1. Introduction to Injury Scoring Systems Part 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 1990’s. 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 =>1 Eye opening to pain =>2 Eye opening to verbal command =>3 Eyes open spontaneously =>4

10. Glasgow Coma Score Best Motor Response. (6) No motor response =>1 Extension to pain=>2 Flexion to pain=>3 Withdrawal from pain=>4 Localizing pain=>5 Obeys Commands=>6

11. Glasgow Coma Score Best Verbal Response. (5) No verbal response =>1 Incomprehensible sounds =>2 Inappropriate words =>3 Confused =>4 Orientated =>5

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 0 003 1 1-51-494-5 2 6-950-756-8 3 >2976-899-12 4 10-29>8913-15 RTS Value Respiratory Rate (RR) Systolic Blood Pressure (SBP) Glasgow Coma Scale (GCS)

16. The Acute Physiology and Chronic Health Evaluation APACHE has two components: 1.The chronic health evaluation, which incorporates the influence of comorbid conditions (such as diabetes and cirrhosis) 2.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/ CDC’s 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