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CAISS Exam Origins of AIS (3) - ANSWER 1) Standardized system
- Classify type/severity of injury from MVC
- Consensus Injury descriptors are organized _________________________? - ANSWER Anatomically Injury severity is ranked relative to its importance to _______________? - ANSWER The whole body AIS reflects severity of single injuries and are unaffected by what three things? - ANSWER 1) time
- sequela
- outcome What type of scale does AIS use? - ANSWER 6 point ordinal scale Which type of measurement is more variable? Anatomic or Physiologic? - ANSWER Physiologic Is clinical training necessary for collecting injury data? - ANSWER NO AIS is based on what three (3) factors? - ANSWER 1) anatomically- based
- consensus driven
- global Severity is NOT contingent upon what two (2) factors? - ANSWER 1) Outcome
- time Numerical ranking of severity: 1 - ANSWER minor Numerical ranking of severity: 2 - ANSWER moderate Numerical ranking of severity: 3 - ANSWER serious Numerical ranking of severity: 4 - ANSWER severe Numerical ranking of severity: 5 - ANSWER critical Numerical ranking of severity: 6 - ANSWER maximum (currently untreatable)
Is mortality a sole determinant of AIS severity? - ANSWER NO Are all AIS data comparable from year to year? - ANSWER NO (updates) Is "DEATH" part of the severity scale? - ANSWER NO Is a patient who dies automatically assigned the highest AIS severity of 6? - ANSWER NO (patients w/ minor injuries can die) Does a linear relationship exist between AIS severity codes? - ANSWER NO (AIS 4 is more, NOT twice as severe as AIS 2) Are all injuries within the same AIS code strictly compatible? - ANSWER NO (tibia fx & alveolar ridge are both AIS - 2, although one may be worse than the other, both are considered 'moderate') What AIS code is assigned to a patient with inadequate information regarding an injury? - ANSWER 9 AIS single digit severity codes are based on what type of patient? - ANSWER Average What four (4) things define the "average" patient? - ANSWER 1) 25-40 yrs old
- no pre-existing conditions
- no tx complications
- received timely/appropriate care Approximately how many injury descriptors are included in AIS? - ANSWER 2000 What part of the AIS code is considered the "Pre-Dot Code?" - ANSWER 6 digits BEFORE the decimal point (left) What part of the AIS code is considered the "AIS Severity Number?" - ANSWER single digit after the decimal (right) (T/F) The 6 digit pre-dot codes are unique and allow for more specificity and accurate coding? - ANSWER TRUE The first digit in the pre-dot code corresponds to what? - ANSWER Body Region The second digit in the pre-dot code corresponds to what? - ANSWER Type of anatomic structure (skeletal, solid organ)
Hypothermia, electrical injuries, and whole body injuries are coded to which ISS region? - ANSWER External The ISS score ranged from _____ to _____? - ANSWER 1 to 75 What are the two ways an ISS of 75 can be achieved? - 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? - ANSWER NO Can less than three regions be used to calculate an ISS? - ANSWER YES Can more than three regions be used to calculate an ISS? - ANSWER NO Do all ISS scores have the same mortality rates? - ANSWER NO (depends on body regions affected) Assigning injuries to too few body regions results in what? - ANSWER underestimation of ISS Assigning injuries to too many body regions results in what? - ANSWER overestimation of ISS Are complications or sequela included in the definition of an injury? - ANSWER NO Define injury? - ANSWER Anatomic lesion resulting from transfer of injury. List seven (7) examples of sequela that are coded in AIS as injuries? - ANSWER 1) HTX/PTX
- retroperitoneal hemorrhage
- cerebral edema/swelling
- ischemic brain damage r/t head trauma
- blood loss
- asphyxia
- compartment syndrome Are preliminary (suspected, possible, rule out) dx codeable? - ANSWER NO Are all clinical dx alone codeable? - ANSWER NO (some require radiologic/autopsy findings)
Cranial nerve contusion is coded when there is what documented? - ANSWER weakness/paresthesia subtotal loss of function Cranial nerve laceration is coded when what is documented? - ANSWER paralysis/total loss of function What five (5) physical signs/manifestations are codeable as basilar skull fx? - ANSWER 1) raccoon's eyes (periorbital ecchymosis)
- 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? - ANSWER evidence of head trauma (not r/t facial fx/injury) Are complications coded as injuries? - ANSWER NO Are sequela or outcomes coded as injuries? - ANSWER NO Are injury etiologies (causes) related to AIS injury scores? - ANSWER NO Can injuries be assumed based on a particular outcome occurrence? - ANSWER NO If an AIS code of 6 is assigned, is it acceptable to stop coding subsequent injuries? - ANSWER NO Is death automatically coded as an AIS 6? - ANSWER NO Can an AIS of 1 result in death? - ANSWER YES (rare) Are cord lesions and vertebral fxs coded separately? - ANSWER NO What is important to look for when coding blunt trauma? - ANSWER associated/underlying injuries Penetrating injuries that do not injure underlying structures should be coded in what ISS body region? - ANSWER External Injuries that result from energy dissipated from a penetrating wound are called direct or indirect? - ANSWER indirect
Brain death/blindness are consequences of injury and can or cannot be coded? - ANSWER cannot Is a foreign body considered and injury in and of itself? - ANSWER NO (cannot code) (T/F) Bilateral injures of kidneys, eyes, ears, and extremities are typically codes as separate injuries (with some exceptions). - ANSWER TRUE (T/F) Multiple fractures to the same bone but in different areas are coded separately. - 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. - ANSWER TRUE If a specific skin lesion is unknown or not required, what AIS code is assigned? - ANSWER 910000.1 (Soft Tissue Injury NFS) When a "crush" code is used, are the separate underlying injuries coded separately as well? - ANSWER NO The term "transection" should be coded as complete or incomplete? - 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. - ANSWER FALSE Are branches of vessels coded as separate injuries? - 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? - ANSWER most severe Blood loss of 20% in a 100 kg patient is approximately how many cc? - ANSWER 1500 cc List the four (4) types of injures defined as penetrating? - 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? - ANSWER External
A penetrating injury to the skull is coded under what ISS body region? - ANSWER Head/Neck A penetrating injury to the face w/ massive destruction is coded under what ISS body region? - ANSWER Face Are entry/exit wounds reflected in the severity of internal organ/structure injuries? - ANSWER YES "GSW to abdomen" with no further description would be coded to External or Abdominal ISS body region? - ANSWER Abdominal If a single penetrating injury to the brain involves more than one structure (entry to cerebrum, exit cerebellum) do you code each region separately? - 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. - ANSWER True Vague descriptions such as "blunt trauma" or "closed head injury" should be assigned which AIS code? - ANSWER 9 When assigning severity codes, the coder should use the physicians description of the injury or the AIS definition? - ANSWER AIS definition If the physicians OIS grading differs from the AIS definition of the injury, which should be used for coding? - ANSWER AIS definition If no description is available for a solid organ injury other than the OIS grade, is it acceptable to use this information for assigning an AIS code? - ANSWER YES (T/F) In order to assign an AIS code with "blood loss > 20%" you must know to what area of the body the blood loss is linked. - ANSWER TRUE Are dimensions of lesions used to determine injury severity? - ANSWER YES In an adult, 100% blood volume is considered approximately how many cc? - ANSWER 5000 cc (T/F) The severity of codes in AIS are NOT age adjusted in some categories. - ANSWER FALSE Fractures may be best described in what type of report? - ANSWER radiology
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? - ANSWER contusions Ecchymosis, subcutaneous hematoma, bruise, and bump are all considered what type of external injury? - ANSWER contusions Tearing or ripping apart of tissues from blunt or penetrating force is known as what type of injury? - 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?
- ANSWER avulsion Traumatic removal of skin and SQ tissue separating tissue planes from their blood supply, esp. from a limb is known as what type of injury? - ANSWER degloving (T/F) Degloving injuries may be open or closed. - ANSWER TRUE Which are typically more extensive - degloving or avulsion? - ANSWER degloving Soft tissue injuries are dispersed across body regions in the AIS book and are coded as what ISS body region? - ANSWER external When an external injury occurs without underlying injury, it is coded to the specific _______________ AIS region, but assigned to the ________________ ISS region. - ANSWER body AIS; external ISS When should the AIS body region external codes be used for skin injuries? - 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. - ANSWER TRUE (ex. open fx, penetrating) 1st degree burn is described as _________? - ANSWER superficial 2nd degree burn is described as __________? - ANSWER partial thickness 3rd degree burn is described as _________? - ANSWER full thickness Is age adjustment required for burns? - ANSWER YES When burns are only described as combined degrees, the coder should choose the least or most severe code? - ANSWER most severe
When burns occur in varying degrees, which type of burns are coded separately from the others? - ANSWER 1st degree When either 2nd and/or 3rd degree burns are < 10% TBSA, should the 2nd and 3rd degree burns be coded separately or combined? - ANSWER separately If 2nd and 3rd degree burns combined are > 10% TBSA, they should be coded separately or combined? - ANSWER combined Burn amputations should be coded to which ISS body region? - ANSWER specific to body part Are burns coded separately from burn amputations they cause? - ANSWER NO If an electrical injury causes a "flash" burn, should the burn injury be coded separately? - ANSWER NO Frostbite is assigned to which ISS body region? - ANSWER external Asphyxia/suffocation is assigned to which ISS body region? - ANSWER Head Caustic agent inhalation injuries are assigned to which ISS body region? - ANSWER Chest Caustic agent ingestion injuries are coded to which ISS body region? - ANSWER specific organ injured Drowning is assigned to which ISS body region? - ANSWER Chest Hypothermia is coded to which ISS body region? - ANSWER External Whole body blast injuries are assigned an AIS code of _______ and are coded to which ISS body region? - ANSWER 6;External List the five (5) body parts coded in the AIS face body region. - ANSWER 1) eyes
- ears
- nose
- mouth
- facial bones What is the only vessel included in the Face AIS body region? - ANSWER external carotid (and its branches, facial/internal maxillary)
The cheek bone is also known as what? - ANSWER malar complex What bone is associated with the malar complex (cheek)? - ANSWER zygoma Below what anatomic landmark are the trachea and esophagus coded to the chest ISS region? - ANSWER sternal notch Which portion of the aorta is coded to the chest ISS region? - ANSWER thoracic The larynx/vocal cords are coded to which ISS body region? - ANSWER Head/Neck The shoulders are coded to which ISS body region? - ANSWER extremities/pelvic girdle (T/F) A "crush" injury to the thoracic region must be bilateral in nature? - ANSWER TRUE A "sucking" wound of the chest indicates that it is open or closed? - ANSWER open What membrane lines the chest wall? - ANSWER Parietal pleura What membrane lines the organ? - ANSWER visceral PTX/HTX fills what cavity in the chest? - ANSWER intrapleural space Is the rib cage considered a single anatomic structure for coding purposes? - ANSWER YES If you have unilateral flail chest with rib fxs to the opposite side are the injuries coded combined or separate? - ANSWER separate Unilateral rib fxs with same sided unilateral flail chest are coded combined or separate? - ANSWER combined Three or more ribs fractured in two or more places defines what injury? - ANSWER flail chest Do multiple rib fxs NFS have a specific AIS code? - ANSWER YES A costal cartilage tear or fracture is coded as what type of injury? - ANSWER rib fx Are "clinical rib fxs" coded? - ANSWER NO (must have radiology/OR/autopsy) Can lung contusions be coded on the bases of pulmonary dysfunction alone?
(T/F) Rib fractures with underlying injuries such as a lung contusion or laceration should be coded as one single injury combined. - ANSWER FALSE Ingestion injuries in the chest are coded to which organ? - ANSWER esophagus (T/F) Air embolus and tamponade are codeable sequela in the chest ISS region. - ANSWER TRUE "Blast" and inhalation injuries in the chest are coded to which organ? - ANSWER lungs What should be used when a specific artery or vein is not named in the AIS description but is injured? - ANSWER other named "Incomplete transection" vessel injuries are coded as what in AIS? - 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? - ANSWER chest abdomen The lumbar spinal cord and lumbar vertebrae are assigned to which ISS body region? - ANSWER abdomen Avulsion, complex, rupture, tissue loss, and deep are all synonyms for what severity of organ injury? - ANSWER massive What type of organ injury involves the ripping away of an organ from its vascular attachment? - ANSWER avulsion No perforation or serosal tear is considered a full thickness or partial thickness tear? - ANSWER partial thickness Is a perforation always considered a complete transection? - ANSWER NO When two parts of a structure are completely separated from each other it is known as what type of injury? - ANSWER transection If retroperitoneal hemorrhage/hematoma occurs in combination with an associated injury, it should be coded as combined or separate? - ANSWER combined If a vessel injury occurs in combination with an associated organ and it is included in the organ injury AIS description, it should be coded as combined or separate? - ANSWER combined
The overall severity of pelvic fractures is related to __________ or ____________.
- ANSWER stability instability Penetrating injuries to bones and tissues are coded as what type of fractures to the specific bone? - ANSWER open (T/F) Thumb and non-thumb fingers are separate injury categories. - ANSWER TRUE Are degloving injuries to extremities coded to the extremity or external ISS body region? - ANSWER external Does fracture displacement affect the severity of an injury for AIS coding purposes? - ANSWER NO What are the two anatomic structures of the pelvis for AIS coding purposes? - ANSWER 1) pelvic ring
- acetabulum (T/F) Bilateral acetabulum fractures are coded separately. - ANSWER TRUE (T/F) Bilateral pelvic ring structures are coded separately. - ANSWER FALSE The severity of a pelvic fracture is related to the extent of damage to which arch, anterior or posterior? - ANSWER posterior How many columns are contained within the acetabulum? - ANSWER two (T/F) A partial articular acetabulum fracture may involve one or both columns? - ANSWER TRUE For a complete articular acetabulum fracture to exist, separation of the attachment between the articular surface and the posterior _____________ must occur. - ANSWER ilium Bilateral proximal amputations are coded combined or separate? - ANSWER combined Level of pelvic instability is determined by extent of damage to which two portions of the pelvis? - ANSWER 1) posterior ligaments
- pelvic floor Pubic symphysis separation greater than _________ cm is considered partially unstable. - ANSWER 2.
Vertical shearing fractures of the pelvis are considered stable, partially unstable, or totally unstable? - ANSWER totally unstable SI joint fracture with anterior disruption is considered partially or totally unstable? - ANSWER partially SI joint fracture with posterior disruption is considered partially or totally unstable? - ANSWER totally Cervical spinal injuries are assigned to which ISS body region? - ANSWER Head/Neck The brachial plexus is part of what major organ structure? - ANSWER spine (T/F) The ISS has a separate body region for spine. - ANSWER FALSE Level of injury of the spinal cord refers to the most ____________ segment of the cord with normal motor/sensory function. - ANSWER caudal Anterior, central, and lateral (Brown-Sequard) cord syndromes are classified as what type of overall cord syndrome? - ANSWER incomplete Quadriplegia or paraplegia with no sensation or motor function is classified as what type of cord syndrome? - ANSWER complete (T/F) In the spine, dislocation and subluxation are synonymous. - ANSWER TRUE "Whiplash" is what type of cervical injury? - ANSWER strain (T/F) Cord injuries and vertebral fractures are coded as separate injuries. - ANSWER FALSE Injuries to more than one location of the spinal cord should be coded as combined or separate? - ANSWER separate When it is not clear whether the spinal cord was lacerated or contused, which injury should be coded? - ANSWER contusion (T/F) Sequela of spinal cord injuries such as transient neurological signs, incomplete cord syndromes, and complete cord syndromes are not codable injuries. - ANSWER FALSE How many hours POST injury in paralysis should the neurological status of a patient be used to code spinal injuries? - ANSWER 24 SCIWORA (Spinal Cord Injury without Radiological Abnormality) should be coded as what type of injury? - ANSWER spinal cord contusion NFS
- compound fracture How many hours after injury/arrival should brain injury diagnoses be used for coding? - ANSWER 24 What two things must be present to code LOC? - ANSWER 1) evidence of head trauma
- dx by a physician Can the GCS be used as an indication of LOC for coding purposes? - ANSWER NO (T/F) Brain edema accompanying a contusion or hematoma is considered part of the lesion when assessing its size. - ANSWER TRUE When head injuries and vessel injuries occur simultaneously, they shoud be coded combined or separate? - ANSWER separate "Closed cisterns" implies what type of brain injury? - ANSWER swelling If a single fracture involves both the skull vault and base, what fracture should be coded? - ANSWER most severe If a single fracture involves both the skull vault and base, and both are equal in severity, which fracture is coded? - ANSWER point of origin Unless specified as base, all skull fractures should be coded as what? - ANSWER vault List five (5) skull bones that comprise the base? - ANSWER 1) ethmoid
- sphenoid
- orbital roof
- portions of occiput
- petrous and mastoid portions of temporal Which two sections of the ISS body region for head can DAI be coded under?
- concussion If DAI lasts more than 24 hours, it is ALWAYS coded to which section of the ISS head body region? - ANSWER concussion
(T/F) Certain findings such as IVH, SAH, SPH, and ischemic brain damage are ALWAYS coded separately from DAI. - ANSWER FALSE When a patient sustains multiple head injuries along with coma, the coma should be assigned ONCE to which of the AIS descriptors? - ANSWER highest (T/F) Coma is included in each and every codable head injury. - ANSWER FALSE Once coma is assigned to one AIS descriptor, other head injuries should use which of the AIS descriptions for coma? - ANSWER NFS Penetrating injuries involving the brain stem are always assigned what AIS? - ANSWER 6 GSW to the head with entry/exit wounds is coded as one or two injuries? - ANSWER one If a head injury is described as penetrating, but there is no skull penetration, what should the injury be coded as? - ANSWER scalp laceration Thyroid and salivary glands are assigned to which anatomical region in the head/neck ISS body region? - ANSWER neck If an injury occurs at the junction of the neck and thorax (i.e. sternal notch) which area should the injury be assigned to? - ANSWER neck Injuries that include lacerations, contusions, abrasions, hypothermia, electrical injury, whole body injury and burns are assigned to what region? - ANSWER External Minor vessel laceration - ANSWER Superficial, incomplete circumferential involvement, blood loss less than or equal to 20% by volume Major vessel laceration - ANSWER Rupture, transection, segmental loss, complete circumferential involvement, blood loss > 20% by volume Thrombosis - ANSWER Includes any injury to the vessel resulting in its occlusion Muscle laceration - ANSWER same as rupture, tear or avulsion
20% blood loss in adults - ANSWER > 1000 cc Nerve paresis (palsy) - ANSWER Subtotal loss of function Nerve paralysis - ANSWER Total loss of function
