Ressources et utilitaires

Scoring systems for ICU and surgical patients:

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
Thorax, front of the neck
All other body areas
RTS
Respiratory rate (per min)
Systolic blood pressure (mmHg)
Glasgow coma scale (help)
Age

Predicted death rate (blunt)
=



Predicted death rate (penetrating)
=
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 + eK)
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 + eK)  

References

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

Glasgow=

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