ABBREVIATED INJURY SCALE DOES NOT REFLECT THE ADDED MORBIDITY OF MULTIPLE LOWER-EXTREMITY FRACTURES

Objectives: To determine if patients with multiple lower extremity fra ctures have worse outcomes than do patients with isolated femur fractu res, and to determine if the Abbreviated Injury Scale (AIS) should dis tinguish between single and multiple lower extremity fractures. Design : A retrospective study. Materials and Methods: All blunt trauma patie nts at least 15 years of age treated at a level 1 trauma center from J anuary 1990 through December 1993, Three groups of patients were selec ted, Group 1 included 50 patients whose only significant injury was a diaphyseal femur fracture, They had no other long bone fractures, mini mal injuries to other body areas, and an Injury Severity Score (ISS) l ess than or equal to 14, Group 2 was consisted of 29 patients with a f emur fracture, at least one other diaphyseal lower extremity fracture, and also an ISS less than or equal to 14, Group 3 consisted of 23 pat ients who had fracture patterns similar to those of group 2, but also had more severe nonextremity injuries (ISS greater than or equal to 15 ), Hospital morbidity and mortality rates were compared with t tests o r chi-square analysis, Type 1 error probability was established at p < 0.05. Measurements and Main Results: Compared with patients in group 1, patients in group 2 had an identical ISS (10.1 vs. 10.6, respective ly), but had higher transfusion requirements (0.3 vs, 3.9 units), more days in the intensive care unit (ICU) (0.02 vs, 1.4), a higher incide nce of adult respiratory distress syndrome (ARDS) (0 vs, 14%), longer hospital stays (6.0 vs, 14.8 days), greater disability at discharge (d isability score 2.2 vs, 3.2), and a higher mortality rate (0 vs, 3.4%; p < 0.05 all variables), Patients in group 3 had worse outcomes than the other two groups: ISS = 30.1; transfusions = 11.9 units; ICU days = 9.1; ARDS incidence = 26%; hospital days = 29.9; disability score = 3.9; mortality = 26% (p < 0.05). Conclusions: Although AIS and ISS app ropriately reflect the impact of extraskeletal injuries in patients wi th femur fractures, they do not adequately reflect the increased morbi dity associated with multiple lower extremity fractures, The AIS-Extre mity Score may need to be upgraded for multiple long bone fractures of the lower extremities.