Grade Description of injury ICD-9 AIS-90

Transcription

1 Scaling system for organ specific injuries Ernest E. Moore, MD, Thomas H. Cogbill, MD, Mark Malangoni, MD, Gregory J. Jurkovich, MD, and Howard R. Champion, MD Table Cervical vascular organ injury scale Grade Description of injury CD-9 AS-90 Thyroid vein Common facial vein External jugular vein Non-named arterial/venous branches External carotid arterial branches (ascending pharyngeal, superior thyroid, ngual, facial maxillary, occipital, posterior auricular) Thyrocervical trunk or primary branches nternal jugular vein External carotid artery Subclavian vein ertebral artery Common carotid artery Subclavian artery nternal carotid artery (extracranial) *ncrease one grade for multiple grade or injuries involving more than 0% vessel circumference. Decrease one grade for less than % vessel circumference disruption for grade or. From Moore et al. []; with permission. Table Chest wall injury scale* Grade njury Type Description of njury CD-9 AS-90 Fracture Fracture Fracture Fracture Fracture Any size Skin & subcutaneous < ribs, closed; nondisplaced clavicle closed Skin, subcutaneous and muscle > adjacent ribs, closed Open or displaced clavicle Nondisplaced sternum, closed Scapular body, open or closed Full thickness including pleural penetration Open or displaced sternum Flail sternum Unilateral flail segment (< ribs) Avulsion of chest wall tissues with underlying rib fractures Unilateral flail chest (> ribs) Bilateral flail chest (> ribs on both sides) 9.0/ / / / / / / *This scale is confined to the chest wall alone and does not reflect associated internal or abdominal injuries. Therefore, further delineation of upper versus lower or anterior versus posterior chest wall was not considered, and a grade was warranted. Specifically, thoracic crush was not used as a descriptive term; instead, the geography and extent of fractures and soft tissue injury were used to define the grade. From Moore et al. []; with permission.

2 Table Heart injury scale Grade Description of injury CD-9 AS-90 Blunt cardiac injury with minor ECG abnormality (nonspecific ST or T wave changes, premature arterial or ventricular contraction or persistent sinus tachycardia) Blunt or penetrating pericardial wound with out cardiac injury, cardiac tamponade, or cardiac herniation Blunt cardiac injury with heart block (right or left bundle branch, left anterior fascicular, or atrioventricular) or ischemic changes (ST depression or T wave inversion) without cardiac failure Penetrating tangential myocardial wound up to, but not extending through endocardium, without tamponade Blunt cardiac injury with sustained (>6 beats/min) or multilocal ventricular contractions Blunt or penetrating cardiac injury with septal rupture, pulmonary or tricuspid valvular incompetence, papillary muscle dysfunction, or distal coronary arterial occlusion without cardiac failure Blunt pericardial laceration with cardiac herniation Blunt cardiac injury with cardiac failure Penetrating tangential myocardial wound up to, but extending through, endocardium, with tamponade Blunt or penetrating cardiac injury with septal rupture, pulmonary or tricuspid valvular incompetence, papillary muscle dysfunction, or distal coronary arterial occlusion producing cardiac failure Blunt or penetrating cardiac injury with aortic mitral valve incompetence Blunt or penetrating cardiac injury of the right ventricle, right atrium, or left atrium Blunt or penetrating cardiac injury with proximal coronary arterial occlusion Blunt or penetrating left ventricular perforation Stellate wound with < 0% tissue loss of the right ventricle, right atrium, or of left atrium Blunt avulsion of the heart; penetrating wound producing > 0% tissue loss of a chamber *Advance one grade for multiple wounds to a single chamber or multiple chamber involvement. From Moore et al. []; with permission.

3 Table Lung njury Scale Grade* njury Type Description of njury CD-9 AS-90 ascular Unilateral, < lobe Unilateral, single lobe Simple pneumothorax Unilateral, > lobe Persistent (> 7 hrs) air leak from distal airway Nonexpanding intraparenchymal Major (segmental or lobar) air leak Expanding intraparenchymal Primary branch intrapulmonary vessel disruption / / 860./ ascular ascular Hilar vessel disruption Total uncontained transection of pulmonary hilum *Advance one grade for bilateral injuries up to grade. Hemothorax is scored under thoracic vascular injury scale. From Moore et al. []; with permission. Table Thoracic ascular njury Scale Grade* Description of injury CD-9 AS-90 ntercostal artery/vein nternal mammary artery/vein Bronchial artery/vein Esophageal artery/vein Hemizygous vein Unnamed artery/vein Azygos vein nternal jugular vein Subclavian vein nnominate vein Carotid artery nnominate artery Subclavian artery Thoracic aorta, descending nferior vena cava (intrathoracic) Pulmonary artery, primary intraparenchymal branch Pulmonary vein, primary intraparenchymal branch Thoracic aorta, ascending and arch Superior vena cava Pulmonary artery, main trunk Pulmonary vein, main trunk Uncontained total transection of thoracic aorta or pulmonary hilum *ncrease one grade for multiple grade or injuries if more than 0% circumference; decrease one grade for grade injuries if less than % circumference. From Moore et al []; with permission

4 Table 6 Diaphragm injury scale Grade* Description of injury CD-9 AS-90 <cm -0cm >0 cm with tissue loss < cm with tissue loss > cm *Advance one grade for bilateral injuries up to grade. From Moore et al. []; with permission Table 7 Spleen injury scale (99 revision) Grade* njury type Description of injury CD-9 AS-90 Subcapsular, <0% surface area Capsular tear, <cm parenchymal depth Subcapsular, 0%-0% surface area; intraparenchymal, < cm in diameter Capsular tear, -cm parenchymal depth that does not involve a trabecular vessel Subcapsular, >0% surface area or expanding; ruptured subcapsular or parecymal hematoma; intraparenchymal hematoma > cm or expanding > cm parenchymal depth or involving trabecular vessels involving segmental or hilar vessels producing major devascularization (>% of spleen) ascular Completely shattered spleen Hilar vascular injury with devascularizes spleen *Advance one grade for multiple injuries up to grade. From Moore et al. []; with permission

5 Table 8 Liver injury scale (99 revision) Grade* Type of njury Description of injury CD-9 AS-90 Subcapsular, <0% surface area Capsular tear, <cm parenchymal depth Subcapsular, 0% to 0% surface area: intraparenchymal <0 cm in diameter Capsular tear - parenchymal depth, <0 cm in length Subcapsular, >0% surface area of ruptured subcapsular or parenchymal hematoma; intraparenchymal hematoma > 0 cm or expanding > cm parenchymal depth Parenchymal disruption involving % to 7% hepatic lobe or - Couinaud s segments Parenchymal disruption involving >7% of hepatic lobe or > Couinaud s segments within a single lobe ascular ascular Juxtahepatic venous injuries; ie, retrohepatic vena cava/central major hepatic veins Hepatic avulsion 6 *Advance one grade for multiple injuries up to grade From Moore et al. []; with permission Table 9 Extrahepatic billiary tree injury scale Grade* Description of injury CD-9 AS-90 Gallbladder contusion/hematoma Portal triad contusion Partial gallbladder avulsion from liver bed; cystic duct intact or perforation of the gallbladder Complete gallbladder avulsion from liver bed Cystic duct laceration Partial or complete right hepatic duct laceration Partial or complete left hepatic duct laceration Partial common hepatic duct laceration (<0%) Partial common bile duct laceration (<0%) >0% transection of common hepatic duct >0% transection of common bile duct Combined right and left hepatic duct injuries ntraduodenal or intrapancreatic bile duct injuries *Advance one grade for multiple injuries up to grade. From Moore et al. []; with permission

6 Table 0 Pancreas njury Scale Grade* Type of njury Description of njury CD-9 AS-90 Minor contusion without duct injury Superficial laceration without duct injury Major contusion without duct injury or tissue loss Major laceration without duct injury or tissue loss Distal transection or parenchymal injury with duct injury 86.9/86.9 Proximal а transection or parenchymal injury involving ampulla Massive disruption of pancreatic head *Advance one grade for multiple injuries up to grade. *86., head; 86.99,86.9-body;86.8,86.9-tail. a Proximal pancreas is to the patients right of the superior mesenteric vein. From Moore et al. [6]: with permission. Table Esophagus injury scale Grade* Description of injury CD-9 AS-90 /hematoma Partial thickness laceration <0% circumference >0% circumference Segmental loss or devascularization <cm Segmental loss or devascularization >cm 86./. 86./. 86./. 86./. 86./. 86./. *Advance one grade for multiple lesions up to grade. From Moore et al []; with permission Table Stomach injury scale Grade* Description of injury CD-9 AS-90 /hematoma Partial thickness laceration <cm in GE junction or pylorus <cm in proximal / stomach <0cm in distal / stomach >cm in GE junction or pylorus >cm in proximal / stomach >0cm in distal / stomach Tissue loss or devascularization </ stomach Tissue loss or devascularization >/ stomach 86.0/. 86.0/. 86.0/. 86.0/. 86.0/. 86.0/. 86.0/. 86.0/. 86.0/. 86.0/. *Advance one grade for multiple lesions up to grade. GE-gastroesophageal. From Moore et al.[]; with permission

7 Table Duodenum injury scale Grade* Type of injury Description of injury CD-9 AS-90 nvolving single portion of duodenum Partial thickness, no perforation nvolving more than one portion Disruption <0% of circumference Disruption 0%-7% of circumference of D Disruption 0%-00% of circumference of D,D,D ascular Disruption >7% of circumference of D nvolving ampulla or distal common bile duct Massive disruption of duodenopancreatic complex Devascularization of duodenum *Advance one grade for multiple injuries up to grade. D-first position of duodenum; D-second portion of duodenum; D-third portion of duodenum; D-fourth portion of duodenum From Moore et al. [6]; with permission. Table Small bowel injury scale Grade* Type of injury Description of injury CD-9 AS-90 or hematoma without devascularization 86.0 Partial thickness, no perforation <0% of circumference > 0% of circumference without transection Transection of the small bowel Transection of the small bowel with segmental tissue loss ascular Devascularized segment 86.0 *Advance one grade for multiple injuries up to grade. From Moore et al. [6]; with permission Table Colon injury scale Grade* Type of injury Description of injury CD-9 AS-90 or hematoma without devascularization Partial thickness, no perforation <0% of circumference > 0% of circumference without transection ascular Transection of the colon Transection of the colon with segmental tissue loss Devascularized segment *Advance one grade for multiple injuries up to grade. *86.,86.-ascending;86., 86.-transverse;86.,86.-descending; 86.,86.-rectum. From Moore et al. [6]; with permission

8 Table 6 Rectum injury scale Grade* Type of injury Description of injury CD-9 AS-90 or hematoma without devascularization 86. Partial-thickness laceration < 0% of circumference > 0% of circumference Full-thickness laceration with extension into the perineum ascular Devascularized segment 86. *Advance one grade for multiple injuries up to grade. From Moore et al. [6]; with permission Table 7 Abdominal vascular injury scale Grade* Description of injury CD-9 AS-90 Non-named superior mesenteric artery or superior mesenteric vein branches Non-named inferior mesenteric artery or inferior mesenteric vein branches Phrenic artery or vein Lumbar artery or vein Gonadal artery or vein Ovarian artery or vein Other non-named small arterial or venous structures requiring ligation Right, left, or common hepatic artery Splenic artery or vein Right or left gastric arteries Gastroduodenal artery nferior mesenteric artery, or inferior mesenteric vein, trunk Primary named branches of messenteric artery (e.g., ileocolic artery) or messenteric vein Other names abdominal vessels requiring ligation or repair Superior mesenteric vein, trunk Renal artery or vein lliac artery or vein Hypogastric artery or vein ena cava, infrarenal Superior mesenteric artery, trunk Celiac axis proper ena cava, suprarenal and infrahepatic Aorta, infrarenal Portal vein Extraparenchymal hepatic vein ena cava, retrohepatic or suprahepatic Aorta suprarenal, subdiaphragmatic 90.0/ / / / /. 90.6/ /. 90./. 90./ NS NS NS NS NS NS NS (hepatic vein) (liver + veins) *This classification system is applicable to extraparenchymal vascular injuries. f the vessel injury is within cm of the organ parenchyma, refer to specific organ injury scale. ncrease one grade for multiple grade or injuries involving > 0% vessel circumference. Downgrade one grade if <% vessel circumference laceration for grades or. NS-not scored. From Moore et al []; with permission

9 Table 8 Adrenal organ injury scale Grade* Description of injury CD-9 AS-90 involving only cortex (< cm) extending into medulla (> cm) >0% parenchymal destruction Total parenchymal destruction (including massive intraparenchymal hemorrhage) Avulsion from blood supply 868.0/ / / / /. *Advance one grade for bilateral lesions up to grade From Moore et al []; with permission Table 9 Kidney injury scale Grade* Type of injury Description of injury CD-9 AS-90 Microscopic or gross hematuria, urologic studies normal Subcapsular, nonexpanding without parenchymal laceration Nonexpanding perirenal hematoma confirmed to renal retroperitoneum <.0 cm parenchymal depth of renal cortex without urinary extravagation <.0 cm parenchymal depth of renal cortex without collecting system rupture or urinary extravagation Parenchymal laceration exteding through renal cortex, medulla, and collecting system 866. ascular Main renal artery or vein injury with contained hemorrhage ascular Completely shattered kidney Avulsion of renal hilum which devascularizes kidney *Advance one grade for bilateral injuries up to grade From Moore et al. [7]; with permission

10 Table 0 Ureter injury scale Grade* Type of injury Description of injury CD-9 AS-90 or hematoma without devascularization 867./867. < 0% transection 867./867. > 0% transection 867./867. Complete transection with < cm devascularization 867./867. Avulsion with > cm of devascularization 867./867. *Advance one grade for bilateral up to grade. From Moore et al. []; with permission Table Bladder injury scale Grade* njury type Description of injury CD-9 AS-90, intramural hematoma Partial thickness 867.0/867. Extraperitoneal bladder wall laceration < cm 867.0/867. Extraperitoneal (>cm) or intraperitoneal (<cm) bladder wall laceration ntraperitoneal bladder wall laceration >cm 867.0/ /867. ntraperitoneal or extraperitoneal bladder wall laceration extending into the bladder neck or ureteral orifice (trigone) 867.0/867. *Advance one grade for multiple lesions up to grade From Moore et al. []; with permission

11 Table Urethra injury scale Grade* njury type Description of injury CD-9 AS-90 Blood at urethral meatus; retrography normal 867.0/867. Stretch injury Partial disruption Complete disruption Complete disruption Elongation of urethra without extravasation on urethrography Extravasation of urethrography contrast at injury site with visualization in the bladder Extravasation of urethrography contrast at injury site without visualization in the bladder; <cm of urethra seperation Complete transaction with > cm urethral separation, or extension into the prostate or vagina 867.0/ / / /867. *Advance one grade for bilateral injuries up to grade From Moore et al. []; with permission Table Uterus (nonpregnant) injury scale Grade* Description of injury CD-9 AS-90 /hematoma Superficial laceration (< cm) Deep laceration (> cm) involving uterine artery Avulsion/devascularization 867./. 867./. 867./ /. *Advance one grade for multiple injuries up to grade From Moore et al. []; with permission Table Uterus (pregnant) injury scale Grade* Description of injury CD-9 AS-90 or hematoma (without placental abruption) Superficial laceration (<cm) or partial placental abruption <% Deep laceration (>cm) occurring in second trimester or placental abruption >% but <0% Deep laceration (>cm) in third trimester involving uterine artery Deep laceration (>cm) with >0% placental abruption Uterine rupture Second trimester Third trimester Complete placental abruption 867./. 867./. 867./. 867./ /. 867./. 867./. 867./. - *Advance one grade for multiple injuries up to grade From Moore et al. []; with permission

12 Table Fallopian tube injury scale Grade* Description of injury CD-9 AS-90 or contusion <0% circumference >0% circumference Transection ascular injury; devascularized segment 867.6/ / / / *Advance one grade for bilateral injuries up to grade From Moore et al. []; with permission Table 6 Ovary injury scale Grade* Description of injury CD-9 AS-90 or hematoma Superficial laceration (depth <0. cm) Deep laceration (depth > 0. cm) Partial disruption or blood supply Avulsion or complete parenchymal destruction 867.6/ / / *Advance one grade for bilateral injuries up to grade From Moore et al. []; with permission Table 7 agina injury scale Grade* Description of injury CD-9 AS-90 or hematoma, superficial (mucosa only), deep into fat or muscle, complex, into cervix or peritoneum njury into adjacent organs (anus, rectum, urethra, bladder) *Advance one grade for multiple injuries up to grade From Moore et al. []; with permission Table 8 ulva injury scale Grade* Description of injury CD-9 AS-90 or hematoma, superficial (skin only), deep (into fat or muscle) Avulsion; skin, fat or muscle njury into adjacent organs (anus, rectum, urethra, bladder) *Advance one grade for multiple injuries up to grade From Moore et al. []; with permission

13 Table 9 Testis injury scale Grade* Description of injury CD-9 AS-90 /hematoma Subclinical laceration of tunica albuginea of tunica albuginea with <0% parenchymal loss Major laceration of tunica albuginea with >0% parenchymal loss Total testicular destruction or avulsion 9.0/ *Advance one grade for bilateral lesions up to grade From Moore et al []; with permission Table 0 Scrotum injury scale Grade Description of injury CD-9 AS-90 <% of scortal diameter >% of scrotal diameter Avulsion <0% Avulsion >0% From Moore et al []; with permission Table Penis injury scale Grade* Description of injury CD-9 AS-90 Cutaneous laceration/contusion Buck s fascia (cavernosum) laceration without tissue loss Cutaneous avulsion through glans/meatus Cavemosal or urethral defect <cm Partial penectomy Cavarnosal or urethral defect > cm Total penectomy *Advance one grade for multiple injuries up to grade From Moore et al. []; with permission

14 Table Peripheral vascular organ injury scale Grade* Description of injury CD-9 AS-90 Digital artery/vein Palmar artery/vein Deep palmar artery/vein Dorsalla pedia artery Plantar artery/vein Non-named arterial/venous branches Basilic/cephalic vein Saphenous vein Radial artery Ulnar artery Axillary vein Superficial/deep femoral vein Popliteal vein Brachial artery Anterior tibial artery Posterior tibial artery Peroneal artery Tibioperoneal trunk Superficial/deep femoral artery Popliteal artery Axillary artery Common femoral artery / / / / *ncrease one grade for multiple grade or injuries involving >0% vessel circumference. Decrease one grade for < % vessel circumference disruption for grades or From Moore et al []; with permission