• Jan C Van Ditshuizen, Charlie A Sewalt, Cameron S Palmer, Van LieshoutEsther M MEMMDepartment of Surgery, Trauma Research Unit, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands., VerhofstadMichiel H JMHJDepartment of Surgery, Trauma Research Unit, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands., Dennis Den Hartog, and Dutch Trauma Registry Southwest.
• Department of Surgery, Trauma Research Unit, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands. j.vanditshuizen@erasmusmc.nl.
• Scand J Trauma Resus. 2021 May 27; 29 (1): 71.

BackgroundA threshold Injury Severity Score (ISS) ≥ 16 is common in classifying major trauma (MT), although the Abbreviated Injury Scale (AIS) has been extensively revised over time. The aim of this study was to determine effects of different AIS revisions (1998, 2008 and 2015) on clinical outcome measures.MethodsA retrospective observational cohort study including all primary admitted trauma patients was performed (in 2013-2014 AIS98 was used, in 2015-2016 AIS08, AIS08 mapped to AIS15). Different ISS thresholds for MT and their corresponding observed mortality and intensive care (ICU) admission rates were compared between AIS98, AIS08, and AIS15 with Chi-square tests and logistic regression models.ResultsThirty-nine thousand three hundred seventeen patients were included. Thresholds ISS08 ≥ 11 and ISS15 ≥ 12 were similar to a threshold ISS98 ≥ 16 for in-hospital mortality (12.9, 12.9, 13.1% respectively) and ICU admission (46.7, 46.2, 46.8% respectively). AIS98 and AIS08 differed significantly for in-hospital mortality in ISS 4-8 (χ2 = 9.926, p = 0.007), ISS 9-11 (χ2 = 13.541, p = 0.001), ISS 25-40 (χ2 = 13.905, p = 0.001) and ISS 41-75 (χ2 = 7.217, p = 0.027). Mortality risks did not differ significantly between AIS08 and AIS15.ConclusionISS08 ≥ 11 and ISS15 ≥ 12 perform similarly to a threshold ISS98 ≥ 16 for in-hospital mortality and ICU admission. This confirms studies evaluating mapped datasets, and is the first to present an evaluation of implementation of AIS15 on registry datasets. Defining MT using appropriate ISS thresholds is important for quality indicators, comparing datasets and adjusting for injury severity.Level Of EvidencePrognostic and epidemiological, level III.

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