Evaluation of Probability of Survival Using Trauma and Injury Severity Score Method in Severe Neurotrauma Patients
Another example is seen in the case of a 51-year-old man sustaining traumatic brain injury combined multiple trauma in a pedestrian accident. Upon arrival at the emergency medicine department, the patient presented a systolic blood pressure of 140 mm Hg and a respiratory rate of 0. Because his eyes were closed and he was intubated, and showed no movement to pain, he was assigned a GCS of 3. His pupils were 6/6 mm in size and not responsive to light. Also, his corneal reflex disappeared. On brain CT, severe brain swelling and global hypoxic damaged brain parenchyme (the so-called, 'whole brain infarct') was revealed (). His blood pressure (RTS coded value=4), respiratory rate (RTS coded value=0), and GCS (RTS coded value=0) gave him an RTS of 2.93 (RTS=0.9368×0+0.7326×4+0.2908×0=2.93). His head and neck injuries, severe brain swelling and acute subdural hemorrhage (AIS=5) and liver injury of the abdomen (AIS=2) and clavicular fracture of extremity (AIS=2) were combined to give him an ISS of 33(ISS=1st AIS2+2nd AIS2+3rd AIS2=52+22+22=33). Thus, his calculated probability of survival by the TRISS methodology was 67.48%. If his AIS of the head and neck was given 6, his calculated probability of survival by the TRISS methodology would have decreased to 6.86%.