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CAISS question with complete solution
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 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 directions to help coder choose appropriate code 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 three 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 & pelvis
- external Asphyxia is assigned to which ISS region? - correct answer Head and Neck
Drowning is assigned to which ISS 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) Assigning injuries to too few body regions results in what? - correct answer underestimation of ISS Assigning injuries to too many body regions results in what? - correct answer overestimation of ISS
What must also exists to code a basilar skull fx when only physical manifestations are present? - correct answer evidence of head trauma (not r/t facial fx/injury) Are complications coded as injuries? - correct answer NO Are sequela or outcomes coded as injuries? - correct answer NO 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 What is important to look for when coding blunt trauma? - correct answer associated/underlying injuries 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 An articular fracture involves what structure? - correct answer JOINT A fracture with three or more fragments with proximal and distal fragments not touching is defined as what? - correct answer complex When two ends of a bone are not aligned the fracture is called what? - correct answer displaced When multiple bone fragments are present a fracture is called what? - correct answer comminuted Sprains occur to joints or muscles? - correct answer joints Strains occur to joints or muscles? - correct answer muscles Massive destruction of a body part with damage to underlying skeletal, tissue, organ, and vascular systems is known as what type of injury? - correct answer crush
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 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
"GSW to abdomen" with no further description would be coded to External or Abdominal ISS body region? - correct 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? - 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 When assigning severity codes, the coder should use the physicians description of the injury or the AIS definition? - correct answer AIS definition If the physicians OIS grading differs from the AIS definition of the injury, which should be used for coding? - correct 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? - correct 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. - correct answer TRUE Are dimensions of lesions used to determine injury severity? - correct answer YES In an adult, 100% blood volume is considered approximately how many cc? - correct answer 5000 cc (T/F) The severity of codes in AIS are NOT age adjusted in some categories. - correct answer FALSE
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 3rd degree burn is described as _________? - correct answer full thickness Is age adjustment required for burns? - correct answer YES When burns are only described as combined degrees, the coder should choose the least or most severe code? - correct answer most severe When burns occur in varying degrees, which type of burns are coded separately from the others? - correct 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? - correct answer separately If 2nd and 3rd degree burns combined are > 10% TBSA, they should be coded separately or combined? - correct answer combined Burn amputations should be coded to which ISS body region? - correct answer specific to body part
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 LeFort III Should minimally displaced facial fractures be coded as displaced? - correct answer NO 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) The cheek bone is also known as what? - correct answer malar complex What bone is associated with the malar complex (cheek)? - correct answer zygoma Below what anatomic landmark are the trachea and esophagus coded to the chest ISS region? - correct answer sternal notch Which portion of the aorta is coded to the chest ISS region? - correct answer thoracic The larynx/vocal cords are coded to which ISS body region? - correct answer Head/Neck The shoulders are coded to which ISS body region? - correct answer extremities/pelvic girdle
(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 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 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 No perforation or serosal tear is considered a full thickness or partial thickness tear?
- correct answer partial thickness
Is a perforation always considered a complete transection? - correct answer NO When two parts of a structure are completely separated from each other it is known as what type of injury? - correct answer transection If retroperitoneal hemorrhage/hematoma occurs in combination with an associated injury, it should be coded as combined or separate? - correct 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? - correct answer combined When an injury occurs at the junction of the duodenum and the jejunum, the injury should be coded to which part of the intestine? - correct answer jejunum Injuries to bilateral abdominal organs such as the kidneys are coded as combined or separate? - correct answer separate (T/F) If OIS grading descriptions are NOT available and no other descriptors are mentioned, it is acceptable to use the terms "minor, major, or massive" as severity descriptors of solid organ injuries. - correct answer TRUE Is a positive DPL (diagnostic peritoneal lavage) a codeable injury in and of itself? - correct answer NO When an organ has a laceration AND associated contusion, they should be coded combined as what type of injury? - correct answer laceration (T/F) Fetal demise as a result of abdominal injury is a codeable AIS injury. - correct answer FALSE (T/F) Abdominal compartment syndrome is a sequela of abdominal trauma and is therefore NOT coded. - correct answer TRUE
