Combat Injury Coding: A Review and Reconfiguration
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
Pagination or Media Count:
BACKGROUND The current civilian Abbreviated Injury Scale AIS, designed for automobile crash injuries, yields important information about civilian injuries. It has been recognized for some time, however, that both the AIS and AIS-based scores such as the Injury Severity Score ISS are inadequate for describing penetrating injuries, especially those sustained in combat. Existing injury coding systems do not adequately describe they actually exclude combat injuries such as the devastating multi-mechanistic injuries resulting from attacks with improvised explosive devices IEDs. METHODS After quantifying the inapplicability of current coding systems, the Military Combat Injury Scale MCIS, which includes injury descriptors that accurately characterize combat anatomic injury, and the Military Functional Incapacity Scale MFIS, which indicates immediate tactical functional impairment, were developed by a large tri-service military and civilian group of combat trauma subject matter experts. Assignment of MCIS severity levels was based on urgency, level of care needed, and risk of death from each individual injury. The MFIS was developed based on the casualty s ability to shoot, move, and communicate, and comprises four levels ranging from Able to continue mission to Lost to military. Separate functional impairments were identified for injuries aboard ship. Preliminary evaluation of MCIS discrimination, calibration, and casualty disposition was performed on 992 combat-injured patients using two modeling processes. RESULTS Based on combat casualty data, the MCIS is a new, simpler, comprehensive severity scale with 269 codes vs. 1999 in AIS that specifically characterize and distinguish the many unique injuries encountered in combat. The MCIS integrates with the MFIS, which associates immediate combat functional impairment with minor and moderate-severity injuries.
- Medicine and Medical Research
- Military Forces and Organizations