Reconsidering injury severity: Looking beyond the maximum abbreviated injury score

Injury severity is often determined by anatomical measures such as the Maximum Abbreviated Injury Score (MAIS). Yet, it is suggested that MAIS provides a limited view on injury severity as the overall burden of trauma is multidimensional, including psychological problems and health care costs for example. It is unclear if MAIS as a single criterion can serve as a proper indicator for overall injury severity, since it has not been compared with other severity measures for different types of injuries. Consequently, scientists and policymakers using MAIS as primary measure for injury severity may have insufficient information for prioritizing prevention policy and research. This study explores the relation between MAIS and other injury severity measures for ten different injury types to determine if MAIS is indicative for the overall burden of trauma.

Trauma patients filled in a questionnaire six months after they visited an emergency department in the Netherlands. In total, 3.698 patients registered in the Dutch Injury Surveillance System responded. The following injury types are included: injuries to the head-brain, face, spinal cord, internal organs, upper and lower extremities, and hips. The questionnaire consisted of questions about the impact of patients' injury regarding quality of life (EQ-5D+), perceived severity, subjective distress (IES-R), anxiety and depression (HADS) and healthcare use.

Logistic regression showed that MAIS was significantly related to hospital stay, quality of life and cognitive complaints. A lack of association was found between MAIS and perceived severity, distress, anxiety and depression. Furthermore, Z-score analysis showed that the relation between severity measures differs between injury types.

MAIS is an anatomical-based discriminative measure for injury severity that correlates with several other severity measures including hospital stay and healthcare costs. However, MAIS is not always a proper indicator for severity when severity involves the patient's psychological burden or perceived health status. In sum, the accuracy of MAIS as an indicator for injury severity depends on the definition of severity and the injury type. Therefore, caution is needed when using and interpreting MAIS as an indicator for injury severity in research or policymaking.