Trauma Research Department, Swedish Medical Center, Englewood, CO 80113, USA.
Injury. 2009 Sep;40(9):999-1003. doi: 10.1016/j.injury.2009.05.013. Epub 2009 Jun 12.
The abbreviated injury scale (AIS) was updated in 2005 from the AIS 1998 version. The purpose of this study is to describe the effects of this change on injury severity scoring and outcome measures.
Analyses were performed on all trauma patients consecutively admitted over a 6-month period at two geographically separate Level I trauma centers. Injuries were manually double-coded according to the AIS 05 and the AIS 98. Changes in AIS, ISS, and new ISS (NISS) were analysed using paired t-tests. Apparent differences in outcome by ISS strata (<16, 16-24, >24) were compared for AIS 05 versus AIS 98 using the Wald-type statistic. Lastly, the percent of patients with a change in ISS strata are reported.
There were 2250 patients included in the study. Nearly half (46.4%) of AIS codes changed, resulting in a different AIS score for 18.9% of all codes. The mean ISS was significantly lower using the AIS 05 (11.7) versus the AIS 98 (13.3, p<0.001). Similarly, the mean NISS was significantly lower (16.3 versus 18.7, p<0.001). In the ISS strata 16-24 an apparent increase in mortality, length of stay, and percent of patients not discharged home was observed for the AIS 05 versus AIS 98. Changes in outcome measures for this stratum were as follows (AIS 98 versus AIS 05): mortality, 4.3% versus 7.7% (p=0.002); hospital length of stay, 5.2 days versus 7.3 days (p<0.001); percent of patients not discharged home, 39.2% versus 49.3% (p<0.001). Finally, there was a 20.5% reduction in patients with an ISS>or=16 and a 26.2% reduction in patients with an ISS>or=25 using the AIS 05.
The AIS revision had a significant impact on overall injury severity measures, clinical outcome measures, and percent of patients in each ISS strata. Therefore, the AIS revision affects the ability to directly compare data generated using AIS 05 and AIS 98 which has implications in trauma research, reimbursement and ACS accreditation.
缩略损伤量表（AIS）于 2005 年从 AIS 1998 版本更新。本研究的目的是描述这种变化对损伤严重程度评分和结果测量的影响。
对在两个地理位置不同的一级创伤中心连续住院的 6 个月内的所有创伤患者进行分析。根据 AIS 05 和 AIS 98 对损伤进行手动双重编码。使用配对 t 检验分析 AIS、ISS 和新 ISS（NISS）的变化。使用 Wald 型统计比较 AIS 05 与 AIS 98 时，按 ISS 分层（<16、16-24、>24）的结果差异。报告 ISS 分层变化的患者百分比。
本研究共纳入 2250 例患者。近一半（46.4%）的 AIS 码发生变化，导致 18.9%的 AIS 码的 AIS 评分不同。使用 AIS 05（11.7）时，ISS 平均值明显低于使用 AIS 98（13.3，p<0.001）。同样，NISS 的平均值也明显降低（16.3 对 18.7，p<0.001）。在 ISS 分层 16-24 中，与 AIS 98 相比，AIS 05 中观察到死亡率、住院时间和未出院回家患者比例的明显增加。对于该分层的结果测量指标，变化如下（AIS 98 与 AIS 05）：死亡率，4.3%对 7.7%（p=0.002）；住院时间，5.2 天对 7.3 天（p<0.001）；未出院回家的患者比例，39.2%对 49.3%（p<0.001）。最后，使用 AIS 05 时，ISS≥16 的患者减少了 20.5%，ISS≥25 的患者减少了 26.2%。
AIS 修订对整体损伤严重程度测量、临床结果测量和每个 ISS 分层的患者比例有显著影响。因此，AIS 修订影响了使用 AIS 05 和 AIS 98 生成的数据的直接比较能力，这对创伤研究、报销和 ACS 认证都有影响。
