CAISS Abdominal Injuries 5 — Questions and Answers
Question 1: An intraperitoneal bladder rupture carries a higher AIS score than an extraperitoneal rupture primarily because of which risk?
- Higher incidence of associated pelvic fractures
- Greater risk of peritonitis and urosepsis from urinary contamination (Correct answer)
- Proximity to the diaphragm
- Associated renal pedicle injury
Correct answer: Greater risk of peritonitis and urosepsis from urinary contamination
Intraperitoneal bladder rupture allows urine to enter the peritoneal cavity, creating a higher risk of peritonitis and urosepsis, justifying a higher AIS score.
Question 2: Which of the following best illustrates the difference between an AIS 4 and AIS 5 hepatic injury?
- Lobe involvement vs. no lobe involvement
- Retrohepatic vena cava or major hepatic vein injury (AIS 5) vs. lobar parenchymal disruption (AIS 4) (Correct answer)
- Presence of capsular tear vs. subcapsular hematoma
- Active hemorrhage vs. contained hematoma
Correct answer: Retrohepatic vena cava or major hepatic vein injury (AIS 5) vs. lobar parenchymal disruption (AIS 4)
AIS 5 hepatic injuries specifically involve the retrohepatic vena cava or major hepatic veins, whereas AIS 4 involves extensive lobar parenchymal disruption without these vessels.
Question 3: A trauma patient's CT scan shows splenic devascularization greater than 75%. According to AIS, this is scored at which level?
- AIS 3
- AIS 4
- AIS 5 (Correct answer)
- AIS 6
Correct answer: AIS 5
Splenic devascularization greater than 75% is an AIS 5 injury, indicating a critical, potentially life-threatening injury requiring urgent intervention.
Question 4: Under AIS coding conventions, mesenteric injuries are primarily coded based on which factor?
- Length of mesentery involved
- Presence and extent of vascular injury and associated bowel ischemia (Correct answer)
- Number of mesenteric lymph nodes injured
- Type of trauma mechanism (blunt vs. penetrating)
Correct answer: Presence and extent of vascular injury and associated bowel ischemia
Mesenteric injury severity in AIS is primarily determined by vascular involvement and whether associated bowel ischemia or necrosis is present.
Question 5: Which of the following would be coded as an abdominal AIS injury rather than a pelvic AIS injury?
- Pubic symphysis diastasis
- Sigmoid colon laceration (Correct answer)
- Acetabular fracture
- Iliac wing fracture
Correct answer: Sigmoid colon laceration
Sigmoid colon lacerations are coded as abdominal injuries in AIS because the colon is an abdominal organ, while bony pelvic structures are coded in the pelvic region.
Question 6: A Grade V renal injury involving a shattered kidney with devascularization is coded at which AIS level?
- AIS 3
- AIS 4
- AIS 5 (Correct answer)
- AIS 6
Correct answer: AIS 5
A Grade V renal injury with complete devascularization or shattered kidney is coded AIS 5, representing a critical life-threatening injury.
Question 7: When a CAISS specialist cannot determine the depth of a liver laceration from available records, what is the recommended coding approach?
- Default to AIS 1
- Code the lowest plausible score and flag the record for review (Correct answer)
- Assign AIS 3 as a universal default for unspecified liver lacerations
- Omit the injury from the coding record entirely
Correct answer: Code the lowest plausible score and flag the record for review
When documentation is insufficient, coders should assign the lowest defensible score supported by available evidence and flag the record for clarification or review.
CAISS Abdominal Injuries 5
An intraperitoneal bladder rupture carries a higher AIS score than an extraperitoneal rupture primarily because of which risk?