Introduction Anatomical injury as measured by the AIS often accounts for only a small proportion of variability in outcomes after injury. The predictive Functional Capacity Index (FCI) appended to the 2008 AIS claims to provide a widely available method of predicting 12-month function following injury.
Objectives To determine the extent to which AIS-based and FCI-based scoring is able to add to a simple predictive model of 12-month function following severe injury.
Methods Adult trauma patients were drawn from the population-based Victorian State Trauma Registry. Major trauma and severely injured orthopaedic trauma patients were followed up via telephone interview including Glasgow Outcome Scale—Extended, the EQ-5D-3L and return to work status. A battery of AIS-based and FCI-based scores, and a simple count of AIS-coded injuries were added in turn to a base model using age and gender.
Results A total of 20 813 patients survived to 12 months and had at least one functional outcome recorded, representing 85% follow-up. Predictions using the base model varied substantially across outcome measures. Irrespective of the method used to classify the severity of injury, adding injury severity to the model significantly, but only slightly improved model fit. Across the outcomes evaluated, no method of injury severity assessment consistently outperformed any other.
Conclusions Anatomical injury is a predictor of trauma outcome. However, injury severity as described by the FCI does not consistently improve discrimination, or even provide the best discrimination compared with AIS-based severity scores or a simple injury count.
- functional capacity index
- abbreviated injury scale
- functional outcomes
- 12-month outcomes
- trauma scoring
- prediction models
- major trauma
- trauma registry
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Contributors CSP, PAC and BJG are investigators of the project, contributed to the study design, reviewed the manuscript and approved the final version of the manuscript. CSP completed all analyses for the study and drafted the manuscript.
Funding The VSTR is a Department of Health, State Government of Victoria and Transport Accident Commission (TAC) funded project. VOTOR is funded by the TAC via the Institute for Safety, Compensation and Recovery Research. BJG and PAC are supported by a Career Development Fellowship (GNT1048731), and a Practitioner Fellowship (ID 545926), from the NHMRC, respectively.
Disclaimer The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Monash University HREC.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data included in this project are not freely available. Requests for access to data from the participating datasets would need to be directed to the relevant data custodian, who can be contacted at firstname.lastname@example.org or at the following URLs: https://www.monash.edu/medicine/sphpm/vstorm/data-requests (VSTR) or https://www.monash.edu/medicine/sphpm/votor/data-requests (VOTOR).
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