2. Injury coding performed centrally at TARN
Ensuring coding uniformity
Coders check injury descriptions & imaging reports
Abbreviated Injury Scale dictionary (AIS2005) used
Every submission assigned an Injury Severity Score (ISS)
>70,000 submissions per year coded
Injury Coding
3. Abbreviated Injury Scale: AIS
THE Internationally recognised system for injury scoring
Produced by AAAM (Association for the Advancement of Automotive Medicine) in U.S.A
Introduced in 1970, originally for Vehicle Crash investigators
Latest version: AIS2005 >2000 injury descriptors
Anatomically based system, ranking injuries according to severity
on a 6 point ordinal scale
4. AIS: 6 point severity scale
AIS
(Severity)
Grade Injury example
1 Minor Bruise to abdomen
2 Moderate Small Liver laceration
3 Serious Liver laceration with >1 litre of blood loss
4 Severe Ruptured liver
5 Critical Liver laceration involving hepatic vessels
6 Maximum Avulsed liver
5. AIS Severity indicates
The relative risk of “threat to life”
in an average person
who sustains the coded injury
as his or her only injury
It’s not a disability scale
8. AIS: Spinal Injuries
Cervical Spine (C1-C7)
Thoracic Spine (T1-T12)
Lumbar spine (L1-L5)
Severity can be affected by location of spinal injury
9. AIS: Confirmed injuries only
Suspected injuries
Possible injuries
Probable injuries
Ruled out injuries
10. AIS: Not Coded
Infections
Pneumonia
Death
Blindness
Miscarriage
Epilepsy following head injury
Pulmonary embolism following skeletal injury
Don’t affect Severity score
11. NFS: Not Further Specified
This appears throughout the AIS dictionary &
allows the coding of injuries when detailed
information is lacking
Example:
Injury description = Liver laceration
Coded as: 541820.2 (Liver laceration NFS)
12. AIS 6: Maximum score
AIS 6 not used just because a patient dies!
Has to be documented medical evidence of an
AIS 6 injury
13. AIS 6: Maximum score
Head or Neck
Brain stem: laceration, crush, penetrating or transection
C3 or higher complete cord transection or contusion
Sigmoid or Transverse sinus or Internal carotid artery: Bilateral lacerations
Thorax
Heart: rupture, multiple lacerations or avulsion
Total chest crush
Aortic rupture + haemorrhage not confined to mediastinum
Bilateral pulmonary artery or vein transection
Severe inhalation
Abdominal & Pelvic contents
Liver avulsion
External
2nd or 3rd degree burns > 90% Total Body Surface
Massive Whole body Explosion type injury
14. AIS: Localisers
2 additional localiser codes, allow coding of:
Localiser 1 Side or aspect of an injury
e.g. Right, left, Upper, Temporal, Frontal
Localiser 2 Actual Site of an injury
e.g. 5th rib, 12th Thoracic vertebrae, 2nd toe
Numerical identifier Severity Localiser 1 Localiser 2
17. Spiral Fracture of left Shaft of Femur 147
Open Comminuted fracture to Tibial Shaft 149
Vertical Shear fracture to left side of pelvis with blood loss
>20%
159
5 ribs fractured on left 82
Subdural haematoma bilateral & 2cm thick on both sides 46
Base of skull fracture 49
Full thickness Rectal laceration 95
853251.3
854272.3
856173.5
450203.3
140655.5
150200.3
543624.3
EXAMPLE SUBMISSION 1: INJURIES Page AIS code
22. Head Subdural haematoma bilateral & 2cm thick on both
sides
140655.5
Base of skull fracture 150200.3
Thorax 5 ribs fractured on left 450203.3
Abdomen Full thickness Rectal laceration 543624.3
Extremities Spiral Fracture of left Shaft of Femur 853251.3
Vertical Shear fracture to left side of pelvis with blood
loss >20%
856173.5
Open Comminuted fracture to Tibial Shaft 854272.3
24. Head Subdural haematoma bilateral & 2cm thick on both sides 140655.5
Base of skull fracture 150200.3
Thorax 5 ribs fractured on left 450203.3
Abdomen Full thickness Rectal laceration 543624.3
Extremities Spiral Fracture of left Shaft of Femur 853251.3
Vertical Shear fracture to left side of pelvis with blood loss >20% 856173.5
Open Comminuted fracture to Tibial Shaft 854272.3
5² =25
5² = 25
3² =9
3² =9
25. Calculating the ISS: Step 4
Code individual injuries
Identify the highest score in each body area
Square the highest score in each body area
Add together the highest AIS2 from 3 different body areas
26. Head Subdural haematoma bilateral & 2cm thick on both sides 140655.5
Base of skull fracture 150200.3
Thorax 5 ribs fractured on left 450203.3
Abdomen Full thickness Rectal laceration 543624.3
Extremities Spiral Fracture of left Shaft of Femur 853251.3
Vertical Shear fracture to left side of pelvis with blood loss >20% 856173.5
Open Comminuted fracture to Tibial Shaft 854272.3
5² =25
5² = 25
3² =9
3² =9
28. Body area Injury AIS code
Head Closed vault fracture 150402.2
Thorax 5+6 ribs fractured on left 450202.2
ISS = 8
Injury Severity Score (ISS)
2² = 4
2² = 4
29. Injury Severity Score (ISS)
Ranges from 1 to 75
Maximum 75 achieved in 2 ways:
1. Severity 5 in 3 different body areas
52 + 52 + 52 = 75
2. ISS convention:
AIS = 6 in any body area, ISS = 75
30. Importance of Injury Detail
Length, depth or Grade of lacerations (especially to internal organs)
Depth, size and location of haemorrhages and contusions (especially in the brain)
Open or Closed fractures
Stability & site of Fractures (e.g. Comminuted/Displaced Shaft/Proximal/Distal fracture)
Articular (joint) involvement (e.g. Intra-articular, extra-articular)
Blood loss
Vessel damage
Location & number of rib fractures
Compression or effacement of ventricles/brain stem cisterns
Neurology associated with spinal cord injuries
Instability, Blood loss or Vascular damage associated with Pelvic Fractures
Cardiac arrest associated with asphyxia or drowning
Ensure all injuries are documented
Include imaging reports or Post Mortems for every submission.
