The Injury Severity Score – importance and uses

Department of Epidemiology, Technion, and the Rambam Medical Center, Haifa, Israel.
Annals of Epidemiology (Impact Factor: 2). 12/1995; 5(6):440-6. DOI: 10.1016/1047-2797(95)00059-3
Source: PubMed


The development and attributes of the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) are reviewed. The ISS was proved to be an excellent method for retrospective comparison of overall injury data between populations differing in time or space. Its strengths, purpose, and appropriate uses are emphasized, together with specific comments on statistical analyses and combined scales of anatomic and physiologic injury.

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    • "Clinical data will be prospectively recorded at the time of enrollment and until study day 28, hospital discharge, or death. We will collect data on baseline patient demographics; past history; indication for damage control laparotomy; injury or illness severity scores (Acute Physiology and Chronic Health Evaluation-II [APACHE-II] [63]; Sequential Organ Failure Assessment [SOFA] [64], and Injury Severity Score [ISS] [65,66]); fluid balance; need for renal replacement therapy and the Risk, Injury, Failure, Loss, and End-stage-kidney-disease (ESKD) (RIFLE) criteria for acute renal dysfunction [67]; and patient physiology (arterial pH, base deficit, and lactate levels; oxygenation indices and partial pressure of arterial oxygen [PaO2]/fraction of inspired oxygen [FIO2] ratios; and gastric residual volumes). IAP will also be measured via an indwelling bladder catheter as recommended by the World Society of the Abdominal Compartment Syndrome (WSACS) [68] every 6 h while the abdomen is open and every 12 h once it has been closed. "
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    ABSTRACT: BackgroundDamage control laparotomy, or abbreviated initial laparotomy followed by temporary abdominal closure (TAC), intensive care unit resuscitation, and planned re-laparotomy, is frequently used to manage intra-abdominal bleeding and contamination among critically ill or injured adults. Animal data suggest that TAC techniques that employ negative pressure to the peritoneal cavity may reduce the systemic inflammatory response and associated organ injury. The primary objective of this study is to determine if use of a TAC dressing that affords active negative pressure peritoneal therapy, the ABThera Open Abdomen Negative Pressure Therapy System, reduces the extent of the systemic inflammatory response after damage control laparotomy for intra-abdominal sepsis or injury as compared to a commonly used TAC method that provides potentially less efficient peritoneal negative pressure, the Barker’s vacuum pack.Methods/DesignThe Intra-peritoneal Vacuum Trial will be a single-center, randomized controlled trial. Adults will be intraoperatively allocated to TAC with either the ABThera or Barker’s vacuum pack after the decision has been made by the attending surgeon to perform a damage control laparotomy. The study will use variable block size randomization. On study days 1, 2, 3, 7, and 28, blood will be collected. Whenever possible, peritoneal fluid will also be collected at these time points from the patient’s abdomen or TAC device. Luminex technology will be used to quantify the concentrations of 65 mediators relevant to the inflammatory response in peritoneal fluid and plasma. The primary endpoint is the difference in the plasma concentration of the pro-inflammatory cytokine IL-6 at 24 and 48 h after TAC dressing application. Secondary endpoints include the differential effects of these dressings on the systemic concentration of other pro-inflammatory cytokines, collective peritoneal and systemic inflammatory mediator profiles, postoperative fluid balance, intra-abdominal pressure, and several patient-important outcomes, including organ dysfunction measures and mortality.DiscussionResults from this study will improve understanding of the effect of active negative pressure peritoneal therapy after damage control laparotomy on the inflammatory response. It will also gather necessary pilot information needed to inform design of a multicenter trial comparing clinical outcomes among patients randomized to TAC with the ABThera versus Barker’s vacuum pack.Trial identifier
    Full-text · Article · May 2013 · Trials
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    • "With regard to ICISS, there is limited evidence on the validation and performance of this scoring method with ICD10 classification of injuries [33-35]. Although there is no consensus on the 'best' method for defining injury severity, the ISS as developed by the American Association for the Advancement of Automotive Medicine remains the 'gold standard', most reliable and extensively used measure of injury severity and ' a cornerstone of injury epidemiology' [31,32,36,37]. The ISS characterises the likely threat to life from injury and is widely used in hospital trauma registries to characterise their activity and performance. "
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    ABSTRACT: Serious injuries have been stated as a public health priority in the UK. However, there appears to be a lack of information on population-based rates of serious injury (as defined by a recognised taxonomy of injury severity) at national level from either official statistics or research papers. We aim to address this through a search and review of literature primarily focused within the UK and Europe. The review summarizes research papers on the subject of population based injury epidemiology published from 1970 to 2008. We examined critically methodological approaches in measuring injury incident rates including data sources, description of the injury pyramid, matching numerator and denominator populations as well as the relationship between injury and socioeconomic status. National representative rates come from research papers using official statistics sources, often focusing on mortality data alone. Few studies present data from the perspective of an injury pyramid or using a standardized measure of injury severity, i.e. Injury Severity Score (ISS). The population movement that may result in a possible numerator - denominator mismatch has been acknowledged in five research studies and in official statistics. The epidemiological profile shows over the past decades in UK and Europe a decrease in injury death rates. No major trauma population based rates are available within well defined populations across UK over recent time periods. Both fatal and non-fatal injury rates occurred more frequently in males than females with higher rates in males up to 65 years, then in females over 65 years. Road traffic crashes and falls are predominant injury mechanisms. Whereas a straightforward inverse association between injury death rates and socio-economic status has been observed, the evidence of socioeconomic inequalities in non-fatal injuries rates has not been wholly consistent. New methodological approaches should be developed to deal with the study design inconsistencies and the knowledge gaps identified across this review. Trauma registries contain injury data from hospitals within larger regions and code injury by Abbreviated Injury Scale enabling information on severity; these may be reliable data sources to improve understanding of injury epidemiology.
    Full-text · Article · Feb 2009 · BMC Public Health
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    ABSTRACT: To investigate the occurrence and severity of agitation in patients after severe traumatic brain injury (TBI), to identify predictors of agitation and to study interrater reliability for a translated version of the Agitated Behavior Scale (ABS). Prospective observational study. From November 1, 2006, through October 2007, 46 consecutive patients with TBI were included in the early rehabilitation phase following neurosurgical intervention. Agitated behavior was assessed by the ABS, which was implemented in clinical practice. Logistic regression analysis identified predictors of agitated behavior and Intra Class Correlation was used to analyze reliability. Agitated behavior occurred in 41% of patients, of whom one third exhibited severely agitated behavior. The interrater reliability between three nurses was good to excellent. Using ABS as a tool in care of patients with agitated behavior may be effective through working as a common language. We recommend the use of ABS as a routine assessment in early rehabilitation of patients with TBI.
    Full-text · Article · May 2013 · Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses
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