Anahita Dua, Sapan S. Desai, John B. Holcomb, Andrew R. Burgess and Julie Ann Freischlag (eds.)Clinical Review of Vascular Trauma201410.1007/978-3-642-39100-2_4
© Springer-Verlag Berlin Heidelberg 2014
4. Vascular Scoring Systems
(1)
Department of Trauma, Duke University Medical Center, Durham, NC, USA
Abstract
An appreciation of various trauma scoring systems and an understanding of their specific application to gauging vascular injuries can help predict morbidity and mortality. A patient’s injuries can thereby be better prioritized when working with a multidisciplinary team of trauma, orthopedic, and vascular surgeons. The basis for most scoring systems is the Abbreviated Injury Score (AIS), which ranks injuries from 1 (minor) to 6 (unsurvivable). An anatomically derived scoring system, the Injury Severity Score (ISS), uses the AIS and assigns scores to one of six body regions. The limitation of both scoring systems is that they do not properly take into account orthopedic and vascular injuries. Despite efforts from multiple centers, there is not yet a concise scoring system that incorporates the full range of general trauma, orthopedic, and vascular injuries to predict outcomes. Using a combination of AIS, ISS, the Revised Trauma Score, Glasgow Coma Scale, and clinical judgment in the context of working as a multidisciplinary team may be the best management strategy when caring for the polytrauma patient.
4.1 Introduction
Trauma scoring systems have been developed for tracking outcomes and developing standards in trauma centers. These standards allow groups like the American College of Surgeons Committee on Trauma (COT) to help develop measure and compare outcomes at trauma centers during the verification process. Injuries are applied to various scoring systems, and the predicted outcomes are measured against the actual outcomes to validate the scoring systems utilized. When applied to patients with concomitant vascular trauma, these scoring systems are poor predictors of outcome.
4.2 Abbreviated Injury Score
The Abbreviated Injury Score (AIS) is the basis from which most other trauma scoring systems are derived. First introduced in 1969 and updated in 1990, this anatomically oriented scoring system was developed by Copes et al. [1]. Injuries are scaled from one to six, with one being minor injuries, five being severe injuries, and six being unsurvivable trauma. The AIS forms the basis for other trauma scoring systems, such as the Injury Severity Score (ISS).
4.3 Injury Severity Score
The Injury Severity Score (ISS) uses the AIS to assign points to six body regions: the head and neck, the face, the chest, the abdomen, the extremities, and the external regions. The top three scores are squared and added together, the sum of which equals the ISS. A score of 6 in any body region leads to an automatic total score of 75 no matter what the other body systems add up to; the overall range of scores falls between 0 and 75. The ISS has a positive correlation to overall morbidity and mortality and length of stay. However, this correlation falters in patients who have concomitant vascular injuries.
A specific organ injury scale (OIS) also exists for a variety of body systems. In general, the more severe the laceration, hematoma, or overall injury to the organ, the greater the score that is assigned. Grade I injuries are relatively minor, while grade V injuries may be lethal. Nonoperative, endovascular, and open surgical management decisions are occasionally based on the grade of injury to a particular organ system.
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