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CAISS CERTIFICATION STUDY GUIDE
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Origins of AIS (3) - correct answer 1) Standardized system
- Classify type/severity of injury from MVC
- Consensus Injury descriptors are organized _________________________? - correct answer Anatomically Injury severity is ranked relative to its importance to _______________? - correct answer The whole body AIS reflects severity of single injuries and are unaffected by what three things? - correct answer 1) time
- sequela
- outcome What type of scale does AIS use? - correct answer 6 point ordinal scale Which type of measurement is more variable? Anatomic or Physiologic? - correct answer Physiologic Is clinical training necessary for collecting injury data? - correct answer NO AIS is based on what three (3) factors? - correct answer 1) anatomically- based
- consensus driven
- global
Severity is NOT contingent upon what two (2) factors? - correct answer 1) Outcome
- time Numerical ranking of severity: 1 - correct answer minor Numerical ranking of severity: 2 - correct answer moderate Numerical ranking of severity: 3 - correct answer serious Numerical ranking of severity: 4 - correct answer severe Numerical ranking of severity: 5 - correct answer critical Numerical ranking of severity: 6 - correct answer maximum (currently untreatable) Is mortality a sole determinant of AIS severity? - correct answer NO Are all AIS data comparable from year to year? - correct answer NO (updates) Is "DEATH" part of the severity scale? - correct answer NO Is a patient who dies automatically assigned the highest AIS severity of 6? - correct answer NO (patients w/ minor injuries can die) Does a linear relationship exist between AIS severity codes? - correct answer NO (AIS 4 is more, NOT twice as severe as AIS 2) Are all injuries within the same AIS code strictly compatible? - correct answer NO (tibia fx & alveolar ridge are both AIS - 2, although one may be worse than the other, both are considered 'moderate')
The third/fourth digits in the pre-dot code correspond to what? - correct answer Specific anatomic structure (femur) The fifth/sixth digits in the pre-dot code correspond to what? - correct answer Level of injury within the specific body region and anatomic structure (NFS, minor, major) Parenthesis in the AIS dictionary indicate what? - correct answer synonyms or definitions for injury types Brackets in the AIS dictionary indicate what? - correct answer inclusionary/exclusionary info, OIS Grades Boxed bold type in the AIS dictionary indicates what? - correct answer directives to assist coder in appropriate use of specific description Semicolons in the AIS dictionary indicate what? - correct answer separate injury descriptors that are comparable in severity Italics in the AIS dictionary indicate what? - correct answer proper-named injuries/structures, OIS grades Does AIS assess the severity of multiple injuries? - correct answer NO (single injury severity only) The injury Severity Score (ISS) is defined as what? - correct answer Sum of the squares of highest AIS in each of 3 most severely injured ISS body regions. What are the six body regions used in the ISS? - correct answer 1) head & neck
- face
- chest
- abdomen & pelvic organs
- extremities & pelvic girdle
- external
Asphyxia is assigned to which ISS body region? - correct answer HEAD & neck Thoracic spine injuries are assigned to which ISS body region? - correct answer Chest Drowning is assigned to which ISS body region? - correct answer Chest Lumbar spine lesions would be assigned to which ISS region? - correct answer Abdomen & pelvic contents Are external injuries coded independent of their body region? - correct answer YES Hypothermia, electrical injuries, and whole body injuries are coded to which ISS region? - correct answer External The ISS score ranged from _____ to _____? - correct answer 1 to 75 What are the two ways an ISS of 75 can be achieved? - correct answer 1) AIS of 5 in each of three different body regions
- AIS of 6 in a single body region Do patients with an AIS 9 achieve an accurate ISS score? - correct answer NO Can less than three regions be used to calculate an ISS? - correct answer YES Can more than three regions be used to calculate an ISS? - correct answer NO Do all ISS scores have the same mortality rates? - correct answer NO (depends on body regions affected)
- Battle's sign (mastoid ecchymosis)
- CSF rhinorrhea
- CSF otorrhea
- hemotympanum What must also exists to code a basilar skull fx when only physical manifestations are present? - correct answer evidence of traumatic head injury (not related to facial fx/injury) Are complications coded as injuries? - correct answer NO (ex: infections, pneumonia, epilepsy following head injury) Are sequela or outcomes coded as injuries? - correct answer NO (ex: death, blindness, obstruction, miscarriage, deafness, swelling-except brain) Are injury etiologies (causes) related to AIS injury scores? - correct answer NO Can injuries be assumed based on a particular outcome occurrence? - correct answer NO If an AIS code of 6 is assigned, is it acceptable to stop coding subsequent injuries? - correct answer NO Is death automatically coded as an AIS 6? - correct answer NO Can an AIS of 1 result in death? - correct answer YES (rare) Are cord lesions and vertebral fxs coded separately? - correct answer NO Penetrating injuries that do not injure underlying structures should be coded in what ISS body region? - correct answer External
Injuries that result from energy dissipated from a penetrating wound are called direct or indirect? - correct answer indirect With penetrating injuries to internal structures, is the overlying skin injury coded separately? - correct answer NO Bullet wounds/penetrating injuries resulting in fx are coded as open or closed fractures? - correct answer OPEN When detailed information regarding an injury is lacking, what descriptor is often used? - correct answer NFS NFS can refer to what two components of a code? - correct answer 1) injury unspecified
- severity unspecified Should patients with AIS code 9 injuries be included in research studies? - correct answer NO Fracture involving the joint? - correct answer articular fracture fracture type with 3 or more fragments with the proximal and distal fragments not touching? - correct answer complex fracture fracture type where skin overlying the fracture is lacerated and communicates with the fracture? - correct answer open fracture fracture type where skin overlying the fracture in not lacerated? - correct answer closed fracture fracture in which 2 ends of bone are not aligned? - correct answer displaced fracture
Brain death/blindness are consequences of injury and can or cannot be coded? - correct answer cannot Is a foreign body considered and injury in and of itself? - correct answer NO (cannot code) (T/F) Bilateral injures of kidneys, eyes, ears, and extremities are typically codes as separate injuries (with some exceptions). - correct answer TRUE (T/F) Multiple fractures to the same bone but in different areas are coded separately.
- correct answer TRUE (T/F) If multiple fractures to a single bone exist but are not specified as to location, they are coded as a single injury. - correct answer TRUE If a specific skin lesion is unknown or not required, what AIS code is assigned? - correct answer 910000.1 (Soft Tissue Injury NFS) When a "crush" code is used, are the separate underlying injuries coded separately as well? - correct answer NO The term "transection" should be coded as complete or incomplete? - correct answer complete (T/F) When a vessel injury and related organ injury occur together, if the descriptor includes the vessel injury in the organ injury descriptor it should still be coded separately. - correct answer FALSE (do not code vessel injury separately if included in organ injury descriptor) Are branches of vessels coded as separate injuries? - correct answer NO (unless named/listed in descriptor)
When more than one injury claims the qualifier "blood loss > 20%," the blood loss is assigned to which associated injury? - correct answer most severe Blood loss of 20% in a 100 kg patient is approximately how many cc? - correct answer 1500 cc List the four (4) types of injures defined as penetrating? - correct answer 1) GSW
- Stabbing
- impalement
- spearing-type Penetrating injuries that do not involve internal organs or structures should be coded under what ISS body region? - correct answer External A penetrating injury to the skull is coded under what ISS body region? - correct answer Head/Neck A penetrating injury to the face w/ massive destruction is coded under what ISS body region? - correct answer Face Are entry/exit wounds reflected in the severity of internal organ/structure injuries? - correct answer YES If a single penetrating injury to the brain involves more than one structure (entry to cerebrum, exit cerebellum) do you code each region separately? - correct answer NO (use whole area section) (T/F) When a penetrating injury exists, and using the penetrating code results in a higher AIS than using subsequent qualifiers, the higher AIS penetrating code should be used. - correct answer True Vague descriptions such as "blunt trauma" or "closed head injury" should be assigned which AIS code? - correct answer 9
- Operative
- Radiology
- Nursing/ICU
- MD progress notes
- ED record
- D/C Summary
- Face Sheet What is considered the least reliable source of injury information? - correct answer patient (especially LOC) List the seven (7) injury descriptions included in the ISS external body region? - correct answer 1) abrasion
- contusion
- laceration
- avulsion
- degloving
- penetrating
- burn A rubbed or scraped area on skin or mucous membranes caused by contact with a rough surface that removes layers is known as what? - correct answer abrasion Road rash and friction burns are considered what type of external injury? - correct answer abrasion Black or blue marks resulting from blunt force causing tiny underlying blood vessels to burst and leak into skin but do not cause a break in the skin are known as what? - correct answer contusions Ecchymosis, subcutaneous hematoma, bruise, and bump are all considered what type of external injury? - correct answer contusions
Tearing or ripping apart of tissues from blunt or penetrating force is known as what type of injury? - correct answer laceration Ripping or tearing away of all layers of skin in which a portion is separated from underlying tissues often creating a flap is known as what type of injury? - correct answer avulsion Traumatic removal of skin and SQ tissue separating tissue planes from their blood supply, esp. from a limp is known as what type of injury? - correct answer degloving (T/F) Degloving injuries may be open or closed. - correct answer TRUE Which are typically more extensive - degloving or avulsion? - correct answer degloving Soft tissue injuries are dispersed across body regions in the AIS book and are coded as what ISS body region? - correct answer external When an external injury occurs without underlying injury, it is coded to the specific _______________ AIS region, but assigned to the ________________ ISS region. - correct answer body AIS; external ISS When should the AIS body region external codes be used for skin injuries? - correct answer no body region info is available (T/F) When a skin injury (abrasion, contusion, etc.) occurs over an underlying injury they should be coded separately to the specific body region. - correct answer TRUE (ex. open fx, penetrating) 1st degree burn is described as _________? - correct answer superficial 2nd degree burn is described as __________? - correct answer partial thickness
Hypothermia is coded to which ISS body region? - correct answer External Whole body blast injuries are assigned an AIS code of _______ and are coded to which ISS body region? - correct answer 6; External List the five (5) body parts coded in the AIS face body region. - correct answer 1) eyes
- ears
- nose
- mouth
- facial bones What is the only vessel included in the Face AIS body region? - correct answer external carotid (and its branches, facial/internal maxillary) What AIS body region do the hyoid & palatine bones belong? - correct answer face What is the only nerve included in the Face AIS body region? - correct answer optic (intraorbital) A compound fracture is considered open or closed? - correct answer open A simple fracture is considered open or closed? - correct answer closed The face is divided into how many sections for coding purposes? - correct answer three A transverse horizontal maxillary alveolar fracture, or palate facial disjunction (Guerin) is known as what type of LeFort Fx? - correct answer LeFort I
A pyramidal facial disjunction is known as what type of LeFort Fx? - correct answer LeFort II A craniofacial disjunction is known as what type of LeFort Fx? - correct answer LeFort III (T/F) The size and associated severity of soft tissue injuries is the same across all body regions. - correct answer FALSE (face > 10cm, other > 20cm) Are bilateral injures to the eyes and ears usually coded combined or separately? - correct answer separate Traumatic enucleation of the eye is coded as what type of external injury? - correct answer avulsion Bilateral maxilla or mandible fractures are coded separately or combined? - correct answer combined Nose fractures by definition are included in which LeFort Fxs and should not be coded separately? - correct answer LeFort II and III Should minimally displaced facial fractures be coded as displaced? - correct answer NO (must be significantly displaced) Multiple and complex fxs involving the middle and lower, upper and middle, or all three locations of the face that are NOT LeFort fractures are called what? - correct answer Panfacial What facial bone must be fractured to have a LeFort fracture? - correct answer pterygoid plate Can you have more than one type LeFort fracture? - correct answer YES (one on each side)
What membrane lines the viscera? - correct answer visceral pleura PTX/HTX fills what cavity in the chest? - correct answer intrapleural space what 2 structures are included in both the neck and thorax chapters of the dictionary? - correct answer esophagus & trachea Is the rib cage considered a single anatomic structure for coding purposes? - correct answer YES If you have unilateral flail chest with rib fxs to the opposite side are the injuries coded combined or separate? - correct answer separate Unilateral rib fxs with same sided unilateral flail chest are coded combined or separate? - correct answer combined Three or more ribs fractured in two or more places defines what injury? - correct answer flail chest Do multiple rib fxs NFS have a specific AIS code? - correct answer YES A costal cartilage tear or fracture is coded as what type of injury? - correct answer rib fx Are "clinical rib fxs" coded? - correct answer NO (must have radiology/OR/autopsy) Can lung contusions be coded on the bases of pulmonary dysfunction alone? - correct answer NO (must be verified by radiograph, autopsy, or collaboration of the physician & have hx of chest trauma) (T/F) Rib fractures with underlying injuries such as a lung contusion or laceration should be coded as one single injury combined. - correct answer FALSE
Injestion injuries in the chest are coded to which organ? - correct answer esophagus (T/F) Air embolus and tamponade are codeable sequela in the chest ISS region. - correct answer TRUE "Blast" and inhalation injuries in the chest are coded to which organ? - correct answer lungs what structure are ingestion injuries coded to? - correct answer esophagus Lung lacerations must be substantiated by ______, ______, or ______. - correct answer CT, operative report, autopsy What should be used when a specific artery or vein is not named in the AIS description but is injured? - correct answer other named "Incomplete transection" vessel injuries are coded as what in AIS? - correct answer incomplete circumferential involvement What two ISS body regions may the aorta and vena cava be coded under depending on the location of their injury? - correct answer chest abdomen The lumbar spinal cord and lumbar vertebrae are assigned to which ISS body region? - correct answer abdomen & pelvic contents Avulsion, complex, rupture, tissue loss, and deep are all synonyms for what severity of organ injury? - correct answer massive What type of organ injury involves the ripping away of an organ from its vascular attachment? - correct answer avulsion
