Further experience with the modified abbreviated injury severity scale

Abstract

In a 3-year period of prospective study, 250 pediatric patients with multiple trauma (injury to at least two body areas) had injuries scored by a modification of the Injury Severity Scale (MISS). This scale uses the categories and rankings of the Abbreviated Injury Scale-1980 (AIS-80) except for neurologic injuries. Neurologic injuries are scored by using a combination of the Glasgow Coma Scale (GCS) and other neurologic findings (presence of surgical mass lesion, pupillary light response, and oculocephalic reflexes). The MISS is calculated as the sum of the squares of the three most severely injured body areas. The mean MISS score was 27.8, with 38% of MISS scores greater than or equal to 25 and 62% less than 25. Among those with MISS scores greater than or equal to 25 there was a 40% mortality and 30% disability, while there were no mortalities and 1% disability for those with MISS scores less than 25 (p less than 0.001). Overall mortality was 15%, with 10% disability. Mean MISS scores for death and disability were 33.4 and 30.2, respectively. Neurologic injuries were present in 173 patients (69%); 128 patients had severe head injuries (coma greater than 6 hours duration); 80% of all deaths were due to neurologic injury and all but two deaths had some degree of head injury; the remaining 20% of deaths were due to chest and abdominal injuries. Patients with MISS grade 5 injury (critical, survival uncertain) had 73% mortality, while those with grades 4 and 3 injury had 8% and 2% mortality, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)