Hörauf Jason-Alexander, Woschek Mathias, Schindler Cora Rebecca, Verboket Rene Danilo, Lustenberger Thomas, Marzi Ingo, Störmann Philipp
Department of Trauma Surgery and Orthopedics, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
Department of Orthopedic Surgery and Traumatology, Inselspital, Freiburgstrasse 18, 3010 Bern, Switzerland.
J Clin Med. 2024 Jun 5;13(11):3333. doi: 10.3390/jcm13113333.
Scientific studies on severely injured patients commonly utilize the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) for injury assessment and to characterize trauma cohorts. However, due to potential deterioration (e.g., in the case of an increasing hemorrhage) during the clinical course, the assessment of injury severity in traumatic brain injury (TBI) can be challenging. Therefore, the aim of this study was to investigate whether and to what extent the worsening of TBI affects the AIS and ISS. We retrospectively evaluated 80 polytrauma patients admitted to the trauma room of our level I trauma center with computed-tomography-confirmed TBI. The initial AIS, ISS, and Trauma and Injury Severity Score (TRISS) values were reevaluated after follow-up imaging. A total of 37.5% of the patients showed a significant increase in AIS (3.7 vs. 4.1; = 0.002) and the ISS (22.9 vs. 26.7, = 0.0497). These changes resulted in an eight percent reduction in their TRISS-predicted survival probability (74.82% vs. 66.25%, = 0.1835). The dynamic nature of intracranial hemorrhage complicates accurate injury severity assessment using the AIS and ISS, necessitating consideration in clinical studies and registries to prevent systematic bias in patient selection and subsequent data analysis.
针对重伤患者的科学研究通常采用简明损伤定级标准（AIS）和损伤严重度评分（ISS）来进行损伤评估以及描述创伤队列。然而，由于在临床过程中可能出现病情恶化（例如出血增加的情况），创伤性脑损伤（TBI）的损伤严重程度评估可能具有挑战性。因此，本研究的目的是调查TBI的恶化是否以及在多大程度上影响AIS和ISS。我们回顾性评估了80例入住我院一级创伤中心创伤室且经计算机断层扫描确诊为TBI的多发伤患者。在随访成像后重新评估初始的AIS、ISS以及创伤和损伤严重度评分（TRISS）值。共有37.5%的患者AIS显著增加（3.7对4.1；P = 0.002），ISS也显著增加（22.9对26.7，P = 0.0497）。这些变化导致他们的TRISS预测生存概率降低了8%（74.82%对66.25%，P = 0.1835）。颅内出血的动态特性使得使用AIS和ISS进行准确的损伤严重程度评估变得复杂，在临床研究和登记中必须加以考虑，以防止在患者选择和后续数据分析中出现系统偏差。
