The Abbreviated Injury Scale and its Correlation with

Preventable Traumatic Accidental Deaths: A study from

South Delhi
R RAUTJI, MBBS DHHM MD (Forensic Med)
Associate Professor, Department of Forensic Medicine, Armed Forces Medical College, Pune, India
D N BHARDWAJ, MBBS MD (Forensic Med)
Additional Professor, Department of Forensic Medicine and Toxicology, AIIMS, New Delhi, India
T D DOGRA, MBBS MD (Forensic Med)
Professor and Head, Department of Forensic Medicine and Toxicology, AIIMS, New Delhi, India
Correspondence: Dr (Lt Col) Ravi Rautji, Department of Forensic Medicine AFMC, Sholapur Road,
Pune, 411040, India. E-mail: rautjiravi@hotmail.com
ABSTRACT
Anatomic trauma scoring systems are fundamental
to trauma research. The Abbreviated Injury Scale
(AIS) and its derivative, the Injury Severity Score
(ISS), are the most frequently used scales.
In a prospective study, 400 autopsies of road
traffic accident victims performed between January
2002 and December 2003 were coded according to the
AIS and ISS methods. All the cases were classified
into different injury groups according to the Injury
Severity Scale. Fifty-eight cases (14.5%) were
assigned an ISS value of <25; 244 (61%) cases were
valued between 25-49; 38 cases (9.5%) were valued
between 50-74 and 60 (15%) cases had a value of 75.
On analysis of medical care, in cases with ISS<50,
about 96% of the victims did not receive optimal care
quickly enough with a lack of pre-hospital resuscita-
tion measures and lengthy transportation time to
hospital being of major importance.
INTRODUCTION
The medical community has only very recently
recognized trauma as a discrete entity. The
national academy of science, exploring the
state of trauma research, has recommended
continuous systemic data collection, using
common coding schemes, in hospitals and
trauma centres. Methods of trauma scoring
are fundamental to any systemthat engages in
this type of research. The most frequently used
methods for scoring trauma rely on anatomical
or physiological measurements or a combina-
tion of the two.
Anatomic scales score each organ injury
separately. These scales rely to a certain extent
on retrospective data and are of limited use in
initial assessment and triage in the field. The
Abbreviated Injury Scale (AIS) and the Injury
Severity Score (ISS), which is based on the
AIS, are the most frequently used anatomical
scales. Physiologically-based scores measure
parameters such as blood pressure, respiratory
rate and level of consciousness. They are
useful for early evaluation of the injured
person. They are not relevant in post-mortem
evaluation. The American Medical Associa-
tion, the American Association for Automotive
Medicine and the Society of Automotive
Engineers established the AIS in 1971. It was
revised five times, most recently in 1990. In its
present form, the AIS codes injuries based on
their anatomic site, nature and severity. All
injuries are assigned a seven digits score in
which the seventh digit represents the AIS
severity. The minimal severity is 1, with the
highest being 6.
The ISS was developed from the AIS and
was first published in 1974. The system
provides a summary severity score based on
AIS coding. The AIS coded injuries are divided
into six body regions. The ISS is the sum of the
squares of the highest AIS severity scores from
the three most severely injured body regions.
Rautji et al.: The Abbreviated Injury Scale and its Correlation with Preventable Traumatic Accidental Deaths 157
Any injury coded as AIS 6 (which is considered
incompatible with life, such as penetrating
brain stem injury) automatically gives an ISS
maximum score of 75.
Interpretation of trauma deaths by autopsy
remains profoundly important to trauma re-
search and particularly to continuous quality
improvement. Quality of care audits using
autopsy and clinical data have indicated that,
in the United States, up to 35% of trauma
deaths were preventable. (Pollock et al., 1993)
Similar studies in England found that about
30% of deaths were preventable. (Royal
College of Surgeons of England, 1988) The
results of these studies led to the implementa-
tion of trauma care systems and trauma
centres. Such studies demonstrate the vital
role of autopsy as a tool in the continuing
efforts to improve the quality of trauma
treatment. The regular use of trauma scores
in forensic medicine may provide a standard-
ized database of autopsy findings, which would
be a tremendous contribution to the quality of
trauma treatment and the assessment of
preventable death.
This paper aims to assess the use of trauma
scoring systems, i.e. the AIS and its derivative,
the ISS, in autopsies of road traffic fatalities
brought to AIIMS, New Delhi and to correlate
incidences of preventable death.
MATERIALS AND METHODS
The All India Institute of Medical Sciences is
the hospital where the medico-legal autopsies
of South Delhi, India, are conducted. The
present study was carried out on the dead
bodies of victims of road traffic fatalities
brought to the mortuary of AIIMS, New Delhi.
These consisted of cases mainly fromDelhi and
a few from the surrounding states. Cases for
the present study include only the prospective
autopsies from January 2002 to December
2003. A total of 400 cases of death due to road
traffic accidents were studied during the
above-mentioned period. Decomposed bodies,
cases with a doubtful history and cases in
which the victim had undergone surgery but
the operative notes could not be recovered
were excluded from the study.
Detailed information regarding the nature
of the accident, the time of accident, type of
vehicle involved, category of victims, mode of
transportation to the hospital (in cases other
than instant death), were noted down. The
injuries reported at each autopsy were
analyzed to determine the Abbreviated Injury
Scale (AIS) score of each injured body region,
and the Injury Severity Score (ISS) was
calculated using the Association for Advance-
ment of Automotive Medicine (AAAM), 1990
protocol. The cases were divided into groups
based on their ISS, where the group with less
serious injuries (ISS<25) was considered sur-
vivable with the type of medical care available
in every hospital. The second group (ISS 25-49)
was considered survivable if a trauma centre
had been available. In the group with more
serious injuries (ISS 50-74), death was con-
sidered inevitable regardless of the kind of
medical care provided (Copes et al., 1988;
Sampalis et al., 1995).
RESULTS
Age incidence
The age group between 21-30 years was the
most vulnerable, comprising 38% (n=152) of
the total cases, followed by the age group 31-40
years (n=80, 20%). Thus the highest number of
deaths, amounting to 58%, was in the 21-40
year age group (Figure 1).
Sex incidence
Males comprised 90% of the total cases
(n=360), while females amounted to only 10%
(n=40). The highest number of deaths in males
was in the age group 21-40 years, amounting to
Figure 1. Age and sex distribution of cases.
158 Med. Sci. Law (2006) Vol. 46, No. 2
53.5% (n=214) of the deaths. Among the
females the highest number of deaths was
observed in the 31-50 years (n=24, 6%) age
group (Figure 1).
Accident victims
Pedestrians were involved in 176 (44%) cases,
followed by riders of two-wheelers, totalling
128 (32%) cases. Cyclists were next on the list,
accounting for 32 (8%) cases, while car occu-
pants accounted for 28 (7%) cases (Figure 2).
Offending vehicles
Buses/minibuses were the most common
offending vehicles, being responsible for
102 (25.5%) deaths, followed by unknown
vehicles (n=76, 19%), trucks (n=74, 18.5%),
cars (n=54, 13.5%) and two-wheelers (n=52,
13%) (Figure 3).
Time of accidents
The majority of accidents (n=120, 30%)
occurred between 18.00hrs to 24.00hrs, fol-
lowed by 28.5%, (n=114) between 12.00hrs to
18.00hrs, 25% (n=100) between 06.00hrs to
12.00hrs and 16.5%(n=66) cases were reported
between 24.00hrs to 06.00hrs.
Alcohol
Blood was analyzed for the qualitative pre-
sence of alcohol in 292 cases. Alcohol was
detected in 52 (17.8%) cases.
Mode of transportation
In 140 cases (35%) the injured were trans-
ported to the nearest hospital by taxi, in 44
cases (11%) they were transferred by private
vehicle, in 200 cases (50%) by PCR (Police
Control Room) vans and in 16 cases (4%) by
ambulance.
Time taken during transportation
Out of the 298 cases transported by various
means to the hospitals, only 32 cases (10.74%)
were able to reach the hospital in less than 15
minutes; 116 cases (38.93%) took less than 30
minutes, and 126 cases (42.28%) arrived in less
than 60 minutes.
Transportation time by different vehicles
The average time taken by a PCR van was
33.86 minutes, followed by an ambulance
(37 minutes) and private vehicles/taxi (45.53
minutes).
Survival time
Of the total 400 cases, 102 (25.5%) died at the
site of the accident and 102 (25.5%) were
already dead on arrival at hospital or died
within an hour of admission. Twenty-one per
cent of cases died within 24 hours of the
accident, 36 cases (9%) survived for up to three
days, 38 (9.5%) cases survived for up to one
week and 38 cases (9.5%) survived for more
than one week. Four cases (1%) survived for
three weeks before succumbing to their in-
juries.
Involvement of body region
The head and neck were the most vulnerable
body regions, involved in 302 (75.5%) cases,
followed by the chest (n=180, 45%), the
extremities (n=162, 40.5%) and the abdomen
(n=138, 34.5%) (Figure 4).
Figure 2. Accident victims. Figure 3. Offending vehicles.
Rautji et al.: The Abbreviated Injury Scale and its Correlation with Preventable Traumatic Accidental Deaths 159
Multiple traumas
Sixty-six per cent of the patients suffered
multiple traumas, i.e. two or more body regions
had severe or critical injuries. Persons with a
higher number of injured body regions had a
higher ISS. In patients who had only a single
body region with a severe or critical injury, the
ISS was low.
Cause of death
Of the 400 fatalities, the major cause of death
was head injury in 43.5% of the cases. Twenty
per cent of deaths resulted from intra-thoracic
or intra-abdominal haemorrhage, 6.5% from
sepsis and 30% from a combination of factors.
AIS in different body regions
Out of 302 cases of head injury, AIS 5 and
above (severe head injury) was seen in 70.2%of
cases, whereas in cases of injury to the thorax
(44.4% of cases), to the abdomen (20.29%) and
to the extremities, only 6.18% of the cases
reported an AIS of 5 or above. An AIS of 4 or
less in the various categories was present less
frequently (Figure 5).
ISS grouping
In the present study 58 (14.5%) cases were
assigned an ISS value of <25 (survivable with
the level of medical care available in every
hospital), 244 (61%) were valued between
25-49 (survivable if a trauma centre is avail-
able), 38 (9.5%) were valued between 50-74
(non-survivable) and 60 (15%) cases were
given a value of 75 (non-survivable). The
majority of cases were seen in the ISS values
of 25, 29 and 34. These values represent one
major injury, most commonly to the head,
resulting in a score of 25 (5
2
); one major injury
accompanied by a minor injury (5
2
+2
2
=29)
and one major injury with a moderately severe
injury (5
2
+3
2
=34), respectively. The average
ISS for the mortalities was 37.86 with a range
from 9-75 (Figure 6).
Relationship between survival time and ISS
Out of the 60 cases with an ISS of 75, 52 cases
Figure 4. Injured body regions.
Figure 5. AIS in different body regions.
160 Med. Sci. Law (2006) Vol. 46, No. 2
(86.67%) were found dead at the accident scene
or were dead on arrival at the hospital. Out of
the 38 cases with an ISS between 50-74, 34
cases (89.47%) were found dead at the accident
scene or were dead on arrival at the hospital,
and only four cases survived until the third
day. Out of 244 cases with an ISS between
25-49, 86 cases (35.25%) survived for more
than one day and out of 58 cases with an ISS<
25, 26 cases (44.83%) survived for more than
one day (Figure 7).
DISCUSSION
Autopsy remains the golden tool by which the
clinicians diagnosis can be confirmed,
amended, or refuted. It is a reliable, accurate
and acceptable established scientific method
for the investigation of injuries. The use of
trauma scoring systems in autopsies may
prove to be a valuable tool in identification of
preventable deaths. The AIS and the ISS are
the most widely used anatomical trauma
scoring systems. They are the basis for most
methods of preventable death evaluation.
In the present study, the majority of the
deceased (90%) were male. It is due to greater
male exposure on urban streets and the
personal and behavioural characteristics of
males. Similar results were reported by others
(Salgado and Colombage, 1988; Sahdev et al.,
1993; Friedman et al., 1996; Sharma et al.,
2001). Henriksson et al. ( 2001); in their study
reported the male incidence as 67%.
The most common age group affected in the
study was between 21-30 years (n=152, 38%)
and 31-40 years (n=80, 20%). It is consistent
with other studies (Chandra et al., 1979;
Salgado and Colombage, 1988; Sahdev et al.,
1993; Friedman et al.,1996; Sharma et al.,
2001). The age group 20-40 years is the most
active phase of life, physically and socially, and
hence people in this group outnumber other
road users. They therefore account for the
maximum number of accidental deaths.
In the present study, the majority (50%) of
patients were transported to the hospital by a
police control room van (PCR van), 46% by
personal vehicles/taxi and 4% by ambulance.
PCR vans were the most effective mode of
transport because of their large numbers and
effective mode of communication. In most of
Figure 6. ISS grouping.
Figure 7. Relationship between ISS and survival time.
Rautji et al.: The Abbreviated Injury Scale and its Correlation with Preventable Traumatic Accidental Deaths 161
the cases PCR vans reached the accident site
within 20 minutes. By contrast, ambulances,
the specialized vehicles for patient transport,
only transported 16 casualties (4%). This is
due to the ineffective mode of communication,
and the keeping of the vehicles at specified
places. Ninety-four per cent of all victims
received no pre-hospital care. This is consis-
tent with the study of Sahdev et al. (1993).
The average time taken by a PCR van to
transport the injured to hospital was 33.86
minutes, followed by the ambulance (37 min-
utes), and then personal vehicles and taxis
(45.53 minutes). The delay in transportation of
the casualties is because of a lower average
road speed (40-50 km p/h), primitive commu-
nication systems, intermingling of various
modes of transport and the callous attitude of
the police and general public. In developed
countries the average transport time of ca-
sualties is much less.
Mini buses/buses were the most common
offending vehicles, being responsible for 102
(25.5%) deaths. There are various means of
public transport in Delhi, wherein the private
buses and minibuses are the main culprits. In
order to gain more profit, they often do not
follow the specified speed limit and traffic
signals. Apart from this, overcrowding is
another factor. Vast areas of bye-lanes, a huge
population and increased vehicular density
mean that hit-and-run cases (unknown
vehicles) come next in accounting for 76
(19%) cases. The third most common offending
vehicles were trucks (n=74, 18.5%), followed by
cars (n=54, 13.5%), and then two-wheelers
(n=52, 13%). This is consistent with the study
conducted by Sharma et al.(2001).
In the present study the majority of fatal-
ities were seen among pedestrians (n=176,
44%), which is consistent with other studies
(Salgado and Colombage, 1988; Maheshwari
and Mohan, 1989; Kumar et al., 1989; Sharma
et al., 2001) Two-wheeler users occupied the
second place, accounting for 32% (n=128) of
deaths and cyclists constituted 8%(n=32). This
is similar to the findings in the study carried
out by Sharma et al. (2001). Occupants of
vehicles (car/bus/truck) accounted for 42 cases
(10.5%). In Delhi there is little segregation
between vehicular and foot traffic and a
pedestrian has the choice of either walking a
long distance to the nearest intersection to
cross the road or darting across several lanes of
heavy, fast moving traffic, resulting in avoid-
able fatal accidents. The impacting vehicle is
generally a bus or a truck.
Out of 128 two-wheeler fatalities, 36 riders
(28.13%) were not wearing a helmet. Of these,
28 died of head and spinal injuries, while eight
died of various visceral injuries.
Most accidents occurred between 18.00hrs
to 24.00hrs accounting for 30% of the cases.
The reason for this is the movement of trucks
between 21.00hrs to 06.00hrs inside the city
limits, insufficient lighting of roads, over-
crowding of roads and alcohol intake. People
after work are generally tired and in a hurry to
reach their destination. Non-functioning
traffic signals and the disobeying of traffic
rules, due to the absence of proper law
enforcement (especially the absence of law
enforcing authorities at night), also contribute
to accidents.
Of the 400 fatalities, the major cause of
death was head injury in 43.5% of the cases.
Twenty per cent of deaths resulted from intra-
thoracic or intra-abdominal haemorrhage,
6.5% from sepsis and 30% from a combination
of factors. Of the 210 cases brought alive to the
emergency department, 36 (17.15%) cases died
within 24 hours of the accident as a result of
intra-abdominal and intra-thoracic haemor-
rhage. Delay in transportation, the absence of
pre-hospital resuscitation measures and, in
a few cases, failure to diagnose an intra-
cavitary haemorrhage promptly, suggests that
measures could be undertaken to improve
survival among this group of patients.
In the present study 58 (14.5%) cases were
assigned an ISS value of <25, 244 (61%) cases
had a value between 25-49, 38 (9.5%) between
50-74, and 60 (15%) cases had a value of 75. In
a study Preventability of vehicle-related fatal-
ities conducted by Henriksson et al. (2001) the
corresponding figures were 12%, 32%, 9%, and
48%, respectively. In a study by Friedman et al.
(1996), cases were grouped into three cate-
gories according to their ISS value: 0-14
(minor) 16-66 (major), and 75 (incompatible
162 Med. Sci. Law (2006) Vol. 46, No. 2
with life). The ISS was 0-14 in 19 (6.8%) cases,
16-66 in 150 (53.76%) cases and 75 in 110
(39.44%) cases. In South Delhi the average
road speed is 40-50 km per hour as compared
with other developed countries where the
average road speed is in the range of 70-80
km per hour. The percentage of cases falling
between ISS 25-49 is consequently much
higher in the present study as compared with
the developed countries, where the highest
percentage of cases are seen with ISS 75 (non-
survivable). The average ISS for the mortal-
ities was 37.86 with a range from 9-75. In a
study by Sahdev et al. (1993) the average ISS
was 37.8 with a range from 8-75.
On analyzing the preventable deaths
(ISS<25), 34 (58.6%) were central nervous
system (CNS) related and 24 (41.4%) were
multi-factorial. Of the possibly preventable
deaths (ISS 25-49, less AIS 5 in the head except
acute epidural/subdural haematoma, i.e. 52
cases) 68 (35.42%) were CNS related and 124
(64.58%) were multi-factorial. Delayed treat-
ment, either because the injured victimwas not
found early enough or due to lack of trained
medical assistance, was a major contributing
factor in the cases assigned an ISS of less than
25. Had proper trained help, such as establish-
ing a patients airway, prompt haemorrhage
control and fluid resuscitation been provided,
death could probably have been prevented.
Each case rated ISS <25 merits attention as
it provides valuable data concerning different
aspects of trauma care systems. Inadequate
training of physicians treating trauma or an
inefficient pre-hospital trauma care system
may cause an increased number of unexpected
deaths. Apart from this, deaths that are
preventable may be caused by the management
errors of untrained medical personnel, and lack
of prompt treatment due to absence of, or
inefficient regionalization of, trauma centres.
It is notable that death due to central
nervous system involvement accounted for
43.5% of all deaths and was the most frequent
cause of death at each time interval, except
death occurring within one hour and between
one to six hours, where intra-thoracic and
intra-abdominal haemorrhage was the main
cause of death (Figure 8).
The majority of cases were seen with ISS
values of 25, 29 and 34. These values represent
one major injury, most commonly to the head,
resulting in a score of 25 (5
2
), one major injury
accompanied by a minor injury (5
2
+2
2
=29)
and one major injury with a moderately severe
injury (5
2
+3
2
=34) respectively. In a study
by Friedman et al. (1996) the most number of
cases were seen with ISS values of 25, 26
and 50.
The severity of injuries graded according to
AIS demonstrated that severe head injury
Figure 8. Cause of death by time from accident.
Rautji et al.: The Abbreviated Injury Scale and its Correlation with Preventable Traumatic Accidental Deaths 163
(AIS 5 and above) was seen in 70.2% of the
cases, whereas in cases of injury to the thorax
(44.4% of cases), to the abdomen (20.29% of
cases) and to the extremities, only 6.18% of the
cases reported an AIS of 5 and above. In a
study carried out by Sahdev et al. (1993),
severe head injury was present in 68% of the
cases, followed by abdominal injury in 20%and
chest injury in 19% of the cases.
Most people either died at the accident
scene or were dead on arrival at casualty, or
died within an hour of the accident (n=204,
51%). Seventy-two per cent (n=288) of the
cases died within 24 hours of the accident.
Similar findings (72.50%) were recorded by
Chandra et al. (1979). Sharma et al. (2001) in
their study found the incidence to be 63.83%.
The higher figure of early mortality is due to
the virtual absence of basic resuscitative
measures being given to the casualties at the
accident sites, as most of the casualties (96%)
in the present study were brought to the
emergency department by the general public
or police personnel who unfortunately have no
practical knowledge of basic first aid. Inade-
quate infrastructure for early transportation
and management of trauma patients is an-
other important factor.
Twenty-eight per cent of the total cases
survived for more than 24 hours, and 9.5% for
more than a week in the present study.
Sharma et al. (2001) found that 36.17% of
the cases survived for more than 24 hours and
6.16% cases for more than a week. A sig-
nificant proportion of the injured in the study
died in the hospital. This may indicate sub-
optimal hospital and pre-hospital care. In a
few cases even incorrect care was given,
mainly due to wrong priorities in the acute
stage, i.e. internal haemorrhage not being
diagnosed in time.
Out of 400 cases, 292 cases were examined
for alcohol. Fifty-two cases (17.8%) were found
positive for alcohol after qualitative esti-
mation. Quantitative estimation of alcohol
was not carried out in the study. Henriksson
et al. (2001) in their study reported the
presence of alcohol in 27% of the cases. No
other drug of abuse was detected in the study.
Limitations
The ISS has found wide acceptance though it
does have a few drawbacks. The most serious
drawback is the limitation of the system to one
injury only in each anatomic region, which has
the effect of eliminating the cumulative effect
of multiple injuries to the same body region.
The other limitations in our study were the
absence of clinical parameters, such as the
quantity of blood loss, and the fact that spinal
symptoms, such as paraplegia, were not avail-
able at the time of autopsy.
CONCLUSION
The importance of post-mortem examinations
in trauma research has been widely accepted.
The introduction of trauma scoring to post-
mortem examinations will further enhance
necropsys prominent role and may help estab-
lish a common language for all aspects of fatal
trauma research. The data so prepared would
be a powerful device for quality assessment of
trauma treatment. Numeric coding will help in
computerization of post-mortem findings and
would increase the availability of data for
population studies. The use of survival scoring
systems permits rapid identification of un-
expected outcomes, allowing investigators to
performdetailed reviews of particular cases and
to determine the reasons for specific outcomes.
Preventive measures
Urgent attention needs to be paid to the
prevention and control of road accidents. Some
of the widely accepted principles for promoting
road safety are listed below:
*
Average speeds of vehicles should be kept as
low as possible in urban areas.
*
All safety measures requiring action by the
road user (e.g. use of safety helmets) must
be enforced by laws and policing.
*
Vehicles moving at very different speeds
should be separated physically on the road
i.e. separate lanes should be designated for
different types of vehicles.
*
Small vehicles and pedestrians should be as
conspicuous as possible in light, bright
(orange/yellow) colours.
164 Med. Sci. Law (2006) Vol. 46, No. 2
*
Toddlers and infants in cars should travel in
proper child safety seats.
*
Use of zebra crossings for crossing the road
by the pedestrian to be made compulsory,
and the general public should be educated
about this.
*
Speed breakers (humps) should be con-
structed wherever vehicle speed should be
low.
*
Organize traffic assistance wardens at
schools, at arrival and dispersal times.
*
Municipal authorities must provide bicycle
lanes and pedestrian paths on as many
roads as possible.
*
All vehicles should conform to international
safety standards, especially on the use of
laminated windshields.
*
Vehicles should not be allowed to have any
pointed or sharp surfaces at the front.
*
Appropriate regulations can have a major
impact on traffic injuries, particularly if
enforcement is effective and the regulations
are acceptable to the public.
*
Establishing specialized trauma centres.
*
Appropriate measures should be instituted
to increase physicians awareness of con-
cealed intracavitary haemorrhage.
*
Improvement in the transport system
should be implemented so as to transfer
casualties to the hospitals quickly.
*
General public should be taught basic first
aid techniques, especially assisted res-
piration.
*
Voluntary organizations, government/non-
government organizations should prepare
educational films on safe driving, defensive
driving etc. and make arrangements to
show them to drivers repeatedly.
*
Educational campaigns on road safety
should also be organized, through hoard-
ings, newspapers, banners, public service
announcements, etc.
*
All out efforts should be made to change the
behaviour of people/drivers so that rash
actions by both drivers and pedestrians are
minimal.
Finally, only we, the people, can prevent road
accidents by concentrating on safe driving and
educating our children. We must be constantly
vigilant while on the road. Each one of us must
become aware, not just for a day or two, but
forever, of what we can do to prevent road
accidents and save precious lives.
REFERENCES
Association for the Advancement of Automobile
Medicine (1990) The Abbreviated Injury Scale
1990 revision. Des Plaines II: Association for the
Advancement of Automobile Medicine.
Chandra J., Dogra T.D. and Dikshit P.C. (1979)
Pattern of cranio-intracranial injuries in fatal
vehicular accidents in Delhi, 1966-76. Med. Sci.
Law 19 (3), 18694.
Copes W.S., Champion H.R., Sacco W.J., Lawmick
M.M., Keast S.L. and Bain L.W. (1988). The
Injury Severity Score Revisited. J. Trauma 28,
6977.
Friedman Z., Kungel C., Hiss J., Margovit K., Stein
M. and Shapira S. (1996) The Abbreviated Injury
Scale a valuable tool for forensic documentation
of trauma. Am. J. Forensic Med. Pathol. 17,
2338.
Henriksson E.M., Ostrom M. and Eriksson A. (2001)
Preventability of vehicle-related fatalities. Accid.
Anal. and Prev. 33, 46775.
Kumar B., Paul G. and Sharma A.K. (1989). Injury
Severity Score as a yardstick in assessing the
severity and mortality of various abdomino-pelvic
trauma hospitalized victims a clinical vis-a` -vis
autopsy study. Med Sci Law 29 (4), 3336.
Maheshwari J. and Mohan D. (1989) Road traffic
fatalities in Delhi: A hospital-based study. J.
Traffic Med. 17, 237.
Royal College of Surgeons of England. (1988) Report
of the Working Party on the Management of
Patients with Major Injuries. London, Royal
College of Surgeons of England.
Sahdev P., Lacqua M.J., Singh B. and Dogra T.D.
(1994) Road traffic fatalities in Delhi: causes,
injury patterns and incidence of preventable
deaths. Accid. Anal. Prev. 26, 37784.
Salgado M.S.L. and Colombage S.M. (1998) Analysis
of fatalities in road accidents. Forensic Sci. Int.
36, 916.
Sampalis J.S., Boukas S., Nikolis A. and Lavoie A.
(1995). Preventable death classification: inter-
rater reliability and comparison with ISS-based
survival probability estimates. Accident Analysis
and Prevention 27, 199206.
Sharma B.R., Harish D., Sharma V. and Vij K. (2001)
Road Traffic accidents a demographic and
topographic analysis. Med. Sci. Law. 41 (3),
26674.
Rautji et al.: The Abbreviated Injury Scale and its Correlation with Preventable Traumatic Accidental Deaths 165