NCEPOD: Trauma - Who Cares? - London Health Programmes

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APPENDIX B - Injury severity scoreAbbreviated Injury ScaleThe Abbreviated Injury Scale (AIS) is an anatomical scoringsystem fi rst introduced in 1969. Injuries are ranked on a scaleof 1 to 6, with 1 being minor, 4 severe and 6 an unsurvivableinjury. This represents the ‘threat to life’ associated withan injury and is not meant to represent a comprehensivemeasure of severity. The AIS is not an injury scale, in that thedifference between AIS1 and AIS2 is not the same as thatbetween AIS4 and AIS5.Injury Severity ScoreThe Injury Severity Score (ISS) is an anatomical scoringsystem that provides an overall score for patients withmultiple injuries. Each injury is assigned an AbbreviatedInjury Scale (AIS) score and is allocated to one of six bodyregions (Head, Face, Chest, Abdomen, Extremities (includingPelvis), External). Only the highest AIS score in each bodyregion is used. The three most severely injured body regionshave their score squared and added together to produce theISS score.AIS ScoreInjuryAn example of the ISS calculation is shown below:1 Minor2 Moderate3 Serious4 Severe5 Critical6 UnsurvivableRegionInjuryDescriptionAISSquareTopThreeHead & Neck Cerebral Contusion 3 9Face No Injury 0Chest Flail Chest 4 16AbdomenMinor Contusion of2Liver Complex5 25Rupture SpleenExtremity Fractured femur 3External No Injury 0Injury Severity Score: 50The ISS score takes values from 0 to 75. If an injury isassigned an AIS of 6 (unsurvivable injury), the ISS scoreis automatically assigned to 75. The ISS score correlateslinearly with mortality, morbidity, hospital stay and othermeasures of severity.Tables and information taken from http://www.trauma.org/scores/ais.html and http://www.trauma.org/scores/iss.html134
CAPPENDIX C -Adult and paediatric Glasgow Coma ScaleAdult and paediatricGlasgow Coma ScaleThe Glasgow Coma Scale and Coma Score (GCS)Table Glasgow Coma Scale and Score (Adults)For clarity the Glasgow Coma Scale and Glasgow ComaScore are described below.The Glasgow Coma Scale provides a framework fordescribing the state of a patient in terms of three aspectsof responsiveness: eye opening, verbal response, and bestmotor response, each stratifi ed according to increasingimpairment. In the fi rst description of the Scale for generaluse, the motor response had only fi ve options, with nodemarcation between ‘normal’ and ‘abnormal’ fl exion.The distinction between these movements can be diffi cultto make consistently and is rarely useful in monitoringan individual patient but is relevant to prognosis and is,therefore, part of an extended six option scale used toclassify severity in groups of patients.The Glasgow Coma Score is an artifi cial index; obtained byadding scores for the three responses. The notation for thescore was derived from the extended scale, incorporatingthe distinction between normal and abnormal fl exionmovements, producing a total score of 15. This score canprovide a useful single fi gure summary and a basis forsystems of classifi cation, but contains less information thana description separately of the three responses.FeatureEyeopeningVerbalresponseBest motorresponseScale responsesSpontaneousTo speechTo painNoneOrientatedConfused conversationWords (inappropriate)Sounds (incomprehensible)NoneObey commandsLocalise painFlexion - Normal- AbnormalExtendNoneScorenotation432154321654321Total coma score 3/15 - 15/15The three responses of the coma scale, not the total score,should therefore be of use in describing, monitoring andexchanging information about individual patients.135
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Trauma: Who cares?A report of the N
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ContentsAcknowledgements 4Foreword
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AcknowledgementsThis is the twenty
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AcknowledgementsThe organisations t
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ForewordSevere injury - a car crash
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Summary of fi ndingsThis study show
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Principal recommendationsOrganisati
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IntroductionTrauma remains the four
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IntroductionReferences1. Chaira 0,
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MethodQuestionnaires and casenotesT
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MethodQuality and confidentialityA
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CHAPTER 1 - Data overviewFigure 2.
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CHAPTER 1 - Data overviewMode of ar
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CHAPTER 2 - Organisational dataTabl
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CHAPTER 3 - Overall assessmentAll c
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CHAPTER 3 - Overall assessmentKey f
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CHAPTER 4 - Prehospital careRespons
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CHAPTER 4 - Prehospital careFigure
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CHAPTER 4 - Prehospital careTranspo
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CHAPTER 4 - Prehospital careAdequac
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CHAPTER 4 - Prehospital careIn 40/5
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CHAPTER 4 - Prehospital carecaused
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CHAPTER 5 - Hospital receptionIntro
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CHAPTER 5 - Hospital receptionTable
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CHAPTER 5 - Hospital receptionTraum
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CHAPTER 5 - Hospital receptionTable
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CHAPTER 5 - Hospital receptionThese
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CHAPTER 5 - Hospital receptionOvera
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CHAPTER 6 - Airway and breathingInt
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CHAPTER 6 - Airway and breathingFig
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CHAPTER 6 - Airway and breathingFig
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CHAPTER 6 - Airway and breathingTab
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CHAPTER 7 - Management of circulati
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Page 114 and 115: CHAPTER 9 - Paediatric careOrganisa
Page 116 and 117: CHAPTER 9 - Paediatric careClinical
Page 118 and 119: CHAPTER 9 - Paediatric careKey find
Page 120 and 121: CHAPTER 10 - TransfersIntroductionM
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Page 126 and 127: CHAPTER 10 - TransfersKey findingsR
Page 128 and 129: CHAPTER 11 -Incidence of trauma and
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Page 140 and 141: APPENDIX D - An example of an excel
Page 142 and 143: APPENDIX E - Level 1 trauma careAs
Page 144 and 145: APPENDIX F - ParticipationTrustCase
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Page 152: Published November 2007 by the Nati
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