Centre for Blast Injury Studies, Imperial College London, London, UK.
Department of General Surgery, The Royal London Hospital, Barts NHS Trust, London, UK.
Br J Anaesth. 2022 Feb;128(2):e127-e134. doi: 10.1016/j.bja.2021.10.007. Epub 2021 Nov 10.
Injury scoring systems can be used for triaging, predicting morbidity and mortality, and prognosis in mass casualty incidents. Recent conflicts and civilian incidents have highlighted the unique nature of blast injuries, exposing deficiencies in current scoring systems. Here, we classify and describe deficiencies with current systems used for blast injury. Although current scoring systems highlight survival trends for populations, there are several major limitations. The reliable prediction of mortality on an individual basis is inaccurate. Other limitations include the saturation effect (where scoring systems are unable to discriminate between high injury score individuals), the effect of the overall injury burden, lack of precision in discriminating between mechanisms of injury, and a lack of data underpinning scoring system coefficients. Other factors influence outcomes, including the level of healthcare and the delay between injury and presentation. We recommend that a new score incorporates the severity of injuries with the mechanism of blast injury. This may include refined or additional codes, severity scores, or both, being added to the Abbreviated Injury Scale for high-frequency, blast-specific injuries; weighting for body regions associated with a higher risk for death; and blast-specific trauma coefficients. Finally, the saturation effect (maximum value) should be removed, which would enable the classification of more severe constellations of injury. An early accurate assessment of blast injury may improve management of mass casualty incidents.
创伤评分系统可用于分诊、预测发病率和死亡率，以及对大规模伤亡事件进行预后判断。最近的冲突和民用事件突显了爆炸伤的独特性质，暴露出当前评分系统的缺陷。在这里，我们对目前用于爆炸伤的系统进行分类和描述。尽管目前的评分系统突出了人群的生存趋势，但仍存在几个主要的局限性。个体死亡率的可靠预测并不准确。其他局限性包括饱和效应（评分系统无法区分高损伤评分个体）、整体损伤负担的影响、区分损伤机制的精度不足以及评分系统系数缺乏数据支持。其他因素也会影响结果，包括医疗保健水平和损伤与就诊之间的时间延迟。我们建议，一个新的评分系统应将损伤的严重程度与爆炸伤的机制结合起来。这可能包括在简明损伤分级法中增加针对高频爆炸伤的细化或额外编码、严重程度评分，或者两者都有；对与更高死亡风险相关的身体区域进行加权处理；以及添加爆炸伤创伤系数。最后，应去除饱和效应（最大值），这将能够对更严重的损伤组合进行分类。早期对爆炸伤的准确评估可能会改善大规模伤亡事件的处理。
