What factors affect length of hospital stay among trauma patients? A single-center study, Southwestern Iran

Extremity fractures, attempted suicide, blood transfusion and thromboembolic events are independent risk factors for a prolonged hospital stay in severely injured elderly

METHODS

Due to demographic change, the number of polytraumatized geriatric patients (> 64 years) is expected to further increase in the coming years. In addition to the particularities of the accident and the associated injury patterns, prolonged inpatient stays are regularly observed in this group. The aim of the evaluation is to identify further factors that cause prolonged inpatient stays. A study of the data from the TraumaRegister DGU® from 2016-2020 was performed. Inclusion criteria were an age of over 64 years, intensive care treatment in the GAS-region, and an Injury Severity Score (ISS) of at least 16 points. All patients who were above the 80th percentile for the average length of stay or average intensive care stay of the study population were defined as so-called long-stay patients. This resulted in a prolonged inpatient stay of > 25 days and an intensive care stay of > 13 days. Among other, the influence of the cause of the accident, injury patterns according to body regions, the occurrence of complications, and the influence of numerous clinical parameters were examined.

RESULTS

A total of 23,026 patients with a mean age of 76.6 years and a mean ISS of 24 points were included. Mean ICU length of stay was 11 ± 12.9 days (regular length of stay: 3.9 ± 3.1d vs. prolonged length of stay: 12.8 ± 5.7d) and mean inpatient stay was 22.5 ± 18.9 days (regular length of stay: 20.7 ± 15d vs. 35.7 ± 22.3d). A total of n = 6,447 patients met the criteria for a prolonged length of stay. Among these, patients had one more diagnosis on average (4.6 vs. 5.8 diagnoses) and had a higher ISS (21.8 ± 6 pts. vs. 26.9 ± 9.5 pts.) Independent risk factors for prolonged length of stay were intubation duration greater than 6 days (30-fold increased risk), occurrence of sepsis (4x), attempted suicide (3x), presence of extremity injury (2.3x), occurrence of a thromboembolic event (2.7x), and administration of red blood cell concentrates in the resuscitation room (1.9x).

CONCLUSIONS

The present analysis identified numerous independent risk factors for significantly prolonged hospitalization of the geriatric polytraumatized patient, which should be given increased attention during treatment. In particular, the need for a smooth transition to psychiatric follow-up treatment or patient-adapted rehabilitative care for geriatric patients with prolonged immobility after extremity injuries is emphasized by these results.

Pattern of admission, outcome and predictors of trauma patients visiting the surgical emergency department in comprehensive specialized hospital: a retrospective follow-up study

Background

Traumatic injuries represent a huge burden in the developing world, and a significant proportion has found in low-income and middle-income countries. However, the pattern, outcome and factors of injury varies from setup to setup and is less studied in public health problems.

Objective

To assess pattern of admission, outcome and its predictors among trauma patients visiting the surgical emergency department in a comprehensive specialized hospital.

Methods

A retrospective follow-up study was conducted, and data were taken from the medical records of patients from 2019 to 2021. A simple random sampling technique was used to get a sample size of 386 from injured patient charts. Data were entered into Epi-Data version 4.6 software and exported to STATA version 14.1 for analysis. The dependent variable was injured patient's outcome, which could be died or not died. The independent variables with P value less than 0.25 in the bi-variable regression analysis were considered for the multivariable regression. Adjusted odds ratio (AOR) with the 95% CI were used to declare statistical significance.

Result

About 13.99% of injured patients with (95% CI: 10, 17) had died during the study period. The leading cause of injury was assault (62.44%) followed by road traffic accidents (26.17%). Severe Glasgow Coma Scale (AOR 6.6; 95% CI: 2.6-16.4), length of hospital stay more than or equal to 7 days (AOR=2.8; 95% CI: 1.2-6.2), time of arrival in between 1 and 24 h (AOR=0.15; 95% CI: 0.06-0.37), and upper trunk injury (AOR=6.3; 95% CI: 1.3-28.5) were significantly associated with mortality.

Conclusion and recommendation

Mortality after traumatic injury was considerably high. Severe Glasgow Coma Scale, Length of hospital stay more than or equal to 7 days, time of arrival in between 1 and 24 h, and upper trunk injury were the associated factors for mortality. Priority should be given for injured patients with decreased levels of consciousness and upper trunk injury. The establishment of organized pre-hospital emergency services and provision of timely arrival is recommended. The authors recommend prospective follow-up study.

Impact of comorbidities in severely injured patients with blunt chest injury: A population-based retrospective cohort study

INTRODUCTION

Blunt chest injuries result in up to 10 % of major trauma admissions. Comorbidities can complicate recovery and increase the mortality rate in this patient cohort. A better understanding of the association between comorbidities and patient outcomes will facilitate enhanced models of care for particularly vulnerable groups of patients, such as older adults.

AIMS

i) compare the characteristics of severely injured patients with blunt chest injury with and without comorbidities and ii) examine the relationship between comorbidities and key patient outcomes: prolonged length of stay, re-admission within 28 days, and mortality within 30 days in a cohort of patients with blunt chest injury admitted after severe trauma.

METHODS

A retrospective cohort study using linked data from the NSW Trauma Registry and NSW mortality and hospitalisation records between 1st of January 2012 and 31st of December 2019.

RESULTS

After adjusting for potential confounding factors, patients with severe injuries, chest injuries, and comorbidities were found to have a 34 % increased likelihood of having a prolonged length of stay (OR = 1.34, 95 %I = 1.17-1.53) compared to patients with no comorbidities. There was no difference in 30-day mortality for patients with a severe chest injury who did or did not have comorbidities (OR = 1.05, 95 %CI = 0.80-1.39). No significant association was found between comorbidities and re-admission within 28 days.

CONCLUSION

Severely injured patients with blunt chest injury and comorbidities are at risk of prolonged length of stay.

Prolonged time to recovery and its predictors among trauma patients admitted to the intensive care units in comprehensive specialized hospitals in Northwest Ethiopia: a multicenter retrospective follow-up study, 2022

Introduction

A prolonged time to recovery in the intensive care units has adverse effects on both the patients and the healthcare providers. However, there is limited evidence in African countries, including Ethiopia. Therefore, this study aimed to assess the time to recovery and its predictors among trauma patients admitted to intensive care units.

Methods

An institutional-based retrospective follow-up study was conducted on trauma patients hospitalized in intensive care units between 9 January 2019 and 8 January 2022. The charts of 450 patients were chosen using a simple random sampling technique. Data collection was conducted using smartphones and tablets. The data were then exported into STATA version 16 for analysis. The log-rank test and the Kaplan-Meier survival curve were fitted for analysis. An adjusted hazard ratio with 95% confidence intervals was reported to declare the strength of association between time to recovery and predictors in the multivariable Weibull regression analysis.

Results

The overall incidence density rate of recovery was 6.53 per 100 person-day observations, with a median time to recovery of 10 days. Significant predictors of time to recovery included being on mechanical ventilation (AHR = 0.47, 95% CI: 0.34, 0.64), having a Glasgow Coma Scale (GCS) score between 9-12 and 13-15 (AHR = 1.58, 95% CI: 1.01, 2.47, and AHR = 1.66, 95% CI: 1.09, 2.53, respectively), experiencing polytrauma (AHR = 0.55, 95% CI: 0.39, 0.78), and having complications (AHR = 0.43, 95% CI: 0.31, 0.59).

Conclusion and recommendations

The incidence rate of recovery for trauma patients is lower than the national standard, and the median time to recovery is longer. Being on mechanical ventilation, mild and moderate GCS scores, polytrauma, and the presence of complications were significantly associated with prolonged time to recovery. Therefore, special attention has to be given to trauma patients who had polytrauma, complications, received mechanical ventilation, and had a lower GCS score.

The predictive value of the Kampala Trauma Score (KTS) in the outcome of multi-traumatic patients compared to the estimated Injury Severity Score (eISS)

PURPOSE

The classification of trauma patients in emergency settings is a constant challenge for physicians. However, the Injury Severity Score (ISS) is widely used in developed countries, it may be difficult to perform it in low- and middle-income countries (LMIC). As a result, the ISS was calculated using an estimated methodology that has been described and validated in a high-income country previously. In addition, a simple scoring tool called the Kampala Trauma Score (KTS) was developed recently. The aim of this study was to compare the diagnostic accuracy of KTS and estimated ISS (eISS) in order to achieve a valid and efficient scoring system in our resource-limited setting.

METHODS

We conducted a cross-sectional study between December 2020 and March 2021 among the multi-trauma patients who presented at the emergency department of Imam Reza hospital, Tabriz, Iran. After obtaining informed consent, all data including age, sex, mechanism of injury, GCS, KTS, eISS, final outcome (including death, morbidity, or discharge), and length of hospital stay were collected and entered into SPSS version 27.0 and analyzed.

RESULTS

381 multi-trauma patients participated in the study. The area under the curve for prediction of mortality (AUC) for KTS was 0.923 (95%CI: 0.888-0.958) and for eISS was 0.910 (95% CI: 0.877-0.944). For the mortality, comparing the AUCs by the Delong test, the difference between areas was not statistically significant (p value = 0.356). The diagnostic odds ratio (DOR) for the prediction of mortality KTS and eISS were 28.27 and 32.00, respectively.

CONCLUSION

In our study population, the KTS has similar accuracy in predicting the mortality of multi-trauma patients compared to the eISS.

Branching Out: A Retrospective Review of Tree Fall-Related Trauma

Introduction Falls from trees (FFTs), although rare, represent a significant public health concern due to the severe consequences they can impose. Such incidents, while statistically uncommon across the wider population, have the potential to cause drastic, lasting alterations in patients' lives. The severity of these events is often substantial, highlighted by high Injury Severity Scores (ISSs) and prolonged hospital length of stay (LOS), which brings to light the urgent need for preventive strategies and heightened awareness. Our study aims to present a current epidemiological understanding of the patterns, nature, and severity of injuries caused by FFTs. Additionally, it provides an analysis and comparison of data obtained from a de-identified trauma database of patients presenting after FFTs. Methods This review presents data from a trauma registry system detailing trauma admissions from March 31, 2016, to December 27, 2021, at the Desert Regional Medical Center in Palm Springs, California, United States, a designated Level 1 trauma center. Throughout this period of nearly five years and eight months, a total of 3,148 patients were recorded to have visited the emergency department due to falls. Specifically, the study zeroes in on the subset of patients who were admitted after experiencing FFTs. From the comprehensive retrospective examination, it was noted that among the 3,148 fall incidents, there were 50 cases that involved FFTs. Results This retrospective analysis focused on 50 patients treated at the emergency department after FFTs, with a predominantly male demographic profile of 49 (98%) and an average age of 44 years. Hospitalization was required for the vast majority (44%), with approximately one-third necessitating ICU care. Surgical procedures were necessary for 35 (70%) of these cases. Upon discharge, 36 (72% of patients) were able to return home. Vertebral fractures were the most frequent injury, present in 24 (22% of admissions), followed closely by soft tissue injuries at 23 (21%). The mean ISS was 11, although those with extended hospital stays of over 10 days had higher ISS scores of 16, in contrast to an ISS of 10 for those with shorter stays. Conclusions FFTs constitute a lesser-known category of trauma-related injuries in the broader spectrum of fall-related incidents. Although relatively infrequent, these incidents result in significant injury burdens. The objective of this review is to compile and summarize the existing body of literature on FFTs. It involves an in-depth analysis of admission, discharge, and demographic data related to FFTs, highlighting the significant consequences associated with such accidents. Additionally, this review incorporates an analysis of a specialized dataset dedicated to injuries resulting from FFTs, facilitating a comparative assessment against current research in this field.

Health-related quality of life following trauma: Prevalence of problems and factors associated with six-month outcomes in a New Zealand cohort

Injury is a leading cause of health loss in Aotearoa me Te Waipounamu (New Zealand; NZ). The NZ Trauma Registry was established in 2015 to monitor outcomes in those experiencing severe injury and to identify ways of improving the quality of care for these patients. Few NZ studies have assessed outcomes in trauma patients using patient-reported outcome measures (PROMs) despite increasing recognition that the impacts of injury are better understood through PROMs. Our aim was to estimate the prevalence of self-reported problems with health-related quality of life (HRQoL) outcomes six months post-injury, and identify factors associated with these, in a cohort of Māori (the Indigenous population of NZ) and non-Māori individuals who had experienced major trauma. HRQoL outcomes were measured according to the five dimensions of the EQ-5D-5L. This information, along with sociodemographic data, was collected via structured telephone interviews. Participants (n = 870), aged 16 years or more, were recruited following admission to a trauma hospital in one of three (of NZ's four) trauma regions. Multivariable models were developed using modified Poisson Regression to identify factors associated with outcomes for both Māori and non-Māori patients. The prevalence and severity of problems across each of the five EQ-5D-5L dimensions was similar for Māori and non-Māori except for Anxiety/Depression. The prevalence and severity of problems with Anxiety/Depression was greater for Māori. Factors associated with HRQoL problems at six-months were also largely similar for each cohort. Those commonly associated with outcomes were age, hospital length of stay, adequacy of household income, and participants' expectations regarding recovery from injury. Further research examining recovery expectations in trauma patients to determine which factors contribute to formulating recovery expectations, and the potential impact of recovery expectations on treatment and rehabilitation, would be of value. Should expectations, at least in part, influence HRQoL outcomes, then routinely collecting data on patients' recovery expectations, adequacy of household income and potential barriers to treatment and rehabilitation, could help inform post-hospital treatment plans, and identify those who may require additional support following discharge from hospital.

Trauma Profile in Shahroud: An 8-Year Report of a Hospital-Based Trauma Registry

BACKGROUND

Trauma is a significant public health concern in Iran, with high mortality and morbidity rates. This study aimed to assess trauma patients' profiles in Shahroud, Iran. Study Design: A cross-sectional study.

METHODS

The study involved trauma patients who met specific criteria at Imam Hossein hospital in Shahroud, Iran, between 2016 and 2023, using the National Trauma Registry of Iran (NTRI). The relationship between injury characteristics and the cause of injury was analyzed using chi-square test and post hoc analysis. Quintile regression models assessed the association of demographic and clinical variables with length of stay.

RESULTS

Among 3513 trauma patients, road traffic crashes (RTCs) had a higher percentage of injuries with the Glasgow Coma Scale (GCS) between 9 and 12 (1.7%) compared to falls (0.3%) (P<0.001). Falls caused more moderate cases with injury severity scores (ISS) ranging from 9 to 15 (22.7%) than RTCs (17.1%) (P<0.001). RTC-related injuries required more ventilation (2.7%) and intensive care unit (ICU) admissions (11.1%) than falls (P<0.001). After adjusting for age, GCS, ISS, and body region, fall had a median length of stay nine hours shorter than RTCs (95% CI = -16.2, -1.8).

CONCLUSION

Significant injury pattern differences were observed between RTCs and falls. RTCs had higher frequencies of injuries resulting in GCS scores between 9 and 12, while falls had higher frequencies of moderate ISS scores. In addition, patients with RTC-related injuries required more mechanical ventilation and ICU admissions. Moreover, after adjusting for various factors, patients with RTC-related injuries had a significantly longer hospital stay compared to those with fall-related injuries.

Falls From Heights: A Retrospective Review of Roof Fall-Related Trauma

Background Falls from roofs (FFRs), while constituting just a segment of all falls, pose a significant public health issue. They not only impact individuals in their daily lives but also pose an increased risk in the construction field. The consequences of these falls range broadly, from minor bruises to serious harm, potentially leading to chronic disability or fatality. For the general populace, such falls might happen during simple activities like maintenance, with outcomes varying from fractures to critical head or spinal injuries. In construction, where elevated work is the norm, the likelihood and potential severity of falls are significantly greater. Construction workers face the threat of falls regularly, with these mishaps often resulting in enduring disabilities that affect both life quality and work capability. Methodology This study presents data from a trauma registry system, covering trauma admissions from March 31, 2016, to December 27, 2021, at a level 1 trauma center (Desert Regional Medical Center, Palm Springs, CA). During this five-year and eight-month period, a total of 3,148 patients presented to the emergency department after a fall. This study focuses on patients admitted after an FFR. A retrospective analysis of this data showed that out of these 3,148 patients, 75 presented after an FFR. Results In this retrospective analysis of 75 patients presenting to the emergency department after an FFR, the patient profile was predominantly male (70, 93%), with an average age of 51 years. Hospitalization was required for the majority of the patients (70, 93%), with a third necessitating intensive care unit (ICU) care. The necessity for surgical procedures was high at 57 (76%). Upon discharge, 8 (11%) patients were moved to acute rehabilitation. Injuries to the extremities were most common, accounting for 21% (36) of cases, in contrast to facial injuries at 8% (15). Upper extremity fractures were the most prevalent presenting injury at 31% (50), while lower extremity fractures were the least at 6% (9). The overall Injury Severity Score (ISS) averaged 12, with patients having hospital length of stays (LOSs) over 10 days presenting higher ISS scores (18) compared to those with shorter stays (ISS of 11). There was no significant difference in ISS between patients aged 60 and above compared to younger patients. Conclusions FFRs represent a substantial cause of injury in both the construction industry and residential settings. This study aims to provide an overview and summary of the existing literature on FFRs, present effective fall prevention methods, and underscore the considerable consequences of such injuries on both construction workers and homeowners. Additionally, it includes an analysis of a dataset detailing injuries resulting from roof-related falls, offering a comparison to existing research.

Attempted Suicide Is Independently Associated with Increased In-Hospital Mortality and Hospital Length of Stay among Injured Patients at Community Tertiary Hospital in Japan: A Retrospective Study with Propensity Score Matching Analysis

Suicide is an increasingly important public healthcare concern worldwide. Studies examining the effect of attempted suicide on clinical outcomes among patients with trauma are scarce. We conducted a retrospective cohort study at a community emergency department in Japan. We included all severely injured patients with an Injury Severity Score > 15 from January 2002 to December 2021. The primary outcome measure was in-hospital mortality. The other outcome of interest was hospital length of stay. One-to-one propensity score matching was performed to compare these outcomes between suicide attempt and no suicide attempt groups. Of the 2714 eligible patients, 183 (6.7%) had trauma caused by a suicide attempt. In the propensity score-matched analysis with 139 pairs, the suicide attempt group showed a significant increase in-hospital mortality (20.9% vs. 37.4%; odds ratio 2.27; 95% confidence intervals 1.33-3.87) compared with the no suicide attempt group. Among survivors, the median hospital length of stay was significantly longer in the suicide attempt group than that in the no suicide attempt group (9 days vs. 12 days, p = 0.0076). Because of the unfavorable consequences and potential need for additional healthcare, increased attention should be paid to patients with trauma caused by a suicide attempt.

Investigating Length of Stay Patterns and Its Predictors in the South Wales Trauma Network

Background

Length of stay (LOS) is frequently employed as a performance metric for trauma care. Following the establishment of the trauma network worldwide, the assessment and prediction of LOS in different levels of trauma centres have been extensively studied. However, assessing the total patient length of stay from a whole trauma network perspective is unclear. The objective of this study was to systematically analyse the overall Length of Stay (LOS) pattern within the SWTN before its establishment and in the immediate time after its foundation and, secondly, to assess the association between relevant impact factors and LOS.

Methodology

A retrospective secondary analysis based on the trauma admission dataset from Trauma Audit and Research Network(TARN) dataset was conducted. The studied sample covered around 18000 patients admitted to trauma centres from South Wales Major trauma network between January 2012 and October 2021. The primary outcome is the total length of stay in the trauma network. Statistical tests were applied to examine the difference between normal and outlier LOS. Data visualisation was utilised to demonstrate the LOS patterns and potential association between LOS and relevant demographic and clinical predictors.

Results

The distribution of length of stay in SWTN follows a right-skewed distribution with a median of 10 (IQR, 5-18) and a mean of 15.92 days. There were 1520 patients with outliers for LOS. A significant difference (p¡ 0.05) was found between the normal and outlier groups of LOS based on demographic (age, gender and residential information) and clinical characteristics(ward type, maximum of anatomically-based injury severity score(AIS) and probability of survival). Age group, maximum AIS score on specific injured region, ward type and its interaction effect with the number of admissions may associated with the LOS. Specifically, patients admitted to the geriatric ward exhibited notably prolonged LOS, and individuals with more than 2 admissions to long-term care and recovery-related wards such as neurosurgical rehabilitation, spinal injuries and burns wards also displayed elevated LOS.

Conclusion

Our finding supports prior evidence indicating elderly people are vulnerable to longer stays. Moreover, concerning the types of admission wards, patients admitted to rehabilitation wards who underwent more than 2 hospitalisations also faced an increased risk of prolonged stay. Based on these results, policymakers and healthcare providers should contemplate expanding the allocation of medical resources to this demographic to mitigate the length of stay and optimise associated healthcare costs.

Development and Validation of Two Prediction Models for 72-Hour Mortality in High-Risk Trauma Patients Using a Benchmark Dataset: A Comparative Study of Logistic Regression and Neural Networks Models

Background Many studies have been conducted to develop scoring systems for trauma patients, with the majority using logistic regression (LR) models. Neural networks (NN), which is a machine learning algorithm, has a potential to increase the performance of these models. Objectives The aim of this study was to develop and validate two separate prediction models for 72-hour mortality of high-risk trauma patients using LR and NN and to compare the performances of these models in detail. We also aimed to share the SPSS calculators for our models. Materials and methods This is a retrospective, single-center study conducted using a benchmark dataset where the patients were retrospectively gathered from a level 1 trauma center. Patients older than 18 years of age, who had multiple injuries, and were treated at the University Hospital Zurich between January 1, 1996, and January 1, 2013, were included. Patients with a condition that may have an impact on the musculoskeletal system, with Injury Severity Score<16, and with missing outcome data were excluded. Results A total of 3,075 patients were included in the analysis. The area under the curve values of the LR and NN models for predicting 72-hour mortality in patients with high-risk trauma in the hold-out cohort were 0.859 (95% CI=0.836 to 0.883) and 0.856 (95% CI=0.831 to 0.880), respectively. There was no statistically significant difference in the performance of the models (p = 0.554, DeLong's test). Conclusion Both of the models showed good discrimination. Our study suggests that the NN and LR models we developed hold promise as screening tools for predicting 72-hour mortality in high-risk trauma patients. These models were made available to clinicians as clinical prediction tools via SPSS calculators. However, further external validation studies in diverse populations are necessary to substantiate their clinical utility. Moreover, in subsequent studies, it would be beneficial to derive NN models with substantial events per predictor variable to attain more robust and greater predictive accuracy. If the dataset is relatively limited, using LR seems to be a viable alternative.

Insurance status and traumatized patients' outcomes: a report from the national trauma registry of Iran

BACKGROUND

Trauma care is one of the most expensive medical procedures that is significantly affected by factors like insurance status. Providing medical care to injured patients has a significant impact on patients' prognosis. This study examined whether insurance status was associated with different outcomes, including hospital length of stay (HLOS), mortality, and Intensive Care Unit (ICU) admission.

METHODS

This prospective study analyzed the data of traumatized patients who had been registered in the National Trauma Registry of Iran (NTRI), and hospitalized at Sina Hospital, Tehran, Iran, from March 22, 2016, to February 8, 2021. Given the type of insurance, the insured patients were classified as basic, road traffic, and foreign nationality. The outcomes of in-hospital death, ICU admission, and HLOS between insured and uninsured patients, and then different insurance statuses, were compared using regression models.

RESULT

A total of 5014 patients were included in the study. 49% of patients (n = 2458) had road traffic insurance, 35.2% (n = 1766) basic insurance, 10.5% (n = 528) were uninsured, and 5.2% (n = 262) had foreign nationality insurance. The mean age of patients with basic, road traffic insurance, foreign nationality, and uninsured patients was 45.2 (SD = 22.3), 37.8 (SD = 15.8), 27.8 (SD = 13.3), and 32.4 (SD = 11.9) years, respectively. There was a statistically significant association between insurance status and mean age. Based on these results, the mean age of patients with basic insurance was higher than other groups (p < 0.001). Additionally, 85.6% of the patients were male, with male to female ratio of 9.64 in road traffic insurance, 2.99 in basic insurance, 14.4 in foreign nationality, and 16 in uninsured patients. There was no statistically significant difference between in-hospital mortality in insured and uninsured patients, 98 (2.3%) vs. 12 (2.3%), respectively. The odds of in-hospital mortality in uninsured patients were 1.04 times the odds of in-hospital death in insured patients [Crude OR: 1.04, 95%CI: 0.58 to 1.90]. Multiple logistic regression showed that after adjusting for age, sex, ISS, and Cause of trauma, the odds of in-hospital death in uninsured patients were 2.97 times the odds of in-hospital death in insured patients [adjusted OR: 2.97, 95%CI: 1.43 to 6.21].

CONCLUSION

This study shows that having insurance can change the ICU admission, death, and HLOS in traumatized patients. The results of this study can provide essential data for national health policy for minimizing the disparities among different insurance statuses and proper use of medical resources.

Hospital mortality prediction in traumatic injuries patients: comparing different SMOTE-based machine learning algorithms

BACKGROUND

Trauma is one of the most critical public health issues worldwide, leading to death and disability and influencing all age groups. Therefore, there is great interest in models for predicting mortality in trauma patients admitted to the ICU. The main objective of the present study is to develop and evaluate SMOTE-based machine-learning tools for predicting hospital mortality in trauma patients with imbalanced data.

METHODS

This retrospective cohort study was conducted on 126 trauma patients admitted to an intensive care unit at Besat hospital in Hamadan Province, western Iran, from March 2020 to March 2021. Data were extracted from the medical information records of patients. According to the imbalanced property of the data, SMOTE techniques, namely SMOTE, Borderline-SMOTE1, Borderline-SMOTE2, SMOTE-NC, and SVM-SMOTE, were used for primary preprocessing. Then, the Decision Tree (DT), Random Forest (RF), Naive Bayes (NB), Artificial Neural Network (ANN), Support Vector Machine (SVM), and Extreme Gradient Boosting (XGBoost) methods were used to predict patients' hospital mortality with traumatic injuries. The performance of the methods used was evaluated by sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), accuracy, Area Under the Curve (AUC), Geometric Mean (G-means), F1 score, and P-value of McNemar's test.

RESULTS

Of the 126 patients admitted to an ICU, 117 (92.9%) survived and 9 (7.1%) died. The mean follow-up time from the date of trauma to the date of outcome was 3.98 ± 4.65 days. The performance of ML algorithms is not good with imbalanced data, whereas the performance of SMOTE-based ML algorithms is significantly improved. The mean area under the ROC curve (AUC) of all SMOTE-based models was more than 91%. F1-score and G-means before balancing the dataset were below 70% for all ML models except ANN. In contrast, F1-score and G-means for the balanced datasets reached more than 90% for all SMOTE-based models. Among all SMOTE-based ML methods, RF and ANN based on SMOTE and XGBoost based on SMOTE-NC achieved the highest value for all evaluation criteria.

CONCLUSIONS

This study has shown that SMOTE-based ML algorithms better predict outcomes in traumatic injuries than ML algorithms. They have the potential to assist ICU physicians in making clinical decisions.

Association between major trauma centre care and outcomes of adult patients injured by low falls in England and Wales

BACKGROUND

Disability and death due to low falls is increasing worldwide and disproportionately affects older adults. Current trauma systems were not designed to suit the needs of these patients. This study assessed the association between major trauma centre (MTC) care and outcomes in adult patients injured by low falls.

METHODS

Data were obtained from the Trauma Audit and Research Network on adult patients injured by falls from <2 m between 2017 and 2019 in England and Wales. 30-day survival, length of hospital stay and discharge destination were compared between MTCs and trauma units or local emergency hospitals (TU/LEHs) using an adjusted multiple logistic regression model.

RESULTS

127 334 patients were included, of whom 27.6% attended an MTC. The median age was 79.4 years (IQR 64.5-87.2 years), and 74.2% of patients were aged >65 years. MTC care was not associated with improved 30-day survival (adjusted OR (AOR) 0.91, 95% CI 0.87 to 0.96, p<0.001). Transferred patients had a significant impact on the results. After excluding transferred patients, MTC care was associated with greater odds of 30-day survival (AOR 1.056, 95% CI 1.001 to 1.113, p=0.044). MTC care was also associated with greater odds of 30-day survival in the most severely injured patients (AOR 1.126, 95% CI 1.04 to 1.22, p=0.002), but not in patients aged >65 years (AOR 1.038, 95% CI 0.982 to 1.097, p=0.184).

CONCLUSION

MTC care was not associated with improved survival compared with TU/LEH care in the whole cohort. Patients who were transferred had a significant impact on the results. In patients who are not transferred, MTC care is associated with greater odds of 30-day survival in the whole cohort and in the most severely injured patients. Future research must determine the optimum means of identifying patients in need of higher-level care, the components of care which improve patient outcomes, develop patient-focused outcomes which reflect the characteristics and priorities of contemporary trauma patients, and investigate the need for transfer in specific subgroups of patients.

The Causes and Prevalence of Maxillofacial Fractures in Iran: A Systematic Review

Background

Maxillofacial fractures are a common type of injury that can result in significant morbidity and mortality. We aimed to systematically review the literature on the prevalence and causes of maxillofacial fractures in Iran to estimate the overall prevalence of maxillofacial fractures and the most common causes.

Methods

A systematic search of PubMed, Cochrane Library, Web of Science (WS) and Google Scholar (GS) electronic databases was conducted to identify relevant articles published up to January 2023. Studies reporting the prevalence and causes of maxillofacial fractures in Iran were included in the analysis. MOOSE guidelines were adopted for the current systematic review. No data or language restriction were applied. Risk of bias across the articles was assessed.

Results

A total of 32 studies comprising 35,720 patients were included in the analysis. The most common cause of maxillofacial fractures was road traffic accidents (RTAs), accounting for 68.97% of all cases, followed by falls (12.62%) and interpersonal violence (9.03%). The prevalence of maxillofacial fractures was higher in males (81.04%) and in the age group of 21-30 years (43.23%). Risk of bias across studies was considered low.

Conclusion

Maxillofacial fractures are a significant public health problem in Iran, with a high prevalence and RTAs being the leading cause. These results highlight the need for increased efforts to prevent maxillofacial fractures in Iran, especially through measures to reduce the incidence of RTAs.

A data fusion approach of police-hospital linked data to examine injury severity of motor vehicle crashes

Injury severity studies typically rely on police-reported crash data to examine risk factors associated with traffic injuries. The police crash database includes essential information on roadways, crashes and driver-vehicle characteristics but may not contain accurate and sufficient information on traffic injuries. Despite sizable efforts on injury severity modelling, very few studies have employed hospital records to classify injury severities accurately. As such, the inferences drawn from the police-recorded injury severity classifications may be questionable. This study investigates factors affecting road traffic injuries of motor vehicle crashes in two approaches (1) police-reported injury severity data and (2) a data fusion approach linking police and hospital records. Data from 2015 to 2019 were collected from the Abu Dhabi Traffic Police Department and linked with hospital records by the Department of Health, Abu Dhabi. A total of 6,333 casualty crashes were categorised into non-severe, severe, and fatal crashes following police-reported data and non-hospitalised, hospitalised and fatal crashes based on the police-hospital linked data. The state-of-the-art random thresholds random parameters hierarchical ordered Probit models were then employed to examine the differences in factors affecting crash-injury severities between police-reported and police-hospital linked data. While there are similarities between these two approaches, there are numerous notable differences in injury severity factors. For instance, head-on collisions are associated with high crash-injury severities in the model with police-hospital linked data, but they tend to show low injury severities in the model with police-reported data. In addition, the police-reported approach identifies that crashes occurred in remote areas and angle collisions are associated with low injury severities, which is not intuitive. These findings highlight that modelling the misclassified injury severity in police crash data may lead to wrong estimations and misleading inferences. Instead, the data fusion approach of police-hospital linked data provides critical and accurate insights into road traffic injuries and is a valuable approach for understanding traffic injuries.

Epidemiological pattern of trauma patients based on the mechanisms of trauma: trends of a regional trauma center in Midwest of Iran

INTRODUCTION

Trauma is one of the important issues in public health because it is responsible for 90% of mortality in Low and Middle-Income Countries (LIMCs). The present study aimed to determine the epidemiological pattern of trauma patients in a regional trauma center in the Midwest of Iran from 2014 to 2020.

METHODS

This study was a retrospective study that was performed on 29,804 trauma patients admitted to Be'sat Hospital in Hamadan from January 2014 to December 2020. Data was collected using Health Information Management (HIM) Center of the Be'sat Hospital. For investigating the relationship of the characteristics of trauma patients and the mechanisms of trauma, Multiple Multinomial Logistic Regression (MMNLR) model was used. All statistical analyses were performed using the IBM SPSS Statistics version 24.

RESULTS

The mean age of all patients was 35.4 (SD = 21.9) years. Most of them were men (71.7%). The most common mechanism of trauma was road traffic accidents (RTAs) (39.6%) followed by falls (30.2%), other (19.7%), violence (6.2%), and burn (4.4%). 1.5% of the trauma patients expired. The results of multiple multinomial logistic regression indicated that significant affected factor on odds referring because of RTAs compared to other mechanism were: season and hospital length of stay (LOS); in falls and violence: age, sex, season, and LOS; and in burn: age, sex, season, evening time, and LOS (p < 0.05).

CONCLUSION

Based on the investigation of 29,804 trauma patients, in Iran as a developing country, RTAs and falls were two common mechanisms of trauma. It seems that as a short-term plan, it is possible to focus on road safety, to improve the quality of vehicles, to hold training courses for drivers. Also, as a long-term goal, considering that the elderly population in Iran is increasing, it is necessary to pay attention to fall reduction programs.

The effect of birth order on length of hospitalization for pediatric traumatic brain injury: an analysis of the 1987 Finnish birth cohort

Purpose

This study examines the relationship between birth order and length of hospitalization due to pediatric traumatic brain injury (TBI).

Methods

We prospectively followed 59,469 Finnish newborns from 1987 until age 18 years. Data on first diagnosis of TBI was recorded within the 1987 Finnish Birth Cohort (FBC). Hospitalization period was divided into two categories: 2 days or less and more than 2 days. The latter was considered in this study as longer hospitalization.

Results

Compared with first born siblings, later born siblings had an increased risk of a longer hospitalization for TBI (12.7% of fourth or higher born birth children diagnosed with TBI were hospitalized for 2 or more days, 11.3% of first born, 10.4% of third born and 9.0% of second born). Fourth or higher born children were more likely to experience a repeat TBI; 13.4% of fourth or higher born children diagnosed with TBI had 2–3 TBIs during the study period compared to 9% of third born, 7.8% of second born and 8.8% of the first born. Injuries in the traffic environment and falls were the most common contributors to pediatric TBI and occurred most frequently in the fourth or higher birth category; 29.3% of TBIs among fourth or higher birth order were due to transport accidents and 21% were due to falls.

Conclusions

This study revealed a significant increase in risk for longer hospitalization due to TBI among later born children within the same sibling group. The study provides epidemiological evidence on birth order as it relates to TBI, and its potential to help to explain some of the statistical variability in pediatric TBI hospitalization over time in this population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00919-x.

Predicting Patients at Risk for Prolonged Hospital Stays Following Pediatrics Traumatic Head Injuries in High-Income Developing Country: A Retrospective Cohort Study

BACKGROUND

Traumatic brain injuries (TBIs) in pediatrics are the most common cause of long-term morbidity and mortality, generating a considerable burden on the health care system. In the current retrospective study, we aimed to identify the predictors that contribute to prolonged hospital stays in pediatric TBI.

METHODS

A retrospective cohort study including all pediatric cases (age younger than 14) who presented to Khoula Hospital with TBI and were seen from January 2015 to December 2019. The multivariate binary logistic regression analysis has been used to determine the independent predictors of prolonged hospital stay. Prolonged hospitalization was defined as mean ± 2 standard deviation days.

RESULTS

A total of 866 cases of pediatric TBI were documented. The mean age was 4.33 years. The length of hospital stay ranged from <1 day to 90 days (mean = 3.65, standard deviation = 6.84). Prolonged hospitalization was calculated to be >17 days. Thirty-one patients had prolonged hospital stay out of the studied cohort, with an incidence proportion of prolonged stay = 3.6% (95% CI = 2.4%-5.0%). Prolonged hospitalizations were associated with motor vehicle collision injuries (odds ratio [OR]: 27.028, 95% confidence interval [CI] = 2.744-266.194, P = 0.005); pedestrian injuries (OR = 11.667, 95% CI = 1.017-133.805, P = 0.048), and Glasgow Coma Scale score on arrival of <9 (OR = 8.149, 95% CI = 1.167-56.921, P = 0.034).

CONCLUSIONS

The current study identified motor vehicle collision and pedestrian injuries, as well as initial Glasgow Coma Scale score of <9 as independent predictors of prolonged hospitalization in pediatrics TBI.

The Volume of Thoracic Irrigation Is Associated With Length of Stay in Patients With Traumatic Hemothorax

INTRODUCTION

Irrigation of the thoracic cavity at tube thoracostomy (TT) placement may decrease the rate of a retained hemothorax (RHTX); however, other resource utilization outcomes have not yet been quantified. This study evaluated the association of thoracic irrigation during TT with the length of stay and outcomes in patients with traumatic hemothorax (HTX).

METHODS

A retrospective chart review was performed of adult patients receiving a TT for HTX at a single, urban Level 1 Trauma Center from January 2019 to December 2020. Those who underwent irrigation during TT at the discretion of the trauma surgeon were compared to a control of standard TT without irrigation. Death within 30 d, as well as TTs, placed at outside hospitals, during traumatic arrest or thoracic procedures, and for isolated pneumothoraces were excluded. The primary outcome was the length of stay as hospital-free, ICU-free, and ventilator-free days (30-day benchmark). Subgroup analysis by irrigation volume was conducted using one-way ANOVA testing with P < 0.05 considered statistically significant.

RESULTS

Eighty-two (41.4%) of 198 patients underwent irrigation during TT placement. Secondary interventions, thoracic infections, and TT duration were not statistically different in the irrigated cohort. Hospital-free and ICU-free days were higher in the irrigated patients than in the controls. Groups irrigated with ≥1000 mL had significant more hospital-free days (P = 0.007) than those receiving less than 1000 mL.

CONCLUSIONS

Patients with traumatic HTX who underwent thoracic irrigation at the time of TT placement had decreased hospital and ICU days compared to standard TT placement alone. Specifically, our study demonstrated that patients irrigated with a volume of at least 1000 mL had greater hospital-free days compared to those irrigated with less than 1000 mL.

Epidemiological characteristics of injury in Georgia: A one-year retrospective study

INTRODUCTION

Injury is a major health problem worldwide and a leading cause of death and disability. Disability caused by traumatic injury is often severe and long-lasting. Injuries place a large burden on societies and individuals in the community, both in cost and lost quality of life. Progress in developing effective injury prevention programs in developing countries is hindered by the lack of basic epidemiological injury data regarding the prevalence of traumatic injuries. The aim of this research was to describe the epidemiological characteristics of injury in all hospitals in Georgia.

METHODS

The database of the National Center for Disease Control and Public Health of Georgia for 2018, which includes all hospital admissions, was used to identify injury cases treated in hospitals. Cases were included based on the S and T diagnosis coded of ICD-10.

RESULTS

A total of 25,103 adult patients were admitted for an injury, of whom 14,798 (59%) were males and 10,305 (41%) were females, between the ages of 18 and 108 years old. The highest prevalence was among the age group 25-44 years old (n = 8654; 34%), followed by 45-64 years old (n = 6852; 27%). The main mechanism of injury was falls (n = 13,932; 55%) and exposure to mechanical forces (n = 2701; 11%). Over 1,50% (n = 379) of injuries resulted in death after hospitalization. The median hospital length of stay (LOS) was 2 days. There was a significant association between age, mechanism of injury, type of injury, performed surgical interventions, and longer LOS.

CONCLUSION

Injuries are prevalent throughout the life course and cause substantial hospitalization time. This research can help focus prevention efforts can focus on the demographic and injury causes that are most prevalent.

Mechanism and severity of mobility scooter-related injuries

OBJECTIVE

As a result of an aging population, mobility scooter use is increasing in Western countries. Consequently, an increase in mobility scooter-related injuries (MSRIs) is observed. Yet there is a paucity of studies in the literature assessing MSRIs. The purpose of this study was to investigate mechanism, severity, and localization of injury of MSRIs in the emergency department (ED) of a Dutch level 2 trauma center over a 9-year period.

METHODS

This was a retrospective study of MSRIs in the ED of a teaching hospital in the Netherlands between January 2010 and December 2019. All patients with an MSRI were included, as long as they were the driver of the vehicle. Data were collected from electronic patient files. The primary outcomes were severity of injury, defined by the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS), and mechanism and localization of injury.

RESULTS

A total of 382 patients were identified. Of these, 208 (54.3%) were female and the median age was 76 years (interquartile range [IQR] = 67.0-83.0). The median Charlson Comorbidity Index (CCI) was 5.0 (IQR = 4.0-6.0). Three (0.8%) patients had an ISS ≥ 16. The median ISS was 3.0 (IQR = 1.0-5.0). The lower extremity was the most commonly injured body region (46.5%), followed by head injury (36.3%), external injury (31.6%), and upper extremity injuries. Fractures were most commonly observed in the shoulder (10.2%), hip (8.9%), and ankle (6.3%). Most crashes were single-vehicle accidents (87.2%) and the most common mechanism of injury was rollover of mobility scooter (49.3%). Almost half of the patients (44.1%) had a fracture and the admission rate was 28.2% with a median length of stay (LOS) of 10 days. Fifty (13.1%) patients required surgery, of which 58% were hip repair surgery.

CONCLUSION

In this cohort of MSRIs, mobility scooter users had a median age of 76 years and severe comorbidity was common. Based on ISS, patients had a mild injury profile. However, the relatively high admission and surgery rates reflect the potential serious consequences of MSRIs and the obvious vulnerability of this population.

Integration of Metabolomic and Clinical Data Improves the Prediction of Intensive Care Unit Length of Stay Following Major Traumatic Injury

Recent advances in emergency medicine and the co-ordinated delivery of trauma care mean more critically-injured patients now reach the hospital alive and survive life-saving operations. Indeed, between 2008 and 2017, the odds of surviving a major traumatic injury in the UK increased by nineteen percent. However, the improved survival rates of severely-injured patients have placed an increased burden on the healthcare system, with major trauma a common cause of intensive care unit (ICU) admissions that last ≥10 days. Improved understanding of the factors influencing patient outcomes is now urgently needed. We investigated the serum metabolomic profile of fifty-five major trauma patients across three post-injury phases: acute (days 0–4), intermediate (days 5–14) and late (days 15–112). Using ICU length of stay (LOS) as a clinical outcome, we aimed to determine whether the serum metabolome measured at days 0–4 post-injury for patients with an extended (≥10 days) ICU LOS differed from that of patients with a short (<10 days) ICU LOS. In addition, we investigated whether combining metabolomic profiles with clinical scoring systems would generate a variable that would identify patients with an extended ICU LOS with a greater degree of accuracy than models built on either variable alone. The number of metabolites unique to and shared across each time segment varied across acute, intermediate and late segments. A one-way ANOVA revealed the most variation in metabolite levels across the different time-points was for the metabolites lactate, glucose, anserine and 3-hydroxybutyrate. A total of eleven features were selected to differentiate between <10 days ICU LOS vs. >10 days ICU LOS. New Injury Severity Score (NISS), testosterone, and the metabolites cadaverine, urea, isoleucine, acetoacetate, dimethyl sulfone, syringate, creatinine, xylitol, and acetone form the integrated biomarker set. Using metabolic enrichment analysis, we found valine, leucine and isoleucine biosynthesis, glutathione metabolism, and glycine, serine and threonine metabolism were the top three pathways differentiating ICU LOS with a p < 0.05. A combined model of NISS and testosterone and all nine selected metabolites achieved an AUROC of 0.824. Differences exist in the serum metabolome of major trauma patients who subsequently experience a short or prolonged ICU LOS in the acute post-injury setting. Combining metabolomic data with anatomical scoring systems allowed us to discriminate between these two groups with a greater degree of accuracy than that of either variable alone.

Epidemiological profile of chest trauma and predictive factors for length of hospital stay in a hospital in Southern Brazil

INTRODUCTION

Thoracic trauma is one of the most common types, corresponding to 10% of the traumas admitted in emergency services.

OBJECTIVE

To analyse epidemiologic aspects of patients diagnosed with chest trauma in a hospital at the south of Brazil and its predictive factor for prolonged length of stay.

METHODS

We conducted a retrospective cohort involving patients who were victims of chest trauma. They were described by the International Classification of Diseases (ICD) from S20 to S29 admited in a regional hospital in Southern Brazil, from January 2008 to December 2018. The analysed variables were: sex, age, ICD, type of trauma, complication, need for intensive care unit (ICU), mechanical ventilation (MV) and oxygen therapy (O2), scores on Injury Severity Score (ISS) and Thoracic Trauma Severity Score (TTSS) and outcomes length of stay and death.

RESULTS

121 patients were evaluated, with median age 47.0 (35-0-58.5) years, where 84.3% being of them were male. Blunt trauma had a higher prevalence with 85.1%, with the most frequent complication being spine fractures (30.4%), followed by rib fractures (23.2%) and pneumothorax (16.8%). There was need of ICU in 14%, use of O2 in 30.6% and need of MV in 5.8%. The median length of stay was 6.0 (4.0-10.5), and death as an outcome was found in only 1.7%. Relying on the TTSS, the median (p25-p75) found was 3.0 (2.0-5.0) points and the ISS score was 4.0 (0.0-9.0). If observing patients with a length of stay ≥ 6 days, there were an association with the female gender, need of ICU, O2 and MV, ISS scores, and TTSS scores in the categories who involved pleural commitment and minor PaO2/FiO2.

CONCLUSION

Most of the victims were male young adults with low mortality. The TTSS and ISS were found to be adequate predictors of prolonged length of stay.

The yield of tertiary survey in patients admitted for observation after trauma

PURPOSE

Existing literature on trauma tertiary survey (TTS) focusses on multitrauma patients. This study examines the yield of the TTS in trauma patients with minor (AIS 1) or moderate (AIS 2) injury for which immediate hospitalization is not strictly indicated.

METHOD

A single center retrospective cohort study was performed in a level II trauma center. All hospitalized trauma patients with an abbreviate injury score (AIS) of one or two at the primary and secondary survey were included. The primary outcome was defined as any missed injury found during TTS (Type 1). Secondary outcomes were defined as any missed injury found after TTS but during admission (Type 2); overall missed injury rate; mortality and hospital length of stay.

RESULTS

Out of 388 included patients, 12 patients (3.1%) had a type 1 missed injury. ISS and alcohol consumption were associated with an increased risk for type 1 missed injuries (resp. OR = 1.4, OR = 5.49). A type 2 missed injury was only found in one patient. This concerned the only case of trauma related mortality. Approximately one out of five patients were admitted for more than 2 days. These patients were significantly older (66 vs. 41 years, p < 0.001), had a higher ISS (4 vs. 3, p = 0.007) and ASA score, 3-4 vs. 1-2 (42.5% vs. 12.6%, p < 0.001).

CONCLUSION

TTS showed a low rate of missed injuries in trauma patients with minor or moderate injury. TTS helped to prevent serious damage in two out of 388 patients (0.5%). ISS and alcohol consumption were associated with finding missed injury during TTS.