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Cellular Injury II: Classification01:21

Cellular Injury II: Classification

Cellular injury is any process that disrupts a cell’s ability to maintain homeostasis, leading to structural or functional changes. It is broadly classified based on etiology (cause) and mechanism of damage.Classification by EtiologyCellular injury may result from several causes. Hypoxic injury happens due to reduced oxygen delivery, most commonly from inadequate blood supply, such as arterial obstruction; for example, coronary artery thrombosis can cause myocardial infarction. Chemical injury...
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Standards of Care II

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Combat injury coding: a review and reconfiguration.

Mary M Lawnick1, Howard R Champion, Thomas Gennarelli

  • 1From Department of Surgery, SimQuest Solutions Inc. (M.M.L., H.R.C., E.J.K.), Annapolis; and Uniformed Services University of the Health Sciences (H.R.C.), Bestheda, Maryland; Medical College of Wisconsin (T.G.), Milwaukee, Wisconsin; Naval Health Research Center (M.R.G., E.D., R.R.V., V.W., J.D.), San Diego, California; University of Texas (B.J.E.); US Army Institute of Surgical Research (M.A.S., L.H.B.); University of Texas Health Science Center (J.H.); and Brooke Army Medical Center (J.R.F.), Fort Sam Houston, San Antonio, Texas; Applied Research Associates (L.A.Y.), Albuquerque, New Mexico; Mayo Clinic (D.H.J.), Rochester, Minnesota; and Walter Reed Army Medical Center, Washington, DC (S.F.).

The Journal of Trauma and Acute Care Surgery
|September 26, 2013
PubMed
Summary

The Military Combat Injury Scale (MCIS) and Military Functional Incapacity Scale (MFIS) offer a more accurate way to classify combat injuries than current civilian scales. These new scales better describe the unique and complex wounds sustained in modern warfare.

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Area of Science:

  • Military medicine
  • Trauma surgery
  • Injury scaling

Background:

  • Current civilian Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) are inadequate for combat injuries.
  • Existing systems fail to adequately describe penetrating and multi-mechanistic injuries from improvised explosive devices (IEDs).

Purpose of the Study:

  • To develop and validate new injury coding systems for combat trauma.
  • Introduce the Military Combat Injury Scale (MCIS) and Military Functional Incapacity Scale (MFIS).

Main Methods:

  • Developed MCIS and MFIS with military and civilian combat trauma experts.
  • Assigned MCIS severity based on urgency, care needs, and mortality risk.
  • Developed MFIS based on casualty's ability to shoot, move, and communicate.
  • Evaluated MCIS on 992 combat-injured patients.

Main Results:

  • MCIS is a simpler, comprehensive scale with 269 codes, outperforming AIS.
  • MCIS integrates with MFIS to associate functional impairment with injury severity.
  • MCIS demonstrates improved validity and reliability for military applications.

Conclusions:

  • MCIS and MFIS were developed, tested, and validated over several years by experts.
  • MCIS shows significant promise for documenting the nature, severity, and complexity of modern combat injuries.