Lack of Concordance Between Abbreviated Injury Scale and American Association for the Surgery of Trauma Organ Injury Scale in Patients with High-Grade Solid Organ Injury

Jeffrey Santos; Shelby Kunz; Areg Grigorian; Stephen Park; Emiliano Tabarsi; Kazuhide Matsushima; Liz Penaloza-Villalobos; Xian Luo-Owen; Kaushik Mukherjee; Claudia Alvarez; Jeffry Nahmias

doi:10.1097/XCS.0000000000001117

Lack of Concordance Between Abbreviated Injury Scale and American Association for the Surgery of Trauma Organ Injury Scale in Patients with High-Grade Solid Organ Injury

J Am Coll Surg. 2024 May 15. doi: 10.1097/XCS.0000000000001117. Online ahead of print.

Affiliations

¹ University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California.
² Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA.
³ Division of Acute Care Surgery, Loma Linda University Health, Loma Linda, CA.

PMID: 38748592
DOI: 10.1097/XCS.0000000000001117

Abstract

Background: The Abbreviated Injury Scale (AIS) is widely utilized for body region-specific injury severity. The AAST-Organ Injury Scale (AAST-OIS) provides organ-specific injury severity but is not included in trauma databases. Previous researchers have used AIS as a surrogate for OIS. This study aims to assess AIS-abdomen concordance with AAST-OIS grade for liver and spleen injuries, hypothesizing concordance in terms of severity (grade of OIS and AIS) and patient outcomes.

Study design: This retrospective study (7/2020-6/2022) was performed at three trauma centers. Adult trauma patients with AAST-OIS grade III-V liver and/or spleen injury were included. AAST-OIS grade for each organ was compared to AIS-abdomen by evaluating the percentage of AAST-OIS grade correlating with each AIS score as well as rates of operative intervention for these injuries. Analysis was performed with Chi-square tests and univariate analysis.

Results: Of 472 patients, 274 had liver injuries and 205 had spleen injuries grades III-V. AAST-OIS grade III-V liver injuries had concordances rates of 85.5%, 71% and 90.9% with corresponding AIS 3-5 scores. AAST-OIS grade III-V spleen injuries had concordances rates of 89.7%, 87.8% and 87.3%. There was a statistical lack of concordance for both liver and spleen injuries (both p<0.001). Additionally, there were higher rates of operative intervention for AAST-OIS grade IV and V liver injuries and grade III and V spleen injuries versus corresponding AIS scores (p<0.05).

Conclusion: AIS should not be used interchangeably with OIS due to lack of concordance. AAST-OIS should be included in trauma databases to facilitate improved organ injury research and quality improvement projects.