Magnitude of the problem and time line concept.pptx

Trauma scoring

1. Magnitude of the problem and time line concept in trauma and scoring systems DR.B.ATHIKA HEENA GENERAL SURGERY

2. THE MAGNITUDE OF THE PROBLEM : Trauma remains the most common cause of death and disability in children and young adults in the resource-rich countries. Globally, approximately 10 000 people die daily as a result of an injury. Road traffic accidents (RTA), falls and intentional violence have been identified as the major vectors of traumatic injury. I major burden of injury is increasingly occurring in middle- and low-income countries . International Classification of Disease, a system that can be limited in providing accurate descriptions of injury severity.

3. e Abbreviated Injury Scale (AIS) dictionary consists of a greater level of detail (including more than 2000 injury codes) and assigns to every injury a severity score between 1 (mild) and 6 (maximum). Injury Severity Score (ISS), providing an image of the anatomical severity of injury suffered by the individual patient. Major trauma is defined as an ISS greater than 15, which can be written as >15. international comparisons are based on road deaths per million inhabitants

4. ● The vast majority of injuries are not life or limb threatening ● Severe trauma continues to be a major cause of death in young patients ● Older patients with fragility fractures pose an additional burden to the healthcare system ● Look for important features of injuries that could influence the outcome

5. TIME LINE CONCEPT IN TRAUMA : Injury can occur in the blink of an eye. the seconds prior to the application of the external injury force or vector, the patient is at their normal baseline, which can be called time zero. All subsequent events, including the acute physiological response to injury, the body’s internal mechanisms to maintain homeostasis (to compensate for the sequelae of trauma), the healing processes and the actions instigated by health professionals, are associated with a ‘timeline’.

6. Critical time window in which we can intervene for a positive treatment outcome, before the loss of compensatory mechanisms Timeline allows evaluation of any progress made from time zero to other important events and to reflect on whether a specific course of action could have been performed better. Overall, interventions can be done The seriousness and the immediate impact of a specific clinical condition should be prioritised and treated in a systematic approach (what kills first should be managed first).

7. The ATLS system delineates an order of priorities set by ABCD This hierarchy of priorities is instituted upon the ‘time dependence’ principle. The clinician should bear in mind that a successful management plan is dependent on, first, the time needed to evaluate and diagnose the nature of the problem and, second, the time taken to respond effectively to the condition discovered. principle that we need to introduce a treatment response even before we have made the definitive diagnosis if we want to save the patient’s life . It is clear, therefore, that the ‘timeline concept’ is critical in the safe management of trauma patients.

8. TRAUMA SCORING: Scoring systems are typically based on either injury anatomy or the physiology demonstrated after one or more injuries are sustained The Abbreviated Injury Scale (AIS) has been the most used anatomic system of injury . Injuries are characterized by a six-digit taxonomy that includes the body region, type of anatomic structure, and specific anatomic detail of the injury. The AIS represents the foundation for other scoring systems

9. ISS, calculated by summing the squares of the AIS severity codes for the three most severely injured body regions. The ISS ranges from 1 to 75, with severity groupings : minor injury (ISS less than 9), moderate injury (ISS between 9 and 16), serious injury (ISS between 16 and 25), and severe injury (ISS more than 25). The ISS has been commonly to quantify the overall burden of injury sustained . the Organ Injury Scale (OIS ) released by the AAST has been incorporated into the more recent versions of the AIS. The OIS has added greater anatomic detail for specific organs and incorporated the ability to better delineate organ injury severity.

10. These physiologic scoring systems are more capable of identifying the overall condition and can also better guide real-time decision making. GCS AND RTS are physiologic scoring system GCS is more commonly used