Injury scoring systems can be used for triaging, predicting morbidity and mortality, and prognosis in mass casualty incidents. Recent conflicts and civilian incidents have highlighted the unique nature of blast injuries, exposing deficiencies in current scoring systems. Here, we classify and describe deficiencies with current systems used for blast injury. Although current scoring systems highlight survival trends for populations, there are several major limitations. The reliable prediction of mortality on an individual basis is inaccurate. Other limitations include the saturation effect (where scoring systems are unable to discriminate between high injury score individuals), the effect of the overall injury burden, lack of precision in discriminating between mechanisms of injury, and a lack of data underpinning scoring system coefficients. Other factors influence outcomes, including the level of healthcare and the delay between injury and presentation. We recommend that a new score incorporates the severity of injuries with the mechanism of blast injury. This may include refined or additional codes, severity scores, or both, being added to the Abbreviated Injury Scale for high-frequency, blast-specific injuries; weighting for body regions associated with a higher risk for death; and blast-specific trauma coefficients. Finally, the saturation effect (maximum value) should be removed, which would enable the classification of more severe constellations of injury. An early accurate assessment of blast injury may improve management of mass casualty incidents.

伤害评分系统可用于分类、预测发病率和死亡率以及大规模伤亡事件的预后。最近的冲突和平民事件凸显了爆炸伤的独特性，暴露了当前评分系统的缺陷。在这里，我们对当前用于爆炸伤害的系统的缺陷进行分类和描述。尽管当前的评分系统突出了人群的生存趋势，但存在几个主要限制。对个体死亡率的可靠预测是不准确的。其他限制包括饱和效应（评分系统无法区分高损伤评分个体）、总体损伤负担的影响、在区分损伤机制方面缺乏精确性以及缺乏支持评分系统系数的数据。其他因素会影响结果，包括医疗保健水平以及受伤和就诊之间的延迟。我们建议新的评分将伤害的严重程度与爆炸伤害的机制结合起来。这可能包括细化或附加的代码、严重性评分或两者，被添加到用于高频、爆炸特异性伤害的缩写伤害量表中；对与较高死亡风险相关的身体区域进行加权；和爆炸特异性创伤系数。最后，应去除饱和效应（最大值），这将有助于对更严重的损伤进行分类。对爆炸伤害的早期准确评估可能会改善对大规模伤亡事件的管理。我们建议新的评分将伤害的严重程度与爆炸伤害的机制结合起来。这可能包括细化或附加的代码、严重性评分或两者，被添加到用于高频、爆炸特异性伤害的缩写伤害量表中；对与较高死亡风险相关的身体区域进行加权；和爆炸特异性创伤系数。最后，应去除饱和效应（最大值），这将有助于对更严重的损伤进行分类。对爆炸伤害的早期准确评估可能会改善对大规模伤亡事件的管理。我们建议新的评分将伤害的严重程度与爆炸伤害的机制结合起来。这可能包括细化或附加的代码、严重性评分或两者，被添加到用于高频、爆炸特异性伤害的缩写伤害量表中；对与较高死亡风险相关的身体区域进行加权；和爆炸特异性创伤系数。最后，应去除饱和效应（最大值），这将有助于对更严重的损伤进行分类。对爆炸伤害的早期准确评估可能会改善对大规模伤亡事件的管理。对与较高死亡风险相关的身体区域进行加权；和爆炸特异性创伤系数。最后，应去除饱和效应（最大值），这将有助于对更严重的损伤进行分类。对爆炸伤害的早期准确评估可能会改善对大规模伤亡事件的管理。对与较高死亡风险相关的身体区域进行加权；和爆炸特异性创伤系数。最后，应去除饱和效应（最大值），这将有助于对更严重的损伤进行分类。对爆炸伤害的早期准确评估可能会改善对大规模伤亡事件的管理。