ASCOT

(A Severity Characterization of Trauma)

. . . . . Organs (help)

Number of AIS 3 lesions

Number of AIS 4 lesions

Number of AIS 5 lesions

Points

Head, brain, spinal cord

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Thorax, front of the neck

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All other body areas

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. . . . . . RTS

Respiratory rate (per min)

Systolic blood pressure (mmHg)

Glasgow coma scale (help)

. . . . . . Age

Predicted death rate (blunt)
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Predicted death rate (penetrating)
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Anatomic Profile Points = square root (((number of AIS 3 injuries) * (3²)) + ((number of AIS 4 injuries) * (4²)) + ((number of AIS 5 injuries) * (5²)))

ASCOT (blunt): K =-1.1570 +Sum ((resp.rate.points) * 0.2810; (sbp.points) * 0.6583; (Glasgow.points) * 0.7705) +Sum ((-0.3002 * (points for AIS injuries to head, brain and spinal cord)) ; (-0.1961 * (points for AIS injuries to thorax and neck)) ; (-0.2086 * (points for AIS injuries to all other sites))) + (-0.6355 * (points for age))
Predicted death rate = 1/(1 + e^K)
ASCOT (penetrating): K =-1.1350 + Sum ((resp.rate.points) * 0.3332; (sbp.points) * 0.3638; (Glasgow.points) * 0.1.0626) + Sum ((-0.3702 * (points for AIS injuries to head, brain and spinal cord)) ; (-0.2053 * (points for AIS injuries to thorax and neck)) ; (-0.3188 * (points for AIS injuries to all other sites))) + (-0.8365 * (points for age))
Predicted death rate = 1/(1 + e^K)

References

Champion HR et al. A new characterization of injury severity. J Trauma 1990;30:539-45.
Champion HR et al. Improved predictions from A Severity Characterization Of Trauma (ASCOT) over Trauma and Injury Severity Score (TRISS) : results of an independant evaluation. J Trauma 1996;40:42-9.

Web page by : Jean-Yves Marandon Centre Chirurgical Marie Lannelongue (France)

With help from Larry Bain, B.S.(Trianalytics.com)

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ASCOT use three Anatomic Profile (AP) components (A, B, C). The fourth component is a summary score for all non-serious (AIS 1 or 2) injuries. It was excluded from this model.

Anatomic Profile defined by ICD-9 codes

A : Head, Brain, Spinal Cord
800, 801, 803 - Skull fx
850 to 854 - Intracranial injury
950 - Injury to optic nerves and pathways
806 - Fx of vertebral column with spinal cord injury
952 - Spinal cord injury without evidence of spinal bone injury
953 - Injury to nerve roots and spinal plexus

B : Thorax, Front of Neck
807 - Fx of rib(s), sternum, larynx, and trachea
839.61, 839.71 - Dislocation of sternum
860 - Traumatic pneumothorax and hemothorax
861 - Injury to heart / lung
862 - Injury to other intrathoracic organs
901 - Injury to blood vessels of the thorax
874 - Open wound of neck
900 - Injury to blood vessels of head and neck

C : All other serious injury (AIS >= 3)

Patient physiology is recorded on Emergency Department admission.
Patients with extremely poor or good prognoses were excluded from logistic function modeling. Table I gives design data set for blunt and penetrating injury "set-aside".

Set-Aside	Patient Description	Blunt, % Death	Penetrating, % Death
1	AIS 6, RTS = 0	100	100
2	MAX AIS < 6, RTS = 0	98,6	97,4
3	AIS 6, RTS > 0	77,1	77,8
4	MAX AIS = 1 or 2, RTS > 0	0,2	0,1

Table I

Definitions:

Blunt injury : Non-penetrating, but including crush, laceration, amputation and asphyxia.
Penetrating injury : Bullet, knife, or spike .

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Eyes Open	Verbal	Motor
Spontaneous To speech To pain Absent	Converses / Oriented Converses / Disoriented Inappropriate Incomprehensible Absent	Obeys Localizes pain Withdraws (flexion) Decorticate (flexion) rigidity Decerebrate (extension) rigidity Absent