title: [Retrospective computation of the ISS in multiple trauma patients: Potential pitfalls and limitations of findings in full body CT scans].
abstract: BACKGROUND
  The Injury Severity Score (ISS) is a well-established anatomical scoring system for polytraumatized patients. However, any inaccuracy in the Abbreviated Injury Score (AIS) directly increases the ISS impreciseness. Using the full body computed tomography (CT) scan report, ISS computation can be associated with certain pitfalls. This study evaluates interpretation variations depending on radiological reports and indicates requirements to reliably determine the ISS.
  
  
  METHODS
  The ISS of 81 polytraumatized patients was calculated based on the full body CT scan report. If an injury could not be attributed to a precise AIS cipher, the minimal and maximal ISS was computed. Real ISS included all conducted investigations, intraoperative findings, and final medical reports. The differences in ISS min, ISS max, and ISS real were evaluated using the Kruskal-Wallis test (p<0.05) and plotted in a linear regression analysis.
  
  
  RESULTS
  Mean ISS min was 24.0 (± 0.7 SEM) points, mean ISS real 38.6 (±1.3 SEM) and mean ISS max was 48.3 (±1.4 SEM) points. All means were significantly different compared to one another (p<0.001). The difference between possible and real ISS showed a distinctive variation. Mean deviation was 9.7 (±0.9 SEM) points downward and 14.5 (±1.1 SEM) points upward. The difference between deviation to ISS min and ISS max was highly significant (p<0.001).
  
  
  CONCLUSIONS
  Objectification of injury severity in polytraumatized patients using the ISS is an internationally well-established method in clinical and scientific settings. The full body CT scan report must meet distinct criteria and has to be written in acquaintance to the AIS scale if intended to be used for correct ISS computation.
authors.affiliation: Klinik für Allgemeine, Unfall und Hand-Plastische Chirurgie, Ludwig Maximilians Universität München, Campus Innenstadt, Nussbaumstraße 20, 80336, München, Deutschland. Viktoria.Bogner@med.uni-muenchen.de.
authors.forename: V
authors.initials: V
authors.lastname: Bogner
authors.affiliation: Klinik für Allgemeine, Unfall und Hand-Plastische Chirurgie, Ludwig Maximilians Universität München, Campus Innenstadt, Nussbaumstraße 20, 80336, München, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Brumann
authors.affiliation: Klinik für Allgemeine, Unfall und Hand-Plastische Chirurgie, Ludwig Maximilians Universität München, Campus Innenstadt, Nussbaumstraße 20, 80336, München, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Kusmenkov
authors.affiliation: Klinik für Allgemeine, Unfall und Hand-Plastische Chirurgie, Ludwig Maximilians Universität München, Campus Innenstadt, Nussbaumstraße 20, 80336, München, Deutschland.
authors.forename: K G
authors.initials: KG
authors.lastname: Kanz
authors.affiliation: Klinik für Allgemeine, Unfall und Hand-Plastische Chirurgie, Ludwig Maximilians Universität München, Campus Innenstadt, Nussbaumstraße 20, 80336, München, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Wierer
authors.affiliation: Institut für Klinische Radiologie, Ludwig Maximilians Universität München, München, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Berger
authors.affiliation: Klinik für Allgemeine, Unfall und Hand-Plastische Chirurgie, Ludwig Maximilians Universität München, Campus Innenstadt, Nussbaumstraße 20, 80336, München, Deutschland.
authors.forename: W
authors.initials: W
authors.lastname: Mutschler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D051598:Whole Body Imaging / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Abbreviated Injury Scale; Polytrauma; Quality of health care; Survival; Trauma and Injury Severity Score