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The predictive value of liver scans for the detection of hepatic metastases is discussed. A retrospective review was done on 104 patients with urologic malignancies who had undergone liver scans and liver function tests. Liver scans had a low predictive value, while serum alkaline phosphatase alone had a higher predictive value. The combination of low predictive value and high cost/benefit ratio indicates that the liver scan has no routine role in the urologic oncologic staging.

Systems for the quantitation of injury severity are crucial to the study of injury epidemiology, and to comparative evaluations of health care delivery in different regions, patient mixes, and environment. Existing anatomic injury severity scores suffer from subjectivity, and may be computed only at relatively high man-hour expense. In this paper we present an injury severity ranking system termed the Anatomic Index, derived from objective, observed probabilities of mortality, and computable from the same HICDA diagnostic codes widely available in hospitals and through software in hospital computer systems. Mathematic underpinnings of the method, theoretical consequences of underprediction and overprediction of mortality, and advantages of the new Index are presented.

Injury severity scales of proven reliability and validity are essential for the appropriate allocation of therapeutic resources, for prediction of outcome, and for evaluation of the quantity and quality of emergency medical care in differing facilities and over time. Quantitation of injury severity in the field is particularly necessary. Existing scales are too imprecise to permit comparisons of management or systems of care. In this paper, the authors present the Triage Index, a measure of injury severity based on five simple variables observed in a design data set of 1084 patients. The Triage Index has been developed with state-of-the-art multivariate statistical techniques, meets the requirements of an interval ranking scale, and has been both validated and assessed for interuser reliability. The Triage Index is proposed as a validated system of early, rapid, noninvasive, accurate patient assessment permitting appropriate matching of trauma victims with available therapeutic resources as a means of reducing mortality and morbidity.