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Montoya L, Davie G, Lilley R, Dicker B, Kool B. Comparison of injury severity scores derived from ICD-10-AM codes with trauma registry derived scores: A study from New Zealand. Injury 2024; 55:111511. [PMID: 38521634 DOI: 10.1016/j.injury.2024.111511] [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: 11/16/2023] [Revised: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Various attempts at automation have been made to reduce the administrative burden of manually assigning Abbreviated Injury Severity (AIS) codes to derive Injury Severity Scores (ISS) in trauma registry data. The accuracy of the resulting measures remains unclear, especially in the New Zealand (NZ) context. The aim of this study was to compare ISS derived from hospital discharge International Classification of Diseases Australian Modification (ICD-10-AM) codes with ISS recorded in the NZ Trauma Registry (NZTR). METHODS Individuals admitted to hospital and enrolled in the NZTR between 1 December 2016 and 30 November 2018 were included. ISS were calculated using a modified ICD to AIS mapping tool. The agreement between both methods for raw scores was assessed by the Intraclass Correlation Coefficient (ICC), and for categorical scores the Kappa and weighted Kappa index were used. Analysis was conducted by gender, age, ethnicity, and mechanism of injury. RESULTS 3,156 patients fulfilled the inclusion criteria. The ICC for agreement between the methods was poor (0.40, 95 % CI: 0.37-0.43). The Kappa index indicated slight agreement between both methods when using a cut-off value of 12 (0.06; 95 % CI: 0.01-0.12) and 15 (0.13 6; 95 % CI: 0.09-0.17). CONCLUSION Although the overall agreement between NZTR-ISS and ICD-ISS was slight, ICD-derived scores may be useful to describe injury patterns and for body region-specific estimations when manually coded ISS are not available.
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Affiliation(s)
- Luisa Montoya
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Gabrielle Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rebbecca Lilley
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Bridget Dicker
- St John, Mt Wellington, Auckland, New Zealand; Department of Paramedicine, Auckland University of Technology, Auckland, New Zealand
| | - Bridget Kool
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
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Hashavia E, Shimonovich S, Shopen N, Finkelstein A, Cohen N. Secular trends in the incidence and severity of injuries sustained by riders of electric bikes and powered scooters: The experience of a level 1 adult trauma center. Injury 2024; 55:111293. [PMID: 38238121 DOI: 10.1016/j.injury.2023.111293] [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: 07/14/2023] [Revised: 11/17/2023] [Accepted: 12/17/2023] [Indexed: 04/19/2024]
Abstract
BACKGROUND The incidence of injuries caused by electric bicycles (E-bikes) and powered scooters (P-scooters) continues to increase. Data on the severity of those injuries is conflicting. The purpose of this study was to explore secular trends in the incidence and severity characteristics of patients following E-bike and P-scooter injuries and predictors for major trauma. METHODS A retrospective cohort study of patients aged ≥16 years following E-bike and P-scooter injuries was performed at a level 1-trauma center between 2017 and 2022. We explored secular trends in major trauma cases (primary outcome), emergency department (ED) visits, hospitalizations, and surgical interventions (secondary outcomes). Major trauma was defined by either an injury severity score (ISS) >15 or the patient's need for acute care, defined by any of the following: Intensive care unit admission, direct disposition to the operating room, acute interventions performed in the trauma room, and in-hospital death. Primary and secondary outcomes were compared between two time frames (2017-2018 vs.2019-2022). RESULTS In total, 9748 patients were presented following P-scooter and E-bike injuries. Of them, 1183 patients (12.1%) were hospitalized (854 males [72.2%],median age 33 years, median ISS 9).During the study period, the number of ED visits increased by 21-fold, with a parallel increase hospitalizations and surgical interventions numbers, which increased by 3.4-and 3.8-fold, respectively. Numbers of patients with ISSs >15 and patients who required acute care sharply increased during the study period, but no significant differences were found in the percentages of patients with ISSs >15 (p = 0.78) or patients' need for acute care (p = 0.32) between early and late periods. A severity analysis revealed that male sex (adjusted odds ratio [aOR] 1.7 [95% confidence interval (CI): 1.2-2.4], p = 0.001) and E-bike riders compared to P-scooter riders (aOR 1.5 [95% CI:1.1-2.0], p = 0.005) were independent predictors for severe trauma. CONCLUSIONS The incidence of E-bike and P-scooter injuries sharply increased over time, with a parallel elevation in numbers of hospitalizations, surgical interventions, and major trauma cases. Major trauma percentages did not increase during the study period. Male sex and E-bikes emerged as independent predictors for major trauma.
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Affiliation(s)
- Eyal Hashavia
- The Division of Trauma, Department of Surgery, Tel Aviv University, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shachar Shimonovich
- The Division of Trauma, Department of Surgery, Tel Aviv University, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noaa Shopen
- Emergency Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aya Finkelstein
- Medical Sciences Program, University of Western Ontario, London, ON, Canada
| | - Neta Cohen
- Emergency Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Khavandegar A, Salamati P, Zafarghandi M, Rahimi-Movaghar V, Sharif-Alhoseini M, Fakharian E, Saeed-Banadaky SH, Hoseinpour V, Sadeghian F, Nasr Isfahani M, Rahmanian V, Ghadiphasha A, Pourmasjedi S, Piri SM, Mirzamohamadi S, Hassan Zadeh Tabatabaei MS, Naghdi K, Baigi V. Comparison of nine trauma scoring systems in prediction of inhospital outcomes of pediatric trauma patients: a multicenter study. Sci Rep 2024; 14:7646. [PMID: 38561381 PMCID: PMC10985103 DOI: 10.1038/s41598-024-58373-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024] Open
Abstract
Hereby, we aimed to comprehensively compare different scoring systems for pediatric trauma and their ability to predict in-hospital mortality and intensive care unit (ICU) admission. The current registry-based multicenter study encompassed a comprehensive dataset of 6709 pediatric trauma patients aged ≤ 18 years from July 2016 to September 2023. To ascertain the predictive efficacy of the scoring systems, the area under the receiver operating characteristic curve (AUC) was calculated. A total of 720 individuals (10.7%) required admission to the ICU. The mortality rate was 1.1% (n = 72). The most predictive scoring system for in-hospital mortality was the adjusted trauma and injury severity score (aTRISS) (AUC = 0.982), followed by trauma and injury severity score (TRISS) (AUC = 0.980), new trauma and injury severity score (NTRISS) (AUC = 0.972), Glasgow coma scale (GCS) (AUC = 0.9546), revised trauma score (RTS) (AUC = 0.944), pre-hospital index (PHI) (AUC = 0.936), injury severity score (ISS) (AUC = 0.901), new injury severity score (NISS) (AUC = 0.900), and abbreviated injury scale (AIS) (AUC = 0.734). Given the predictive performance of the scoring systems for ICU admission, NTRISS had the highest predictive performance (AUC = 0.837), followed by aTRISS (AUC = 0.836), TRISS (AUC = 0.823), ISS (AUC = 0.807), NISS (AUC = 0.805), GCS (AUC = 0.735), RTS (AUC = 0.698), PHI (AUC = 0.662), and AIS (AUC = 0.651). In the present study, we concluded the superiority of the TRISS and its two derived counterparts, aTRISS and NTRISS, compared to other scoring systems, to efficiently discerning individuals who possess a heightened susceptibility to unfavorable consequences. The significance of these findings underscores the necessity of incorporating these metrics into the realm of clinical practice.
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Affiliation(s)
- Armin Khavandegar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyed Houssein Saeed-Banadaky
- Trauma Research Center, Rahnemoon Hospital, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Vahid Hoseinpour
- Department of Emergency Medicine, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Farideh Sadeghian
- Center for Health-Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mehdi Nasr Isfahani
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Trauma Data Registration Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Rahmanian
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Amir Ghadiphasha
- Shahid Modarres Hospital, Saveh University of Medical Sciences, Saveh, Iran
| | - Sobhan Pourmasjedi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Piri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Mirzamohamadi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Khatereh Naghdi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Science, Tehran, Iran.
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Yang S, Hu P, Kalpakis K, Burdette B, Chen H, Parikh G, Felix R, Podell J, Badjatia N. Utilizing ultra-early continuous physiologic data to develop automated measures of clinical severity in a traumatic brain injury population. Sci Rep 2024; 14:7618. [PMID: 38556518 PMCID: PMC10982286 DOI: 10.1038/s41598-024-57538-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/19/2024] [Indexed: 04/02/2024] Open
Abstract
Determination of prognosis in the triage process after traumatic brain injury (TBI) is difficult to achieve. Current severity measures like the Trauma and injury severity score (TRISS) and revised trauma score (RTS) rely on additional information from the Glasgow Coma Scale (GCS) and the Injury Severity Score (ISS) which may be inaccurate or delayed, limiting their usefulness in the rapid triage setting. We hypothesized that machine learning based estimations of GCS and ISS obtained through modeling of continuous vital sign features could be used to rapidly derive an automated RTS and TRISS. We derived variables from electrocardiograms (ECG), photoplethysmography (PPG), and blood pressure using continuous data obtained in the first 15 min of admission to build machine learning models of GCS and ISS (ML-GCS and ML-ISS). We compared the TRISS and RTS using ML-ISS and ML-GCS and its value using the actual ISS and GCS in predicting in-hospital mortality. Models were tested in TBI with systemic injury (head abbreviated injury scale (AIS) ≥ 1), and isolated TBI (head AIS ≥ 1 and other AIS ≤ 1). The area under the receiver operating characteristic curve (AUROC) was used to evaluate model performance. A total of 21,077 cases (2009-2015) were in the training set. 6057 cases from 2016 to 2017 were used for testing, with 472 (7.8%) severe TBI (GCS 3-8), 223 (3.7%) moderate TBI (GCS 9-12), and 5913 (88.5%) mild TBI (GCS 13-15). In the TBI with systemic injury group, ML-TRISS had similar AUROC (0.963) to TRISS (0.965) in predicting mortality. ML-RTS had AUROC (0.823) and RTS had AUROC 0.928. In the isolated TBI group, ML-TRISS had AUROC 0.977, and TRISS had AUROC 0.983. ML-RTS had AUROC 0.790 and RTS had AUROC 0.957. Estimation of ISS and GCS from machine learning based modeling of vital sign features can be utilized to provide accurate assessments of the RTS and TRISS in a population of TBI patients. Automation of these scores could be utilized to enhance triage and resource allocation during the ultra-early phase of resuscitation.
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Affiliation(s)
- Shiming Yang
- Program in Trauma, University of Maryland School of Medicine, 22. S. Greene Street, G7K19, Baltimore, MD, 21201, USA
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, USA
| | - Peter Hu
- Program in Trauma, University of Maryland School of Medicine, 22. S. Greene Street, G7K19, Baltimore, MD, 21201, USA
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, USA
| | - Konstantinos Kalpakis
- Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Baltimore, USA
| | - Bradford Burdette
- Program in Trauma, University of Maryland School of Medicine, 22. S. Greene Street, G7K19, Baltimore, MD, 21201, USA
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, USA
| | - Hegang Chen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Gunjan Parikh
- Program in Trauma, University of Maryland School of Medicine, 22. S. Greene Street, G7K19, Baltimore, MD, 21201, USA
- Department of Neurology, University of Maryland School of Medicine, Baltimore, USA
| | - Ryan Felix
- Fischell Department of Bioengineering, University of Maryland, College Park, USA
| | - Jamie Podell
- Program in Trauma, University of Maryland School of Medicine, 22. S. Greene Street, G7K19, Baltimore, MD, 21201, USA
- Department of Neurology, University of Maryland School of Medicine, Baltimore, USA
| | - Neeraj Badjatia
- Program in Trauma, University of Maryland School of Medicine, 22. S. Greene Street, G7K19, Baltimore, MD, 21201, USA.
- Department of Neurology, University of Maryland School of Medicine, Baltimore, USA.
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Kodali S, He CH, Patel S, Tao A, Szlechter M, Parsikia A, Mbekeani JN. Characteristics of ocular injuries associated with mortality in patients admitted with major trauma. BMC Ophthalmol 2024; 24:125. [PMID: 38504178 PMCID: PMC10949718 DOI: 10.1186/s12886-024-03392-y] [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] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Few ocular trauma studies have addressed mortality outcomes. We sought to determine characteristics of mortality-related ocular trauma admissions and compared them with non-fatal injuries. METHODS A retrospective study was conducted using de-identified data of patients admitted with major trauma from the National Trauma Data Bank (2008-2014). Patients with ocular injury were identified using ICD- 9CM codes. Demographics, intention and mechanism, types of ocular and head injuries, and injury severity were documented. Mortality was determined using post-admission disposition. Statistical analysis using student t-test, chi-square, and odds ratios (OR) calculations were performed with STATA-17 software. Significance was set at P < 0.05. RESULTS Of 316,485 patients admitted with ocular trauma, 12,233 (3.86%) were mortality related. Expired patients were older than survivors: mean (SD) of 50.1(25.5) vs. 41.5(22.8) years. White (OR = 1.32; P < 0.001), ≥ 65years old (OR = 2.25; P < 0.001), and male (OR = 1.05; P = 0.029) patients were most likely to expire than their counterparts. Common mechanisms of injury in survivors were falls (25.3%), motor vehicle traffic-occupant, MVTO (21.8%) and struck by/against (18.1%) and for fatal injuries, falls (29.7%), MVTO (21.9%) and firearms (11.5%). Traumatic brain injury (TBI) was documented in 88.2% of mortality-related admissions. Very severe injury severity scores (ISS > 24) (OR = 19.19; P < 0.001) and severe Glasgow Coma Score (GCS < 8) (OR = 19.22; P < 0.001) were most associated with mortality than survival. Firearms were most associated with very severe ISS (OR = 3.73; P < 0.001), severe GCS (OR = 4.68; P < 0.001) and mortality (OR = 5.21; P < 0.001) than other mechanisms. Patients with cut/pierce injuries had the greatest odds of survival (OR = 13.48; P < 0.001). Optic nerve/visual pathways injuries (3.1%) had the highest association with very severe ISS (OR = 2.51; P < 0.001), severe GCS (OR = 3.64; P < 0.001) and mortality (OR = 2.58; P < 0.001) than other ocular injuries. Black patients with very severe ISS (OR = 32.14; P < 0.001) and severe GCS (OR = 31.89; P < 0.001) were more likely to expire than other race/ethnicities with similar injury severity. CONCLUSIONS Mortality-related admissions were older, male, and mostly of White race than ocular trauma admissions of survivors. Firearms were the deadliest mechanism. TBI was commonly associated and patients with optic nerve/pathway injuries, very severe ISS and severe GCS had higher mortality rates. Characteristics and demographic variations identified in this study may be useful in developing focused measures aimed at preventing trauma-related deaths.
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Affiliation(s)
- Sruthi Kodali
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Catherine H He
- Department of Ophthalmology & Visual Sciences, Yale School of Medicine, New Haven, Conn, USA
| | - Sheel Patel
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Alice Tao
- Department of Ophthalmology, Jamaica Hospital Medical Center, New York Medical College, Queens, NY, USA
| | - Moshe Szlechter
- Department of Surgery (Ophthalmology), Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY, 10461, USA
- Department of Ophthalmology & Visual Sciences, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY, USA
| | - Afshin Parsikia
- Department of Research Services, University of Pennsylvania, Philadelphia, PA, USA
| | - Joyce N Mbekeani
- Department of Surgery (Ophthalmology), Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY, 10461, USA.
- Department of Ophthalmology & Visual Sciences, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY, USA.
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Bhaumik S, Suresh K, Lategan H, Steyn E, Mould-Millman NK. The new injury severity score underestimates true injury severity in a resource-constrained setting. Afr J Emerg Med 2024; 14:11-18. [PMID: 38173687 PMCID: PMC10761343 DOI: 10.1016/j.afjem.2023.12.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/25/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Background The new injury severity score (NISS) is widely used within trauma outcomes research. NISS is a composite anatomic severity score derived from the Abbreviated Injury Scale (AIS) protocol. It has been postulated that NISS underestimates trauma severity in resource-constrained settings, which may contribute to erroneous research conclusions. We formally compare NISS to an expert panel's assessment of injury severity in South Africa. Methods This was a retrospective chart review of adult trauma patients seen in a tertiary trauma center. Randomly selected medical records were reviewed by an AIS-certified rater who assigned an AIS severity score for each anatomic injury. A panel of five South African trauma experts independently reviewed the same charts and assigned consensus severity scores using a similar scale for comparability. NISS was calculated as the sum of the squares of the three highest assigned severity scores per patient. The difference in average NISS between rater and expert panel was assessed using a multivariable linear mixed effects regression adjusted for patient demographics, injury mechanism and type. Results Of 49 patients with 190 anatomic injuries, the majority were male (n = 38), the average age was 36 (range 18-80), with either a penetrating (n = 23) or blunt (n = 26) injury, resulting in 4 deaths. Mean NISS was 16 (SD 15) for the AIS rater compared to 28 (SD 20) for the expert panel. Adjusted for potential confounders, AIS rater NISS was on average 11 points (95 % CI: 7, 15) lower than the expert panel NISS (p < 0.001). Injury type was an effect modifier, with the difference between the AIS rater and expert panel being greater in penetrating versus blunt injury (16 vs. 7; p = 0.04). Crush injury was not well-captured by AIS protocol. Conclusion NISS may under-estimate the 'true' injury severity in a middle-income country trauma hospital, particularly for patients with penetrating injury.
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Affiliation(s)
- Smitha Bhaumik
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Krithika Suresh
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Hendrick Lategan
- Department of Surgery, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elmin Steyn
- Department of Surgery, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nee-Kofi Mould-Millman
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
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Craig HA, Lowe DJ, Khan A, Paton M, Gordon MW. Exploring the impact of traumatic injury on mortality: An analysis of the certified cause of death within one year of serious injury in the Scottish population. Injury 2024; 55:111470. [PMID: 38461710 DOI: 10.1016/j.injury.2024.111470] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/01/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Few studies effectively quantify the long-term incidence of death following injury. The absence of detailed mortality and underlying cause of death data results in limited understanding and a potential underestimation of the consequences at a population level. This study takes a nationwide approach to identify the one-year mortality following injury in Scotland, evaluating survivorship in relation to pre-existing comorbidities and incidental causes of death. STUDY DESIGN This retrospective cohort study assessed the one-year mortality of adult trauma patients with an Injury Severity Score ≥ 9 during 2020 using the Scottish Trauma Audit Group (STAG) registry linked to inpatient hospital data and death certificate records. Patients were divided into three groups: trauma death, trauma-contributed death, and non-trauma death. Kaplan-Meier curves were used for survival analysis to evaluate mortality, and cox proportional hazards regression analysed risk factors linked to death. RESULTS 4056 patients were analysed with a median age 63 years (58-88) and male predominance (55.2 %). Falls accounted for 73.1 % of injuries followed by motor vehicle accidents (16.3 %) and blunt force (4.9 %). Extremity was the most commonly injured region overall followed by chest and head. However, head injury prevailed in those who died. The registry demonstrated a one-year mortality of 19.3 % with 55 % deaths occurring post-discharge. Of all deaths reported, 35.3 % were trauma deaths, and 47.7 % were trauma-contributed deaths. These groups accounted for over 70 % of mortality within 30 days of hospital admission and continued to represent the majority of deaths up to 6 months post-injury. Patients who died after 6 months were mainly the result of non-traumatic causes, frequently circulatory, neoplastic, and respiratory diseases (37.7 %, 12.3 %, 9.1 %, respectively). Independent risk factors for one-year mortality included a GCS ≤ 8, modified Charlson Comorbidity score >5, Injury Severity Score >25, serious head injury, age and sex. CONCLUSION With a one-year mortality of 19.3 %, and post-discharge deaths higher than previously appreciated, patients can face an extended period of survival uncertainty. As mortality due to index trauma lasted up to 6 months post-admission, short-term outcomes fail to represent trauma burden and so cogent survival predictions should be avoided in clinical and patient settings.
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Affiliation(s)
- Hannah A Craig
- University of Glasgow School of Medicine, G12 8QQ, Glasgow, United Kingdom.
| | - David J Lowe
- Department of Emergency Medicine, Queen Elizabeth University Hospital, Glasgow, G51 4TF, United Kingdom; Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, United Kingdom
| | - Angela Khan
- Scottish National Audit Programme, Area 143c, Clinical & Protecting Health Directorate, Public Health Scotland, 1 South Gyle Crescent, Edinburgh EH12 9EB, United Kingdom
| | - Martin Paton
- Scottish National Audit Programme, Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, United Kingdom
| | - Malcolm Wg Gordon
- Department of Emergency Medicine, Queen Elizabeth University Hospital, Glasgow, G51 4TF, United Kingdom
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Chen S, Lien P, Lan C, Hsu C, Lin C, Lin Y, Lin C, Yu Y. Predicting Union, Osteomyelitis, and Amputation Outcomes of Gustilo IIIC Open Tibial Fractures: A Retrospective Study. Orthop Surg 2024; 16:94-103. [PMID: 38014457 PMCID: PMC10782230 DOI: 10.1111/os.13940] [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: 06/28/2023] [Revised: 10/03/2023] [Accepted: 10/13/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE Open tibial fractures are frequently encountered in high-energy traumas and can result in significant complications such as nonunion, osteomyelitis, and even amputation. Among open tibial fractures, Gustilo type IIIC cases are particularly challenging due to the concomitant occurrence of neurovascular injuries and soft tissue defects. This study aimed to assess factors that affect union time and complications in Gustilo IIIC tibial fractures. METHODS Patients who presented at our center with IIIC open tibial fractures from January 2000 to October 2020 were eligible for this retrospective analysis. Patient demographics, fracture characteristics, and the timing, number, and type of surgical intervention were documented. Outcomes of interest included union time, occurrence of osteomyelitis, and amputation. We performed univariate analyses including chi-squared test, Fischer's exact test, analysis of variance, and Kruskal-Wallis test based on the normality of the data and multivariate analyses including Cox proportional hazards model and logistic regression analyses. RESULTS Fifty-eight patients were enrolled and grouped by fracture healing time; eight had timely union (13.8%); 27 had late union (46.6%); eight had delayed union (13.8%); three had nonunion (5.2%); and 12 underwent amputation (20.7%). Nine fractures (15.5%) were complicated by osteomyelitis. Union time was prolonged in cases of triple arterial injury, distal third fractures, multiple trauma with injury severity score (ISS) ≥ 16 points, and increased bone defect length. Additionally, a bone gap >50 mm, diabetes mellitus, low body mass index, and triple arterial injury in the lower leg were significant risk factors for amputation. A time from injury to definitive soft tissue coverage of more than 22 days was the major risk factor for osteomyelitis. A scoring system to predict union time was devised and the predicted probability of union within 2 years was stratified based on this score. CONCLUSION IIIC tibial fractures involving the distal third of the tibia, fractures with bone defects, triple arterial injury, and multiple trauma with ISS ≥16 points demonstrated delayed union, and an effective prediction system for union time was introduced in this study. Early soft tissue coverage can reduce the risk of osteomyelitis. Finally, diabetes and severe bone and soft tissue defects pose a higher risk of amputation.
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Affiliation(s)
- Shih‐Heng Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial HospitalChang Gung University and Medical CollegeTaoyuan, TaiwanChina
| | - Po‐Hao Lien
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial HospitalChang Gung University and Medical CollegeTaoyuan, TaiwanChina
| | - Ching‐Yu Lan
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial HospitalChang Gung University and Medical CollegeTaoyuan, TaiwanChina
| | - Chung‐Cheng Hsu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial HospitalChang Gung University and Medical CollegeTaoyuan, TaiwanChina
| | - Cheng‐Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial HospitalChang Gung University and Medical CollegeTaoyuan, TaiwanChina
| | - Yu‐Te Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial HospitalChang Gung University and Medical CollegeTaoyuan, TaiwanChina
| | - Chih‐Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial HospitalChang Gung University and Medical CollegeTaoyuan, TaiwanChina
| | - Yi‐Hsun Yu
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial HospitalChang Gung University and Medical CollegeTaoyuan, TaiwanChina
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Yoganandan N, Somasundaram K, Pintar F. Analysis of experimental injuries to obese occupants with different postures in frontal impact. Accid Anal Prev 2023; 193:107294. [PMID: 37722257 DOI: 10.1016/j.aap.2023.107294] [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] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/26/2023] [Accepted: 09/06/2023] [Indexed: 09/20/2023]
Abstract
The objective of the present study was to analyze injuries and their patterns to obese occupants in frontal impacts with upright and reclined postures using experimental data. Twelve obese post-mortem human subjects (PMHS) were positioned on a sled buck with seatback angles of 250 or 450 from the vertical, termed as upright and reclined postures. They were restrained with a seat belt and pretensioner. Frontal impact tests were conducted at 8.9 or 13.9 m/s, termed as low and high velocities. After the test, x-rays and CTs were taken, and an autopsy was conducted. The Maximum AIS (MAIS) and Injury Severity Score (ISS) were calculated, and injury patterns were analyzed. The mean age, stature, total body mass, and body mass indexes were 67 years, 112 kg, and 1.7 m, and 38 kg/m2. None of these parameters were statistically significantly different between any groups. The mean thickness of the soft tissues in the left anterior lateral, central, and right anterior lateral aspects were 44 mm, 24 mm, and 46 mm. In the low-velocity tests, the ISS data were 9, 18, and 9 for the upright, and 9, 9, and 4 for the reclined specimens, and in the high velocity tests, they were 29, 17, and 27 for the upright, and 27, 13, and 27 for the reclined postures. Other data are given in the paper. For both postures at the low velocity, injuries were concentrated at one body region, and the ISS data were in the mild category; in contrast, at the high velocity, other body regions also sustained injuries, and the ISS data were in the major trauma category. From MAIS perspectives, injuries to obese occupants did not change between postures and were independent of the energy input to the system. The association of chest with pelvis injuries in upright and reclined postures to obese occupants may have additional consequences following the initial injury to this group of our population.
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Affiliation(s)
| | | | - Frank Pintar
- Medical College of Wisconsin, Milwaukee, WI, United States
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10
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Barik AK, Mohanty CR, Shaji IM, Radhakrishnan RV, Jain M. Comments on "The role of trauma services in intentional self-harm at a regional level 1 trauma centre". Injury 2023; 54:111064. [PMID: 37806265 DOI: 10.1016/j.injury.2023.111064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Amiya Kumar Barik
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, India.
| | - Ijas Muhammed Shaji
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Mantu Jain
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, India
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Wu CY, Chien LC, Lin CC, Ma HM, Hu RH, Chen CL, Lin TH. Original Article: The impacts of DRG payment system on financial balance of multiple trauma: Experiences of three trauma centers in Taiwan. Injury 2023; 54:110703. [PMID: 37045657 DOI: 10.1016/j.injury.2023.03.031] [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: 10/30/2022] [Revised: 02/28/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION There are concerns regarding the adequacy of applying the diagnosis-related groups (DRG) payment system for multiple traumas (i.e., major diagnostic category 24, MDC-24) patients in Taiwan. Therefore, this study used a multi-center dataset to assess the influence of the DRG payment system on the cost and outcome of multiple trauma care. MATERIALS AND METHODS We collected data of all multiple trauma patients from the Trauma Registry of three hospitals from 2014 - 2017. Next, we selected patients who met the criteria of MDC-24 and calculated the corresponding DRG payment. Subsequently, we combined the clinical care information with health insurance information to analyze the problems of applying the DRG payment system to multiple trauma care. RESULTS Overall, of 465 cases, 367 met the criteria of MDC-24, and the mean injury severity score (ISS) was high (average 20.1). The total deficit of the polytrauma DRG cases amounted to 131,445 USD, and the average deficit in each case was 397 USD. In the multivariable analysis, higher revised trauma score and specific lower abbreviated Injury Scale (AIS) scores in certain body regions resulted in profits, while increased length of stay in intensive care units, longer operative time, and higher AIS score in the thorax were significantly correlated with deficits in medical costs. CONCLUSION Our study revealed that the current DRG payment system results in financial losses for hospitals. Further, the payment grouping of MDC-24 should consider adding more disease severity factors to reduce the financial constraints faced by trauma centers.
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Affiliation(s)
- Chao-Ying Wu
- Department of Surgery, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
| | - Li-Chien Chien
- Department of Emergency Medicine, Taipei City Hospital, Taipei, Taiwan
| | - Chen-Chiang Lin
- Department of Orthopedic Surgery, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
| | - Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
| | - Rey-Heng Hu
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Lin Chen
- Department of Surgery, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan.
| | - Tzu-Hsin Lin
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
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Choi DH, Jeong TS, Jang MJ. Comparison of Preventable Trauma Death Rates in Patients With Traumatic Brain Injury Before and After the Establishment of Regional Trauma Center: A Single Center Experience. Korean J Neurotrauma 2023; 19:227-233. [PMID: 37431367 PMCID: PMC10329879 DOI: 10.13004/kjnt.2023.19.e16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 07/12/2023] Open
Abstract
Objective To compare preventable trauma death rates (PTDRs) in patients with traumatic brain injury before and after the establishment of a regional trauma center (RTC) at a single center. Methods Our institution established an RTC in 2014. A total of 709 patients were enrolled from January 2011 to December 2013 (before RTC) and 672 from January 2019 to December 2021 (after RTC). The revised trauma score, injury severity score, and trauma and injury severity score (TRISS) were evaluated. Definitive preventable (DP), possibly preventable (PP), and non-preventable deaths were defined as TRISS >0.5, TRISS 0.25-0.5, and TRISS <0.25, respectively. PTDR was the proportion of deaths from DP+PP out of all deaths, and the preventable major trauma death rate (PMTDR) was the proportion of deaths from DP+PP out of all DP+PP. Results The overall mortality rates before and after the establishment of RTC were 20.3 and 13.1%, respectively. PTDR was lower after the establishment of RTC than before (90.3% vs. 79.5%). The PMTDR was also lower after the establishment of RTC than before (18.8% vs. 9.7%). The ratio of direct hospital visits was higher in patients before the establishment of RTC than in those after (74.9% vs. 61.3%, p<0.001). Conclusion Establishing the RTC reduced PTDRs. Additional studies on factors associated with PTDR reduction are required.
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Affiliation(s)
- Dae Han Choi
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Tae Seok Jeong
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Myung Jin Jang
- Regional Trauma Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Yu JY, Heo S, Xie F, Liu N, Yoon SY, Chang HS, Kim T, Lee SU, Hock Ong ME, Ng YY, Do shin S, Kajino K, Cha WC. Development and Asian-wide validation of the Grade for Interpretable Field Triage (GIFT) for predicting mortality in pre-hospital patients using the Pan-Asian Trauma Outcomes Study (PATOS). Lancet Reg Health West Pac 2023; 34:100733. [PMID: 37283981 PMCID: PMC10240358 DOI: 10.1016/j.lanwpc.2023.100733] [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] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/24/2023] [Accepted: 02/19/2023] [Indexed: 03/07/2023]
Abstract
Background Field triage is critical in injury patients as the appropriate transport of patients to trauma centers is directly associated with clinical outcomes. Several prehospital triage scores have been developed in Western and European cohorts; however, their validity and applicability in Asia remains unclear. Therefore, we aimed to develop and validate an interpretable field triage scoring systems based on a multinational trauma registry in Asia. Methods This retrospective and multinational cohort study included all adult transferred injury patients from Korea, Malaysia, Vietnam, and Taiwan between 2016 and 2018. The outcome of interest was a death in the emergency department (ED) after the patients' ED visit. Using these results, we developed the interpretable field triage score with the Korea registry using an interpretable machine learning framework and validated the score externally. The performance of each country's score was assessed using the area under the receiver operating characteristic curve (AUROC). Furthermore, a website for real-world application was developed using R Shiny. Findings The study population included 26,294, 9404, 673 and 826 transferred injury patients between 2016 and 2018 from Korea, Malaysia, Vietnam, and Taiwan, respectively. The corresponding rates of a death in the ED were 0.30%, 0.60%, 4.0%, and 4.6% respectively. Age and vital sign were found to be the significant variables for predicting mortality. External validation showed the accuracy of the model with an AUROC of 0.756-0.850. Interpretation The Grade for Interpretable Field Triage (GIFT) score is an interpretable and practical tool to predict mortality in field triage for trauma. Funding This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant Number: HI19C1328).
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Affiliation(s)
- Jae Yong Yu
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Digital & Smart Health Office, Tan Tock Seng Hospital, Singapore
| | - Sejin Heo
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Feng Xie
- Programme in Health Services and Systems Research, Duke–National University of Singapore Medical School, Singapore
- Department of Biomedical Data Science, Stanford University, Stanford, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, USA
| | - Nan Liu
- Programme in Health Services and Systems Research, Duke–National University of Singapore Medical School, Singapore
- Health Service Research Centre, Singapore Health Services, Singapore
- Institute of Data Science, National University of Singapore, Singapore
| | - Sun Yung Yoon
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Han Sol Chang
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Taerim Kim
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Marcus Eng Hock Ong
- Programme in Health Services and Systems Research, Duke–National University of Singapore Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Yih Yng Ng
- Digital & Smart Health Office, Tan Tock Seng Hospital, Singapore
| | - Sang Do shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Kentaro Kajino
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Moriguchi, Japan
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Digital Innovation Center, Samsung Medical Center, Seoul, South Korea
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Shen BS, Cheng WY, Liang ZR, Tang Q, Li KY. Impact of lockdown policies during the COVID-19 outbreak on a trauma center of a tertiary hospital in China. World J Clin Cases 2023; 11:2237-2245. [PMID: 37122529 PMCID: PMC10131008 DOI: 10.12998/wjcc.v11.i10.2237] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/03/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a major and costly public health emergency.
AIM To investigate the impact of China’s lockdown policies during the COVID-19 outbreak on the level I trauma center of a tertiary comprehensive hospital of Traditional Chinese Medicine.
METHODS All patients admitted to our trauma center during a lockdown in 2020 and the same period in 2019 were enrolled. We collected data on demographics, daily visits, injury type, injury mechanism, injury severity score, and patient management for comparative analysis.
RESULTS The total number of patients in the trauma center of our hospital decreased by 50.38% during the COVID-19 Lockdown in 2020 compared to the same period in 2019. The average number of trauma visits per day in 2019 was 47.94, compared to 23.79 in 2020. Comparing the patients’ demographic data, loss of employment was the most predominate characteristic in 2020 compared to 2019, while there was no significant difference in gender, age, and marital status between both periods. During the lockdown period, the proportion of traffic accident-related injuries, injuries due to falls greater than 1.5 m, and mechanical injuries decreased significantly, whereas the proportion of injuries caused by falls less than 1.5 m, cuts, assault, bites, and suicidal tendencies and other injuries increased relatively. In addition, the proportion of patients with minor injuries increased and serious injuries decreased during the lockdown. The hospitalization rate increased significantly, and there was no significant difference in emergency surgery and death rates.
CONCLUSION The lockdown policies during the COVID-19 outbreak significantly altered the number and mechanism of traumatic events in our hospital, which can be monitored regularly. Our results suggest that mandatory public health prevention and control measures by the government can reduce the incidence of traumatic events and the severity of traumatic injuries. Emergency surgery and mortality rates remain high, increased because of factors such as family injury and penetrating injury, and hospitalization rates have increased significantly. Therefore, our trauma center still needs to be fully staffed. Finally, from the perspective of the injury mechanism, indoor trauma is a major risk during a lockdown, and it is particularly important to develop prevention strategies for such trauma to reduce the medical burden of the next catastrophic epidemic.
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Affiliation(s)
- Bi-Sheng Shen
- Department of Emergency Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, Guangdong Province, China
| | - Wei-Yin Cheng
- Department of Clinical Nutrition, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, Guangdong Province, China
| | - Zhang-Rong Liang
- Department of Emergency Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, Guangdong Province, China
| | - Qi Tang
- Department of Emergency Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, Guangdong Province, China
| | - Kuang-Yi Li
- Department of Emergency Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, Guangdong Province, China
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15
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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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Kolbeinsson HM, Aubrey J, Lypka MM, Pounders S, Krech LA, Fisk CS, Chapman AJ, Gibson CJ. Out of sight, out of mind? The impact on trauma patient opioid use when the medicine administration schedule is not displayed. Am J Surg 2023; 225:504-507. [PMID: 36631372 DOI: 10.1016/j.amjsurg.2023.01.007] [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: 08/25/2022] [Revised: 11/30/2022] [Accepted: 01/06/2023] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The impact of a visual pain medication schedule on opioid use among hospitalized trauma patients is unknown. We examined whether removal of this displayed schedule would decrease oral morphine equivalent (OME) use. METHODS This retrospective cohort study compared OME use in trauma patients in the inpatient setting before and after removing the patient-facing pain medication schedule that is typically displayed on the patient's white board for all trauma admissions. RESULTS 707 patients were included. The control (n = 308, 43.6%) and intervention (n = 399, 56.4%) groups were similar in age (p = 0.06). There was no difference in total inpatient OME use between the control and intervention groups, median 50 (IQR: 22.5-118) vs 60 (IQR: 22.5-126), p = 0.79, respectively. No difference in total OME use was observed when patients were stratified by age, sex, race, ISS, and length of hospital stay. CONCLUSION Removing a visual display of the pain medication schedule did not decrease OME use in inpatient trauma patients.
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Affiliation(s)
- Hordur M Kolbeinsson
- Spectrum Health/Michigan State University, General Surgery Residency, Grand Rapids, MI, USA.
| | - Jason Aubrey
- Spectrum Health/Michigan State University, General Surgery Residency, Grand Rapids, MI, USA
| | | | - Steffen Pounders
- Spectrum Health Trauma Research Institute, Grand Rapids, MI, USA
| | - Laura A Krech
- Spectrum Health Trauma Research Institute, Grand Rapids, MI, USA
| | - Chelsea S Fisk
- Spectrum Health Trauma Research Institute, Grand Rapids, MI, USA
| | - Alistair J Chapman
- Spectrum Health/Michigan State University, General Surgery Residency, Grand Rapids, MI, USA; Spectrum Health Trauma Research Institute, Grand Rapids, MI, USA; Spectrum Health Medical Group, Division of Acute Care Surgery, Grand Rapids, MI, USA
| | - Charles J Gibson
- Spectrum Health/Michigan State University, General Surgery Residency, Grand Rapids, MI, USA; Spectrum Health Trauma Research Institute, Grand Rapids, MI, USA; Spectrum Health Medical Group, Division of Acute Care Surgery, Grand Rapids, MI, USA
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Schweickhardt SK, Sams VG, Radowsky JS, Sobieszczyk MJ, Marcus JE, Sobieszczyk MJ, Medicine P&CC, Marcus JE, Disease I. Infections complicating extracorporeal membrane oxygenation in patients with traumatic injuries. Injury 2023; 54:405-408. [PMID: 36450617 DOI: 10.1016/j.injury.2022.11.048] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Extracorporeal Membrane Oxygenation (ECMO) has increasing utility in adult patients with traumatic injuries. There is currently limited data on the pathogens complicating a trauma patient's ECMO course, making empiric antibiotic decisions difficult. This study aims to characterize the types of infection among patients with traumatic injuries on ECMO. METHODS A chart review was performed on all trauma patients at Brooke Army Medical Center receiving ECMO between February 2013 and July 2021. Charts were reviewed to identify pathogens by culture site as well as time to infection following cannulation. RESULTS Twenty-one trauma patients underwent ECMO during the study period. The majority of patients were men (90%) with a median age of 30 [IQR 27-38], and a median ECMO course of 9.8 days [IQR 3.9-14.1]. Motor vehicle crashes (81%) accounted for the majority of mechanisms of injury. Of the 24 infections, the majority were respiratory (n = 13, 58/1000 ECMO days) followed by skin and soft tissue (n = 6, 26/1000 ECMO days), blood stream (n = 4, 18/1000 ECMO days), and urinary tract (n = 1, 5/1000 ECMO days). Gram-negative bacteria were the most commonly isolated organism from all sites and at all time periods following cannulation. Multi-drug resistant organisms accounted for 35% (n = 9) of infections and were independent of time from cannulation. DISCUSSION/CONCLUSION This is the first study to describe infections in trauma patients requiring ECMO support. We observed majority Gram-negative infections regardless of culture site or time after cannulation. Thus, with infection in this population, empiric antibiotics should have broad spectrum coverage of Gram-negative organisms.
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Affiliation(s)
- Samantha K Schweickhardt
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States
| | - Valerie G Sams
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States; Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Ft. Sam Houston, San Antonio, TX 78234, United States
| | - Jason S Radowsky
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States; Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Ft. Sam Houston, San Antonio, TX 78234, United States
| | - Michal J Sobieszczyk
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States; Department of Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Ft. Sam Houston, San Antonio, TX 78234, United States
| | - Joseph E Marcus
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States; Department of Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Ft. Sam Houston, San Antonio, TX 78234, United States.
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Roumeliotis L, Kanakaris NK, Papadopoulos IN. Incidence, risk factors and potential timing of occurrence of pulmonary embolism in fatal trauma: An autopsy based case-control study on 2705 victims. Surgeon 2023; 21:8-15. [PMID: 35317982 DOI: 10.1016/j.surge.2022.03.002] [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] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pulmonary embolism (PE) following trauma is a potentially preventable but highly lethal complication. We sought to investigate the incidence, risk factors and potential timing of occurrence of post-traumatic PE in a large cohort of trauma fatalities. METHODS A case-control study on 9266 consecutive trauma fatalities (between 1996 and 2005) from a regional autopsy-based trauma registry. Injuries were classified according to the Abbreviated Injury Scale-1990 edition (AIS-90) and the Injury Severity Score (ISS) was calculated. Hospitalized victims were categorized according to the presence or absence of PE on autopsy. Univariate comparisons and multivariate logistic regression analysis for probabilities of association (odds ratios-OR) were performed. RESULTS Out of 2705 subjects who met the inclusion criteria, 116 had autopsy findings of PE and constituted the PE group (incidence of 4,3%), while the remaining victims formed the control group. The survival time of the PE group ranged from 0.66 to 104.73 days. Victims in the PE group were older (median age 69.5 vs 59), had lower ISS values (median 16 vs 26) and longer post-injury survival times (median 13.6 vs 5.7 days). Positively associated risk factors were AIS2-5 pelvic ring injuries (OR:2.23) and secondary deaths following an uneventful hospital discharge (OR:3.97), while AIS2-5 head (OR:0.33) and abdominal injuries (OR:0.23) showed a reverse association. CONCLUSIONS Trauma fatalities with autopsy findings of PE were associated with less severe trauma indicating that PE was likely detrimental to the fatal outcome. Both the early and delayed occurrence of PE was reaffirmed. Prophylactic measures should be initiated promptly and extended post discharge for high risk patients to prevent secondary deaths.
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Affiliation(s)
- Leonidas Roumeliotis
- 4th Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, University General Hospital 'Attikon', Athens, Greece.
| | - Nikolaos K Kanakaris
- Leeds Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, UK
| | - Iordanis N Papadopoulos
- 4th Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, University General Hospital 'Attikon', Athens, Greece
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Zhou Q, Huang H, Zheng L, Chen H, Zeng Y. Effects of the establishment of trauma centres on the mortality rate among seriously injured patients: a propensity score matching retrospective study. BMC Emerg Med 2023; 23:5. [PMID: 36653746 PMCID: PMC9850752 DOI: 10.1186/s12873-023-00776-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Little evidence suggests that trauma centres are associated with a lower risk of mortality in severely injured patients (Injury Severity Score (ISS) ≥16) with multiple injuries in China. The objective of this study was to determine the association between the establishment of trauma centres and mortality among severely injured patients with multiple injuries and to identify some risk factors associated with mortality. METHODS A retrospective single-centre study was performed including trauma patients admitted to the First Affiliated Hospital of Nanchang University (FAHNU) between January 2016 and December 2021. To determine whether the establishment of a trauma centre was an independent predictor of mortality, logistic regression analysis and propensity score matching (PSM) were performed. RESULTS Among 431 trauma patients, 172 were enrolled before the trauma centre was built, while 259 were included after the trauma centre was built. A higher frequency of older age and traffic accident injury was found in patients diagnosed after the trauma centre was built. The times for the completion of CT examinations, emergency operations and blood transfusions in the "after trauma centre" group were shorter than those in the "before trauma centre" group. However, the total expenditure of patients was increased. In the overall group, univariate and multivariate logistic regression analyses showed that a higher ISS was an independent predictor for worse mortality (OR = 17.859, 95% CI, 8.207-38.86, P < 0.001), while the establishment of a trauma centre was favourable for patient survival (OR = 0.492), which was also demonstrated by PSM. After determining the cut-off value of time for the completion of CT examination, emergency operation and blood transfusion, we found that the values were within the "golden one hour", and it was better for patients when the time was less than the cut-off value. CONCLUSION Our study showed that for severely injured patients, the establishment of a trauma centre was favourable for a lower mortality rate. Furthermore, the completion of a CT examination, emergency surgery and blood transfusion in a timely manner and a lower ISS were associated with a decreased mortality rate.
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Affiliation(s)
- Qiangping Zhou
- grid.412604.50000 0004 1758 4073Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 17 Yongwaizheng Street, Nanchang, 330006 Jiangxi China
| | - Haijin Huang
- grid.412604.50000 0004 1758 4073Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Linhui Zheng
- grid.412604.50000 0004 1758 4073Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 17 Yongwaizheng Street, Nanchang, 330006 Jiangxi China
| | - Haiming Chen
- grid.412604.50000 0004 1758 4073Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 17 Yongwaizheng Street, Nanchang, 330006 Jiangxi China
| | - Yuanlin Zeng
- grid.412604.50000 0004 1758 4073Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 17 Yongwaizheng Street, Nanchang, 330006 Jiangxi China
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Buijs MAS, van den Kieboom J, Sliepen J, Wever KLH, van Breugel JM, Hietbrink F, IJpma FFA, Govaert GAM. Outcome and risk factors for recurrence of early onset fracture-related infections treated with debridement, antibiotics and implant retention: Results of a large retrospective multicentre cohort study. Injury 2022; 53:3930-3937. [PMID: 36307267 DOI: 10.1016/j.injury.2022.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 10/01/2022] [Accepted: 10/15/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Early Fracture-Related Infections (FRIs) are a common entity in hospitals treating trauma patients and are often treated with a Debridement, Antibiotics and Implant Retention (DAIR) procedure. Aims of this study were to 1) evaluate the recurrence rate after DAIR procedures for early onset FRI, 2) establish the number of surgical procedures to gain control of the initial infection and 3) identify independent predictors for recurrence in this cohort. METHODS A retrospective multicentre cohort study was conducted in two level 1 trauma centres. Consecutive patients who underwent a DAIR procedure between January 1st 2015 and July 1st 2020 for confirmed FRI with an onset of <6 weeks after the latest osseous operation were included. Recorded data included patient demographics, treatment characteristics and follow-up. Univariate and multivariate logistic regression analyses were performed to assess predictors for recurrent FRI. RESULTS A total of 141 patients with early FRI were included in this study with a median age of 54.0 years (interquartile range (IQR) 34.5-64.0). The recurrence rate of FRI was 13% (n = 19) at one year follow-up and 18% (n = 25) at 23.1 months (IQR 15.3-36.4) follow-up. Infection control was achieved in 94% (n = 127/135) of cases. In total, 73 patients (52%) underwent at least two surgical procedures to treat the ongoing initial episode of FRI, of whom 54 patients (74%) required two to three procedures and 17 patients (23%) four to five procedures. Predictors for recurrent FRI were use of an intramedullary nail during index operation (odds ratio (OR) 4.0 (95% confidence interval (CI) 1.1-13.8)), need for additional surgical procedures to treat ongoing infection during the treatment period following the first presentation of early FRI (OR 1.9 (95% CI 1.1-3.5)) and a decreased Injury Severity Score (ISS) (inverted OR 1.1 (95% CI 1.0-1.1)). CONCLUSION The recurrence rate after treatment of early onset FRI in patients treated with a DAIR procedure was 18% at 23.1 months follow-up. At least two surgical procedures to gain control of the initial infection were needed in 52% of patients. Independent predictors for recurrent FRI were the use of an intramedullary nail during index operation, need for additional surgical procedures and a decreased ISS.
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Affiliation(s)
- M A S Buijs
- Department of Trauma Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - J van den Kieboom
- Department of Trauma Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - J Sliepen
- Department of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - K L H Wever
- Department of Trauma Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - J M van Breugel
- Department of Trauma Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - F Hietbrink
- Department of Trauma Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - F F A IJpma
- Department of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - G A M Govaert
- Department of Trauma Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands.
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Jeong TS, Choi DH, Kim WK. The Relationship Between Trauma Scoring Systems and Outcomes in Patients With Severe Traumatic Brain Injury. Korean J Neurotrauma 2022; 18:169-177. [PMID: 36381431 PMCID: PMC9634297 DOI: 10.13004/kjnt.2022.18.e54] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE This study investigated the relationship between trauma scoring systems and outcomes in patients with severe traumatic brain injury (TBI). METHODS From January 2018 to June 2021, 1,122 patients with severe TBI were registered in the Korean Neuro-Trauma Data Bank System. Among them, 697 patients with data on trauma scoring systems were included in the study. According to the Glasgow Outcome Scale-Extended score, the patients were divided into unfavorable and favorable outcome groups. The abbreviated injury scale (AIS), injury severity score (ISS), revised trauma score (RTS), and trauma and injury severity score (TRISS) were evaluated. RESULTS The AIS head score was higher in the unfavorable outcome group than in the favorable outcome group (4.39 vs. 4.06, p<0.001). ISS was also higher in the unfavorable outcome group (27.27 vs. 24.22, p=0.001). The RTS and TRISS were higher in the favorable outcome group (RTS, 4.74 vs. 5.45, p<0.001; TRISS, 48.05 vs. 71.02, p<0.001). In comparing the survival and death groups, the ISS was lower in the survival group (25.76 vs. 27.29, p=0.036). Furthermore, RTS was higher in the survival group (5.26 vs. 4.54, p<0.001), as was TRISS (62.11 vs. 44.91, p<0.001). CONCLUSION Trauma scoring systems, including ISS, RTS, and TRISS, provide tools for quantifying posttraumatic risk and can be used to predict prognosis. Among these, TRISS is an indicator of the predicted survival rate and is considered a clinically useful tool for predicting unfavorable and favorable outcomes in patients with severe TBI.
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Affiliation(s)
- Tae Seok Jeong
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Dae Han Choi
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Woo Kyung Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Wu CY, Chou CC, Hsu HC, Ma MHM, Ho YC, Lin CC, Chen YJ, Chiang WC. The preventability of trauma-related death: A two-year cohort study in a trauma center in middle Taiwan. Injury 2022; 53:3039-3046. [PMID: 35817606 DOI: 10.1016/j.injury.2022.06.038] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/14/2022] [Accepted: 06/26/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The preventable death rate (PDR) is an important parameter in the quality assurance of traumatic care. Medical errors or untimely management may occur during stressful trauma care, resulting in preventable deaths. We aimed to develop an applicable PDR model in a trauma center in middle Taiwan. MATERIALS AND METHODS We identified adult trauma-related deaths which occurred from January 1, 2018 to December 31, 2019 at our hospital. Patients with a trauma and injury severity score (TRISS) <75% or ≥75% but with a chance of preventability, as determined by a trauma surgeon, were discussed by a panel comprising an emergency physician and surgeons specializing in different fields of medicine. Deaths were subsequently classified as definitely preventable (DP), potentially preventable (PP), or non-preventable (NP). Causes of DP or PP deaths were categorized as delayed diagnosis, delayed treatment, technical error, or inadequate infection prevention/control. The relationship between the time and cause of preventable deaths was also analyzed. RESULTS This study included 127 trauma-related deaths, of which 39 were discussed by the panel. Eight patients (6.3%) were categorized as DP, eight (6.3%) as PP, and 111 (87.4%) as NP. Among patients with preventable deaths, inadequate infection prevention/control, delayed treatment, delayed diagnosis, and technical error were identified in six (37.5%), five (31.2%), three (18.8%), and two (12.5%) patients, respectively. Four patients in the inadequate infection prevention/control group (4/6, 66.7%) died of aspiration pneumonia during the recovery phase. CONCLUSION A PDR evaluation model was developed and revealed that postoperative care is as important as a timely diagnosis and treatment to avoid preventable deaths following trauma.
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Affiliation(s)
- Chao-Ying Wu
- Department of Surgery, National Taiwan University Hospital, Yunlin Branch, No. 579, Yunlin Road, Douliu City, 640 Yunlin, Taiwan (R.O.C.)
| | - Chun-Chih Chou
- Department of Surgery, National Taiwan University Hospital, Yunlin Branch, No. 579, Yunlin Road, Douliu City, 640 Yunlin, Taiwan (R.O.C.)
| | - Hao-Chun Hsu
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan (R.O.C.)
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan (R.O.C.); Department of Emergency Medicine, National Taiwan University Hospital
| | - Yi-Ching Ho
- Department of Surgery, National Taiwan University Hospital, Yunlin Branch, No. 579, Yunlin Road, Douliu City, 640 Yunlin, Taiwan (R.O.C.)
| | - Chen-Chiang Lin
- Department of Orthopedic Surgery, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan (R.O.C.)
| | - Yi-Jung Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan (R.O.C.)
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan (R.O.C.); Department of Emergency Medicine, National Taiwan University Hospital.
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Li YH, Yeung JHH, Hung KKC, Lai CY, Leung LY, Cheng CH, Cheung NK, Graham CA. Impact of AIS 2015 versus 1998 on injury severity scoring and mortality prediction - single centre retrospective comparison study. Am J Emerg Med 2022; 60:73-7. [PMID: 35908299 DOI: 10.1016/j.ajem.2022.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A key component of trauma system evaluation is the Injury Severity Score (ISS). The ISS is dependent on the AIS, and as AIS versions are updated this effects the number of patients within a health system which are considered severely injured (ISS >15). This study aims to analyse the changes comparing AIS1998 and AIS2015, and its impact on injury severity scoring and survival prediction model in a major trauma centre. METHODS This retrospective study reviewed all blunt trauma admissions from 1 January 2020 to 31 December 2020 from the trauma registry of Prince of Wales Hospital, Hong Kong. Patients were manually double coded with AIS1998 and AIS2015 by the same experienced trauma nurse who have completed both AIS 1998 and AIS 2015 Courses. AIS patterns and Injury Severity Scores (ISS) derived from AIS 1998 and 2015 were compared using the Wilcoxon Signed Rank Test. The area under the receiving operator curve (AUROC) was compared based on the Trauma and Injury Severity Score (TRISS) model using AIS 1998 and AIS 2015. RESULTS 739 patients were included. There were 34 deaths within 30 days (30-day mortality rate 4.6%). Patients coded with AIS2015 compared with AIS1998 had significant reductions in the classification of serious, severe and critical categories of AIS, with a substantial increase in the mild and moderate categories. The largest reduction was observed in the head and neck region (Z = -11.018, p < 0.001), followed by the chest (Z = -6.110, p < 0.001), abdomen (Z = -4.221, p < 0.001) and extremity regions (Z = -4.252, p < 0.001). There was a 27% reduction in number of cases with ISS >15 in AIS2015 compared with AIS1998. Rates of 30-day mortality, ICU admission, emergency operation and trauma team activation of ISS > 15 using AIS 1998 were similar to the cut off for New Injury Severity Score (NISS) >12 using AIS 2015. The AUROC from the TRISS (AIS2015) was 0.942, and not different from the AUROC for TRISS (AIS1998) of 0.936. The sensitivity and specificity were 93.9% and 82.1% for TRISS (AIS2015), and 93.9% and 76.0% for TRISS (AIS1998). CONCLUSION Trauma centres should be aware of the impact of the AIS2015 update on the benchmarking of trauma care, and consider the need for updating the ISS cut off for major trauma definitions.
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Medline A, Wham R, Kim G, Staley C, Steck A, Boissonneault A, Schenker ML. Opioid Prescribing Behavior in the Emergency Department During Routine Orthopedic Manipulations. Am Surg 2022:31348221091957. [PMID: 35522851 DOI: 10.1177/00031348221091957] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND The emergency department (ED) often represents the first exposure orthopedic trauma patients have to prescription opioids and thus a critical opportunity for prevention of potential long-term opioid use. This study will analyze the impact of opioid prescribing patterns among both ED providers and orthopedic surgery residents on the utilization of opioids during routine orthopedic trauma manipulations. MATERIALS AND METHODS This retrospective study reviewed opioid utilization among patients with an ankle or distal radius fracture at a large, urban, level 1 trauma center. Data on clinical providers, patient demographics, and injury severity score (ISS) were collected. Total opioid use was reported in oral morphine milligram equivalents (MME). Regression analyses were performed to determine how provider opioid prescribing intensity affected administered MME. RESULTS Five-hundred and ninety-five patients were included. The mean MME administered was 40.84 (SD 30.0) and was inversely associated with ISS (R = -.05; P = .40). Patients treated by a high-intensity ED prescriber had approximately three times higher odds of receiving over 40.84 MME (OR 2.8, 95% CI 1.33-5.90 P = .07). For those with an ISS score less than 15, the presence of a low-intensity orthopedic resident decreased the odds of receiving over 40.84 MME from 2.25 to 1.78 in the presence of a high-intensity ED prescriber. CONCLUSION For isolated orthopedic manipulations in the ED, involvement of a low-intensity prescribing orthopedic resident significantly decreased the quantity of opioids administered for those with lower ISS injuries, thus effectively mitigating the effect of high-intensity prescribing behavior prescriber.
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Affiliation(s)
- Alexandra Medline
- Department of Orthopaedics, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Robert Wham
- Department of Orthopaedics, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Grace Kim
- 160343Augusta University/ Medical College of Georgia, Atlanta, GA, USA
| | | | - Alaina Steck
- Department of Emergency Medicine, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Adam Boissonneault
- Department of Orthopaedics, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Mara L Schenker
- Department of Orthopaedics, 12239Emory University School of Medicine, Atlanta, GA, USA
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Berk T, Halvachizadeh S, Backup J, Kalbas Y, Rauer T, Zettl R, Pape HC, Hess F, Welter JE. Increased injury severity and hospitalization rates following crashes with e-bikes versus conventional bicycles: an observational cohort study from a regional level II trauma center in Switzerland. Patient Saf Surg 2022; 16:11. [PMID: 35248128 PMCID: PMC8897912 DOI: 10.1186/s13037-022-00318-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 10/26/2021] [Accepted: 01/17/2022] [Indexed: 11/15/2022] Open
Abstract
Background As electric bicycles (e-bikes) become increasingly popular, reports of injuries associated with e-bike usage are also rising. Patterns, characteristics, and severity of injuries following e-bike crashes need further investigation, particularly in contrast to injuries from conventional bicycle crashes. Methods This prospective observational study included 82 patients treated at a Level II trauma center for injuries resulting from an electric or conventional bicycle crash. Data were collected over one year (05.09.2017–19.09.2018) during in- and outpatient visits. A study-specific case report form was used to identify the bicycle type, cycling behavior (e.g., use of a helmet, safety gear, alcohol), and circumstances of the crash (e.g., road conditions, speed, cause of the incident, time of day, season). Additional information about patient demographics, treatment, and injury characteristics, such as the Injury Severity Score (ISS) and body region injured, were documented. Results were analyzed using chi-square, Fisher’s exact, or Wilcoxon tests. Simple logistic or linear regression models were used to estimate associations. Results Of the 82 patients, 56 (67%) were riding a conventional bike and 27 (33%) were using an e-bike. Most incidents were either single-bicycle crashes (66%) or automobile collisions (26%), with no notable difference in prevalence rates between groups. Although a higher proportion of conventional bikers were male (67% vs. 48%), the difference was not significant. E-bikers were older (median 60 years (IQR 44–70) vs. 45 years (IQR 32–62); p = 0.008), were hospitalized more often (48% vs. 24%, p = 0.025), and had worse ISS (median 3 (IQR 2–4) vs. 1 (IQR 1–3), p < 0.001), respectively. Body regions most affected were the extremities (78%) and external/skin (46%), and these were distributed similarly in both groups. Concomitant injury patterns of the thorax/chest with external/skin were higher among e-bikers (p < 0.001). When we controlled for the difference in the median age of the two groups, only the injury severity score of e-bikers remained significantly worse. Conclusions Hospitalization and chest trauma rates were higher among e-bikers. After controlling for the older age of this group, the severity of their injuries remained worse than in conventional cyclists. Initial clinical assessments at trauma units should include an evaluation of the thorax/chest, particularly among elderly e-bikers. Level of evidence Level III.
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Affiliation(s)
- Till Berk
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. .,Division of Traumatology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Sascha Halvachizadeh
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Johannnes Backup
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
| | - Yannik Kalbas
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Thomas Rauer
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Ralph Zettl
- Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Florian Hess
- Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| | - Jo Ellen Welter
- Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
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Gómez-García L, Hidalgo-Solórzano E, Pérez-Núñez R, Jacobo-Zepeda VF, Ascencio-Tene RG, Lunnen JC, Mehmood A. Factors associated with the severity of road traffic injuries from emergency department based surveillance system in two Mexican cities. BMC Emerg Med 2022; 22:20. [PMID: 35120440 PMCID: PMC8815254 DOI: 10.1186/s12873-022-00576-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background Limited data from low- and middle-income countries (LMICs) on the severity of road traffic injuries (RTIs) and their relation to different variables of interest are routinely obtained. Knowledge on this subject relies on evidence from high-income countries, which might not be the same as in LMICs. This information is greatly needed to advance and inform local and regional efforts towards the United Nations’ Decade of Action and the Sustainable Development Goals. Methods From May 2012 to November 2014, a RTI surveillance system was implemented in two referral hospitals in two Mexican cities, León and Guadalajara, with the objective of exploring the relationship between Injury Severity Score (ISS) and different sociodemographic characteristics of the injured as well as different variables related to the event and the environment. All individuals suffering RTIs who visited the Emergency Rooms (ER) were included after granting informed consent. A Zero-Truncated Negative Binomial Model was employed to explore the statistical association between ISS and variables of interest. Results 3024 individuals participated in the study: 2185 (72.3%) patients from León and 839 patients (27.7%) from Guadalajara. Being male, in the 20–59 age-group, having less schooling, events occurring in Guadalajara, on Sundays, at night, and arriving at ER via public/private ambulance were all associated with an increased log count of ISS. Found a significant interaction effect (p-value< 0.05) between type of road user and alcohol intake six hours before the accident on severity of the injury (ISS). The use of illicit drugs, cellphones and safety devices during the event showed no association to ISS. Conclusions Our study contributes to the statistical analysis of ISS obtained through RTI hospital surveillance systems. Findings might facilitate the development and evaluation of focused interventions to reduce RTIs in vulnerable users, to enhance ER services and prehospital care, and to reduce drink driving.
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Affiliation(s)
- Lourdes Gómez-García
- Center for Health Systems Research, National Institute of Public Health, Universidad #655, Colonia Santa María Ahuacatitlán, Cerr los Pinos y Caminera, CP 62100, Cuernavaca, Morelos, Mexico
| | - Elisa Hidalgo-Solórzano
- Center for Health Systems Research, National Institute of Public Health, Universidad #655, Colonia Santa María Ahuacatitlán, Cerr los Pinos y Caminera, CP 62100, Cuernavaca, Morelos, Mexico.
| | - Ricardo Pérez-Núñez
- Center for Health Systems Research, National Institute of Public Health, Universidad #655, Colonia Santa María Ahuacatitlán, Cerr los Pinos y Caminera, CP 62100, Cuernavaca, Morelos, Mexico
| | | | | | - Jeffrey C Lunnen
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amber Mehmood
- University of South Florida College of Public Health, Tampa, FL, USA
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Wali B, Ahmad N, Khattak AJ. Toward better measurement of traffic injuries - Comparison of anatomical injury measures in predicting the clinical outcomes in motorcycle crashes. J Safety Res 2022; 80:175-189. [PMID: 35249598 DOI: 10.1016/j.jsr.2021.11.013] [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] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/31/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Little evidence exists in the literature regarding the discrimination power of better anatomical injury measures in differentiating clinical outcomes in motorcycle crashes. Furthermore, multiple injuries to different body parts of the rider are seldom analyzed. This study focuses on comparing anatomical injury measures such as the injury severity score (ISS) and the new injury severity score (NISS) in capturing injuries of multiple injured riders and examining the discriminatory capabilities of the ISS and NISS in predicting clinical outcomes post motorcycle crash. METHODS The study harnessed unique and comprehensive injury data on 322 riders from the US DOT Federal Highway Administration's Motorcycle Crash Causation Study (MCCS). Detailed exploratory analysis is performed and discrete/ordered statistical models are estimated for three clinical outcomes: mortality risk, trauma risk, and trauma status. RESULTS Around 9% of the riders died and 45% of the riders had injuries. Around 36% of the riders were hospitalized, disabled, or institutionalized. While a very strong dependence was found between ISS and NISS, ISS underestimated injuries sustained by riders. Statistical models for mortality risk revealed that a unit increase in the ISS and NISS was correlated with a 1.18 and 1.17 times increase in the odds of mortality, respectively. Moreover, a unit increase in ISS and NISS values was correlated with a higher trauma risk by 1.48 and 1.36 times, respectively. Our analysis reveals that the probability of a rider being hospitalized or disabled/institutionalized increases with an increase in the NISS. Conclusions and practical applications: The NISS exhibits significantly better calibration and discriminatory ability in differentiating survivors and non-survivors and in predicting trauma status - underscoring the importance of accounting for microscopic body-part-level injury data in motorcycle crashes. We consider that compared with the KABCO scale, the ISS and NISS are more nuanced scores that can better measure the overall injury intensity and can lead to more targeted countermeasures.
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Affiliation(s)
- Behram Wali
- Urban Design 4 Health, Inc., 24 Jackie Circle East, Rochester, NY 14612, USA; Senseable City Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Numan Ahmad
- Department of Civil & Environmental Engineering, The University of Tennessee, Knoxville, TN 37996, USA.
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Xu CF, Huo MC, Huang JH, Liu CF, Xu W. Early changes in white blood cell, C-reactive protein and procalcitonin levels in children with severe multiple trauma. World J Emerg Med 2022; 13:448-452. [PMID: 36636564 PMCID: PMC9807391 DOI: 10.5847/wjem.j.1920-8642.2022.093] [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: 01/29/2022] [Accepted: 04/20/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND To analyze early changes in white blood cells (WBCs), C-reactive protein (CRP) and procalcitonin (PCT) in children with multiple trauma, before secondary inflammation develops. METHODS This single-center retrospective study collected data from patients with blunt traumatic injury admitted to the pediatric intensive care unit (PICU). According to the prognostic outcome of 28 d after admission to the PICU, patients were divided into survival group (n=141) and non-survival group (n=36). Characteristics between the two groups were compared. Receiver operation characteristic (ROC) curve analysis was conducted to evaluate the capacity of different biomarkers as predictors of mortality. RESULTS The percentages of children with elevated WBC, CRP, and PCT levels were 81.36%, 31.07%, and 95.48%, respectively. Patients in the non-survival group presented a statistically significantly higher injury severity score (ISS) than those in the survival group: 37.17±16.11 vs. 22.23±11.24 (t=6.47, P<0.01). WBCs were also higher in non-survival group than in the survival group ([18.70±8.42]×109/L vs. [15.89±6.98] ×109/L, t=2.065, P=0.040). There was no significant difference between the survival and non-survival groups in PCT or CRP. The areas under the ROC curves of PCT, WBC and ISS for predicting 28-day mortality were 0.548 (P=0.376), 0.607 (P=0.047) and 0.799 (P<0.01), respectively. CONCLUSIONS Secondary to multiple trauma, PCT levels increased in more patients, even if their WBC and CRP levels remained unchanged. However, early rising WBC and ISS were superior to PCT at predicting the mortality of multiple trauma patients in the PICU.
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Affiliation(s)
- Cai-fang Xu
- The Pediatrics Department, Shengjing Hospital of China Medical University, Shenyang 110004, China,Department of Critical Care Medicine, Shanghai Children’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200062, China
| | - Ming-chao Huo
- The Pediatrics Department, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Jin-hui Huang
- The Pediatrics Department, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Chun-feng Liu
- The Pediatrics Department, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Wei Xu
- The Pediatrics Department, Shengjing Hospital of China Medical University, Shenyang 110004, China,Corresponding Author: Wei Xu,
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Okada I, Hifumi T, Yoneyama H, Inoue K, Seki S, Jimbo I, Takada H, Nagasawa K, Kohara S, Hishikawa T, Hasegawa E, Morimoto K, Ichinose Y, Sato F, Kiriu N, Matsumoto J, Yokobori S. The effect of participation of interventional radiology team in a primary trauma survey on patient outcome. Diagn Interv Imaging 2021; 103:209-215. [PMID: 34922886 DOI: 10.1016/j.diii.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/31/2021] [Revised: 11/11/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to examine the survival benefits of a workflow in which an interventional radiology (IR) team participates in a primary trauma survey on patients with hemodynamically unstable trauma. MATERIALS AND METHODS A retrospective observational study was conducted between 2012 and 2019 at a single institution. Patients who underwent an IR procedure as the initial hemostasis were assigned to the hemodynamically stable group (HSG) or hemodynamically unstable group (HUG). The primary and secondary outcomes were survival at hospital discharge compared with the probability of survival (Ps) and the time course. RESULTS A total of 160 patients (100 men, 60 women; median age, 57.5 years [interquartile range (IQR): 31.5-72 years]) with an injury severity score of 24 (IQR: 13.75-34) were included. A total of 125 patients were included in the HSG group and 35 patients in the HUG group. The observational survival rate was significantly greater than the Ps rate by 4.9% (95% confidence interval [CI]: 1.6-8.4%; P = 0.005) in HSG and by 24.6% in HUG (95% CI: 16.9-32.3%; P < 0.001). The observational survival rate was significantly greater than Ps in HUG than in HSG (P < 0.001). The median time to initiate IR procedures and the median procedure time in HUG were 54 min [IQR: 45-66 min] and 48 min [IQR: 30-85 min], respectively; both were significantly shorter than those in the HSG. CONCLUSION A trauma workflow utilizing an IR team in a primary survey is associated with improved survival of patients with hemodynamically unstable trauma when compared with Ps with a shorter time course.
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Affiliation(s)
- Ichiro Okada
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Toru Hifumi
- Department of Emergency Medicine, St. Luke's International Hospital, 9-1, Akashicho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Hisashi Yoneyama
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan
| | - Kazushige Inoue
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan
| | - Satoshi Seki
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan
| | - Ippei Jimbo
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan
| | - Hiroaki Takada
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan
| | - Koichi Nagasawa
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan
| | - Saiko Kohara
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan
| | - Tsuyoshi Hishikawa
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan
| | - Eiju Hasegawa
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan
| | - Kohei Morimoto
- Department of radiology, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan
| | - Yoshiaki Ichinose
- Department of radiology, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan
| | - Fumie Sato
- Department of radiology, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan
| | - Nobuaki Kiriu
- Department of Traumatology and Critical Care Medicine(,) National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Junichi Matsumoto
- Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Heydari F, Azizkhani R, Ahmadi O, Majidinejad S, Nasr-Esfahani M, Ahmadi A. Physiologic Scoring Systems versus Glasgow Coma Scale in Predicting In-Hospital Mortality of Trauma Patients; a Diagnostic Accuracy Study. Arch Acad Emerg Med 2021; 9:e64. [PMID: 34870230 PMCID: PMC8628642 DOI: 10.22037/aaem.v9i1.1376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: In recent years, several scoring systems have been developed to assess the severity of trauma and predict the outcome of trauma patients. This study aimed to compare Rapid Emergency Medicine Score (REMS), Modified Early Warning Score (MEWS), Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) in predicting the in-hospital mortality of trauma patients. Methods: This diagnostic accuracy study was done on adult patients admitted to the emergency department (ED) between June 21, 2019, and September 21, 2020, following multiple trauma. Patients were followed as long as they were hospitalized. The REMS, MEWS, GCS, and ISS were calculated after data gathering and comprehensive assessment of injuries. Receiver operating characteristics (ROC) analysis was performed to examine the prognostic performance of the four different tools. Results: Of the 754 patients, 32 patients (4.2%) died and 722 (95.8%) survived after 24 hours of admission. The mean age of the patients was 38.54 ± 18.58 years (78.9% male). The area under the ROC curves (AUC) of REMS, MEWS, ISS, and GCS score for predicting in-hospital mortality were 0.942 (95% CI [0.923-0.958]), 0.886 (95% CI [0.861-0.908]), 0.866 (95% CI [0.839-0.889]), and 0.851 (95% CI [0.823-0.876]), respectively. The AUC of REMS was significantly higher than GCS (p=0.035). The sensitivities of GCS ≤ 11, ISS ≥ 13, REMS ≥ 4, and MEWS ≥ 3 scores for in-hospital mortality were 0.56, 0.97, 0.81, and 0.94, respectively. Also, the specificities of GCS, ISS, REMS, and MEWS scores for in-hospital mortality were 0.93, 0.82, 0.81, and 0.85, respectively. Conclusion: It seems that REMS is more accurate than GCS, ISS, and MEWS in predicting in-hospital mortality ≥ 24 hours of multiple trauma patients.
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Affiliation(s)
- Farhad Heydari
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Azizkhani
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Ahmadi
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Majidinejad
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Nasr-Esfahani
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Ahmadi
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Bick H, Wasfie T, Labond V, Hella JR, Pearson E, Barber KR. Traumatic brain injury in the elderly with high Glasgow coma scale and low injury severity scores: Factors influencing outcomes. Am J Emerg Med 2021; 51:354-357. [PMID: 34808458 DOI: 10.1016/j.ajem.2021.11.005] [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: 10/05/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Current trauma activation guidelines do not clearly address age as a risk factor when leveling trauma patients. Glasgow coma scale (GCS) and mode of injury play a major role in leveling trauma patients. We studied the above relationship in our elderly patients presenting with traumatic head injury. METHODS This study was a retrospective analysis of patients who presented to the emergency department with traumatic brain injuries. We classified the 270 patients into two groups. Group A was 64 years and younger, and group B was 65 years and older. Their GCS, ISS, age, sex, comorbidities, and anticoagulant use were abstracted. The primary outcome was mortality and length of stay. The groups were compared using an independent student's t-test and Chi-square analysis. The Cox regression analysis was used to analyze differences in the outcome while adjusting for the above factors. RESULTS There were 140 patients in group A, and 130 patients in group B who presented to the ED with a GCS of 14-15 and an ISS of below 15. The mean ISS significantly differed between group A (6.2 ± 6.8) vs (7.9 ± 3.2) in group B (p < 0.0001). The most common diagnosis in group A was concussion (57.3%), while in group B was subdural and subarachnoid hemorrhage (55%). In group B, 13.8% presented as a level one or level two trauma activation. The mean hospital and intensive care stay for group A was 2.1 (±1.9) days and 0.9 (±1.32) days, respectively, versus 4.2 (±3.04) days and 2.4 (±2.02 days) for the elderly group B. Mortality in group A was zero and in group B was 3.8%. Cox regression analysis showed age as an independent predictor of death as well as length of stay. CONCLUSION Elderly traumatic brain injury patients presenting to the ED with minor trauma and high GCS should be triaged at a higher level in most cases.
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Affiliation(s)
- Heather Bick
- Ascension Genesys Hospital, Emergency Department, Grand Blanc, MI, United States of America
| | - Tarik Wasfie
- Ascension Genesys Hospital, Department of Trauma Services, Grand Blanc, MI, United States of America.
| | - Virginia Labond
- Ascension Genesys Hospital, Emergency Department, Grand Blanc, MI, United States of America
| | - Jennifer R Hella
- Ascension Genesys Hospital, Department of Clinical & Academic Research, Grand Blanc, MI, United States of America
| | - Eric Pearson
- Ascension Genesys Hospital, Emergency Department, Grand Blanc, MI, United States of America
| | - Kimberly R Barber
- Ascension Genesys Hospital, Department of Clinical & Academic Research, Grand Blanc, MI, United States of America
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Stewart N, MacConchie JG, Castillo R, Thomas PG, Cipolla J, Stawicki SP. Beyond Mortality: Does Trauma-related Injury Severity Score Predict Complications or Lengths of Stay Using a Large Administrative Dataset. J Emerg Trauma Shock 2021; 14:143-147. [PMID: 34759632 PMCID: PMC8527059 DOI: 10.4103/jets.jets_125_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/12/2020] [Accepted: 02/22/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Despite its shortcomings, trauma-related injury severity score (TRISS) correlates well with mortality in large trauma datasets. The aim of this study was to determine if TRISS correlates with morbidity and hospital lengths of stay using data from an institutional registry at a Level I Trauma Center. We hypothesized that higher TRISS correlates with increased complications and longer hospital stays. Methods: A retrospective review of our institutional registry was performed, examining all trauma admissions between January 1999 and June 30, 2015. Out of a total of 32,026 patient records, TRISS data were available in 23,205 cases. Abstracted data included patient age, gender, ISS, TRISS, presence of complication, Glasgow Coma Scale (GCS), hospital length of stay, intensive care unit LOS, step-down unit LOS, functional independence measure, and 30-day mortality. Results: TRISS was highly predictive of mortality, with the AUC value of 0.95 (95% confidence interval 0.936–0.954, P < 0.01) compared to ISS (AUC 0.794), GCS (AUC 0.827), and age (AUC 0.650). TRISS also performed better than the other variables in terms of the ability to predict morbidity events (AUC 0.813). TRISS was comparable to ISS in terms of prediction of ICU admission (AUC 0.801 versus 0.811, respectively). After correcting for patient age and gender, higher TRISS significantly correlated with longer hospital stays . Conclusions: Despite previous criticisms, we found that TRISS is superior to ISS for mortality and morbidity prediction. TRISS correlated significantly with a hospital, step down, and ICU lengths of stay using a large administrative dataset.
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Affiliation(s)
- Nakosi Stewart
- Department of Acute Care Surgical Services, St. Luke's University Hospital, Bethlehem, PA, USA
| | - James G MacConchie
- Department of Acute Care Surgical Services, St. Luke's University Hospital, Bethlehem, PA, USA
| | - Roberto Castillo
- Department of Acute Care Surgical Services, St. Luke's University Hospital, Bethlehem, PA, USA
| | - Peter G Thomas
- Department of Acute Care Surgical Services, St. Luke's University Hospital, Bethlehem, PA, USA
| | - James Cipolla
- Department of Acute Care Surgical Services, St. Luke's University Hospital, Bethlehem, PA, USA
| | - Stanislaw P Stawicki
- Department of Acute Care Surgical Services, St. Luke's University Hospital, Bethlehem, PA, USA
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Singh PK, Ali SM, Radhakrishnan RV, Mohanty CR, Sahu MR, Patro BP, Ms I, Panda SK. Pattern of injuries due to wild animal attack among patients presenting to the emergency department: A retrospective observational study. Chin J Traumatol 2021; 24:383-388. [PMID: 34654596 PMCID: PMC8606701 DOI: 10.1016/j.cjtee.2021.09.004] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/26/2021] [Accepted: 08/30/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The human-wildlife conflicts (HWCs) causing nuisances and injuries are becoming a growing public health concern over recent years worldwide. We aimed to study the demographic profile, mode of injury, pattern of injury, and outcome of wild animal attack victims presented to the emergency department. METHODS This retrospective cross-sectional study was conducted in the emergency department of a tertiary-care hospital in Eastern India. Data were retrieved from the medical records from May 2017 to May 2021. Patients of all ages and genders attacked by wild animals and secondary injuries were included in this study. Patients with incomplete data, injuries due to the attack of stray and domestic animals and trauma due to other causes were excluded. Demographic profile, mode of injury, the pattern of injury, injury severity score (ISS), radiological pattern, and outcome were recorded. Statistical analysis with R (version 3.6.1.) was conducted. RESULTS A total of 411 wild animal attack victims were studied, of which 374 (90.9%) were snakebite injuries and 37 (9.1%) were wild mammalian (WM) attack injuries. The mean age of WM attack victims was 46 years, and the male-to-female ratio was 4:1. Elephant attack injury (40.5%) was the most common WM attack injury reported. Most WM attacks (43.2%) occurred between 4:00 a.m. to 8:00 a.m. The median ISS was 18.5 (13-28), where 54.2% of patients had polytrauma (ISS>15). Elephant attack was associated with a higher ISS, but the difference was not significant compared to other animal types (p = 0.2). Blunt trauma was common pattern of injury in the elephant attack injury cases. Lacerations and soft tissue injuries were common patterns in other animal attacks. Among snakebites, neurotoxic was the most common type (55.4%), and lower extremity was the most common site involved. CONCLUSION The young male population is the major victim of HWCs; and elephant is the most common animal involved. There is a need to design scientifically sound preventive strategies for HWCs and to strengthen the preparedness in health establishments to manage victims effectively.
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Affiliation(s)
- Pradeep Kumar Singh
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
| | - S Manwar Ali
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
| | | | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, 751019, India.
| | - Manas Ranjan Sahu
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
| | - Bishnu Prasad Patro
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
| | - Ijas Ms
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
| | - Susant Kumar Panda
- Department of General Surgery, District Head Quarter Hospital, Angul, Odisha, 759122, India
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Choi Y, Lee DH, Lee JI. Patterns and clinical outcomes of injuries related to two-wheeled vehicles (bicycle and motorcycle) in the geriatric population: a nationwide analysis in South Korea (2016-2018). BMC Geriatr 2021; 21:603. [PMID: 34702189 PMCID: PMC8546953 DOI: 10.1186/s12877-021-02505-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background South Korea has a rapidly ageing population. This study aimed to provide epidemiologic data and to identify the characteristics of the patterns and clinical outcomes of two-wheeled vehicle-related injuries (bicycle and motorcycle) in elderly riders. Methods This study retrospectively analyzed data from the National Emergency Department Information System from 2016 to 2018. Adult patients (≥ 20 years old) who were injured while using two-wheeled vehicles were included. Elderly patients were defined as being 65 years and older. The analysis was performed for 65,648 bicycle-related injuries (15,272 elderly patients) and 87,855 motorcycles-related injuries (17,292 elderly patients). Results In emergency departments (EDs), the average injury severity score (ISS) for motorcycle-related accidents was 9.8 ± 11.2 in the younger group and 14.1 ± 14.7 in the elderly group (p = 0.001). In addition, the average ISS of bicycle-related accidents was 7.1 ± 8.9 in the younger group and 10.5 ± 12.3 in the elderly group (p = 0.001). Two-wheeled vehicle accident mortality rates of elderly riders (0.9% for bicycle and 1.8% for motorcycle in the ED; 4.1% for bicycle and 3.8% for motorcycle in the hospital) were more than twice those of younger riders. The elderly stayed in the hospital longer than younger patients (485.2 ± 543.0 h vs 336.8 ± 385.5 h, p = 0.001) for bicycle-related injuries. They also stayed longer for motorcycle-related injuries (529 ± 598.6 h vs 452.0 ± 543.55 h, p = 0.001). The logistic regression analysis showed that age ≥ 65 years was an independent factor associated with severe trauma (ISS ≥ 16) for both bicycle-related injuries (adjusted odds ratio [OR] 2.185 [95% Confidence Interval (CI) 2.072–2.303]) and motorcycle-related injuries (adjusted OR 1.220 [95% CI 1.137–1.287]). Conclusion Two-wheeled vehicle-related injuries in the elderly were associated with higher ISS, length of hospital stay, and mortality than in younger riders. Analysing the characteristics of two-wheeled vehicle-related injuries in the elderly can be the basis for planning to reduce and prevent injuries in elderly riders.
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Affiliation(s)
- Yoonhyung Choi
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea.
| | - Jung Il Lee
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, South Korea.
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Soliman SS, Jordan GB, Bilaniuk JW, Benfante A, Kong K, Rolandelli RH, Curran T, Nemeth ZH. The impact of BMI on morbidity and mortality after femoral fractures. Eur J Trauma Emerg Surg 2021; 48:2441-2447. [PMID: 34642802 PMCID: PMC8508396 DOI: 10.1007/s00068-021-01787-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022]
Abstract
Purpose Femur fractures are the result of high energy injury and are associated with life-threatening complications. Therefore, we studied how body mass index (BMI) contributes to complications after femoral fractures. Methods Using the 2016 American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) database, we stratified 41,362 patients into groups based on their BMI: Normal Weight (NW), Overweight (OW), Obese (OB), Severely Obese (SO), and Morbidly Obese (MO). We compared each BMI group to the NW cohort for differences in demographic factors, comorbidities, complications, and mechanism of injury. Results OB, SO, and MO patients sustained higher rates of traumatic injury from high energy mechanisms, such as motor vehicle trauma, in comparison to NW patients, who sustained more injuries from falls (p < 0.05). Correspondingly, obese patients were more likely than NW patients to sustain shaft and distal end fractures (p < 0.05). At hospital admission, obese patients presented with more comorbidities, such as bleeding disorders, congestive heart failure, diabetes mellitus, and hypertension (p < 0.05). Despite these individual findings, patients with OB, SO, and MO BMI, as opposed to NW BMI, were independently associated with a higher probability of developing at least one post-trauma complication. More specifically, MO patients were associated with a 45% higher odds of developing a complication (p < 0.05). Conclusion Irrespective of presenting with more comorbidities and sustaining high energy injuries, OB, SO, and MO patients were independently associated with having a higher risk of developing complications following a femoral fracture. Overall, better clinical outcomes are observed among patients with no underlying conditions and normal BMI.
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Affiliation(s)
- Sara S Soliman
- Department of Surgery, Morristown Medical Center, 100 Madison Ave. #88, Morristown, NJ, 07960, USA
| | - Garrett B Jordan
- Department of Surgery, Morristown Medical Center, 100 Madison Ave. #88, Morristown, NJ, 07960, USA
| | - Jaroslaw W Bilaniuk
- Department of Surgery, Morristown Medical Center, 100 Madison Ave. #88, Morristown, NJ, 07960, USA
| | - Amanda Benfante
- Department of Surgery, Morristown Medical Center, 100 Madison Ave. #88, Morristown, NJ, 07960, USA
| | - Karen Kong
- Department of Surgery, Morristown Medical Center, 100 Madison Ave. #88, Morristown, NJ, 07960, USA
| | - Rolando H Rolandelli
- Department of Surgery, Morristown Medical Center, 100 Madison Ave. #88, Morristown, NJ, 07960, USA
| | - Terrence Curran
- Department of Surgery, Morristown Medical Center, 100 Madison Ave. #88, Morristown, NJ, 07960, USA
| | - Zoltan H Nemeth
- Department of Surgery, Morristown Medical Center, 100 Madison Ave. #88, Morristown, NJ, 07960, USA.
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Asghar EB, Howard R, Shelton T, Kent WT. Lower extremity CT angiograms and their effect on kidney function in orthopedic trauma patients. Injury 2021; 52:3060-3063. [PMID: 34419250 DOI: 10.1016/j.injury.2021.08.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the frequency of unindicated CT Angiograms (CTAs) obtained at our institution and the association between contrast-induced nephropathy (CIN) and decreased glomerular filtration rate (GFR). DESIGN Retrospective case series SETTING: Academic Level 1 trauma center PATIENTS/PARTICIPANTS: Patients aged 18 years and older with CTAs following lower-extremity (LE) trauma between 2010-2018. INTERVENTION CTAs performed in 257 LEs and corresponding pre- and post-contrast renal function labs in these LE trauma patients. MAIN OUTCOME MEASUREMENTS The primary outcome was vascular injury requiring intervention. Secondary outcomes were CIN and the association of CIN with decreased GFR and injury severity score (ISS). RESULTS There was no indication (no hard signs of vascular injury, ABI>0.9) for CTA in 121 patients (61%) of the total 199 patients. Of the 78 patients with signs of vascular injury or ABI<0.9, 35 (45%) had positive CTAs and 15 (19.2%) required vascular intervention. Of the 121 unindicated patients, 26 (21%) had positive CTAs and 1 (0.008%), a knee dislocation, required vascular intervention. In 155 patients with renal function labs, initial GFR<60ml/min was a risk factor for CIN as compared to GFR>60ml/min (p=0.001). Rate of CIN did not correlate with Injury Severity Score (ISS). CONCLUSIONS CTAs are obtained more often than indicated and initial GFR<60ml/min is a risk factor for developing CIN, irrespective of the trauma burden. CTAs should be reserved for when hard signs of vascular injury or ABI<0.9, especially in those patients with decreased renal function. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Elise Britt Asghar
- Department of Orthopaedic Surgery University of California San Diego, USA.
| | - Roland Howard
- Department of Orthopaedic Surgery University of California San Diego, USA.
| | - Trevor Shelton
- Department of Orthopaedic Surgery University of California Davis, USA.
| | - William T Kent
- Department of Orthopaedic Surgery University of California San Diego, USA.
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Li H, Ma YF. New injury severity score (NISS) outperforms injury severity score (ISS) in the evaluation of severe blunt trauma patients. Chin J Traumatol 2021; 24:261-5. [PMID: 33581981 DOI: 10.1016/j.cjtee.2021.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/20/2020] [Accepted: 12/16/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The injury severity score (ISS) and new injury severity score (NISS) have been widely used in trauma evaluation. However, which scoring system is better in trauma outcome prediction is still disputed. The purpose of this study is to evaluate the value of the two scoring systems in predicting trauma outcomes, including mortality, intensive care unit (ICU) admission and ICU length of stay. METHODS The data were collected retrospectively from three hospitals in Zhejiang province, China. The comparisons of NISS and ISS in predicting outcomes were performed by using receiver operator characteristic (ROC) curves and Hosmer-Lemeshow statistics. RESULTS A total of 1825 blunt trauma patients were enrolled in our study. Finally, 1243 patients were admitted to ICU, and 215 patients died before discharge. The ISS and NISS were equivalent in predicting mortality (area under ORC curve [AUC]: 0.886 vs. 0.887, p = 0.9113). But for the patients with ISS ≥25, NISS showed better performance in predicting mortality. NISS was also significantly better than ISS in predicting ICU admission and prolonged ICU length of stay. CONCLUSION NISS outperforms ISS in predicting the outcomes for severe blunt trauma and can be an essential supplement of ISS. Considering the convenience of NISS in calculation, it is advantageous to promote NISS in China's primary hospitals.
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Crawford R, Kruger D, Moeng M. Shock index as a prognosticator for emergent surgical intervention and mortality in trauma patients in Johannesburg: A retrospective cohort study. Ann Med Surg (Lond) 2021; 69:102710. [PMID: 34429962 PMCID: PMC8365323 DOI: 10.1016/j.amsu.2021.102710] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Trauma is the leading cause of morbidity and mortality worldwide with exsanguination being the primary preventable cause through early surgical intervention. We assessed two popular trauma scoring systems, injury severity scores (ISS) and shock index (SI) to determine the optimal cut off values that may predict the need for emergent surgical intervention (ESI) and in-hospital mortality. Methods A retrospective analysis of patient records from a tertiary hospital's trauma unit for the year 2019 was done. Descriptive statistics, univariate and multivariate logistic regression analyses were performed. Receiver operator characteristic (ROC) curve analysis was conducted and area under the curve (AUC) reported for predicting the need for ESI in all study participants, as well as in patients with penetrating injuries alone, based on continuous variables of ISS, SI or a combination of ISS and SI. The Youdin Index was applied to determine the optimal ISS and SI cut off values. Results A total of 1964 patients’ records were included, 89.0% were male and the median age (IQR) was 30 (26–37) years. Penetrating injuries accounted for 65.9% of all injuries. ISS and SI were higher in the ESI group with median (IQR) 11 (10–17) and 0.74 (0.60–0.95), respectively. The overall mortality rate was 4.5%. The optimal cut-off values for ESI and mortality by ISS (AUC) were 9 (0.74) and 12 (0.86) (p = 0.0001), with optimal values for SI (AUC) being 0.72 (0.60), and 0.91 (0.68) (p = 0.0001), respectively. Conclusion ISS and SI are significant, independent prognosticators for the need of ESI and in-hospital mortality. The ISS cut-off of 15 for severe trauma may underestimate the severity of trauma within our local South African population. Our study reports an optimal SI cut off value of ≥0.72 for emergency surgical intervention. At an optimal SI cut off of ≥0.91 for in-hospital mortality, the odds of demise were 6.7 times higher. ISS was a stronger predictor than SI of both ESI and in-hospital mortality in our study.
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Affiliation(s)
- Richard Crawford
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Deirdre Kruger
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maeyane Moeng
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Trauma Unit, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
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Kraus S, Friederichs J, von Rüden C, Stuby F, Schneidmüller D, Beck M. [Das unterschätzte Verletzungsrisiko beim Freizeitschlittenfahren]. Unfallchirurg 2021; 125:951-958. [PMID: 34351476 PMCID: PMC8340807 DOI: 10.1007/s00113-021-01063-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/28/2022]
Abstract
Hintergrund Rodeln bzw. Schlittenfahren gilt i. Allg. als relativ ungefährliche Freizeitbeschäftigung im Winter. Das vermehrte Aufkommen von z. T. schweren Verletzungen in unserer Notaufnahme im Einzugsgebiet mehrerer Rodelbahnen und Schlittenpisten war Anlass zur Analyse dieses Patientenkollektivs hinsichtlich Häufigkeit und Schwere der Verletzungen. Patienten und Methoden Anhand der Klinikdokumentation erfolgte eine retrospektive Auswertung aller Notaufnahmebesuche der Winter 2016–2019. Als Schlagwörter wurden die Worte „Rodel“, „Schlitten“, „Bob“, „Zipfelbob“, „Schlittenfahren“, „rodeln“ verwendet und die erfassten Daten in Bezug auf ambulante-, stationäre Behandlung, stationäre Behandlungstage, Behandlungstage auf der Intensivstation, Zahl der notwendigen Operationen, Verletzungsmuster sowie Verletzungsschwere analysiert. Ergebnisse Insgesamt wurden über den Zeitraum von 3 Jahren 175 Verletzte erfasst. Bei 94 Patienten (54 %) wurde die Verletzung als leicht eingestuft, 70 Patienten (40 %) benötigten eine stationäre Behandlung mit einer durchschnittlichen Verweildauer von 8 Tagen; in der Summe entstanden 590 stationäre Behandlungstage. Operativ behandelt wurden 49 (28 %) der Verunfallten mit insgesamt 66 Operationen, 81 Patienten erlitten schwere Verletzungen bis hin zu einer Polytraumatisierung mit einem Injury Severity Score (Iss) von 34. Diskussion Unsere Untersuchung zeigt, dass das Rodeln und Schlittenfahren ein deutlich höheres Verletzungspotenzial besitzen als allgemein angenommen, und dass die hierdurch entstehenden Kosten und Unfallfolgen nicht unerheblich sind. Insbesondere auf den ausgewiesenen Rodelpisten könnte durch entsprechende Maßnahmen und Regeln eine Erhöhung des Sicherheitsstandards erreicht werden.
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Affiliation(s)
- Stephanie Kraus
- BG-Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland.
| | - Jan Friederichs
- BG-Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - Christian von Rüden
- BG-Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland.,Universitätsinstitut für Biomechanik, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
| | - Fabian Stuby
- BG-Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | | | - Markus Beck
- BG-Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
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Higgin R, Dean M, Qureshi A, Hancock N. Outcomes following the delayed management of open tibial fractures. Injury 2021; 52:2434-2438. [PMID: 34158158 DOI: 10.1016/j.injury.2021.05.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/10/2021] [Accepted: 05/26/2021] [Indexed: 02/02/2023]
Abstract
AIMS National guidelines set standards for the definitive management of open fractures within 72 h. This study aims to investigate our outcomes where this timeline was unachievable for most cases due to a split-site orthoplastic service. PATIENTS & METHODS 116 consecutive Gustilo-Anderson grade IIIB & IIIC open tibial fractures presenting to our major trauma centre (MTC) between September 2012 and April 2018 were reviewed. The mean follow up was 46 months (17 to 88). 110 (95%) were grade IIIB and 6 (5%) grade IIIC. The most common injury mechanism included road traffic accidents (59%) and falls (28%). Primary outcomes were recorded according to; timing of initial debridement and definitive cover, rates of superficial and deep infection, non-union and amputation. Subgroups were statistically analysed according to time to initial debridement, definitive soft-tissue cover and injury severity score (ISS). RESULTS The mean time to initial debridement was 11.3 h (2.9 to 38.9) and definitive soft-tissue cover 9.9 days (0 to 37). We recorded rates of: superficial infection; 42 cases (36%), deep infection; 14 cases (12%) and non-union requiring revision; 19 cases (16%). There were 20 amputations (17%) with 9 (8.6%) performed early and 11 (9.5%) delayed. Subgroup analysis showed higher rates of superficial infection (50%, p = 0.002) and amputation (26.6%, p = 0.01) for those debrided <12 h. A greater presenting ISS related to a delay to definitive cover >7 days (p = 0.05). Primary outcomes trended worse for those covered >7 days but did not reach significance. CONCLUSION Major trauma patients are particularly vulnerable to poor outcomes resulting from the delay in definitive management of open fractures. MTC's need resources and a co-located orthoplastic service to achieve national standards and better outcomes. Current guidelines do not advise for the management of patients where a delay in definitive surgery is anticipated.
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Affiliation(s)
- Ryan Higgin
- Trauma & Orthopaedic Department, University Hospital Southampton, Tremona Road, Southampton SO16 6YD United Kingdom.
| | - Michael Dean
- Trauma & Orthopaedic Department, University Hospital Southampton, Tremona Road, Southampton SO16 6YD United Kingdom
| | - Amir Qureshi
- Trauma & Orthopaedic Department, University Hospital Southampton, Tremona Road, Southampton SO16 6YD United Kingdom.
| | - Nicholas Hancock
- Trauma & Orthopaedic Department, University Hospital Southampton, Tremona Road, Southampton SO16 6YD United Kingdom.
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Sarode AL, Ho VP, Pieracci FM, Moorman ML, Towe CW. The financial burden of rib fractures: National estimates 2007 to 2016. Injury 2021; 52:2180-7. [PMID: 34059325 DOI: 10.1016/j.injury.2021.05.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/28/2021] [Accepted: 05/13/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study is to define the cost of rib fracture hospitalization by single, multiple, and flail type using a nationally representative sample. METHODS The national inpatient sample (NIS) was used to identify patients with a primary diagnosis of rib fracture hospitalization 2007-2016. International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes were used to characterize patients as having single, multiple, or flail chest rib fractures. Patients with only trauma related diagnosis groups (DRG) at the time discharge were included in the final sample. The cost of hospitalization was obtained by converting reported charges into cost using the all-payer inpatient cost-to-charge ratio (CCR) for all hospitals in the NIS data. The log of cost was modeled using multivariate linear regression. The rib fracture type was the primary predictor in the model. RESULTS There were 373,053 rib fracture admissions during 2007-2016. The average cost per hospitalization was $10,169 (95%Confidence Interval [CI]: 9,942-10,395), which translated into a national expenditure of $3.64 billion over 10 years. The cost of rib fracture hospitalization increased from $209 million in 2007 to $469 million in 2016. Compared to single rib fracture patients, the cost of hospitalization for multiple rib fractures and flail chest was 3% (p = 0.001) and 5% (p=0.02) higher, respectively. Higher injury severity score, total number of body regions injured and longer length of stay were associated with higher rib fracture hospitalization cost. CONCLUSIONS Rib fractures affect ~22,000-45,000 people per year in the United States. The cost of rib fractures is over $469 million per year and is increasing over time. Multiple rib fractures and flail chest rib fractures are associated with increased cost. Pathways to improve care in patients with rib fractures should consider the cost of treatment.
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Tsinaslanidis P, Smith TO, Brown OS, Tsinaslanidis G, Umarji S, Hing CB. The association of hand and wrist injuries with other injuries in multiple trauma patients. A retrospective study in a UK Major Trauma Centre. Injury 2021; 52:1778-82. [PMID: 33883075 DOI: 10.1016/j.injury.2021.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Approximately 20,000 major trauma cases occur in England every year. However, the association with concomitant upper limb injuries is unknown. This study aims to determine the incidence, injury pattern and association of hand and wrist injuries with other body injuries and the Injury Severity Score (ISS) in multiply injured trauma patients. METHODS Single centre retrospective study was performed at a level-one UK Major Trauma Centre (MTC). Trauma Audit and Research Network (TARN) eligible multiply injured trauma patients that were admitted to the hospital between January 2014 and December 2018 were analysed. TARN is the national trauma registry. Eligible patients were: a trauma patient of any age who was admitted for 72 h or more, or was admitted to intensive care, or died at the hospital, was transferred into the hospital for specialist care, was transferred to another hospital for specialist care or for an intensive care bed and whose isolated injuries met a set of criteria. Data extracted included: age, gender, mode of arrival, location of injuries including: hand and/or wrist and mechanism of injury. We performed a logistic regression analysis to assess the association between hand/wrist injury to ISS score of 15 points or above/below and to the presentation of other injuries. RESULTS 107 patients were analysed. Hand and wrist injuries were the second most common injury (26.2%), after thoracic injuries. Distal radial injuries were found in 5.6%, carpal/carpometacarpal in 6.5%, concurrent distal radius and carpometacarpal in 0.9%, phalangeal injuries in 4.7%, tendon injuries in 0.9% and concurrent hand and wrist injuries in 7.5% cases. There was a significant association between hand or wrist injuries and lower limb injuries (Odds Ratio (OR): 3.84; 95% confidence intervals (CI): 1.09 to 13.50; p = 0.04) and pelvic injuries (OR: 4.78; 95% CI: 1.31 to 17.44; p = 0.02). There was no statistical association between hand and wrist injuries and ISS score (OR: 0.80; 95% CI: 0.11 to 5.79; p = 0.82). CONCLUSIONS Hand and wrist injuries are prevalent in trauma patients admitted to MTCs. They should not be under-estimated but routinely screened for in multiply injured patients particularly those with a pelvic or lower limb injury.
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Beppu S, Hitosugi M, Ueda T, Koh M, Nishiyama K. Factors influencing the length of emergency room stay and hospital stay in non-fatal bicycle accidents: A retrospective analysis. Chin J Traumatol 2021; 24:148-152. [PMID: 33781635 PMCID: PMC8173571 DOI: 10.1016/j.cjtee.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 01/29/2021] [Accepted: 02/25/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Lengthy hospitalization places a burden on patients and healthcare resources. However, the factors affecting the length of hospital stay (LHoS) and length of emergency room stay (LERS) in non-fatal bicycle accidents are currently unclear. We investigated these factors to inform efforts to minimize hospitalization. METHODS We performed a retrospective analysis of data from non-fatal injured bicyclists admitted to the Emergency and Critical Care Center at Kyoto Medical Center between January 2012 and December 2016. We measured LHoS, LERS, mechanism of injury, head injury prevalence, polytrauma, operations performed, injury severity score (ISS), abbreviated injury scale (AIS) score, maximum AIS score, and trauma and injury severity score probability of survival. We conducted multiple regression analysis to determine predictors of LHoS and LERS. RESULTS Within the study period, 82 victims met the inclusion and exclusion criteria and were included. Mean age was (46.0 ± 24.7) years. Overall mean LHoS was (16.8 ± 25.2) days, mean LERS was (10.6 ± 14.7) days, median ISS was 9 (interquartile range (IQR): 3-16), median maximum AIS was 3 (IQR: 1-4), and median trauma and injury severity score probability of survival was 98.0% (IQR: 95.5%-99.6%). Age, maximum AIS, ISS, and prevalence of surgery were significantly greater in long LHoS and LERS group compared with short LHoS and LERS group (p < 0.05). Performance of surgery independently explained LHoS (p = 0.0003) and ISS independently explained LERS (p = 0.0009). CONCLUSION Surgery was associated with long hospital stays and ISS was associated with long emergency room stays. To improve the quality life of the bicyclists, preventive measures for reducing injury severity or avoiding injuries needing operation are required.
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Affiliation(s)
- Satoru Beppu
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, 612-0861, Japan; Department of Legal Medicine, Shiga University of Medical Science, Shiga, 520-2192, Japan.
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Shiga, 520-2192, Japan
| | - Tadahiro Ueda
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, 612-0861, Japan
| | - Mirae Koh
- Department of Legal Medicine, Shiga University of Medical Science, Shiga, 520-2192, Japan
| | - Kei Nishiyama
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, 612-0861, Japan
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Saeednejad M, Zafarghandi M, Khalili N, Baigi V, Khormali M, Ghodsi Z, Sharif-Alhoseini M, O’Reilly GM, Naghdi K, Khaleghi-Nekou M, Piri SM, Rahimi-Movaghar V, Bahrami S, Laal M, Mohammadzadeh M, Fakharian E, Pirnejad H, Pahlavanhosseini H, Salamati P, Sadeghi-Bazargani H. Evaluating mechanism and severity of injuries among trauma patients admitted to Sina Hospital, the National Trauma Registry of Iran. Chin J Traumatol 2021; 24:153-158. [PMID: 33640244 PMCID: PMC8173574 DOI: 10.1016/j.cjtee.2021.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 12/23/2020] [Accepted: 01/15/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries. METHODS The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset. RESULTS The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0% vs. 43.5%, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8% vs. 12.9%, p = 0.003). CONCLUSION Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.
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Affiliation(s)
- Mina Saeednejad
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Narjes Khalili
- Preventive Medicine and Public Health Research Center, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Khormali
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gerard M. O’Reilly
- National Health and Medical Research Council (NHMRC), Australia, National Trauma Research Institute, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Khatereh Naghdi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Melika Khaleghi-Nekou
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed mohammad Piri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Bahrami
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Laal
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Esmaeil Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Habibollah Pirnejad
- Patient Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author.
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Noureldine MHA, Hartnett S, Zavadskiy G, Pressman E, Kim JK, Davis D, Ciesla D, Bull B, Agazzi S. Predicting neurosurgical clearance in the polytrauma patient with concomitant traumatic brain injury. J Clin Neurosci 2021; 89:51-55. [PMID: 34119294 DOI: 10.1016/j.jocn.2021.04.023] [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: 09/09/2020] [Revised: 03/02/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
The goal of this study is to develop a model based on previously used prognostic predictors in traumatic brain injury (TBI) patients with polytrauma, which will facilitate the decision-making of whether to clear these patients for non-cranial surgery. Data of eligible patients was obtained from a trauma database at a Level I trauma and academic tertiary referral center in the United States. The number of days seen by the neurosurgical service prior to clearance, injury severity score (ISS), post-trauma day 0 (PTD 0) of Glasgow Coma Score (GCS), intracranial pressure (ICP) score and computed tomography (CT) score, as well as the changes in GCS, ICP score and CT score between PTD 0 and day of clearance were the variables used in developing the model. The Neurosurgical Clearance Model (NCM) was developed using data from 50 patients included in the study. Patients were cleared by neurosurgeons 1.6 days later than it would appear possible based on a retrospective review of the patients' clinical conditions. A single model equation was developed, the ultimate result of which is a clearance probability value. The best cutoff clearance probability value was found to be 0.584 (or 58.4%) using Receiver Operator Characteristic curve analysis. Our data suggests that neurosurgeons are risk-averse in clearing polytrauma patients for non-cranial surgery. This pilot NCM, if reproduced and validated by other groups and in larger prospective studies, may become a useful tool to assist clinicians in this often-difficult decision-making process.
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Affiliation(s)
| | - Sara Hartnett
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Gleb Zavadskiy
- Muma College of Business, University of South Florida, Tampa, FL, USA
| | - Elliot Pressman
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Joon Kyung Kim
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Donald Davis
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of South Florida, Tampa, FL, USA
| | - David Ciesla
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Brooke Bull
- Division of Trauma and Acute Care Surgery, Department of Surgery, Tampa General Hospital, Tampa, FL, USA
| | - Siviero Agazzi
- Department of Surgery, University of South Florida, Tampa, FL, USA
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Jung PY, Chung JS, Youn Y, Kim CW, Park IH, Kim OH, Byun CS. Characteristics of pediatric thoracic trauma: in view of before and after the establishment of a regional trauma center. Eur J Trauma Emerg Surg 2021; 48:195-204. [PMID: 33813596 PMCID: PMC8019336 DOI: 10.1007/s00068-021-01658-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 03/21/2021] [Indexed: 12/31/2022]
Abstract
Purpose Pediatric thoracic trauma differs from those of adult in terms of the small anatomy and rapid tissue recovery. Therefore, it is important to know the characteristics of the pediatric thoracic trauma to improve treatment results. In addition, this study examined the changes in pediatric thoracic trauma features and results from the establishment of a level 1 regional trauma center.
Methods Data of 168 patients’ ≤ 15 years old diagnosed with thoracic trauma between 2008 and 2019 were retrospectively analyzed. Results Pedestrian traffic accidents were the most common cause of chest injury. The average injury severity score was 17.1 ± 12.4 and the average pediatric trauma score was 5.6 ± 4.1. Lung contusion was the most common in 134 cases. There were 48 cases of closed thoracostomy. There was one thoracotomy for cardiac laceration, one case for extracorporeal membranous oxygenation, and six cases for embolization. Of all, 25 patients died, providing a mortality rate of 14.9%. In addition, independent risk factors of in-hospital mortality were hemopneumothorax and cardiac contusion. Since 2014, when the level 1 regional trauma center was established, more severely injured thoracic trauma patients came. However, the mortality was similar in the two periods. Conclusions Understanding the clinical features of pediatric thoracic trauma patients can help in efficient treatment. In addition, as the severity of pediatric thoracic trauma patients has increased due to the establishment of the regional trauma center, so pediatric trauma center should be organized in regional trauma center to improve the outcomes of pediatric thoracic trauma. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-021-01658-4.
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Affiliation(s)
- Pil Young Jung
- Regional Trauma Center, Wonju Severance Christian Hospital, Wonju, Republic of Korea.,Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jae Sik Chung
- Regional Trauma Center, Wonju Severance Christian Hospital, Wonju, Republic of Korea.,Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Youngin Youn
- Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwon, 26426, Republic of Korea
| | - Chang Wan Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwon, 26426, Republic of Korea
| | - Il Hwan Park
- Regional Trauma Center, Wonju Severance Christian Hospital, Wonju, Republic of Korea.,Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwon, 26426, Republic of Korea
| | - Oh Hyun Kim
- Regional Trauma Center, Wonju Severance Christian Hospital, Wonju, Republic of Korea.,Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Chun Sung Byun
- Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwon, 26426, Republic of Korea.
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Mohanty CR, Radhakrishnan RV, Jain M, Sasmal PK, Hansda U, Vuppala SK, Doki SK. A Study of the Pattern of Injuries Sustained from Road Traffic Accidents Caused by Impact with Stray Animals. J Emerg Trauma Shock 2021; 14:23-27. [PMID: 33911432 PMCID: PMC8054802 DOI: 10.4103/jets.jets_29_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/07/2020] [Accepted: 07/07/2020] [Indexed: 11/04/2022] Open
Abstract
Background The incidence of road traffic accidents (RTA) is increasing every day, especially in developing nations. Amongst various attributable factors, the menace of the stray animals remains one of the most underrecognized factors leading to animal-vehicle collision (AVC). Objectives: Our prospective cross-sectional study aims to survey the incidence of RTA attributable to stray animals and record the pattern of injuries along with other epidemiological parameters. Methods The present study was conducted at a tertiary care trauma centre located in a major city of eastern India, between June 2019 and March 2020. Variables like demographic details, type of vehicle and injury with severity score, use of safety gear including types of stray animals were collected and analysed. Results A total of 185 patients had suffered RTA due to AVC during the study period. The median age of occurrence was 29.0 years. The evening was the most frequent time of accidents (4 PM to 8 PM) with two-wheelers affected in 92% of cases. Stray dogs account for 69% of cases followed by cattle 21% cases. 41% of all RTA victims had polytrauma. Patients with RTA due to impact with ox were found to have higher injury severity score (ISS). The ISS comparison between two-wheeler drivers with and without helmet and influence of alcohol were statistically significant (P<0.01). Conclusion The study highlights an alarming incidence of RTA due to stray animals roaming freely on roads, thus adding significant morbidity and costs to the society. There is a need of the hour for imposing stringent measures from the appropriate authority, including public awareness to make sustainable action plans to prevent animal homelessness and wander freely on streets and major roads.
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Affiliation(s)
- Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | - Mantu Jain
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prakash Kumar Sasmal
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Upendra Hansda
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sunil Krishna Vuppala
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sunil Kumar Doki
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Abback PS, Brouns K, Moyer JD, Holleville M, Hego C, Jeantrelle C, Bout H, Rennuit I, Foucrier A, Codorniu A, Jurcisin I, Paugam-Burtz C, Gauss T. ISS is not an appropriate tool to estimate overtriage. Eur J Trauma Emerg Surg 2021; 48:1061-1068. [PMID: 33725158 DOI: 10.1007/s00068-021-01637-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/17/2020] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this work is to study a cohort of patients of ISS < 15 admitted to a TC, and to determine the number of patients that ultimately benefited from the skills and resources specific of a level 1 trauma center. METHODS Retrospective study from a prospective cohort of patients admitted to TC (Beaujon Hospital, APHP) for suspected severe trauma from January 2011 to December 2017. The main outcome criterion was the use of surgery or interventional radiology within the first 24 h after admission of patients with ISS < 15. The secondary outcomes were stratified into severe (mortality, resuscitation care, length of stay in intensive care units) and non-severe criteria (mild head injury, hospital discharge or transfer within 24 h). RESULTS Of 3035 patients admitted during the study period, 1409 with an ISS < 15 were included, corresponding to a theoretical overtriage rate of 46.4%. Among these, 611 patients (43.4%) underwent emergency intervention within the first 24 h (586 surgical interventions, 19 direct transfers to the operating theater and 6 acts of interventional radiology), 238 (16.9%) of patients presented with severe and 531 (38%) with non-severe outcome criteria. CONCLUSION This work demonstrates that in a cohort of patients classified as ISS < 15 admitted to a TC, a considerable amount of TC-specific resources are required, and patients present with severe outcome criteria despite being classified as overtriaged. These results suggest that triage of trauma patients should be based on resource use and clinical outcome rather than anatomic criteria.
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Affiliation(s)
- Paër-Sélim Abback
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France.
| | - Kelly Brouns
- Department of Anaesthesia and Intensive Care, Robert-Debré University Hospital, APHP, Paris, France
| | - Jean-Denis Moyer
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Mathilde Holleville
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Camille Hego
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Caroline Jeantrelle
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Hélène Bout
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Isabelle Rennuit
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Arnaud Foucrier
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Anaïs Codorniu
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Igor Jurcisin
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Catherine Paugam-Burtz
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France.,Université de Paris, Paris, France
| | - Tobias Gauss
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France
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Cuevas-Østrem M, Røise O, Wisborg T, Jeppesen E. Epidemiology of geriatric trauma patients in Norway: A nationwide analysis of Norwegian Trauma Registry data, 2015-2018. A retrospective cohort study. Injury 2021; 52:450-459. [PMID: 33243523 DOI: 10.1016/j.injury.2020.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/20/2020] [Accepted: 11/01/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Geriatric patients have a high risk of poor outcomes after trauma and is a rapid-increasing group within the trauma population. Given the need to ensure that the trauma system is targeted, efficient, accessible, safe and responsive to all age groups the aim of the present study was to explore the epidemiology and characteristics of the Norwegian geriatric trauma population and assess differences between age groups within a national trauma system. MATERIALS AND METHODS This retrospective analysis is based on data from the Norwegian Trauma Registry (2015-2018). Injury severity was scaled using the Abbreviated Injury Scale (AIS), and the New Injury Severity Score (NISS). Trauma patients 16 years or older with NISS ≥9 were included, dichotomized into age groups 16-64 years (Group 1, G1) and ≥65 years (Group 2, G2). The groups were compared with respect to differences in demographics, injury characteristics, management and outcome. Descriptive statistics and relevant parametric and non-parametric tests were used. RESULTS Geriatric patients proved to be at risk of sustaining severe injuries. Low-energy falls predominated in G2, and the AIS body regions 'Head' and 'Pelvis and lower extremities' were most frequently injured. Crude 30-day mortality was higher in G2 compared to G1 (G1: 2.9 vs. G2: 13.6%, P<0.01) and the trauma team activation (TTA) rate was lower (G1: 90 vs. G2: 73%, P<0.01). A lower proportion of geriatric patients were treated by a physician prehospitally (G1: 30 vs. G2: 18%, [NISS 15-24], P<0.01) and transported by air-ambulance (G1: 24 vs. G2: 14%, [NISS 15-24], P<0.01). Median time from alarm to hospital admission was longer for geriatric patients (G1: 71 vs. G2: 78 min [NISS 15-24], P<0.01), except for the most severely injured patients (NISS≥25). CONCLUSION In this nationwide study comparing adult and geriatric trauma patients, geriatric patients were found to have a higher mortality, receive less frequently advanced prehospital treatment and transportation, and a lower TTA rate. This is surprising in the setting of a Nordic country with free access to publicly funded emergency services, a nationally implemented trauma system with requirements to pre- and in-hospital services and a national trauma registry with high individual level coverage from all trauma-receiving hospitals. Further exploration and a deeper understanding of these differences is warranted.
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Affiliation(s)
- Mathias Cuevas-Østrem
- Faculty of Health Sciences, University of Stavanger, Norway; Department of Research, Norwegian Air Ambulance Foundation, NO-0103 Oslo, Norway.
| | - Olav Røise
- Faculty of Health Sciences, University of Stavanger, Norway; Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torben Wisborg
- Anesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway; Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway
| | - Elisabeth Jeppesen
- Faculty of Health Sciences, University of Stavanger, Norway; Department of Research, Norwegian Air Ambulance Foundation, NO-0103 Oslo, Norway
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Taylor R, McCrea A, Poldiak NP, Muertos K, Biswas S, Kaufmann C. Trauma Recidivism in an Aging Population: Who Is Most at Risk? HCA Healthc J Med 2021; 2:63-69. [PMID: 37424893 PMCID: PMC10324728 DOI: 10.36518/2689-0216.1121] [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] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background Repeated episodes of trauma, particularly in older adults, result in increased morbidity and mortality. This study investigates trauma recidivism in our adult population to identify which patients in our region are more likely to become recidivists. Materials and Methods This 4 year retrospective study (2013 to 2017) examines all patients 18 years of age or older with multiple hospital admissions for trauma, comparing patients ages 65 and older (older adults) to those ages 18 to 64 (younger adults). Exclusion criteria consisted of those younger than 18 and/or had a home zip code outside of the study region. Data included admission demographics, injury characteristics and other clinical metrics. Results There were 240 younger adult and 182 older adult trauma recidivists included. In total, 4% of all patients were recidivists with significantly higher rates of recidivism among older adults (OR: 1.94 [1.59-2.36], p <0.001). Older adult recidivists were more likely to be female (OR: 4.28 [2.82-6.51], p <0.001) and suffer blunt trauma secondary to a fall (OR: 5.36 [3.91-7.35], p <0.001). Trauma recidivism in older adults also correlated with a higher Injury Severity Score, longer length of stay and an increased proportion of patients requiring to be discharged home with organizational help or to a rehabilitation facility. Conclusions Trauma can be recurrent and associated with poor health outcomes, particularly in older adults. Recidivists in the studied region were significantly older with the most at-risk population consisting of females suffering blunt injury secondary to a fall. Improved prevention strategies are needed for this population.
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Affiliation(s)
- Ryan Taylor
- University of South Carolina School of Medicine, Columbia, SC
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