CAISS Thorax Injuries 5 — Questions and Answers
Question 1: A patient with blunt chest trauma has a chest X-ray showing a widened mediastinum. The injury most consistent with this finding is:
- Pulmonary contusion
- Esophageal perforation
- Traumatic aortic injury (Correct answer)
- Sternal fracture
Correct answer: Traumatic aortic injury
Widened mediastinum on chest X-ray is a classic radiographic sign of traumatic aortic injury, typically at the isthmus just distal to the left subclavian artery.
Question 2: Which AIS thorax code structure component identifies the specific anatomical structure injured?
- The first digit
- The third and fourth digits (Correct answer)
- The fifth and sixth digits
- The decimal value
Correct answer: The third and fourth digits
In the AIS 6-digit code, digits 3 and 4 represent the specific anatomical structure within the body region that was injured.
Question 3: Traumatic esophageal perforation is coded in the AIS thorax region and carries a high mortality primarily due to:
- Direct cardiac compression
- Mediastinitis from leakage of esophageal contents (Correct answer)
- Tracheal compression causing airway obstruction
- Immediate exsanguination
Correct answer: Mediastinitis from leakage of esophageal contents
Esophageal perforation allows gastric and oral bacteria to contaminate the mediastinum, causing rapidly fatal mediastinitis if not treated urgently.
Question 4: Which of the following is NOT a component of the 'thorax' body region in AIS coding?
- Lung parenchyma
- Thoracic aorta
- Thoracic spine vertebral body (Correct answer)
- Diaphragm
Correct answer: Thoracic spine vertebral body
Thoracic spine vertebral body injuries are coded under AIS body region 6 (spine), not the thorax (body region 4).
Question 5: A patient with blunt chest trauma develops subcutaneous emphysema, pneumomediastinum, and respiratory distress. The most likely injury is:
- Rib fracture series
- Tracheal or major bronchial injury (Correct answer)
- Massive hemothorax
- Diaphragmatic rupture
Correct answer: Tracheal or major bronchial injury
Tracheal or major bronchial injuries allow air to dissect into the mediastinum and subcutaneous tissues, causing pneumomediastinum and subcutaneous emphysema.
Question 6: In polytrauma scoring, the Injury Severity Score (ISS) uses AIS thorax scores by:
- Summing all AIS thorax codes together
- Taking the highest AIS code in the thorax and squaring it
- Including the thorax as one of the three worst-injured body regions (Correct answer)
- Averaging the thorax AIS scores across all injuries
Correct answer: Including the thorax as one of the three worst-injured body regions
The ISS squares the highest AIS score from each of the three most severely injured body regions and sums them, so the highest thorax AIS code contributes if the thorax is one of the three worst regions.
Question 7: A traumatic diaphragmatic rupture is typically coded at AIS severity level:
- AIS 2
- AIS 3
- AIS 4 (Correct answer)
- AIS 5
Correct answer: AIS 4
Traumatic diaphragmatic rupture is coded as AIS 4 (severe) because it allows abdominal viscera to herniate into the thorax, causing significant cardiopulmonary compromise.
CAISS Thorax Injuries 5
A patient with blunt chest trauma has a chest X-ray showing a widened mediastinum.
The injury most consistent with this finding is: