Organ Injury Scaling VI

Abstract

The Organ Injury Scaling (OIS) Committee of the American Association for the Surgery of Trauma (AAST) was organized formally in 1987; the fundamental purpose was to devise injury severity scores for individual organs to facilitate clinical investigation and outcomes research. The OIS Committee members were selected on the basis of recognized clinical expertise as well as experience with injury scoring. The Committee was charged to develop a comprehensive set of OISs, monitor their application in the current literature, and recommend modifications when deemed appropriate. To date, OISs for spleen, liver, kidney; [1] pancreas, duodenum, small bowel, colon, rectum; [2] chest wall, abdominal vascular, ureter, bladder, urethra; [3] and thoracic vascular, lung, cardiac, diaphragm [4] have been developed and published in the Journal of Trauma. The following OISs are the initial versions for extrahepatic biliary (Table 1), esophagus (Table 2), stomach (Table 3), vulva (Table 4), vagina (Table 5), uterus--nonpregnant (Table 6), uterus--pregnant (Table 7), fallopian tube (Table 8), and ovary (Table 9).Table 1: Extrahepatic biliary tree injury scale.Table 2: Esophagus injury scale.Table 3: Stomach injury scale.Table 4: Vulva injury scale.Table 5: Vagina injury scale.Table 6: Uterus (non-pregnant) injury scale.Table 7: Uterus (pregnant) injury scale.Table 8: Fallopian tube scale.Table 9: Ovary injury scale.Conceptually, OIS is a classification scheme based on the anatomic disruption of an individual organ scaled 1 to 6, representing the least to most severe injury. Grades 1 to 5 represent increasingly complex injuries encountered in salvageable patients, whereas grade 6 is a destructive lesion incompatible with survival. Severity is based on potential threat to the patient's life, and the progressive scale is derived from a comprehensive review of the current literature with consensus of the OIS Committee. Finally, the AAST Board of Managers approves all OISs before submission for publication. Despite this extensive preparation process, OISs are inherently limited by design and, thus, are anticipated to ultimately necessitate revision predicated on clinical experience and scientific analysis. In fact, the first OISs (spleen and liver) have undergone formal restructuring. [5] We look forward to your critial evaluation of the enclosed OISs and assistance in improving them in the future.