05 introduction to injury scoring systems

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  • Injury severity characterization formally began in 1969, with the development of the Abbreviated Injury Scale (AIS).
  • Teasdale and Jennet initially published the Glasgow Coma Scale in 1974 and later modified in1976 to include withdrawal as part of the motor component.
  • The RTS is heavily weighted towards the Glasgow Coma Scale to compensate for major head injury without multisystem injury or major physiological changes.
  • The main advantage of the coded RTS is that the weighting of the individual components emphasizes the significant impact of traumatic brain injury on outcome.
  • An RTS of less than 11 is used to indicate the need for transport to a designated trauma center.
  • Champion HR et al, "A Revision of the Trauma Score", J Trauma 29:623-629,1989 Champion HR et al, "Trauma Score", Crit Care Med 9:672-676,1981
  • The Acute Physiology and Chronic Health Evaluation (APACHE) was introduced in 1981, is widely used for the assessment of illness severity in intensive care units.
  • In 1985, the APACHE system was revised (APACHE II) by reducing the number of APS variables to 12 (from 34), restricting the co morbid conditions, and deriving coefficients for specific diseases. APACHE II is the most widely applied APACHE system.
  • 05 introduction to injury scoring systems

    1. 1. Introduction to Injury Scoring Systems Part 1- Physiologic Scores Amado Alejandro Báez MD MSc
    2. 2. About the Author <ul><li>Dr. Amado Alejandro Báez MD MSc initiated his involvement with trauma and injuries while working as an Emergency medical Services provider in Santo Domingo Dominican Republic in the early 1990’s. After graduating from medical school at the Universidad Nacional Pedro Henriquez Ureña, he furthered his studies with graduate education in Emergency medical services, Public health and Clinical Research. </li></ul>
    3. 3. Learning Objectives <ul><li>To understand the basic principles of injury scoring. </li></ul><ul><li>To review the principal physiological injury scoring systems. </li></ul><ul><li>The review basic r applications of these systems. </li></ul>
    4. 4. Performance Objectives <ul><li>At the end of this module to participant will be able to: </li></ul><ul><li>Apply basic principles of injury scoring in clinical and research scenarios. </li></ul><ul><li>Understand literature containing injury scoring systems. </li></ul>
    5. 5. Introduction <ul><li>Scoring systems used in Trauma can be classified into: </li></ul><ul><ul><li>Physiologic such as the Trauma Score, and Glasgow Coma Scale. </li></ul></ul><ul><ul><li>Anatomical such as the Abbreviated Injury Scale and the Injury Severity Score </li></ul></ul><ul><ul><li>Combined score such as the TRISS method and ASCOT </li></ul></ul>
    6. 6. PHYSIOLOGIC SCORES <ul><li>The Revised Trauma Score (RTS) </li></ul><ul><li>Glasgow Coma Scale (GCS) </li></ul><ul><li>The Acute Physiology and Chronic Health Evaluation (APACHE) </li></ul>
    7. 7. Glasgow Coma Score <ul><li>The Glasgow Coma Scale (GCS) is the standard measure used to quantify level of consciousness in head injured patients. </li></ul><ul><li>Widely used in scoring systems, treatment protocols and general clinical decision-making in critically ill patients. </li></ul>Teasdale G., Jennett B., LANCET (ii) 81-83, 1974.
    8. 8. Glasgow Coma Score <ul><li>The GCS is scored between 3 and 15, 3 being the worst, and 15 the best. </li></ul><ul><li>GCS is composed of three parameters : Best Eye Response, Best Verbal Response, Best Motor Response. </li></ul><ul><li>  A GCS of 13 or higher correlates with a mild brain injury, 9 to 12 is a moderate injury and 8 or less a severe brain injury. </li></ul>
    9. 9. Glasgow Coma Score <ul><li>Best Eye Response. (4) </li></ul><ul><li>No eye opening => 1 </li></ul><ul><li>Eye opening to pain => 2 </li></ul><ul><li>Eye opening to verbal command => 3 </li></ul><ul><li>Eyes open spontaneously => 4 </li></ul>
    10. 10. Glasgow Coma Score <ul><li>Best Motor Response. (6) </li></ul><ul><li>No motor response => 1 </li></ul><ul><li>Extension to pain=> 2 </li></ul><ul><li>Flexion to pain=> 3 </li></ul><ul><li>Withdrawal from pain=> 4 </li></ul><ul><li>Localizing pain=> 5 </li></ul><ul><li>Obeys Commands=> 6 </li></ul>
    11. 11. Glasgow Coma Score <ul><li>Best Verbal Response. (5) </li></ul><ul><li>No verbal response => 1 </li></ul><ul><li>Incomprehensible sounds => 2 </li></ul><ul><li>Inappropriate words => 3 </li></ul><ul><li>Confused => 4 </li></ul><ul><li>Orientated => 5 </li></ul>
    12. 12. The Revised Trauma Score <ul><li>RTS utilizes 3 physiologic parameters: </li></ul><ul><ul><ul><ul><li>Glasgow Coma Scale (GCS) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Systemic blood pressure (SBP) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Respiratory rate (RR) </li></ul></ul></ul></ul><ul><li>The RTS has been used in the out-of-hospital setting as a tool for trauma center triage. </li></ul><ul><li>The RTS has also been used as a prognostic tool for survival. </li></ul>
    13. 13. The Revised Trauma Score <ul><li>Two types of RTS: </li></ul><ul><ul><li>1.Triage RTS: Determined by adding each of the coded values together. </li></ul></ul><ul><ul><li>2.The coded form of the RTS is more frequently used for quality assurance and outcome prediction. The coded RTS is calculated as follows: </li></ul></ul><ul><ul><ul><li>RTSc = 0.7326 SBPc + 0.2908 RRc + 0 .9368 GCSc </li></ul></ul></ul>
    14. 14. The Revised Trauma Score 0 0 0 3 1 1-5 1-49 4-5 2 6-9 50-75 6-8 3 >29 76-89 9-12 4 10-29 >89 13-15 RTS Value Respiratory Rate (RR) Systolic Blood Pressure (SBP) Glasgow Coma Scale (GCS)
    15. 16. The Acute Physiology and Chronic Health Evaluation <ul><li>APACHE has two components: </li></ul><ul><ul><li>The chronic health evaluation, which incorporates the influence of comorbid conditions (such as diabetes and cirrhosis) </li></ul></ul><ul><ul><li>Acute Physiology Score (APS). </li></ul></ul>
    16. 17. The Acute Physiology and Chronic Health Evaluation <ul><li>The APS consists of weighted variables representing the major physiologic systems, including neurological, cardiovascular, respiratory, renal, gastrointestinal, metabolic, and hematological variables. </li></ul>
    17. 18. Web Based Resources <ul><li>http://www. cdc . gov / ncipc / </li></ul><ul><li>CDC’s The National Center for Injury Prevention and Control (NCIPC) </li></ul><ul><li>http://www. carcrash .org/ </li></ul><ul><li>Association for the Advancement of Automotive Medicine. An international multidisciplinary organization for crash injury control </li></ul><ul><li>http://www. injurycontrol .com/ icrin / </li></ul><ul><li>Injury Control Resource Information Network </li></ul>
    18. 19. Web Based Resources <ul><li>http://www. jhsph . edu /Research/Centers/CIRP/ </li></ul><ul><li>The Johns Hopkins Center for Injury Research & Policy </li></ul><ul><li>http://www.trauma.org </li></ul><ul><li>A British web-based trauma resource center </li></ul><ul><li>http://www.trauma.org/scores/ rtscalc .html </li></ul><ul><ul><li>Revised Trauma Score Calculator from trauma.org </li></ul></ul>

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