Not all 16s are equal

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I've got a paper under review by JTrauma right now
that discusses helmet effect in 1,982 motorcycle
accidents investigated "on the street" -- as opposed
to ER admissions, hospital admissions, fatalities,
trauma registries, etc.

Our data suggested that somatic (below-the-neck)
injury severity may have more influence on mortality
than head-neck severity.   Something like 34 of 35
riders with AIS-5 injuries below the neck died, as did
a big chunk (mostly unhelmeted) of those with AIS-4
somatic injuries.  On the other hand, the fatality
rate for riders with AIS-5 head injury was something
in the neighborhood of 50%, and some with AIS-5 head
injury survived with somatic injury as high as AIS-4. 


As a result, an ISS>15 that is mostly head injury may
not be quite as life-threatening as an ISS>15 that is
mostly due to below-the-neck injury.  

I hope the reviewer who faulted you for under-triage
has enough flexibility in his/her opinions to
recognize that an ISS score is a valuable guideline,
but not necessarily a bright-line standard.  

JIM OUELLET


		
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