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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2021 | Original research

The definition of major trauma using different revisions of the abbreviated injury scale

Authors: Jan C. Van Ditshuizen, Charlie A. Sewalt, Cameron S. Palmer, Esther M. M. Van Lieshout, Michiel H. J. Verhofstad, Dennis Den Hartog, Dutch Trauma Registry Southwest

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2021

Abstract

Background

A threshold Injury Severity Score (ISS) ≥ 16 is common in classifying major trauma (MT), although the Abbreviated Injury Scale (AIS) has been extensively revised over time. The aim of this study was to determine effects of different AIS revisions (1998, 2008 and 2015) on clinical outcome measures.

Methods

A retrospective observational cohort study including all primary admitted trauma patients was performed (in 2013–2014 AIS98 was used, in 2015–2016 AIS08, AIS08 mapped to AIS15). Different ISS thresholds for MT and their corresponding observed mortality and intensive care (ICU) admission rates were compared between AIS98, AIS08, and AIS15 with Chi-square tests and logistic regression models.

Results

Thirty-nine thousand three hundred seventeen patients were included. Thresholds ISS08 ≥ 11 and ISS15 ≥ 12 were similar to a threshold ISS98 ≥ 16 for in-hospital mortality (12.9, 12.9, 13.1% respectively) and ICU admission (46.7, 46.2, 46.8% respectively). AIS98 and AIS08 differed significantly for in-hospital mortality in ISS 4–8 (χ² = 9.926, p = 0.007), ISS 9–11 (χ² = 13.541, p = 0.001), ISS 25–40 (χ² = 13.905, p = 0.001) and ISS 41–75 (χ² = 7.217, p = 0.027). Mortality risks did not differ significantly between AIS08 and AIS15.

Conclusion

ISS08 ≥ 11 and ISS15 ≥ 12 perform similarly to a threshold ISS98 ≥ 16 for in-hospital mortality and ICU admission. This confirms studies evaluating mapped datasets, and is the first to present an evaluation of implementation of AIS15 on registry datasets. Defining MT using appropriate ISS thresholds is important for quality indicators, comparing datasets and adjusting for injury severity.

Level of evidence

Prognostic and epidemiological, level III.

Available only for authorised users

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Title: The definition of major trauma using different revisions of the abbreviated injury scale
Authors: Jan C. Van Ditshuizen
Charlie A. Sewalt
Cameron S. Palmer
Esther M. M. Van Lieshout
Michiel H. J. Verhofstad
Dennis Den Hartog
Dutch Trauma Registry Southwest
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2021
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/s13049-021-00873-7

At a glance: The STEP trials

Springer Medicine

The definition of major trauma using different revisions of the abbreviated injury scale

Abstract

Background

Methods

Results

Conclusion

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Level of evidence

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