Organ Injury Scaling

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Abstract
The Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A.A.S.T.) was appointed by President Trunkey at the 1987 Annual Meeting (23). The principal charge was to devise injury severity scores for individual organs to facilitate clinical research. The resultant classification scheme is fundamentally an anatomic description, scaled from 1 to 5, representing the least to the most severe injury. A number of similar scales have been developed in the past, but none has been uniformly adopted. In fact, this concept was introduced at the A.A.S.T. in 1979 as the Abdominal Trauma Index (A.T.I.) (12) and has proved useful in several areas of clinical reseach (13, 14, 19). The enclosed O.I.S.''s for spleen (Table I), liver (Table II), and kidney (Table III) represent an amalgamation of previous scales applied for these organs (2-4, 9, 10-12, 15-18, 22), and a consensus of the O.I.S. Committee as well as the A.A.S.T. Board of Managers. The O.I.S. differs from the Abbreviated Injury Score (A.I.S.) (6-8), which is also based on an anatomic scale but designed to reflect the impact of a specific organ injury on ultimate patient outcome. The individual A.I.S.''s are, of course, the basic elements used to calculate the Injury Severity Score (I.S.S.) (1) as well as T.R.I.S.S. methodology (5). To ensure that the O.I.S. interdiffuses with the A.I.S. and I.C.D.-9 codes, these are listed alongside the respective O.I.S. Both the currently used A.I.S. 85 and proposed A.I.S. 90 are provided because of the obiligatory transition period. Indeed, A.I.S. 90 contains the identical descriptive text as the current O.I.S.''s. The Abdominal Trauma Index (12) and other similar indices using organ injury scoring can be easily modified by replacing older scores with the O.I.S.''s. Finally, we emphasize that the enclosed O.I.S.''s represent an initial classification system that must undergo continued refinement as newer diagnostic tools become available and further clinical application has been tested. Recent studies employing the spleen O.I.S. appear to validate its utility (20, 21). Our Committee is presently formalizing O.I.S.''s for the remaining abdominal viscera in parallel with efforts to develop similar scales for thoracic trauma, various fractures, and neurologic injuries. These O.I.S.''s will be published in the Journal as soon as they endure the same systematic review process.