@article{ref1,
title="Specific abbreviated injury scale values are responsible for the underestimation of mortality in penetrating trauma patients by the injury severity score",
journal="Journal of trauma",
year="2011",
author="Rowell, Susan E. and Barbosa, Ronald R. and Diggs, Brian S. and Schreiber, Martin A. and Holcomb, J. B. and Wade, C. E. and Brasel, Karen J. and Vercruysse, G. and MacLeod, J. and Dutton, R. P. and Hess, J. R. and Duchesne, J. C. and McSwain, Norman E. and Muskat, P. and Johannigamn, J. and Cryer, H. M. and Tillou, A. and Cohen, M. J. and Pittet, J. F. and Knudson, P. and De Moya, M. A. and Schreiber, Martin A. and Tieu, B. and Brundage, S. and Napolitano, L. M. and Brunsvold, M. and Sihler, Kristen C. and Beilman, G. and Peitzman, A. B. and Zenait, M. S. and Sperry, J. and Alarcon, L. and Croce, Martin A. and Minei, J. P. and Kozar, R. and Gonzalez, E. A. and Stewart, R. M. and Cohn, S. M. and Mickalek, J. E. and Bulger, E. M. and Cotton, B. A. and Nunez, T. C. and Ivatury, R. and Meredith, J. W. and Miller, P. and Pomper, J. and Marin, B.",
volume="71",
number="2 Suppl 3",
pages="S384-8",
abstract="BACKGROUND: The Injury Severity Score (ISS) is widely used as a method for rating severity of injury. The ISS is the sum of the squares of the three worst Abbreviated Injury Scale (AIS) values from three body regions. Patients with penetrating injuries tend to have higher mortality rates for a given ISS than patients with blunt injuries. This is thought to be secondary to the increased prevalence of multiple severe injuries in the same body region in patients with penetrating injuries, which the ISS does not account for. We hypothesized that the mechanism-based difference in mortality could be attributed to certain ISS ranges and specific AIS values by body region. METHODS: Outcome and injury scoring data were obtained from transfused patients admitted to 23 Level I trauma centers. ISS values were grouped into categories, and a logistic regression model was created. Mortality for each ISS category was determined and compared with the ISS 1 to 15 group. An interaction term was added to evaluate the effect of mechanism. Additional logistic regression models were created to examine each AIS category individually. RESULTS: There were 2,292 patients in the cohort. An overall interaction between ISS and mechanism was observed (p = 0.049). Mortality rates between blunt and penetrating patients with an ISS between 25 and 40 were significantly different (23.6 vs. 36.1%; p = 0.022). Within this range, the magnitude of the difference in mortality was far higher for penetrating patients with head injuries (75% vs. 37% for blunt) than truncal injuries (26% vs. 17% for blunt). Penetrating trauma patients with an AIS head of 4 or 5, AIS abdomen of 3, or AIS extremity of 3 all had adjusted mortality rates higher than blunt trauma patients with those values. CONCLUSION: Significant differences in mortality between blunt and penetrating trauma patients exist at certain ISS and AIS category values. The mortality difference is greatest for head injured patients.<p /> <p>Language: en</p>",
language="en",
issn="0022-5282",
doi="10.1097/TA.0b013e3182287c8d",
url="http://dx.doi.org/10.1097/TA.0b013e3182287c8d"
}