The Impact of Multiple Extremity Injuries (MEI) on the Severity of Trauma: Injury Severity Score in Patients Died from Head Injury
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Date
2006
Journal Title
Journal ISSN
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Publisher
Sebha University
Abstract
Objective: Orthopaedic injuries do have a significant effect on the severity of head trauma. Trauma systems based on breakdown of anatomic structure of organs and tissues, could be used for objectification, comparison and establishing of severity of injuries. The Injury Severity Score (ISS) and its new version (NISS) are important tools for grading the severity of injury to trauma patients.
Purpose: The purpose of this paper is to study the effect of fractures of extremities on trauma severity in persons fatally injured in road accidents, and, according to this finding, to point out the ISS and NISS values of critical injuries.
Materials And Methods: A retrospective study of all cases of road accident (RA) admitted to 2nd March Hospital during a 12 month period (2002-2004) were analyzed. The abbreviated injury score (AIS) of the most severe injury in each of the six body regions was recorded under AIS score in the scoring table. The ISS and NISS were then obtained.
Results: The present study shows that the mean age was 30.7 ±20.2 years, and the male to female ratio was about 4:1. The most susceptible age group was between 21-30, and comprising 26.9% of total 160 cases. Children below 10 years constitute 18% of total cases. The mean ISS in our patients was 36.5 (SD ±8.97) and the mean NISS was 44.97(SD±10.8). The ISS of patients without MEI (33.8±9.03) was lower than the values in patients with MEI (37.9±8.49). However, the NISS was nearly the same in patients with (44.3±10.1) and without (45.6±11.45) MEI. Children with MEI had a higher ISS (40 versus 31) and NISS (47 versus 40) among the three age groups. The ISS of adults and elderly patients with MEI was higher than those who had no MEI (37.4 versus 34.8 and 37.8 versus 33.3). On the other hand, adults and elderly patients without MEI had NISS higher than those with MEI ( 46 versus 43.1 and 47 versus 45.1). Critical (n= 195) and severe but not life threatening (n=138) head and neck injuries were present in 40.2 % of the total injuries. Multiple injuries of the extremities constituted 21.1 %, of the total injuries. Fifty percent of the patients had MEIs. These include fractures of upper (n=53) and lower limbs and pelvis (n=128).
Conclusion: The NISS is a more accurate predictor of in-hospital death than the ISS and should be chosen over the ISS for case-mix control in trauma research, especially in certain subpopulations such as head/neck-injured patients.