Measurement of disability after multiple injuries: the functional independence measure. Clinical review

Collection of data about injured patients must include a description of the injuries using the International Classification of Disease (ICD9) and their severity using the Anatomical Injury Scale (AIS) from which the Injury Severity Score (ISS) is calculated. This method was developed for assessing the risk of mortality and is a good way of defining the extent of injury or impairment. Morbidity after injury is equally important. The terms "disability", (relating to the individual person's behaviour and performance of activities) and "handicap" (relating more to the disadvantage for a given patient in society) are accepted as the two main sub headings of long term morbidity. There are limitations to total overall health measurements and a functional disability approach is necessary for patients with multiple injuries. Of the different assessment tools the Functional Independence Measure, originally developed in Buffalo, USA, has been chosen as the most reliable and valid as it has the additional advantage of a large database containing the records of 200,000 patients throughout the world. This has been introduced at the Royal London Hospital to measure the disability outcome of patients brought there by the Helicopter Emergency Medical Service.