TRAUMA SCORINGORGAN INJURY SCALE

 

 

  

Organ Injury ScalingThoracic Vasculature

Grade Injury Description AIS-90 I Intercostal artery/vein 2-3

Internal mammary artery/vein 2-3 Bronchial artery/vein 2-3 Oesophageal artery/vein 2-3 Hemiazygous vein 2-3 Unnamed artery/vein 2-3

 

II Azygous vein 2-3 Internal jugular vein 2-3 Subclavian vein 3-4 Innominate vein 3-4

 

III Carotid artery 3-5 Innominate artery 3-4 Subclavian artery 3-4

 

IV Thoracic aorta, descending 4-5 Inferior vena cava (intrathoracic) 3-4 Pulmonary artery, primary intraparenchymal branch

3

Pulmonary vein, primary intraparenchymal branch

3

 

V Thoracic aorta, ascending and arch 5 Superior vena cava 3-4 Pulmonary artery, main trunk 4 Pulmonary vein, main trunk 4

 

VI Uncontained total transection of thoracic aorta

5

Uncontained total transection of pulmonary hilum

4

 

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

TRAUMA SCORINGORGAN INJURY SCALE

 

 

  

Organ Injury ScalingLung

Grade Injury Description AIS-90

I Contusion Unilateral, <1 lobe 3

 

II Contusion Unilateral, single lobe 3

Laceration Simple pneumothorax 3

 

III Contusion Unilateral, >1 lobe 3

Laceration Persistent (>72 hrs), airleak from distal airway.

3-4

Haematoma

Nonexpanding intraparenchymal

3-4

 

IV Laceration Major (segmental or lobar) airway leak.

4-5

Haematoma

Expanding intraparenchymal 4-5

Vascular Primary branch intrapulmonary vessel disrupion

3-5

 

V Vascular Hilar vessel disruption 4

 

VI Vascular Total, uncontained transection of pulmonary hilum

4

 

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

TRAUMA SCORINGORGAN INJURY SCALE

 

  

Organ Injury ScalingCardiac

Grade Injury Description AIS-90

I Blunt cardiac injury with minor ECG abnormality (nonspecific ST or T wave changes, premature atrial or ventricular contraction or persistent sinus tachycardia)

3

Blunt or penetrating pericardial wound without cardiac injury, cardiac tamponade or cardiac herniation

3

 

II Blunt cardiac injury with heart block or ischaemic changes without cardiac failure

3

Penetrating tangential cardiac wound up to but not extending through endocardium, without tamponade

3-4

 

III Blunt cardiac injury with sustained or multifocal ventricular contractions

3-4

Blunt or penetrating cardiac injury with septal rupture, pulmonary or tricuspid incompetence, papillary muscle dysfunction or distal coronary artery occlusion without cardiac failure

3-4

Blunt pericardial laceration with cardiac herniation

3-4

Blunt cardiac injury with cardiac failure 3-4

Penetrating tangential myocardial wound up to but not through endocardium, with tamponade

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

3

Blunt or penetrating cardiac injury with aortic or mitral incompetence

3

Blunt or penetrating cardiac injury of the right ventricle, right or left atrium

5

 

V Blunt or penetating cardiac injury with proximal coronary artery occlusion

5

Blunt or penetrating left ventricular perforation

5

Stellate injuries <50% tissue loss of the right ventricle, right or left atrium

5

 

VI Blunt avulsion of the heart 6

Penetrating would producing >50% tissue loss of a chamber

6

 

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

TRAUMA SCORINGORGAN INJURY SCALE

 

 

  

Organ Injury ScalingChest Wall

Grade Injury Description AIS-90 I Contusion Any size 1

Laceration

Skin and subcutaneous 1

Fracture <3 ribs, closed 1-2 nondisplaced clavicle,closed 2

 

II Laceration

Skin, subcutaneous and muscle 1

Fracture =>3 adjacent ribs, closed 2-3 Open or displaced clavicle 2

Nondisplaced sternum, closed 2

Scapular body 2

 

III Laceration

Full thickness including pleura 2

Fracture Open, displaced or flail sternum 2 Unilateral flail segment <3 ribs 3-4

 

IV Laceration

Avulsion of chest wall tissues with underlying rib fractures

4

Fracture Unilateral flail chest => 3 ribs 3-4

 

V Fracture Bilateral flail chest 5

 

Advance one grade for bilateral injuries.

TRAUMA SCORINGORGAN INJURY SCALE

 

 

  

Organ Injury ScalingDiaphragm

Grade Injury Description AIS-90 I Contusion 2

 

II Laceration <= 2cm 3

 

III Laceration 2 - 10cm 3

 

IV Laceration >10cm with tissue loss <= 25sq cm

3

 

V Laceration with tissue loss >25sq cm 3

 

Advance one grade for bilateral injuries.

TRAUMA SCORINGORGAN INJURY SCALE

 

 

  

Organ Injury ScalingSpleen

Grade Injury Description AIS-90

I Haematoma

Subcapsular, <10% surface area

2

Laceration Capsular tear, <1cm parenchymal depth

2

 

II Haematoma

Subcapsular, 10-50% surface areaIntraparenchymal, <5cm diameter

2

Laceration 1-3cm parenchymal depth not involving a parenchymal vessel

2

 

III Haematoma

Subcapsular, >50% surface area or expanding. Ruptured subcapsular or parenchymal haematoma. Intraparencymal haematoma >5cm

3

Laceration >3cm parenchymal depth or involving trabecular vessels

3

 

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

4

 

V Laceration Completely shattered spleen 5

Vascular Hilar vascular injury which devascularized spleen

5

 

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

TRAUMA SCORINGORGAN INJURY SCALE

 

  

Organ Injury ScalingLiver

Grade Injury Description AIS-90

I Haematoma

Subcapsular, <10% surface area

2

Laceration Capsular tear, <1cm parenchymal depth

2

 

II Haematoma

Subcapsular, 10-50% surface area

2

Intraparenchymal, <10cm diameter

2

Laceration 1-3cm parenchymal depth, <10cm length

2

 

III Haematoma

Subcapsular, >50% surface area or expanding. Ruptured subcapsular or parenchymal haematoma

3

Intraparencymal haematoma >10cm or expanding

3

Laceration >3cm parenchymal depth 3

 

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

4

 

V Laceration Parenchymal disruption involving >75% of hepatic lobe or >3 Coinaud's segments within a single lobe

5

Vascular Juxtahepatic venous injuries ie. retrohepatic vena cava/central major hepatic veins

5

 

VI Vascular Hepatic Avulsion 6

 

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

TRAUMA SCORINGORGAN INJURY SCALE

  

Organ Injury ScalingAbdominal Vasculature

Grade Injury Description AIS-90 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

-

 

II Right, left or common hepatic artery 3 Splenic artery/vein 3 Right or left gastric arteries 3 Gastroduodenal artery 3 Inferior mesenteric artery or vein 3 Primary named branches of mesenteric artery or vein

3

Other named abdominal vessels requiring ligation

3

 

III Superior mesenteric vein 3 Renal artery/vein 3 Iliac artery/vein 3 Hypogastric artery/vein 3 Infra renal vena cava 3

 

IV Superior mesenteric artery 3 Coeliac axis 3 Suprarenal, infrahepatic vena cava 3 Infrarenal aorta 3

 

V Portal vein 3 Extra-parenchymal hepatic vein 3-5 Retro or suprahepatic vena cava 5 Suprarenal, subdiaphragmatic aorta 5

TRAUMA SCORINGORGAN INJURY SCALE

 

 

  

Organ Injury ScalingKidney

Grade Injury Description AIS-90

I Contusion Microscopic or gross haematuria, urological studies normal

2

Haematoma

Subcapsular, nonexapnding without parenchymal laceration

2

 

II Haematoma

Nonexpanding perirenal haematoma confined to renal retroperitoneum

2

Laceration <1cm parenchymal depth of renal cortex without urinary extravasation

2

 

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

3

 

IV Laceration Parenchymal laceration extending through the renal cortex, medulla and collecting system

4

Vascular Main renal artery or vein injury with contained haemorrhage

5

 

V Laceration Completely shattered kidney 5

Vascular Avulsion of renal hilum which devascularizes kidney

5

 

Advance one grade for multiple injuries to same organ.

TRAUMA SCORINGORGAN INJURY SCALE

 

 

  

Organ Injury ScalingUreter

Grade Injury Description AIS-90

I Haematoma

Contusion or haematoma without devascularization

2

 

II Laceration <50% transection 2

 

III Laceration >50% transection 3

 

IV Laceration Complete transection with 2cm devascularization

3

 

V Laceration Complete transection with >2cm devascularization

3

 

Advance one grade for multiple injuries.

TRAUMA SCORINGORGAN INJURY SCALE

  

Organ Injury ScalingBladder

Grade Injury Description AIS-90 I Haematom

a Contusion, intramural haematoma

2

Laceration Partial thickness 3

 

II Laceration Extraperitoneal bladder wall laceration <2cm

4

 

III Laceration Extraperitoneal (>2cm) or intra-peritoneal (<2cm) bladder wall lacerations

4

 

IV Laceration Intraperitoneal bladder wall laceration >2cm

4

 

V Laceration Laceration extending into bladder neck or ureteral orifice (trigone)

4

 

Advance one grade for multiple injuries.

TRAUMA SCORINGORGAN INJURY SCALE

 

 

  

Organ Injury ScalingUrethra

Grade Injury Description AIS-90

I Contusion Blood at urethral meatus, urethrography normal

2

 

II Stretch injury

Elongation of urethra without extravasation on urethrography

2

 

III Partial disruption

Extravasation of contrast at injury site with contrast visualized in bladder

2

 

IV Complete disruption

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

3

 

V Complete disruption

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

4

 

Advance one grade for multiple injuries.

TRAUMA SCORING

 

  

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 Injury

1 Minor

2 Moderate

3 Serious

4 Severe

5 Critical

6 Unsurvivable

 

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 Medicine2340 Des Plaines Avenue, Suite 106Des PlainesIllinois 60018USA