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Excerpt
I would like to thank Dr. Anderson for his comments in his Point of View, but I believe that our methodology may have been misunderstood. Although I agree with Dr. Anderson’s contention that an ISS greater than 9 may not purely reflect multisystem trauma, the intention of our study was to analyze the spectrum of injury associated with spinal fracture; in our statistical methods, we used the entire range of the ISS (from 4 to 75) to obtain correlations. A number of studies in the literature have defined “major trauma” as being associated with an ISS greater than 15; however, other studies have used 18, 20, 25, or the continuum of ISS scores with no lower limit in their statistical analyses to relate injury severity to outcome. Rosman et al, 2 using discriminant analysis, suggested that the AIS could be separated into minor and major injuries at a score of 3, and the ISS at a score of 9. The fact that 28.3% of our patients with spine injury only (as determined by absence of scores in other AIS regions) had an ISS of 8.95, whereas 71.7% of patients with AIS codings in categories other than spine had a much higher ISS, supports rather than refutes the use of an ISS of 9 to determine multiple trauma. I therefore do not see this definition as a major methodologic flaw. We may have erred in our description of polytrauma in the “Definitions and Measures” section and may have given an inadequate description of the statistical methods, if this is the impression given.
I also agree that the FIM is likely to be neurologically biased given its origins; however, it has been shown to be an applicable and sensitive measure to evaluate disability in the multitrauma population, 1 and is a reasonable tool to use along with the measures of pain and return to work to reflect important outcomes in this population.
