Ulus Travma Acil Cerrahi Derg. 2006; 12(3): 195-200

A different approach to trauma scoring

Haluk Ýnce¹, Nurhan Ýnce², Korhan Taviloðlu³, Recep Güloðlu^3
1Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi Adli Týp Anabilim Dalý, Ýstanbul, Turkey
²Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi Halk Saðlýðý Anabilim Dalý, Ýstanbul, Turkey
³Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi Genel Cerrahi Anabilim Dalý, Ýstanbul, Turkey

BACKGROUND: We have compared the Injury Severity Score (ISS) at admission to Emergency Surgery and Trauma Center (ES&TC) with the ISS during autopsy. Cases with ISS less than 14 (defined as preventable deaths) were evaluated and the results were compared with those in other countries.
METHODS: The study was performed between January 1, 2000 and December 31, 2002 at Istanbul Medical Faculty TS&ES and the Turkish Council of Forensic Medicine. The 160 autopsies of trauma deaths which could have been performed within this three year period were evaluated.
RESULTS: The average age of trauma victims in the study was 32,9±15,6 (r=1-79); the majority of victims were males 78,1% (n=125). In four autopsies (3%) ISS were rated as “preventable death” (ISS ≤14). The severely injured (ISS: 16-66) patients with lower survival rates were 96% (n=155). In addition, one case (1%) had an ISS score of 75. In clinical evaluations, ISS scores were found to be between 16-66 (68%), 75 (20%, n=32), and ≤14 (12%; n=19).
CONCLUSION: Although it is widely used, difficulties in the applications of ISS still exist. Alcohol, drug, pregnancy and the presence of underlying diseases are the factors contributing to death but not being reflected by ISS. Moreover a difficulty exists in the evaluation of anatomical injuries which are not accompanied by physiological changes. ISS should be improved according to updates. In this way, evaluation of clinics care quality and standardization of trauma centers can be done more accurrately.
BACKGROUND: We have compared the Injury Severity Score (ISS) at admission to Emergency Surgery and Trauma Center (ES&TC) with the ISS during autopsy. Cases with ISS less than 14 (defined as preventable deaths) were evaluated and the results were compared with those in other countries.
METHODS: The study was performed between January 1, 2000 and December 31, 2002 at Istanbul Medical Faculty TS&ES and the Turkish Council of Forensic Medicine. The 160 autopsies of trauma deaths which could have been performed within this three year period were evaluated.
RESULTS: The average age of trauma victims in the study was 32,9±15,6 (r=1-79); the majority of victims were males 78,1% (n=125). In four autopsies (3%) ISS were rated as “preventable death” (ISS ≤14). The severely injured (ISS: 16-66) patients with lower survival rates were 96% (n=155). In addition, one case (1%) had an ISS score of 75. In clinical evaluations, ISS scores were found to be between 16-66 (68%), 75 (20%, n=32), and ≤14 (12%; n=19).
CONCLUSION: Although it is widely used, difficulties in the applications of ISS still exist. Alcohol, drug, pregnancy and the presence of underlying diseases are the factors contributing to death but not being reflected by ISS. Moreover a difficulty exists in the evaluation of anatomical injuries which are not accompanied by physiological changes. ISS should be improved according to updates. In this way, evaluation of clinics care quality and standardization of trauma centers can be done more accurrately.

Keywords: Abbreviated Injury Scale, autopsy, Injury Severity Score; multiple trauma/classification/diagnosis/mortality; trauma severity indices.

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Travma skorlamasýna farklý yaklaþým

Haluk Ýnce¹, Nurhan Ýnce², Korhan Taviloðlu³, Recep Güloðlu^3
1Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi Adli Týp Anabilim Dalý, Ýstanbul
²Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi Halk Saðlýðý Anabilim Dalý, Ýstanbul
³Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi Genel Cerrahi Anabilim Dalý, Ýstanbul

AMAÇ: Travma nedeniyle hayatýný kaybeden olgularýn Acil Cerrahi ve Travma Merkezine (ACTM) geliþteki Yaralanma Aðýrlýk Skoru (YAS) ile otopsi esnasýndaki YAS karþýlaþtýrýldý. Yaralanma Aðýrlýk Skoru 14 puanýn altýnda (önlenebilir ölümler olarak tanýmlanan) olgular araþtýrýlarak sonuçlarýn diðer ülkelerdeki verilerle karþýlaþtýrýlmasý amaçlandý.
GEREÇ-YÖNTEM: Çalýþma 1 Ocak 2000 ile 31 Aralýk 2002 tarihleri arasýnda Ýstanbul Týp Fakültesi ACTM ile Adli Týp Kurumu’nda gerçekleþtirildi. Üç yýllýk bir dönemde travma nedeniyle ölen ve otopsisi yapýlabilen 160 olgu incelendi.
BULGULAR: Otopsi sýrasýnda saptanan YAS deðeri 14’ün altýnda olan (önlenebilir ölüm) olgularýnýn oraný %3 (n=4), YAS deðeri 16-66 olan (önlenmesi muhtemel ölüm) olgularýn oraný %96, YAS deðeri 75 olan (ölümün önlenemez olduðu) olgu oraný %1 (n=1) olarak bulundu. Acil Cerrahi ve Travma Merkezine geliþlerde ise bu oranlar; YAS deðeri 14’ün altýnda olan %12 (n=19), YAS deðeri 16-66 olan %68 (n=109), YAS deðeri 75 olan %20 (n=32) idi. Otopsi sýrasýnda hesaplanan YAS deðeri ile ACTM’ye geliþlerinde saptanan YAS deðerleri arasýnda zayýf da olsa bir ilinti saptandý (r=0.16; p=0.04).
SONUÇ: Travmalý hastalarda YAS deðerlendirmesinin kullanýlmasýnda birtakým güçlükler vardýr. Ölüme katkýsý olan alkol, ilaç kullanýmý gebelik gibi fizyolojik deðiþiklikler YAS’da gösterilmemektedir. YAS’ýn güncellenerek geliþtirilmesi gereklidir. Bu sayede kliniklerin bakým kalitesinin deðerlendirilmesi ve travma merkezlerinin standardizasyonu daha doðru yapýlabilir.

Anahtar Kelimeler: Kýsaltýlmýþ Yaralanma Ölçeði, otopsi, Yaralanma Aðýrlýk Skoru; multipl travma/sýnýflama/taný/mortalite; travma aðýrlýk indeksi.

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