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Proper coding of the Abbreviated Injury Scale: can clinical parameters help as surrogates in estimating blood loss?

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Abstract

Purpose

The Abbreviated Injury Scale (AIS) requires the estimation of the lost blood volume for some severity assignments. This study aimed to develop a rule of thumb for facilitating AIS coding by using objective clinical parameters as surrogate markers of blood loss.

Methods

Using the example of pelvic ring fractures, a retrospective analysis of TraumaRegister DGU® data from 2002 to 2011 was performed. As potential surrogate markers of blood loss, we recorded the hemoglobin (Hb) level, systolic blood pressure (SBP), base excess (BE), Quick’s value, units of packed red blood cells (PRBCs) transfused before intensive care unit (ICU) admission, and mortality within 24 h.

Results

We identified 11,574 patients with pelvic ring fractures (Tile/OTA classification: 39 % type A, 40 % type B, 21 % type C). Type C fractures were 73.1 % AISpelvis 4 and 26.9 % AISpelvis 5. Type B fractures were 47 % AISpelvis 3, 47 % AISpelvis 4, and 6 % AISpelvis 5. In type C fractures, cut-off values of <7 g/dL Hb, <90 mmHg SBP, <−9 mmol/L BE, <35 % Quick’s value, >15 units PRBCs, and death within 24 h had a positive predictive value of 47 % and a sensitivity of 62 % for AISpelvis 5. In type B fractures, these cut-off values had poor sensitivity (48 %) and positive predictive value (11 %) for AISpelvis 5.

Conclusions

We failed to develop a rule of thumb for facilitating a proper future AIS coding using the example of pelvic ring fractures. The estimation of blood loss for severity assignment still remains a noteworthy weakness in the AIS coding of traumatic injuries.

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Acknowledgments

We thank the staff of the Institute for Research in Operative Medicine (IFOM) under the direction of Prof. Neugebauer and his associate Prof. Lefering for their outstanding support. We also thank the members of the Committee of Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the DGU for their longstanding involvement in trauma registration, as well as all the hospitals who actively supported the TraumaRegister DGU®.

Conflict of interest

Markus Burkhardt, Joerg H. Holstein, Philipp Moersdorf, Alexander Kristen, Rolf Lefering, Tim Pohlemann, and Antonius Pizanis declare that they have no conflict of interest.

Compliance with Ethics Guidelines

This article does not contain any studies with human or animal subjects performed by the any of the authors. The TraumaRegister DGU® is a voluntary register and is approved by the review board of the German Trauma Society. The register is in compliance with institutional requirements, and as the data are anonymized, our institutional review board waived the need for patient consent. Use of the data in the register was approved by the ethics committee of the University of Witten/Herdecke, Cologne, Germany.

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Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, University of Saarland, Kirrbergerstraße 100, 66421, Homburg, Germany

    M. Burkhardt, J. H. Holstein, P. Moersdorf, A. Kristen, T. Pohlemann & A. Pizanis

  2. Institute for Research in Operative Medicine (IFOM), Faculty of Health, University of Witten/Herdecke, Cologne Merheim Medical Centre, Ostmerheimer Straße 200, 51109, Cologne, Germany

    R. Lefering

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  1. M. Burkhardt
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  2. J. H. Holstein
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  3. P. Moersdorf
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  4. A. Kristen
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  5. R. Lefering
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  6. T. Pohlemann
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  7. A. Pizanis
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Correspondence to M. Burkhardt.

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Burkhardt, M., Holstein, J.H., Moersdorf, P. et al. Proper coding of the Abbreviated Injury Scale: can clinical parameters help as surrogates in estimating blood loss?. Eur J Trauma Emerg Surg 40, 473–479 (2014). https://doi.org/10.1007/s00068-013-0335-x

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  • DOI: https://doi.org/10.1007/s00068-013-0335-x

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