Understanding the GHOIS Score
The GHOIS (Ganga Hospital Open Injury Score) is a validated scoring system designed specifically to evaluate the severity of Type IIIB open injuries of the tibia without vascular deficit, guiding decisions regarding limb salvage, timing, and type of reconstruction. 1
Components and Scoring System
- GHOIS evaluates three key components of limb injury separately on a scale from 0 to 5:
- Skin/soft tissue damage
- Bone injury
- Musculotendinous structures 1
- The score also includes seven comorbid factors that influence treatment outcomes, with each factor assigned two points 1
- The total score ranges help predict outcomes and guide management decisions 1
Clinical Significance and Interpretation
- Total score ≤14: Indicates limb salvage is likely feasible 1
- Total score ≥17: Suggests amputation may be necessary 1
- Scores of 15-16: Represent a "grey zone" where decisions must be made on a case-by-case basis 1
Practical Applications in Management
- Skin score >3: Indicates need for flap coverage, suggesting an orthoplastic approach from the initial procedure 1
- Bone score of 4-5: Suggests requirement for complex reconstruction procedures (bone transport, extensive grafting, or free fibular graft) 1
- Score ≤9: Indicates low-violence trauma suitable for early soft tissue reconstruction 1
- Score ≥10: Suggests high-violence injury requiring staged reconstruction 1
Advantages Over Other Scoring Systems
- GHOIS addresses limitations of other classification systems like Gustilo-Anderson, which suffers from imprecise definitions and poor interobserver correlation 1
- Unlike other scores (MESS, PSI, LSI, HFS-97), GHOIS was designed specifically for Type IIIB injuries and provides guidance not just on salvage decisions but also on reconstruction approaches 1
- The score helps reduce unnecessary secondary amputations by providing more precise guidance for limb salvage decisions 1
Clinical Implementation
- GHOIS should be calculated during the initial assessment of patients with Type IIIB open tibial injuries 1
- The individual tissue scores should be documented separately to guide specific reconstruction strategies 1
- Serial assessments may be valuable in cases where the initial injury severity is evolving 1
Important Distinctions
- It's important to note that GHOIS is distinct from other medical scores with similar acronyms:
- Not to be confused with GHOST (Global Health Outcome Score after Trauma), which measures disability, cognitive impairment, and health-related quality of life 2
- Different from GOS/GOSE (Glasgow Outcome Scale/Extended), which evaluates outcomes after traumatic brain injury 3, 4
- Not related to GOSSIS (Global Open Source Severity of Illness Score), which is used for critical care patients 5