The impact of the AIS 2005 revision on injury severity scores and clinical outcome measures.

BACKGROUND: The abbreviated injury scale (AIS) was updated in 2005 from the AIS 1998 version. The purpose of this study is to describe the effects of this change on injury severity scoring and outcome measures. MATERIALS AND METHODS: Analyses were performed on all trauma patients consecutively admitted over a 6-month period at two geographically separate Level I trauma centers. Injuries were manually double-coded according to the AIS 05 and the AIS 98. Changes in AIS, ISS, and new ISS (NISS) were analysed using paired t-tests. Apparent differences in outcome by ISS strata (<16, 16-24, >24) were compared for AIS 05 versus AIS 98 using the Wald-type statistic. Lastly, the percent of patients with a change in ISS strata are reported. RESULTS: There were 2250 patients included in the study. Nearly half (46.4%) of AIS codes changed, resulting in a different AIS score for 18.9% of all codes. The mean ISS was significantly lower using the AIS 05 (11.7) versus the AIS 98 (13.3, p<0.001). Similarly, the mean NISS was significantly lower (16.3 versus 18.7, p<0.001). In the ISS strata 16-24 an apparent increase in mortality, length of stay, and percent of patients not discharged home was observed for the AIS 05 versus AIS 98. Changes in outcome measures for this stratum were as follows (AIS 98 versus AIS 05): mortality, 4.3% versus 7.7% (p=0.002); hospital length of stay, 5.2 days versus 7.3 days (p<0.001); percent of patients not discharged home, 39.2% versus 49.3% (p<0.001). Finally, there was a 20.5% reduction in patients with an ISS>or=16 and a 26.2% reduction in patients with an ISS>or=25 using the AIS 05. CONCLUSIONS: The AIS revision had a significant impact on overall injury severity measures, clinical outcome measures, and percent of patients in each ISS strata. Therefore, the AIS revision affects the ability to directly compare data generated using AIS 05 and AIS 98 which has implications in trauma research, reimbursement and ACS accreditation.

Unsafe at any age: a retrospective review of all-terrain vehicle injuries in two level I trauma centers from 1995 to 2003.

BACKGROUND: All-terrain vehicles (ATVs) are popular recreational and utility vehicles. In 1984, Cogbill published an article regarding three-wheelers. These are no longer manufactured, but the injury and death rate with four-wheeled ATVs is high and disproportionately affects young riders. METHODS: We conducted a retrospective review at two Level I trauma centers from January 1994 to April 2003. Statistical analysis was performed using the SAS V8.2 program. Values of p < 0.05 were significant. RESULTS: Two hundred eight patients were identified. There were no differences identified in demographics, mechanism, types of injury, Injury Severity Score (ISS), or Glasgow Coma Scale (GCS) score. Seventy-five percent were male and 84% were white. The mean age was 23 +/- 13 years. The average ISS was 12.3 +/- 9 and the mean GCS score was 13.1 +/- 3.7. Injury mechanisms were loss of stability (33%), separation of rider from ATV (32%), and ATV versus stationary object (27%). ISS for ages 12 to 15 years was significantly higher than for other ages (14.5 vs. 11.5, p = 0.04, Wilcoxon rank sum test) and included more major head injuries (40.4% vs. 21.8%, p = 0.09, Wilcoxon rank sum test). They experienced fewer spinal fractures (3.9% vs. 15.4%, p = 0.03) and pelvic injuries (0% vs. 9%, p = 0.02, Wilcoxon rank sum test). The GCS score in this group was lower (12.3 vs. 13.4, p = 0.03, Wilcoxon rank sum test). CONCLUSION: Adolescent ATV riders have more severe injuries and more head injuries than other age groups. Prevention efforts should target this group.

Morbidity and mortality of children following motor vehicle crashes.

HYPOTHESIS: The use of passenger compartment safety measures has not led to decreases in pediatric morbidity or mortality in our population of patients. DESIGN: Retrospective review. SETTING: University, tertiary care, level I trauma center. PATIENTS: All patients admitted to the Trauma Center at Louisiana State University Health Science Center School of Medicine in Shreveport between July 1, 1991, and December 31, 2000, who were younger than 16 years and involved in a motor vehicle crash. MAIN OUTCOME MEASURES: Intensive care complications, postoperative complications, and mortality. RESULTS: We reviewed the experience of all pediatric patients involved in motor vehicle crashes and transported to the Trauma Center at Louisiana State University Health Science Center School of Medicine in Shreveport from July 1, 1991, through December 31, 2000. A total of 191 patients met these criteria. There were 8 deaths, and only 1 of these patients was restrained. There were significantly more injuries in those patients who died compared with those who survived (Modified Injury Severity Score, 29 vs 9; P<.001). We compared the use of restraints in our cohort with the use of restraints in the US pediatric population. Only 20% of our patients were restrained vs 68% of the general pediatric population. This difference was significant (P<.001, chi2) test). CONCLUSIONS: In our population of patients, death was a relatively infrequent occurrence. All patients who died presented in extremis. No patient died as the result of a complication. The rate of seat belt use in our population of patients was low. The exact reason for why we were unable to detect any survival benefit with seat belt use is unclear and demands further investigation.