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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 4/2014

01-08-2014 | Original Article

Proper coding of the Abbreviated Injury Scale: can clinical parameters help as surrogates in estimating blood loss?

Authors: M. Burkhardt, J. H. Holstein, P. Moersdorf, A. Kristen, R. Lefering, T. Pohlemann, A. Pizanis, TraumaRegister DGU

Published in: European Journal of Trauma and Emergency Surgery | Issue 4/2014

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Abstract

Purpose

The Abbreviated Injury Scale (AIS) requires the estimation of the lost blood volume for some severity assignments. This study aimed to develop a rule of thumb for facilitating AIS coding by using objective clinical parameters as surrogate markers of blood loss.

Methods

Using the example of pelvic ring fractures, a retrospective analysis of TraumaRegister DGU® data from 2002 to 2011 was performed. As potential surrogate markers of blood loss, we recorded the hemoglobin (Hb) level, systolic blood pressure (SBP), base excess (BE), Quick’s value, units of packed red blood cells (PRBCs) transfused before intensive care unit (ICU) admission, and mortality within 24 h.

Results

We identified 11,574 patients with pelvic ring fractures (Tile/OTA classification: 39 % type A, 40 % type B, 21 % type C). Type C fractures were 73.1 % AISpelvis 4 and 26.9 % AISpelvis 5. Type B fractures were 47 % AISpelvis 3, 47 % AISpelvis 4, and 6 % AISpelvis 5. In type C fractures, cut-off values of <7 g/dL Hb, <90 mmHg SBP, <−9 mmol/L BE, <35 % Quick’s value, >15 units PRBCs, and death within 24 h had a positive predictive value of 47 % and a sensitivity of 62 % for AISpelvis 5. In type B fractures, these cut-off values had poor sensitivity (48 %) and positive predictive value (11 %) for AISpelvis 5.

Conclusions

We failed to develop a rule of thumb for facilitating a proper future AIS coding using the example of pelvic ring fractures. The estimation of blood loss for severity assignment still remains a noteworthy weakness in the AIS coding of traumatic injuries.
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Metadata
Title
Proper coding of the Abbreviated Injury Scale: can clinical parameters help as surrogates in estimating blood loss?
Authors
M. Burkhardt
J. H. Holstein
P. Moersdorf
A. Kristen
R. Lefering
T. Pohlemann
A. Pizanis
TraumaRegister DGU
Publication date
01-08-2014
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 4/2014
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-013-0335-x

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