The Abbreviated Injury Scale: application to autopsy data

Area of Science:

• Forensic Pathology
• Trauma Scoring Systems

Background:

• Autopsy reports provide detailed injury information.
• Established trauma scoring systems like AIS and ISS are used for injury severity assessment.

Purpose of the Study:

• To evaluate the adequacy of the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) in coding various autopsy-identified trauma fatalities.
• To identify discrepancies between autopsy findings and the coding criteria of AIS and ISS.

Main Methods:

• Twenty autopsy reports (fall, cutting, burn, drowning, strangulation, gunshot, traffic fatalities) were analyzed.
• Injuries were scored using the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS).
• Autopsy descriptions were compared against AIS and ISS coding criteria.

Main Results:

• AIS and ISS codes were adequate for skin, long bone, and most visceral injuries.
• Autopsy descriptions exceeded coding criteria for craniocerebral, cervicovertebral, and muscular trauma.
• Lung contusions and rib fractures received high scores, potentially due to autopsy sensitivity.
• AIS scores were low for fatalities with purely physiologic lethal mechanisms (e.g., concussion, strangulation) or delayed therapy, not reflecting lethal outcomes.
• Complete skull base hinge fractures were underestimated in severity.

Conclusions:

• AIS and ISS may underestimate injury severity in fatalities with non-morphologic lethal mechanisms or therapeutic complications.
• Low AIS/ISS scores in trauma fatalities can be retrospective indicators of physiologic death mechanisms or treatment issues.
• The coding systems require refinement to capture the full spectrum of trauma mortality, including physiologic factors.