechanism at the tissue level, although injury can also be
secondary to rapid deceleration that tears the splenic parenchyma or capsule
where it is fixed to the retroperitoneum

16. KIDNEY INJURY SCALE
• The majority of renal injuries
• are the result of blunt trauma
(80%); the remainder are the
result of penetrating injury (20%)

19. LIVER INJURY SCALE
• Mechanisms of blunt hepatic trauma include compression
with direct parenchymal damage and shearing forces,
which tear hepatic tissue and disrupt vascular and
ligamentous attachments
• Penetrating mechanisms directly lacerate the hepatic
parenchyma while also causing adjacent tissue contusion

21. PANCREATIC INJURY SCALE
• Pancreatic injuries are uncommon
• The most common mechanism in paediatric patients is
abdominal blunt trauma. The most common segment of
the pancreas affected is the body.
• Penetrating injuries into the abdomen are the most
common injuries seen in adults.

23. ANATOMIC PROFILE
• This index summarizes all serious injuries (AIS greater ≥3) into 3
categories. Category A includes the head and spinal cord. Category
B encompasses the thorax and anterior neck. Category C includes all
remaining serious injuries. A fourth category, category D,
summarizes all nonserious injuries.
• Practitioners calculate each component as the square root of the
sum of squares of the AIS scores of all serious injuries within each
region. A region with no injury receives a score of zero

24. PENETRATING ABDOMINAL TRAUMA INDEX (PATI)
• Fourteen organs are examined and assigned a risk factor from 1-5
(eg, pancreas=5, spleen=3, bladder=1). Injuries to any organ are
graded by severity from 1 for minimal injury (eg, tangential wound
to the pancreas) to 5 for maximal injury (eg, pancreatic proximal
duct disruption). The severity grade is multiplied by the risk factor;
the final penetrating score is obtained by summing the individual
organ scores.

27. PHYSIOLOGICAL SCORES

28. GLASGOW COMA SCORE
• The Glasgow Coma Scale (GCS) is the standard measure used to
quantify level of consciousness in head injured patients.
• GCS is composed of three parameters :
• Best Eye Response (4,)Best Verbal Response (5),Best Motor Response
(6)
• A GCS of:
• 13 or higher correlates with a mild brain injury
• 9 to 12 is a moderate injury
• 8 or less a severe brain injury

30. CONS OF GCS
• It does not take into account
• focal or lateralizing signs
• diffuse metabolic processes
• intoxication

31. Revised Trauma Score (RTS)
• Variables
• Glasgow Coma Scale (GCS)
• systolic blood pressure
• respiratory rate
• Interpretation:
• The magnitude of derangement in each parameter is scored from 0-4
• RTS <4 proposed for transfer of the patient to trauma centre
• Cons:
• can underestimate injury severity in patients injured in one system

32. 0003
11-51-494-5
26-950-756-8
3>2976-899-12
410-29>8913-15
RTS
Value
Respiratory
Rate
(RR)
Systolic Blood
Pressure
(SBP)
Glasgow
Coma Scale
(GCS)

33. APACHE II
• APACHE II ("Acute Physiology and Chronic Health
Evaluation II") is a severity-of-disease classification system
(Knaus et al., 1985),[1].
• An integer score from 0 to 71 is computed based on
several measurements

34. • Components:
(acute physiology score) + (age points) + (chronic health
points)

35. CALCULATION OF APS
1. PaO2 (depending on FiO2)
• 2.Temperature (rectal)
• 3.Mean arterial pressure
• 4.pH arterial
• 5.Heart rate

36. 6.Respiratory rate
7.Sodium (serum)
8.Potassium (serum)
9.Creatinine
10.Hematocrit
11.White blood cell count
12.Glasgow Coma Scale

37. COMBINED SCORES

38. TRISS
TRAUMA SCORE - INJURY SEVERITY SCORE
• The TRISS determines the probability of survival using the
variables:
• ISS
• RTS
• Patient's age (Age Index)

39. CALCULATION
• TRISS determines the probability of survival (Ps) of a patient from the ISS and RTS
using the following formulae:
• Where 'b' is calculated from:

40. b0 to b3 are coefficients which are different for blunt and penetrating
trauma.

41. ASCOT
A SEVERITY CHARACTERIZATION OF TRAUMA
• ASCOT uses the AP in place of the ISS and categorizes age
into deciles. In addition, changes include the individual
components of the coded RTS were included as
independent predictors in the final logistic regression
model.

42. INTERNATIONAL CLASSIFICATION OF DISEASES
(ICD-9) INJURY SEVERITY SCORE (ICISS)
• ICISS utilizes the ICD-9 codes assigned to each patient to calculate a severity of
injury score. Measured survival risk ratios are assigned to all ICD-9 trauma codes.
The ICISS is based on ICD-9 Clinical Modification (CM) codes (800-989, excluding
burns [940-949], late effects of injury [905-909.9], and unspecified injury [959-
959.9])
• The simple product of all such survival risk ratios for an individual patient's injuries
have been found to predict outcome more accurately than ISS
• ICISS = (SRR)injury1 x (SRR)injury2 x (SRR)injury3 X (SRR)injury4…

43. CRAMS
• The five components measured: Circulation, Respiration,
Abdomen, Motor, and Speech.
• Major trauma <8

45. THANK YOU

46. EMERGENCY TRAUMA SCORE (EMTRAS) PHY
Raum et al developed the emergency trauma score (EMTRAS), which
uses parameters that are available within 30 minutes, does not
require knowledge of anatomic injuries,
EMTRAS comprises 4 parameters: patient age, Glasgow Coma Scale,
base excess, and prothrombin time (PT).
SCORE AGE GCS BASE
EXCESS
PT
0 <40 13-15 >-1 <80%
1 40-60 10-12 -5 TO -1 80-50%
2 60-75 6-9 -10 TO -5 20-50%
3 >75 3-5 < -10 >20%

47. SEQUENTIAL ORGAN FAILURE ASSESSMENT SCORE
(SOFA) PHY
The sequential organ failure assessment (SOFA) score is a scoring
system to determine the extent of a person's organ function or the
rate of failure in critically ill patients.
The score is based on 6 different parameters, as follows: respiratory
system (PaO2/FiO2, mm Hg), cardiovascular system (blood
pressure/vasopressors), hepatic system (bilirubin, mg/dL), coagulation
system (plateletsX103/mm3), renal system (creatinine, mg/dL), and
neurological system (Glasgow Coma Scale).

48. TRAUMA MORTALITY PREDICTION MODEL (TMPM-ICD9)
AN
• A new ICD-9 -based injury model was proposed that replaces the simple ratio
measurements with empiric measures of injury severity based on regression
modelling. Because TMPM-ICD9 (like ICISS) is based on nearly universally
available ICD-9 CM codes, it can be used by virtually any hospital caring for
trauma patients to adjust for case-mix

49. MANGLED EXTREMITY SEVERITY SCORE
• Described by Johansen et al (1990)
• Components include:
• Skeletal / soft-tissue injury
• Limb ischemia
• Shock
• Age
• Interpretation:
• a MESS score of greater than or equal to 7 had a 100% predictable value for
amputation

50. SKELETAL / SOFT-TISSUE INJURY
• Low energy (stab; simple fracture; pistol gunshot wound): 1
• Medium energy (open or multiple fractures, dislocation): 2
• High energy (high speed MVA or rifle GSW): 3
• Very high energy (high speed trauma + gross contamination): 4
• LIMB ISCHEMIA
• Pulse reduced or absent but perfusion normal: 1*
• Pulseless; paresthesias, diminished capillary refill: 2*
• Cool, paralyzed, insensate, numb: 3*
• * Score doubled for ischemia > 6 hours

51. SHOCK
• Systolic BP always > 90 mm Hg: 0
• Hypotensive transiently: 1
• Persistent hypotension: 2
• AGE ( YEARS )
< 30: 0
30-50: 1
> 50: 2