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Introduction to Injury Scoring Systems Part 1- Physiologic Scores

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Introduction to Injury Scoring Systems Part 1- Physiologic Scores Amado Alejandro B ez MD MSc About the Author Dr. Amado Alejandro B ez MD MSc initiated his ... – PowerPoint PPT presentation

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Title: Introduction to Injury Scoring Systems Part 1- Physiologic Scores


1
Introduction to Injury Scoring SystemsPart 1-
Physiologic Scores
Amado Alejandro Báez MD MSc
2
About the Author
  • Dr. Amado Alejandro Báez MD MSc initiated his
    involvement with trauma and injuries while
    working as an Emergency medical Services provider
    in Santo Domingo Dominican Republic in the early
    1990s. After graduating from medical school at
    the Universidad Nacional Pedro Henriquez Ureña,
    he furthered his studies with graduate education
    in Emergency medical services, Public health and
    Clinical Research.

3
Learning Objectives
  • To understand the basic principles of injury
    scoring.
  • To review the principal physiological injury
    scoring systems.
  • The review basic r applications of these systems.

4
Performance Objectives
  • At the end of this module to participant will be
    able to
  • Apply basic principles of injury scoring in
    clinical and research scenarios.
  • Understand literature containing injury scoring
    systems.

5
Introduction
  • Scoring systems used in Trauma can be classified
    into
  • Physiologic such as the Trauma Score, and
    Glasgow Coma Scale.
  • Anatomical such as the Abbreviated Injury Scale
    and the Injury Severity Score
  • Combined score such as the TRISS method and ASCOT

6
PHYSIOLOGIC SCORES
  • The Revised Trauma Score (RTS)
  • Glasgow Coma Scale (GCS)
  • The Acute Physiology and Chronic Health
    Evaluation (APACHE)

7
Glasgow Coma Score
  • The Glasgow Coma Scale (GCS) is the standard
    measure used to quantify level of consciousness
    in head injured patients.
  • Widely used in scoring systems, treatment
    protocols and general clinical decision-making in
    critically ill patients.

Teasdale G., Jennett B., LANCET (ii) 81-83, 1974.

8
Glasgow Coma Score
  • The GCS is scored between 3 and 15, 3 being the
    worst, and 15 the best.
  • GCS is composed of three parameters Best Eye
    Response, Best Verbal Response, Best Motor
    Response.
  •  A GCS of 13 or higher correlates with a mild
    brain injury, 9 to 12 is a moderate injury and 8
    or less a severe brain injury.

9
Glasgow Coma Score
  • Best Eye Response. (4)
  • No eye opening gt1
  • Eye opening to pain gt2
  • Eye opening to verbal command gt3
  • Eyes open spontaneously gt4

10
Glasgow Coma Score
  • Best Motor Response. (6)
  • No motor response gt1
  • Extension to paingt2
  • Flexion to paingt3
  • Withdrawal from paingt4
  • Localizing paingt5
  • Obeys Commandsgt6

11
Glasgow Coma Score
  • Best Verbal Response. (5)
  • No verbal response gt1
  • Incomprehensible sounds gt2
  • Inappropriate words gt3
  • Confused gt4
  • Orientated gt5

12
The Revised Trauma Score
  • RTS utilizes 3 physiologic parameters
  • Glasgow Coma Scale (GCS)
  • Systemic blood pressure (SBP)
  • Respiratory rate (RR)
  • The RTS has been used in the out-of-hospital
    setting as a tool for trauma center triage.
  • The RTS has also been used as a prognostic tool
    for survival.

13
The Revised Trauma Score
  • Two types of RTS
  • 1.Triage RTS Determined by adding each of the
    coded values together.
  • 2.The coded form of the RTS is more frequently
    used for quality assurance and outcome
    prediction. The coded RTS is calculated as
    follows
  • RTSc 0.7326 SBPc 0.2908 RRc 0 .9368 GCSc

14
The Revised Trauma Score
RTS Value
Respiratory Rate(RR)
Systolic Blood Pressure(SBP)
Glasgow Coma Scale(GCS)
4
10-29
gt89
13-15
3
gt29
76-89
9-12
2
6-9
50-75
6-8
1
1-5
1-49
4-5
0
0
0
3
15

16
The Acute Physiology and Chronic Health
Evaluation
  • APACHE has two components
  • The chronic health evaluation, which incorporates
    the influence of comorbid conditions (such as
    diabetes and cirrhosis)
  • Acute Physiology Score (APS).

17
The Acute Physiology and Chronic Health Evaluation
  • The APS consists of weighted variables
    representing the major physiologic systems,
    including neurological, cardiovascular,
    respiratory, renal, gastrointestinal, metabolic,
    and hematological variables.

18
Web Based Resources
  • http//www.cdc.gov/ncipc/
  • CDCs The National Center for Injury Prevention
    and Control (NCIPC)
  • http//www.carcrash.org/
  • Association for the Advancement of Automotive
    Medicine. An international multidisciplinary
    organization for crash injury control
  • http//www.injurycontrol.com/icrin/
  • Injury Control Resource Information Network

19
Web Based Resources
  • http//www.jhsph.edu/Research/Centers/CIRP/
  • The Johns Hopkins Center for Injury Research
    Policy
  • http//www.trauma.org
  • A British web-based trauma resource center
  • http//www.trauma.org/scores/rtscalc.html
  • Revised Trauma Score Calculator from trauma.org
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