Transcript Abbreviated Injury Scale (AIS 90) - TARN

A Major Problem for
the Health Service
Worldwide injury is a major public health problem
 The commonest cause of death between the ages
of 1 and 40 years is injury
 For every fatality there are 2 survivors with serious
and permanent disability
 There appears to be a strong relationship between
social deprivation and injury
 Facilities for treatment of the injured and their
effectiveness varies across the UK

Our Healthier Nation
Quotes from this document indicate the importance of
‘injury’ and its consequences:
“ It is clearly important that we continue to reduce
the number of deaths from accidents.”
“… many people suffer prolonged distress and poor
quality of life as the result of a serious accident ”
Is there potential for improvement
in the care of injured patients?
Working Party on the
Management of Patients with Major Injury,
Royal College of Surgeons 1988
“….this report reveals significant deficiencies
in the management of seriously injured patients.”
“Standards of hospital care of the injured should be
monitored through a national audit scheme…..”
Improvements in systems of trauma
care may be achieved by :
Enhancing pre-hospital care, ensuring
– appropriate medical intervention
– rapid transfer to best local facility
Assessing the use of helicopters
 Adopting ATLS principles
 Integrating trauma care services within
and between hospitals
 Investing in rehabilitation services
and
 Auditing and Researching injury and systems of care

Trauma Network
Background
1988 the Major Trauma Outcome Study was
established
 1992 1st REPORT published in BMJ:
- UK mortality rate higher than US
- large interhospital variation
- slow response time
- lack of senior input
 1994 Statistical analysis was improved and modified
 1996 New funding system1998
 104 hospitals in Europe audited their trauma services
through the Network

Widespread Participation
Annual new Attendances
at A &E Departments
< 30,000
30,001 - 40,000
40,001 - 50,000
50,000 - 60,000
60,001 - 70,000
70,001 - 80,000
>80,000
Total
Active members
October 1998
13
18
31
15
8
7
10
104
Trauma Network
Objectives

collect and analyse
clinical and epidemiological data

provide a statistical base
to support clinical audit

aid the development of trauma services
and inform the research agenda
Quality Cycle
Health Care Systems
Measurement
Analysis
Measurement
Data collection should be:
 Accurate
 Complete
 Comprehensive
Measurement / Data Collection
Simple
vs
Complex
Accurate, complete, comprehensive
Patient Inclusion Criteria
 Admission
> 72 hours
 Admission to an intensive care area
 Transfers for continuing care > 72 hours
 All deaths
 Excluding:
Fractures of the femoral neck or single pubic rami
(age > 65yrs)
OR SIMPLE isolated injuries
The Trauma Network
Analysis
INPUT
 Common
 Common
PROCESS
OUTPUT
standards for severity measurement
measures for performance
assessment
Assessment of Trauma Severity
Anatomical Injury
Physiological
Measurements
Age
Blunt/Penetrating
Probability of survival of individual patients
Hospital Comparisons
Physiological - Revised Trauma Score
 Is
a physiological measurement and
 by convention, recorded on arrival at
hospital
The RTS includes:
 Respiratory rate
 Systolic blood pressure
 Glasgow Coma Scale
Abbreviated Injury Scale (AIS 90)
1 injury = 1 code with a range of 0 - 6
Injury Severity Score (ISS)
Uses a formula to represent multiple
injuries in 1 number with a range of
0 - 75
INJURY SEVERITY SCORE
Example
Abbreviated Injury
Scale
Small subdural haematoma
Parietal lobe swelling
Major liver laceration
Upper tibial fracture (displaced)
ISS = 42 + 42 + 32 = 41
4
3
4
3
Ps cannot be applied to individuals
If the Probability of Survival (Ps)
of an injured patient = 0.4
Then, on average, 6 out of 10 patients will die
The Trauma Network Reports
Monthly:
Clinical activities
Quarterly:
Outcome statistics (anonymous)
Process filters
Ad Hoc Reports
Formatted data
Process Measures

Time intervals
– injury and arrival at A&E
– arrival in A&E and 1st doctor seeing the patient
– transfer to another hospital
Seniority of staff
 Haemo/pneumothorax

– evidence of chest drains

# skull, brain & spinal injury (AIS3+ )
– evidence of CT scan
– immobilisation of spine
– recorded GCS
Hospital comparisons 1994 - 1998
Summary Ws scores and 95%CI. Blunt injuries, excl. referrals
9
7
5
Ws & 95% CI
3
More
survivors
1
-1
-3
More
deaths
-5
-7
-9
The UK TRAUMA Audit & Research NETWORK
Compiled November 1998
Morbidity
 Wider
variation than with mortality
 Inadequate scoring systems
 What to estimate?
– temporary
– permanent
Trauma Audit - Closing the loop
D Yates, J Bancewicz, M Woodford, P Driscoll,
RAC Jones, R Kishen, D Marsh, S Hollis.
Injury (1994) 25:511
Conclusions and lessons learnt
 Close
inter-disciplinary cooperation and clinical
improvement at a senior level.
 Application of protocols to provide continuity
of care from the scene of the accident through
to the hospital ward.
 Frequent statistical analysis of performance at
audit meetings to ‘close the loop’ is an essential
part of the strategy to improve trauma care.
Setting quality standards
National Institute for Clinical Excellence
Clinical Governance
Commission for Health Improvement
National Service Frameworks