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Ranson R, Esper GW, Woodruff R, Solasz SJ, Egol KA, Konda SR. The effect of traumatic head injuries on the outcome of middle-aged and geriatric orthopedic trauma patients. Injury 2024; 55:111299. [PMID: 38199073 DOI: 10.1016/j.injury.2023.111299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND The purpose of this study is to characterize the effects of head injuries amongst the middle-aged and geriatric populations on hospital quality measures, costs, and outcomes in an orthopedic trauma setting. METHODS Patients with head and orthopedic injuries aged >55 treated at an academic medical center from October 2014-April 2021 were reviewed for their Abbreviated Injury Score for Head and Neck (AIS-H), baseline demographics, injury characteristics, hospital quality measures and outcomes. Univariate comparative analyses were conducted across AIS-H groups with additional regression analyses controlling for confounding variables. All statistical analyses were conducted with a Bonferroni adjusted alpha. RESULTS A total of 1,051 patients were included. The mean age was 74 years, and median AIS-H score was 2 (range 1-6). While outcomes worsened and costs increased as AIS-H scores increased, the most drastic (and clinically relevant) rise occurs between scores 2-3. Patients who sustained a head injury warranting an AIS-H score of 3 experienced a significantly higher rate of major complications, need for ICU admission, inpatient and 1-year mortality with longer lengths of stay and higher total costs despite no differences in demographics or injury characteristics. Regression analysis found a higher AIS-H score was independently associated with greater mortality risk. CONCLUSION AIS-H scores >2 correlate with significantly worse outcomes and higher hospital costs. Concomitant head injuries impact both outcomes and direct variable costs for middle-aged and geriatric orthopedic trauma patients. Clinicians, hospitals, and payers should consider the significant effect of head injuries on the hospitalization of these patients.
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Affiliation(s)
- Rachel Ranson
- NYU Langone Orthopaedic Hospital, New York, NY, United States; The George Washington University Hospital, Washington, DC, United States.
| | - Garrett W Esper
- NYU Langone Orthopaedic Hospital, New York, NY, United States
| | - Robert Woodruff
- Campbell University School of Osteopathic Medicine, Lillington, NC, United States
| | - Sara J Solasz
- NYU Langone Orthopaedic Hospital, New York, NY, United States
| | - Kenneth A Egol
- NYU Langone Orthopaedic Hospital, New York, NY, United States; Jamaica Hospital Medical Center, 8900 Van Wyck Expy, Queens, NY 11418, United States
| | - Sanjit R Konda
- NYU Langone Orthopaedic Hospital, New York, NY, United States; Jamaica Hospital Medical Center, 8900 Van Wyck Expy, Queens, NY 11418, United States
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Duncan AJ, Chahal IK, Nowotny DJ, Sang HI, Ahmeti M. "Blunt adrenal injury does not affect outcomes in the pediatric population with isolated abdominal injury- a National Trauma Data Bank Review®.". Am J Surg 2024:S0002-9610(24)00113-2. [PMID: 38413352 DOI: 10.1016/j.amjsurg.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND The incidence of blunt abdominal injury (BAI) in the adult population has been estimated to be between 0.03% and 4.95%. However, the impact of BAI on the pediatric population remains unknown. METHODS We conducted a retrospective review of National Trauma Data Bank datasets for the years 2017-2019. We included patients under the age of 18 who experienced blunt trauma and had suffered a blunt abdominal injury with an Abbreviated Injury Scale (AIS) severity score of 2 or higher. RESULTS Out of the 8064 pediatric patients with isolated abdominal trauma, 134 patients also suffered from BAI. We found no difference in the outcomes of patients with blunt adrenal injury in terms of mortality, length of stay in the intensive care unit (ICU) and hospital, and the number of ventilator days. Within poly-trauma patients BAI was associated with worst patient outcomes. CONCLUSIONS This study demonstrates that BAI has minimal clinical impact on patient outcomes in isolation. However it is associated with worst outcomes in poly trauma patients suggesting correlation with increased trauma burden. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anthony J Duncan
- University of North Dakota School of Medicine and Health Sciences, Department of Surgery, 1919 N Elm Street, Fargo, ND, 58102, USA; Sanford Medical Center Fargo, Department of Trauma and Acute Care Surgery, 5225 23rd Ave. S. Fargo, North Dakota, 58104, USA.
| | - Ikttesh K Chahal
- University of North Dakota School of Medicine and Health Sciences, Department of Surgery, 1919 N Elm Street, Fargo, ND, 58102, USA
| | - Dustin J Nowotny
- University of North Dakota School of Medicine and Health Sciences, Department of Surgery, 1919 N Elm Street, Fargo, ND, 58102, USA; Essentia Health, 3000 32nd Ave S, Fargo, ND, 58103, USA
| | - Hilla I Sang
- Sanford Medical Center Fargo, Department of Trauma and Acute Care Surgery, 5225 23rd Ave. S. Fargo, North Dakota, 58104, USA
| | - Mentor Ahmeti
- University of North Dakota School of Medicine and Health Sciences, Department of Surgery, 1919 N Elm Street, Fargo, ND, 58102, USA; Sanford Medical Center Fargo, Department of Trauma and Acute Care Surgery, 5225 23rd Ave. S. Fargo, North Dakota, 58104, USA
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Spota A, Giorgi PD, Cioffi SPB, Altomare M, Schirò GR, Legrenzi S, Villa FG, Chiara O, Cimbanassi S. Spinal injury in major trauma: Epidemiology of 1104 cases from an Italian first level trauma center. Injury 2023; 54:1144-1150. [PMID: 36849304 DOI: 10.1016/j.injury.2023.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/22/2023] [Accepted: 02/19/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Traumatic spinal injuries are frequent and their management is debated, especially in major trauma patients. This study aims to describe a large population of major trauma patients with vertebral fractures to improve prevention measures and fracture management. PATIENTS AND METHODS Retrospective analysis of 6274 trauma patients prospectively collected between October 2010 and October 2020. Collected data include demographics, mechanism of trauma, type of imaging, fracture morphology, associated injuries, injury severity score (ISS), survival, and death timing. The statistical analysis focused on mechanism of trauma and the search of predictive factors for critical fractures. RESULTS Patients showed a mean age of 47 years and 72.5% were males. Trauma included 59.9% of road accidents and 35.1% of falls. 30.7% patients had at least a severe fracture, while 17.2% had fractures in multiple spinal regions. 13.7% fractures were complicated by spinal cord injury (SCI). The mean ISS of the total population was 26.4 (SD 16.3), with 70.7% patients having an ISS≥16. There is a higher rate of severe fractures in fall cases (40.1%) compared to RA (21.9% to 26.3%). The probability of a severe fracture increased by 164% in the case of fall and by 77% in presence of AIS≥3 associated injury of head/neck while reduced by 34% in presence of extremities associated injuries. Multiple level injuries increased with ISS rise and in the case of extremities associated injuries. The probability of a severe upper cervical fracture increased by 5.95 times in the presence of facial associated injuries. The mean length of stay was 24.7 days and 9.6% of patients died. CONCLUSIONS In Italy, road accidents are still the most frequent trauma mechanism and cause more cervico-thoracic fractures, while falls cause more lumbar fractures. Spinal cord injuries represent an indicator of more severe trauma. In motorcyclists or fallers/jumpers, there is a higher risk of severe fractures. When a spinal injury is diagnosed, the probability of a second vertebral fracture is consistent. These data could help the decisional workflow in the management of major trauma patients with vertebral injury.
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Affiliation(s)
- Andrea Spota
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy; Tissue Bank and Therapy, ASST GOM Niguarda, Milan, Italy.
| | | | | | - Michele Altomare
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy; Tissue Bank and Therapy, ASST GOM Niguarda, Milan, Italy
| | | | | | | | - Osvaldo Chiara
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Stefania Cimbanassi
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Clark DE, Black AW, Skavdahl DH, Hallagan LD. Open-access programs for injury categorization using ICD-9 or ICD-10. Inj Epidemiol 2018; 5:11. [PMID: 29629480 PMCID: PMC5890002 DOI: 10.1186/s40621-018-0149-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background The article introduces Programs for Injury Categorization, using the International Classification of Diseases (ICD) and R statistical software (ICDPIC-R). Starting with ICD-8, methods have been described to map injury diagnosis codes to severity scores, especially the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS). ICDPIC was originally developed for this purpose using Stata, and ICDPIC-R is an open-access update that accepts both ICD-9 and ICD-10 codes. Methods Data were obtained from the National Trauma Data Bank (NTDB), Admission Year 2015. ICDPIC-R derives CDC injury mechanism categories and an approximate ISS (“RISS”) from either ICD-9 or ICD-10 codes. For ICD-9-coded cases, RISS is derived similar to the Stata package (with some improvements reflecting user feedback). For ICD-10-coded cases, RISS may be calculated in several ways: The “GEM” methods convert ICD-10 to ICD-9 (using General Equivalence Mapping tables from CMS) and then calculate ISS with options similar to the Stata package; a “ROCmax” method calculates RISS directly from ICD-10 codes, based on diagnosis-specific mortality in the NTDB, maximizing the C-statistic for predicting NTDB mortality while attempting to minimize the difference between RISS and ISS submitted by NTDB registrars (ISSAIS). Findings were validated using data from the National Inpatient Survey (NIS, 2015). Results NTDB contained 917,865 cases, of which 86,878 had valid ICD-10 injury codes. For a random 100,000 ICD-9-coded cases in NTDB, RISS using the GEM methods was nearly identical to ISS calculated by the Stata version, which has been previously validated. For ICD-10-coded cases in NTDB, categorized ISS using any version of RISS was similar to ISSAIS; for both NTDB and NIS cases, increasing ISS was associated with increasing mortality. Prediction of NTDB mortality was associated with C-statistics of 0.81 for ISSAIS, 0.75 for RISS using the GEM methods, and 0.85 for RISS using the ROCmax method; prediction of NIS mortality was associated with C-statistics of 0.75–0.76 for RISS using the GEM methods, and 0.78 for RISS using the ROCmax method. Instructions are provided for accessing ICDPIC-R at no cost. Conclusions The ideal methods of injury categorization and injury severity scoring involve trained personnel with access to injured persons or their medical records. ICDPIC-R may be a useful substitute when this ideal cannot be obtained.
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Affiliation(s)
- David E Clark
- Department of Surgery, Maine Medical Center, Portland, ME, USA. .,MMC Center for Outcomes Research and Evaluation, Maine Medical Center, 509 Forest Avenue, Portland, ME, 04101, USA. .,Tufts University School of Medicine, Boston, MA, USA.
| | - Adam W Black
- MMC Center for Outcomes Research and Evaluation, Maine Medical Center, 509 Forest Avenue, Portland, ME, 04101, USA
| | | | - Lee D Hallagan
- Department of Surgery, Maine Medical Center, Portland, ME, USA.,Tufts University School of Medicine, Boston, MA, USA
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Koo M, Otero I, Sabaté A, Martínez R, Mauro A, García P, López S. Do the severity and the body region of injury correlate with long-term outcome in the severe traumatic patient? Braz J Anesthesiol 2014; 64:134-9. [PMID: 24794459 DOI: 10.1016/j.bjane.2013.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 03/20/2013] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate if the Injury Severity Score (ISS) and the Abbreviated Injury Score (AIS) are correlated with the long-term quality of life in severe trauma patients. METHODS Patients injured from 2005 to 2007 with an ISS≥15 were surveyed 16-24 months after injury. The Health Assessment Questionnaire (HAQ-DI) was used for measuring the functional status and the Short Form-12 (SF-12) was used for measuring the health status divided into its two components, the PCS (Physical Component Summary) and the MCS (Mental Component Summary). The results of the questionnaires were compared with the ISS and AIS components. Results of the SF-12 were compared with the values expected from the general population. RESULTS Seventy-four patients filled the questionnaires (response rate 28%). The mean scores were: PCS 42.6±13.3; MCS 49.4±1.4; HAQ-DI 0.5±0.7. Correlation was observed with the HAQ-DI and the PCS (Spearman's Rho: -0.83; p<0.05) and no correlation between the HAQ-DI and the MCS neither between the MCS and PCS (Spearman's Rho=-0.21; and 0.01 respectively). The cutaneous-external and extremities-pelvic AIS punctuation were correlated with The PCS (Spearman's Rho: -0.39 and -0.34, p<0.05) and with the HAQ-DI (Spearman's Rho: 0.31 and 0.23; p<0.05). The physical condition compared with the regular population was worse except for the groups aged between 65-74 and 55-64. CONCLUSIONS Patients with extremities and pelvic fractures are more likely to suffer long-term disability. The severity of the external injuries influenced the long-term disability.
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Affiliation(s)
- Maylin Koo
- Bellvitge Biomedical Research Institute, L'Hospital de Llobregat, Spain.
| | - Israel Otero
- Bellvitge Biomedical Research Institute, L'Hospital de Llobregat, Spain
| | - Antoni Sabaté
- Bellvitge Biomedical Research Institute, L'Hospital de Llobregat, Spain
| | - Ruben Martínez
- Bellvitge Biomedical Research Institute, L'Hospital de Llobregat, Spain
| | - Augusto Mauro
- Bellvitge Biomedical Research Institute, L'Hospital de Llobregat, Spain
| | - Pilar García
- Bellvitge Biomedical Research Institute, L'Hospital de Llobregat, Spain
| | - Silvia López
- Bellvitge Biomedical Research Institute, L'Hospital de Llobregat, Spain
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