The definition of major trauma using different revisions of the abbreviated injury scale

Jan C. Van Ditshuizen; Charlie A. Sewalt; Dutch Trauma Registry Southwest; Cameron S. Palmer; Esther M.M. Van Lieshout; Michiel H.J. Verhofstad; Dennis Den Hartog

doi:10.1186/s13049-021-00873-7

The definition of major trauma using different revisions of the abbreviated injury scale

Jan C. Van Ditshuizen^*, Charlie A. Sewalt, Dutch Trauma Registry Southwest, Cameron S. Palmer, Esther M.M. Van Lieshout, Michiel H.J. Verhofstad, Dennis Den Hartog

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

55 Citations (Scopus)

Abstract

Background: A threshold Injury Severity Score (ISS) ≥ 16 is common in classifying major trauma (MT), although the Abbreviated Injury Scale (AIS) has been extensively revised over time. The aim of this study was to determine effects of different AIS revisions (1998, 2008 and 2015) on clinical outcome measures. Methods: A retrospective observational cohort study including all primary admitted trauma patients was performed (in 2013–2014 AIS98 was used, in 2015–2016 AIS08, AIS08 mapped to AIS15). Different ISS thresholds for MT and their corresponding observed mortality and intensive care (ICU) admission rates were compared between AIS98, AIS08, and AIS15 with Chi-square tests and logistic regression models. Results: Thirty-nine thousand three hundred seventeen patients were included. Thresholds ISS08 ≥ 11 and ISS15 ≥ 12 were similar to a threshold ISS98 ≥ 16 for in-hospital mortality (12.9, 12.9, 13.1% respectively) and ICU admission (46.7, 46.2, 46.8% respectively). AIS98 and AIS08 differed significantly for in-hospital mortality in ISS 4–8 (χ² = 9.926, p = 0.007), ISS 9–11 (χ² = 13.541, p = 0.001), ISS 25–40 (χ² = 13.905, p = 0.001) and ISS 41–75 (χ² = 7.217, p = 0.027). Mortality risks did not differ significantly between AIS08 and AIS15. Conclusion: ISS08 ≥ 11 and ISS15 ≥ 12 perform similarly to a threshold ISS98 ≥ 16 for in-hospital mortality and ICU admission. This confirms studies evaluating mapped datasets, and is the first to present an evaluation of implementation of AIS15 on registry datasets. Defining MT using appropriate ISS thresholds is important for quality indicators, comparing datasets and adjusting for injury severity. Level of evidence: Prognostic and epidemiological, level III.

Original language	English
Article number	71
Journal	Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Volume	29
Issue number	1
DOIs	https://doi.org/10.1186/s13049-021-00873-7
Publication status	Published - 27 May 2021

Bibliographical note

Funding Information:
Thanks to Trauma Center Southwest Netherlands, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands, especially data management, for making this study possible. Collaboration group Dutch Trauma Registry Southwest: ? N.M.R. Soesman, MD, Department of Surgery, Francisus Gasthuis & Vlietland, Rotterdam, the Netherlands. ? T.S.C. Jakma, MD, Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands. ? M. Waleboer, MD, Department of Surgery, Admiraal de Ruyter Hospital, Goes, the Netherlands. ? M. Staarink, MD, Department of Surgery, Het Van Weel-Bethesda Hospital, Dirksland, the Netherlands. ? M.M.M. Bruijninckx, MD, Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands. ? A.Y.M.V.P. Cardon, MD, Department of Surgery, ZorgSaam Zeeuws-Vlaanderen Hospital, Terneuzen, the Netherlands. ? P.T. den Hoed, MD, PhD, Department of Surgery, Ikazia Hospital, Rotterdam, the Netherlands. ? G.R. Roukema, MD, Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands. ? C.H. van der Vlies, MD, PhD, Burn Center, Maasstad Hospital, Rotterdam, the Netherlands. ? N.W.L. Schep, MD, PhD, Department of Surgery, Spijkenisse Medisch Centrum Hospital, Rotterdam, the Netherlands ? L. van de Schoot, MD, Department of Surgery, Beatrixhospital, Gorinchem, the Netherlands

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© 2021, The Author(s).

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10.1186/s13049-021-00873-7

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Van Ditshuizen, J. C., Sewalt, C. A., Dutch Trauma Registry Southwest, Palmer, C. S., Van Lieshout, E. M. M., Verhofstad, M. H. J., & Den Hartog, D. (2021). The definition of major trauma using different revisions of the abbreviated injury scale. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29(1), Article 71. https://doi.org/10.1186/s13049-021-00873-7

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title = "The definition of major trauma using different revisions of the abbreviated injury scale",

abstract = "Background: A threshold Injury Severity Score (ISS) ≥ 16 is common in classifying major trauma (MT), although the Abbreviated Injury Scale (AIS) has been extensively revised over time. The aim of this study was to determine effects of different AIS revisions (1998, 2008 and 2015) on clinical outcome measures. Methods: A retrospective observational cohort study including all primary admitted trauma patients was performed (in 2013–2014 AIS98 was used, in 2015–2016 AIS08, AIS08 mapped to AIS15). Different ISS thresholds for MT and their corresponding observed mortality and intensive care (ICU) admission rates were compared between AIS98, AIS08, and AIS15 with Chi-square tests and logistic regression models. Results: Thirty-nine thousand three hundred seventeen patients were included. Thresholds ISS08 ≥ 11 and ISS15 ≥ 12 were similar to a threshold ISS98 ≥ 16 for in-hospital mortality (12.9, 12.9, 13.1% respectively) and ICU admission (46.7, 46.2, 46.8% respectively). AIS98 and AIS08 differed significantly for in-hospital mortality in ISS 4–8 (χ2 = 9.926, p = 0.007), ISS 9–11 (χ2 = 13.541, p = 0.001), ISS 25–40 (χ2 = 13.905, p = 0.001) and ISS 41–75 (χ2 = 7.217, p = 0.027). Mortality risks did not differ significantly between AIS08 and AIS15. Conclusion: ISS08 ≥ 11 and ISS15 ≥ 12 perform similarly to a threshold ISS98 ≥ 16 for in-hospital mortality and ICU admission. This confirms studies evaluating mapped datasets, and is the first to present an evaluation of implementation of AIS15 on registry datasets. Defining MT using appropriate ISS thresholds is important for quality indicators, comparing datasets and adjusting for injury severity. Level of evidence: Prognostic and epidemiological, level III.",

author = "{Van Ditshuizen}, {Jan C.} and Sewalt, {Charlie A.} and {Dutch Trauma Registry Southwest} and Palmer, {Cameron S.} and {Van Lieshout}, {Esther M.M.} and Verhofstad, {Michiel H.J.} and {Den Hartog}, Dennis",

note = "Funding Information: Thanks to Trauma Center Southwest Netherlands, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands, especially data management, for making this study possible. Collaboration group Dutch Trauma Registry Southwest: ? N.M.R. Soesman, MD, Department of Surgery, Francisus Gasthuis & Vlietland, Rotterdam, the Netherlands. ? T.S.C. Jakma, MD, Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands. ? M. Waleboer, MD, Department of Surgery, Admiraal de Ruyter Hospital, Goes, the Netherlands. ? M. Staarink, MD, Department of Surgery, Het Van Weel-Bethesda Hospital, Dirksland, the Netherlands. ? M.M.M. Bruijninckx, MD, Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands. ? A.Y.M.V.P. Cardon, MD, Department of Surgery, ZorgSaam Zeeuws-Vlaanderen Hospital, Terneuzen, the Netherlands. ? P.T. den Hoed, MD, PhD, Department of Surgery, Ikazia Hospital, Rotterdam, the Netherlands. ? G.R. Roukema, MD, Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands. ? C.H. van der Vlies, MD, PhD, Burn Center, Maasstad Hospital, Rotterdam, the Netherlands. ? N.W.L. Schep, MD, PhD, Department of Surgery, Spijkenisse Medisch Centrum Hospital, Rotterdam, the Netherlands ? L. van de Schoot, MD, Department of Surgery, Beatrixhospital, Gorinchem, the Netherlands Publisher Copyright: {\textcopyright} 2021, The Author(s).",

year = "2021",

month = may,

day = "27",

doi = "10.1186/s13049-021-00873-7",

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T1 - The definition of major trauma using different revisions of the abbreviated injury scale

AU - Van Ditshuizen, Jan C.

AU - Sewalt, Charlie A.

AU - Dutch Trauma Registry Southwest

AU - Palmer, Cameron S.

AU - Van Lieshout, Esther M.M.

AU - Verhofstad, Michiel H.J.

AU - Den Hartog, Dennis

N1 - Funding Information: Thanks to Trauma Center Southwest Netherlands, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands, especially data management, for making this study possible. Collaboration group Dutch Trauma Registry Southwest: ? N.M.R. Soesman, MD, Department of Surgery, Francisus Gasthuis & Vlietland, Rotterdam, the Netherlands. ? T.S.C. Jakma, MD, Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands. ? M. Waleboer, MD, Department of Surgery, Admiraal de Ruyter Hospital, Goes, the Netherlands. ? M. Staarink, MD, Department of Surgery, Het Van Weel-Bethesda Hospital, Dirksland, the Netherlands. ? M.M.M. Bruijninckx, MD, Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands. ? A.Y.M.V.P. Cardon, MD, Department of Surgery, ZorgSaam Zeeuws-Vlaanderen Hospital, Terneuzen, the Netherlands. ? P.T. den Hoed, MD, PhD, Department of Surgery, Ikazia Hospital, Rotterdam, the Netherlands. ? G.R. Roukema, MD, Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands. ? C.H. van der Vlies, MD, PhD, Burn Center, Maasstad Hospital, Rotterdam, the Netherlands. ? N.W.L. Schep, MD, PhD, Department of Surgery, Spijkenisse Medisch Centrum Hospital, Rotterdam, the Netherlands ? L. van de Schoot, MD, Department of Surgery, Beatrixhospital, Gorinchem, the Netherlands Publisher Copyright: © 2021, The Author(s).

PY - 2021/5/27

Y1 - 2021/5/27

N2 - Background: A threshold Injury Severity Score (ISS) ≥ 16 is common in classifying major trauma (MT), although the Abbreviated Injury Scale (AIS) has been extensively revised over time. The aim of this study was to determine effects of different AIS revisions (1998, 2008 and 2015) on clinical outcome measures. Methods: A retrospective observational cohort study including all primary admitted trauma patients was performed (in 2013–2014 AIS98 was used, in 2015–2016 AIS08, AIS08 mapped to AIS15). Different ISS thresholds for MT and their corresponding observed mortality and intensive care (ICU) admission rates were compared between AIS98, AIS08, and AIS15 with Chi-square tests and logistic regression models. Results: Thirty-nine thousand three hundred seventeen patients were included. Thresholds ISS08 ≥ 11 and ISS15 ≥ 12 were similar to a threshold ISS98 ≥ 16 for in-hospital mortality (12.9, 12.9, 13.1% respectively) and ICU admission (46.7, 46.2, 46.8% respectively). AIS98 and AIS08 differed significantly for in-hospital mortality in ISS 4–8 (χ2 = 9.926, p = 0.007), ISS 9–11 (χ2 = 13.541, p = 0.001), ISS 25–40 (χ2 = 13.905, p = 0.001) and ISS 41–75 (χ2 = 7.217, p = 0.027). Mortality risks did not differ significantly between AIS08 and AIS15. Conclusion: ISS08 ≥ 11 and ISS15 ≥ 12 perform similarly to a threshold ISS98 ≥ 16 for in-hospital mortality and ICU admission. This confirms studies evaluating mapped datasets, and is the first to present an evaluation of implementation of AIS15 on registry datasets. Defining MT using appropriate ISS thresholds is important for quality indicators, comparing datasets and adjusting for injury severity. Level of evidence: Prognostic and epidemiological, level III.

AB - Background: A threshold Injury Severity Score (ISS) ≥ 16 is common in classifying major trauma (MT), although the Abbreviated Injury Scale (AIS) has been extensively revised over time. The aim of this study was to determine effects of different AIS revisions (1998, 2008 and 2015) on clinical outcome measures. Methods: A retrospective observational cohort study including all primary admitted trauma patients was performed (in 2013–2014 AIS98 was used, in 2015–2016 AIS08, AIS08 mapped to AIS15). Different ISS thresholds for MT and their corresponding observed mortality and intensive care (ICU) admission rates were compared between AIS98, AIS08, and AIS15 with Chi-square tests and logistic regression models. Results: Thirty-nine thousand three hundred seventeen patients were included. Thresholds ISS08 ≥ 11 and ISS15 ≥ 12 were similar to a threshold ISS98 ≥ 16 for in-hospital mortality (12.9, 12.9, 13.1% respectively) and ICU admission (46.7, 46.2, 46.8% respectively). AIS98 and AIS08 differed significantly for in-hospital mortality in ISS 4–8 (χ2 = 9.926, p = 0.007), ISS 9–11 (χ2 = 13.541, p = 0.001), ISS 25–40 (χ2 = 13.905, p = 0.001) and ISS 41–75 (χ2 = 7.217, p = 0.027). Mortality risks did not differ significantly between AIS08 and AIS15. Conclusion: ISS08 ≥ 11 and ISS15 ≥ 12 perform similarly to a threshold ISS98 ≥ 16 for in-hospital mortality and ICU admission. This confirms studies evaluating mapped datasets, and is the first to present an evaluation of implementation of AIS15 on registry datasets. Defining MT using appropriate ISS thresholds is important for quality indicators, comparing datasets and adjusting for injury severity. Level of evidence: Prognostic and epidemiological, level III.

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The definition of major trauma using different revisions of the abbreviated injury scale

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