TheThe AbbreviatedAbbreviated InjuryInjury ScaleScale (AIS)(AIS)

AA briefbrief introductionintroduction

AbbreviatedAbbreviated InjuryInjury ScaleScale

19901990 RevisionRevision

UpdateUpdate 9898 TheThe AbbreviatedAbbreviated InjuryInjury ScaleScale producedproduced by:by: Association for the Advancement of Automotive Medicine (AAAM) BasedBased inin IlinoisIlinois,, U.S.A.U.S.A.

Developed in 1971 to aid vehicle crash investigators Extended in 1990 to be more relevant to medical audit and research AISAIS -- EvolutionEvolution

„ 1976 - Clarified injury terminology „ 1980 - Revised ‘brain’ section „ 1985 - Extended in 1990 to be more relevant to medical audit and research „ 1990 – Introduced age (<15) to some injury descriptors „ 1990 - Update-98 Expanded coding rules Clarified coding of External injuries Included the Organ Injury Scale grades „ 2004 – Update due with expansion of Orthopaedic codes AISAIS defineddefined

TheThe AISAIS isis an:an: AnatomicallyAnatomically basedbased ConsensusConsensus derivedderived GlobalGlobal

Severity scoring system that classifies each injury in every body region according to its relative importance on a six point ordinal scale TheThe 66 pointpoint ordinalordinal AISAIS (Post(Post dot)dot) severityseverity scalescale 11 == minorminor 22 == moderatemoderate 33 == seriousserious

44 == severesevere 55 == criticalcritical

66 == maximummaximum (Currently untreatable) What does the AIS severity score indicate?

TheThe relativerelative riskrisk ofof “threat“threat toto life”life” inin anan averageaverage personperson whowho sustainssustains thethe codedcoded injuryinjury asas hishis oror herher onlyonly injuryinjury InIn additionaddition toto thethe singlesingle ‘Post‘Post dot’dot’ AISAIS severityseverity code,code, therethere isis aa 66 digitdigit ‘Pre‘Pre dot’dot’ numericalnumerical identifieridentifier

e.g. Femoral Shaft fracture:-

Numerical identifier = 851814851814

AIS == .3.3 HowHow areare thethe numericalnumerical identifiersidentifiers structured?structured?

Example:Example: FemoralFemoral shaftshaft fracturefracture == 851814.3851814.3

8 = Body Region: LowerLower ExtremityExtremity 5 =Type of Anatomic Structure: SkeletalSkeletal

18 =Specific Anatomic Structure: FemurFemur

14= Level of injury: ShaftShaft .3 = AIS:AIS: SeveritySeverity scorescore TheThe structurestructure && contentcontent ofof thethe AISAIS dictionarydictionary AISAIS DictionaryDictionary hashas 99 separateseparate chapterschapters HeadHead All codes begin with 1 FaceFace All codes begin with 2 NeckNeck All codes begin with 3 ThoraxThorax All codes begin with 4 AbdomenAbdomen && pelvicpelvic contentscontents All codes begin with 5 SpineSpine All codes begin with 6

UpperUpper extremitiesextremities All codes begin with 7

LowerLower extremitiesextremities All codes begin with 8

External,External, burnsburns && otherother traumatrauma All codes begin with 9 MostMost AISAIS chapterschapters havehave injuriesinjuries categorisedcategorised inin thethe followingfollowing order:order: WholeWhole AreaArea VesselsVessels NervesNerves InternalInternal OrgansOrgans SkeletalSkeletal ExceptionsExceptions are:are:--

HeadHead ChapterChapter WhichWhich hashas twotwo additionaladditional categories:categories

1) Length of Unconsciousness 2) Level of Unconsciousness SpinalSpinal ChapterChapter WhichWhich isis divideddivided intointo 33 sections:sections: (1)(1) CervicalCervical Spine,Spine, (2)(2) ThoracicThoracic Spine,Spine, (3)(3) LumbarLumbar spinespine And has a unique structure: ƒ Cord Injury ƒ Disc Injury ƒ Ligament Injury ƒ Nerve Root Injury ƒ Whole Area

Cervical Spine also contains: Brachial Plexus Injury Lumbar Spine also contains: Cauda Equina Injury Abdomen & Pelvic Contents Chapter Which has no skeletal injuries

Upper & Lower Extremities Chapter Which includes 2 additional categories

1) Muscles, Tendons, Ligaments 2) Joints External, Burns, Other Trauma Chapter Which has a unique structure:

ƒ Skin and Subcutaneous Tissue ƒ Burns ƒ Other Trauma HowHow toto codecode usingusing thethe AISAIS dictionarydictionary AISAIS AllowsAllows CodingCoding ofof

„„ BluntBlunt TraumaTrauma „„ PenetratingPenetrating TraumaTrauma „„ BurnsBurns „„ SelectedSelected OtherOther TraumaTrauma •Inhalation injury •High Voltage electrical injury PreliminaryPreliminary diagnosisdiagnosis areare notnot coded!coded!

„„ SuspectedSuspected „„ PossiblePossible „„ ProbableProbable „„ RuleRule outout ComplicationsComplications areare notnot coded!coded!

Examples:Examples:-- „ InfectionsInfections

„ PneumoniaPneumonia

„ EpilepsyEpilepsy followingfollowing headhead injuryinjury

„ PulmonaryPulmonary embolismembolism followingfollowing skeletalskeletal injuryinjury Consequences or outcomes are not coded as injuries!

Including:- „ Death „ Blindness „ Asphyxia „ Obstruction „ Miscarriage „ Detachment „ Deafness „ Swelling (except in the brain)

With the following exceptions>>>>>>> ƒ Blood loss

ƒ Air embolism

ƒ Haemo/pneumothorax

ƒ Cerebral oedema

ƒ Compartment syndrome

ƒ Retroperitoneal haemorrhage

Each of these may affect the severity score of a given AIS code, but must only be taken into account, following strict AIS guidelines! NFSNFS == NotNot furtherfurther specifiedspecified

ThisThis appearsappears throughoutthroughout thethe AISAIS dictionarydictionary && allowsallows thethe codingcoding ofof injuriesinjuries whenwhen detaileddetailed informationinformation isis lackinglacking

e.g. Injury description is Liver laceration Would be coded as: 541820.2 (Liver laceration NFS) RulesRules forfor codingcoding AISAIS 66 injuriesinjuries

„„ NeverNever codecode AISAIS 66 justjust becausebecause aa patientpatient dies!dies!

„ An AIS 6 code should only be used when there is documented medical evidence of an injury equivalent to AIS 6 ListList ofof AISAIS 66 InjuriesInjuries byby bodybody regionregion

HeadHead oror NeckNeck » Brain stem: laceration, crush, penetrating or transection » C3 or higher complete cord transection or contusion ThoraxThorax » Heart: rupture, multiple lacerations or avulsion » Total chest crush » Aortic rupture + haemorrhage not confined to mediastinum

AbdominalAbdominal && PelvicPelvic contentscontents » Liver avulsion ExternalExternal » 2nd or 3rd degree burns > 90% Total Body Surface AISAIS 99 Usually appears at the start of an AIS chapter What does AIS 9 mean? We have no information regarding injury to specific organ or structure e.g. Closed head injury NFS 115099.9 Blunt thoracic injury NFS 415099.9 Blunt cervical spine injury NFS – died without further evaluation 615999.9 When should AIS 9 be used? ƒAIS 9 should only be used for frequency counts ƒ AIS 9 does not allow the calculation of an Injury Severity Score (ISS) - & therefore should not be used on this course FINALLYFINALLY

ALWAYSALWAYS REMEMBER:REMEMBER: To help the coder, the Anatomical Index at the Back of the dictionary, lists:

ƒ All the injury descriptions in alphabetical order

ƒ The body region in which the injury is located

ƒ The page on which it can be found