Organ Injury Scaling

Thoracic Vasculature
Grade Injury Description I Intercostal artery/vein Internal mammary artery/vein Bronchial artery/vein Oesophageal artery/vein Hemiazygous vein Unnamed artery/vein II Azygous vein Internal jugular vein Subclavian vein Innominate vein Carotid artery Innominate artery Subclavian artery Thoracic aorta, descending Inferior vena cava (intrathoracic) Pulmonary artery, primary intraparenchymal branch Pulmonary vein, primary intraparenchymal branch Thoracic aorta, ascending and arch Superior vena cava Pulmonary artery, main trunk Pulmonary vein, main trunk Uncontained total transection of thoracic aorta Uncontained total transection of pulmonary hilum AIS-90 2-3 2-3 2-3 2-3 2-3 2-3 2-3 2-3 3-4 3-4 3-5 3-4 3-4 4-5 3-4 3 3

TRAUMA SCORING ORGAN INJURY SCALE III

IV

5 3-4 4 4 5 4

VI

Advance one grade for multiple grade III or IV if >50% circumference. Decrease one grade for grade IV & V if <25% circumference.

Organ Injury Scaling

Lung
Grade I Contusion Injury Description Unilateral, <1 lobe AIS90 3

II

Contusion Laceration

Unilateral, single lobe Simple pneumothorax

3 3

III TRAUMA SCORING ORGAN INJURY SCALE

Contusion Laceration

Unilateral, >1 lobe Persistent (>72 hrs), airleak from distal airway.

3 3-4 3-4

Haematoma Nonexpanding intraparenchymal

IV

Laceration

Major (segmental or lobar) airway leak. Primary branch intrapulmonary vessel disrupion

4-5 4-5 3-5

Haematoma Expanding intraparenchymal Vascular

Vascular

Hilar vessel disruption

VI

Vascular

Total, uncontained transection of pulmonary hilum

Advance one grade for bilateral injuries. Haemothorax is graded by thoracic vascular OIS.

Organ Injury Scaling

Cardiac
Grade I Injury Description Blunt cardiac injury with minor ECG abnormality (nonspecific ST or T wave changes, premature atrial or ventricular contraction or persistent sinus tachycardia) Blunt or penetrating pericardial wound without cardiac injury, cardiac tamponade or cardiac herniation AIS90 3

TRAUMA SCORING ORGAN INJURY SCALE

II

Blunt cardiac injury with heart block or ischaemic changes without cardiac failure Penetrating tangential cardiac wound up to but not extending through endocardium, without tamponade

3 3-4

III

Blunt cardiac injury with sustained or multifocal ventricular contractions Blunt or penetrating cardiac injury with septal rupture, pulmonary or tricuspid incompetence, papillary muscle dysfunction or distal coronary artery occlusion without cardiac failure Blunt pericardial laceration with cardiac herniation Blunt cardiac injury with cardiac failure Penetrating tangential myocardial wound up to but not through endocardium, with tamponade

3-4 3-4

3-4 3-4 3

IV

Blunt or penetrating cardiac injury with septal rupture, pulmonary or tricuspid incompetence, papillary muscle dysfunction or distal coronary artery occlusion producing cardiac failure Blunt or penetrating cardiac injury with aortic or mitral incompetence Blunt or penetrating cardiac injury of the right ventricle, right or left atrium

3 5

Blunt or penetating cardiac injury with proximal coronary artery occlusion Blunt or penetrating left ventricular perforation Stellate injuries <50% tissue loss of the right ventricle, right or left atrium

5 5 5

VI

Blunt avulsion of the heart Penetrating would producing >50% tissue loss of a chamber

6 6

Advance one grade multiple penetrating wounds to a single chamber or multiple chamber involvement.

Organ Injury Scaling

Chest Wall
Grade Injury Description I Contusion Any size Laceration Skin and subcutaneous Fracture <3 ribs, closed nondisplaced clavicle,closed II Laceration Skin, subcutaneous and muscle Fracture =>3 adjacent ribs, closed Open or displaced clavicle Nondisplaced sternum, closed TRAUMA SCORING ORGAN INJURY SCALE III Scapular body Laceration Full thickness including pleura Fracture Open, displaced or flail sternum Unilateral flail segment <3 ribs Laceration Avulsion of chest wall tissues with underlying rib fractures Fracture Unilateral flail chest => 3 ribs Fracture Bilateral flail chest AIS-90 1 1 1-2 2 1 2-3 2 2 2 2 2 3-4 4 3-4 5

IV

Advance one grade for bilateral injuries.

Organ Injury Scaling

Diaphragm
Grade Injury Description I Contusion II III IV Laceration <= 2cm Laceration 2 - 10cm Laceration >10cm with tissue loss <= 25sq cm Laceration with tissue loss >25sq cm AIS-90 2 3 3 3

TRAUMA SCORING ORGAN INJURY SCALE

Advance one grade for bilateral injuries.

Organ Injury Scaling

Spleen
Grade I Injury Description Haematoma Subcapsular, <10% surface area Laceration Capsular tear, <1cm parenchymal depth AIS90 2 2

II

TRAUMA SCORING ORGAN INJURY SCALE

Haematoma Subcapsular, 10-50% surface area Intraparenchymal, <5cm diameter Laceration 1-3cm parenchymal depth not involving a parenchymal vessel

III

Haematoma Subcapsular, >50% surface area or expanding. Ruptured subcapsular or parenchymal haematoma. Intraparencymal haematoma >5cm Laceration >3cm parenchymal depth or involving trabecular vessels

IV

Laceration

Laceration of segmental or hilar vessels producing major devascularization (>25% of spleen)

Laceration Vascular

Completely shattered spleen Hilar vascular injury which devascularized spleen

5 5

Advance one grade for multiple injuries to same organ up to Grade III.

Organ Injury Scaling

Liver
Grade I Injury Description Haematoma Subcapsular, <10% surface area Laceration Capsular tear, <1cm parenchymal depth AIS90 2 2

II

Haematoma Subcapsular, 10-50% surface area Intraparenchymal, <10cm diameter Laceration 1-3cm parenchymal depth, <10cm length

2 2 2

TRAUMA SCORING ORGAN INJURY SCALE

III

Haematoma Subcapsular, >50% surface area or expanding. Ruptured subcapsular or parenchymal haematoma Intraparencymal haematoma >10cm or expanding Laceration >3cm parenchymal depth

3 3

IV

Laceration

Parenchymal disruption involving 25-75% of hepatic lobe or 1-3 Coinaud's segments in a single lobe

Laceration

Parenchymal disruption involving >75% of hepatic lobe or >3 Coinaud's segments within a single lobe Juxtahepatic venous injuries ie. retrohepatic vena cava/central major hepatic veins

Vascular

VI

Vascular

Hepatic Avulsion

Advance one grade for multiple injuries to same organ up to Grade III.

Organ Injury Scaling

Abdominal Vasculature
Grade Injury Description I Non-named superior mesenteric artery or vein branches Non-named inferior mesenteric artery or vein branches Phrenic artery/vein Lumbar artery/vein Gonadal artery/vein Ovarian artery/vein Other non-named arterial or venous structure requiring ligation TRAUMA SCORING ORGAN INJURY SCALE II Right, left or common hepatic artery Splenic artery/vein Right or left gastric arteries Gastroduodenal artery Inferior mesenteric artery or vein Primary named branches of mesenteric artery or vein Other named abdominal vessels requiring ligation Superior mesenteric vein Renal artery/vein Iliac artery/vein Hypogastric artery/vein Infra renal vena cava Superior mesenteric artery Coeliac axis Suprarenal, infrahepatic vena cava Infrarenal aorta Portal vein Extra-parenchymal hepatic vein Retro or suprahepatic vena cava Suprarenal, subdiaphragmatic aorta AIS-90 -

3 3 3 3 3 3 3

III

3 3 3 3 3 3 3 3 3 3 3-5 5 5

IV

Organ Injury Scaling

Kidney
Grade I Contusion Injury Description Microscopic or gross haematuria, urological studies normal AIS90 2

Haematoma Subcapsular, nonexapnding without parenchymal laceration

II TRAUMA SCORING ORGAN INJURY SCALE

Haematoma Nonexpanding perirenal haematoma confined to renal retroperitoneum Laceration <1cm parenchymal depth of renal cortex without urinary extravasation

III

Laceration

>1cm depth of renal cortex, without collecting system rupture or urinary extravasation

IV

Laceration

Parenchymal laceration extending through the renal cortex, medulla and collecting system Main renal artery or vein injury with contained haemorrhage

Vascular

Laceration Vascular

Completely shattered kidney Avulsion of renal hilum which devascularizes kidney

5 5

Advance one grade for multiple injuries to same organ.

Organ Injury Scaling

Ureter
Grade I Injury Description Haematoma Contusion or haematoma without devascularization AIS90 2

II

Laceration

<50% transection

III TRAUMA SCORING ORGAN INJURY SCALE

Laceration

>50% transection

IV

Laceration

Complete transection with 2cm devascularization

Laceration

Complete transection with >2cm devascularization

Advance one grade for multiple injuries.

Organ Injury Scaling

Bladder
Grade Injury Description I Haematoma Contusion, intramural haematoma Laceration Partial thickness II Laceration Extraperitoneal bladder wall laceration <2cm Extraperitoneal (>2cm) or intra-peritoneal (<2cm) bladder wall lacerations Intraperitoneal bladder wall laceration >2cm Laceration extending into bladder neck or ureteral orifice (trigone) AIS-90 2 3 4

III

Laceration

TRAUMA SCORING ORGAN INJURY SCALE

IV

Laceration

Laceration

Advance one grade for multiple injuries.

Organ Injury Scaling

Urethra
Grade I Contusion Injury Description Blood at urethral meatus, urethrography normal AIS90 2

II

Stretch injury

Elongation of urethra without extravasation on urethrography

III TRAUMA SCORING ORGAN INJURY SCALE

Partial disruption

Extravasation of contrast at injury site with contrast visualized in bladder

IV

Complete disruption

Extravasation of contrast at injury site without visualization of the bladder. <2cm urethral separation

Complete disruption

Complete transection with >2cm urethral separation, or extension into the prostate or vagina

Advance one grade for multiple injuries.

Abbreviated Injury Scale

The Abbreviated Injury Scale (AIS) is an anatomical scoring system first introduced in 1969. Since this time it has been revised and updated against survival so that it now provides a reasonably accurrate was of ranking the severity of injury. The latest incarnation of the AIS score is the 1990 revision. The AIS is monitored by a scaling committee of the Association for the Advancement of Automotive Medicine. Injuries are ranked on a scale of 1 to 6, with 1 being minor, 5 severe and 6 an unsurvivable injury. This represents the 'threat to life' associated with an injury and is not meant to represent a comprehensive measure of severity. The AIS is not an injury scale, in that the difference between AIS1 and AIS2 is not the same as that between AIS4 and AIS5. There are many similarities between the AIS scale and the Organ Injury Scales of the American Association for the Surgery of Trauma. AIS Score 1 2 3 4 5 6 Injury Minor Moderate Serious Severe Critical Unsurvivable

TRAUMA SCORING

Copes WS, Sacco WJ, Champion HR, Bain LW, "Progress in Characterising Anatomic Injury", In Proceedings of the 33rd Annual Meeting of the Association for the Advancement of Automotive Medicine, Baltimore, MA, USA 205-218 Association for the Advancement of Automotive Medicine 2340 Des Plaines Avenue, Suite 106 Des Plaines Illinois 60018 USA