Commonly Used Scoring and Grading Systems in Trauma

Must-Know Essentials: Injury Severity Scores for Trauma Assessment

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An anatomical scoring system
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Each injury is ranked on a scale of 1 to 6 based on the severity of the injury.

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An anatomical scoring system
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Provides an overall score for patients with multiple injuries
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Is the only anatomical scoring system that correlates linearly with mortality, morbidity, hospital stay, and other measures of severity
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The AIS for the following six body regions is used to calculate the ISS:
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  Head and neck
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  Face
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  Chest
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  Abdomen
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  Extremity including the pelvis
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  External
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AIS scores of the three most severely injured body regions are added and squared to calculate the ISS.
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ISS scores range from 0 to 75.
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An AIS score of 6 (unsurvivable injury) is assigned an ISS score of 75.

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Predicts pediatric trauma mortality
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A higher trauma score is associated with lower mortality.
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  A score >8 has an estimated mortality rate of 9%.
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  A score ≤0 has an estimated mortality rate of 100%.
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Calculated by using weight (kg), airway, systolic blood pressure (SBP), mental status, skin injury, and fracture with a minimal score of −6 and the maximum score of +12.

Factors	+2	+1	−1
Weight (kg)	>20	10–20	<10
Airway	Patent	Oral/nasal airway Oxygen	Need for airway
Systolic blood pressure	>90 mm Hg	50–90 mm Hg	<50 mm Hg
Mental status	Awake	Obtunded	Comatose
Skin injury	None	Contusion, abrasion, laceration <7 cm not involving fascia	Tissue loss, penetrating wound involving fascia
Fracture	None	Single closed	Open or multiple

Grade I	Subcapsular hematoma: <10% surface area Capsular tear Laceration: <1 cm parenchymal depth
Grade II	Subcapsular hematoma: 10%–50% surface area Intraparenchymal hematoma: <5 cm diameter Laceration: 1–3 cm parenchymal depth, not involving a parenchymal vessel
Grade III	Subcapsular hematoma: >50% surface area or expanding Ruptured subcapsular or parenchymal hematoma Intraparenchymal hematoma: >5 cm diameter Laceration: ≥3 cm parenchymal depth Laceration involving trabecular vessels
Grade IV	Laceration: Segmental or hilar vessels producing major devascularization (>25% of spleen)
Grade V	Completely shattered spleen Hilar vascular injury with devascularized spleen

Grade I	Subcapsular hematoma: <10% surface area Capsular tear or p arenchymal laceration <1 cm deep
Grade II	Subcapsular hematoma: 10%–50 % surface area Intraparenchymal laceration <10 cm diameter Capsular tear or parenchymal laceration 1–3 cm deep, <10 cm in length
Grade III	Subcapsular hematoma: >50% surface area Ruptured subcapsular or parenchymal hematoma Intraparenchymal hematoma >10 cm or expanding hematoma Parenchymal laceration ≥3 cm deep
Grade IV	Parenchymal laceration with disruption of 25%–75% hepatic lobe or 1–3 Couinaud’s segments
Grade V	Parenchymal laceration with disruption of >75% hepatic lobe or >3 Couinaud’s segments within a single lobe Juxtahepatic venous injury (retrohepatic vena cava/central major hepatic veins)
Grade VI	Hepatic avulsion

Grade I	Minor contusion without duct injury Superficial laceration without duct injury
Grade II	Major contusion without duct injury or tissue loss Major laceration without duct injury or tissue loss
Grade III	Distal transection (left of the superior mesenteric vessels) Distal parenchymal injury with duct injury (left of the mesenteric vessels)
Grade IV	Proximal transection (right of superior mesenteric vein) Parenchymal injury involving ampulla
Grade V	Massive disruption of the pancreatic head

Grade I	Subcapsular hematoma and /or parenchymal contusion without laceration
Grade II	Perirenal hematoma confined to Gerota’s fascia Renal parenchymal laceration ≤1 cm depth without urinary extravasation
Grade III	Renal parenchymal laceration >1 cm depth without collecting system rupture or urinary extravasation Any injury in the presence of a kidney vascular injury or active bleeding contained within Gerota’s fascia
Grade IV	Parenchymal laceration extending into urinary collecting system with urinary extravasation Renal pelvis laceration and/or complete ureteropelvic disruption Segmental renal vein or artery injury Active bleeding beyond Gerota’s fascia into the retroperitoneum or peritoneum Segmental or complete kidney infarction due to vessel thrombosis without active bleeding
Grade V	Main renal artery or vein laceration or avulsion of hilum Devascularized kidney with active bleeding Shattered kidney with loss of identifiable parenchymal renal anatomy

Grade I	Contusion /intramural hematoma Partial thickness laceration
Grade II	Laceration <2 cm in gastroesophageal (GE) junction or pylorus Laceration <5 cm in proximal one-third of stomach Laceration < 10 cm in distal two-thirds of stomach
Grade III	Laceration >2 cm in GE junction or pylorus Laceration >5 cm in proximal one-third of stomach Laceration >10 cm in distal two-thirds of stomach
Grade IV	Tissue loss or devascularization in less than two-thirds of stomach
Grade V	Tissue loss or devascularization less than two-thirds of stomach

Grade I	Hematoma involving single portion of the duodenum Partial thickness laceration, no perforation
Grade II	Hematoma involving more than one portion of the duodenum Laceration with disruption <50% of the circumference of the duodenum
Grade III	Laceration with disruption of 50%–75% circumference of D2 segment of the duodenum Laceration with disruption of 50%–100% circumference of D1, D3, D4 segment of the duodenum
Grade IV	Laceration with disruption of >75% circumference of D2 segment of the duodenum Laceration involving ampulla or intrapancreatic portion (distal) common bile duct
Grade V	Laceration with massive disruption of duodenopancreatic complex Devascularization of the duodenum

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