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De Simone B, Chouillard E, Podda M, Pararas N, de Carvalho Duarte G, Fugazzola P, Birindelli A, Coccolini F, Polistena A, Sibilla MG, Kruger V, Fraga GP, Montori G, Russo E, Pintar T, Ansaloni L, Avenia N, Di Saverio S, Leppäniemi A, Lauretta A, Sartelli M, Puzziello A, Carcoforo P, Agnoletti V, Bissoni L, Isik A, Kluger Y, Moore EE, Romeo OM, Abu-Zidan FM, Beka SG, Weber DG, Tan ECTH, Paolillo C, Cui Y, Kim F, Picetti E, Di Carlo I, Toro A, Sganga G, Sganga F, Testini M, Di Meo G, Kirkpatrick AW, Marzi I, déAngelis N, Kelly MD, Wani I, Sakakushev B, Bala M, Bonavina L, Galante JM, Shelat VG, Cobianchi L, Mas FD, Pikoulis M, Damaskos D, Coimbra R, Dhesi J, Hoffman MR, Stahel PF, Maier RV, Litvin A, Latifi R, Biffl WL, Catena F. The 2023 WSES guidelines on the management of trauma in elderly and frail patients. World J Emerg Surg 2024; 19:18. [PMID: 38816766 PMCID: PMC11140935 DOI: 10.1186/s13017-024-00537-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/26/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. METHODS Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. RESULTS The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patient's directives, family feelings and representatives' desires, and all decisions should be shared. CONCLUSIONS The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes.
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Affiliation(s)
- Belinda De Simone
- Department of Emergency Minimally Invasive Surgery, Academic Hospital of Villeneuve St Georges, Villeneuve St Georges, France.
- Department of General Minimally Invasive Surgery, Infermi Hospital, AUSL Romagna, Rimini, Italy.
- General Surgery Department, American Hospital of Paris, Paris, France.
| | - Elie Chouillard
- General Surgery Department, American Hospital of Paris, Paris, France
| | - Mauro Podda
- Department of Surgical Science, Unit of Emergency Surgery, University of Cagliari, Cagliari, Italy
| | - Nikolaos Pararas
- 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | | | - Paola Fugazzola
- Unit of General Surgery I, IRCCS San Matteo Hospital of Pavia, University of Pavia, Pavia, Italy
| | | | | | - Andrea Polistena
- Department of Surgery, Policlinico Umberto I Roma, Sapienza University, Rome, Italy
| | - Maria Grazia Sibilla
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy
| | - Vitor Kruger
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Giulia Montori
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy
| | - Emanuele Russo
- Department of Anesthesia, Level I, Trauma Center, Bufalini Hospital, Cesena, Italy
| | - Tadeja Pintar
- UMC Ljubljana and Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - Luca Ansaloni
- New Zealand Blood Service, Christchurch, New Zealand
| | - Nicola Avenia
- Endocrine Surgical Unit - University of Perugia, Terni, Italy
| | - Salomone Di Saverio
- General Surgery Unit, Madonna del Soccorso Hospital, AST Ascoli Piceno, San Benedetto del Tronto, Italy
| | - Ari Leppäniemi
- Division of Emergency Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Andrea Lauretta
- Department of Surgical Oncology, Centro Di Riferimento Oncologico Di Aviano IRCCS, Aviano, Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, Macerata, Italy
| | - Alessandro Puzziello
- Dipartimento di Medicina, Chirurgia e Odontoiatria, Campus Universitario di Baronissi (SA) - Università di Salerno, AOU San Giovanni di Dio e Ruggi di Aragona, Salerno, Italy
| | - Paolo Carcoforo
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy
| | - Vanni Agnoletti
- Department of Anesthesia, Level I, Trauma Center, Bufalini Hospital, Cesena, Italy
| | - Luca Bissoni
- Department of Anesthesia, Level I, Trauma Center, Bufalini Hospital, Cesena, Italy
| | - Arda Isik
- Istanbul Medeniyet University, Istanbul, Turkey
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Oreste Marco Romeo
- Bronson Methodist Hospital/Western Michigan University, Kalamazoo, MI, USA
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al‑Ain, United Arab Emirates
| | | | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital and The University of Western Australia, Perth, Australia
| | - Edward C T H Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ciro Paolillo
- Emergency Department, Ospedale Civile Maggiore, Verona, Italy
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Fernando Kim
- University of Colorado Anschutz Medical Campus, Denver, CO, 80246, USA
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Adriana Toro
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Federica Sganga
- Department of Geriatrics, Ospedale Sant'Anna, Ferrara, Italy
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Giovanna Di Meo
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Nicola déAngelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France
| | | | - Imtiaz Wani
- Department of Surgery, Government Gousia Hospital, DHS, Srinagar, India
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Miklosh Bala
- Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Luigi Bonavina
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Joseph M Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Novena, Singapore
| | - Lorenzo Cobianchi
- Unit of General Surgery I, IRCCS San Matteo Hospital of Pavia, University of Pavia, Pavia, Italy
- Collegium Medicum, University of Social Sciences, Łodz, Poland
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Venice, Italy
- Collegium Medicum, University of Social Sciences, Łodz, Poland
| | - Manos Pikoulis
- Department of Surgical Science, Unit of Emergency Surgery, University of Cagliari, Cagliari, Italy
| | | | - Raul Coimbra
- Riverside University Health System Medical Center, Riverside, CA, USA
| | - Jugdeep Dhesi
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Melissa Red Hoffman
- Department of Surgery, University of North Carolina, Surgical Palliative Care Society, Asheville, NC, USA
| | - Philip F Stahel
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Ronald V Maier
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, University Clinic, Gomel, Belarus
| | - Rifat Latifi
- University of Arizona, Tucson, AZ, USA
- Abrazo Health West Campus, Goodyear, Tucson, AZ, USA
| | - Walter L Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, AUSL Romagna, Cesena, Italy
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Liu XY, Qin YM, Tian SF, Zhou JH, Wu Q, Gao W, Bai X, Li Z, Xie WM. Performance of trauma scoring systems in predicting mortality in geriatric trauma patients: comparison of the ISS, TRISS, and GTOS based on a systemic review and meta-analysis. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02467-1. [PMID: 38363328 DOI: 10.1007/s00068-024-02467-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE This meta-analysis aimed to evaluate the performance of the Injury Severity Score (ISS), Trauma and Injury Severity Score (TRISS), and the Geriatric Trauma Outcome Score (GTOS) in predicting mortality in geriatric trauma patients. METHODS The MEDLINE, Web of Science, and EMBASE databases were searched for studies published from January 2008 to October 2023. Studies assessing the performance of the ISS, TRISS, or GTOS in predicting mortality in geriatric trauma patients (over 60 years old) and reporting data for the analysis of the pooled area under the receiver operating characteristic curve (AUROC) and the hierarchical summary receiver operating characteristic curve (HSROC) were included. Studies that were not conducted in a group of geriatric patients, did not consider mortality as the outcome variable, or had incomplete data were excluded. The Critical Appraisal Skills Programme (CASP) Clinical Prediction Rule Checklist was utilized to assess the risk of bias in included studies. STATA 16.0. was used for the AUROC analysis and HSROC analysis. RESULTS Nineteen studies involving 118,761 geriatric trauma patients were included. The pooled AUROC of the TRISS (AUC = 0.82, 95% CI: 0.77-0.87) was higher than ISS (AUC = 0.74, 95% CI: 0.71-0.79) and GTOS (AUC = 0.80, 95%CI: 0.77-0.83). The diagnostic odds ratio (DOR) calculated from HSROC curves also suggested that the TRISS (DOR = 21.5) had a better performance in predicting mortality in geriatric trauma patients than the ISS (DOR = 6.27) and GTOS (DOR = 4.76). CONCLUSION This meta-analysis suggested that the TRISS showed better accuracy and performance in predicting mortality in geriatric trauma patients than the ISS and GTOS.
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Affiliation(s)
- Xin-Yu Liu
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yu-Meng Qin
- Department of Neurosurgery, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning, 437000, China
| | - Shu-Fang Tian
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jun-Hao Zhou
- School of Laboratory Medicine, Hubei University of Chinese Medicine, Wuhan, 430065, China
| | - Qiqi Wu
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei Gao
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiangjun Bai
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhanfei Li
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Wei-Ming Xie
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430034, China.
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Zhou P, Ling L, Xia X, Yuan H, Guo Z, Feng Q, Ma J. Independent predictors of mortality for critically ill patients with polytrauma: A single center, retrospective study. Heliyon 2024; 10:e25163. [PMID: 38371971 PMCID: PMC10873658 DOI: 10.1016/j.heliyon.2024.e25163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Abstract
Independent predictors of mortality and transfusion therapy in polytrauma patients from the Chinese population remain unknown. Here, we aimed to identify these predictors by retrospectively collecting and analyzing vital signs and laboratory results for 408 critically ill patients suffering from polytrauma who were treated in Affiliated Kunshan Hospital of Jiangsu University, Jiangsu Province, China from January 2020 to December 2021. We identified risk factors for mortality and transfusion therapy using logistic regression analysis. As a results, we enrolled a total of 408 polytrauma patients, with a male-to-female ratio of 2:1, a mean age of 49.02 ± 16.84 years, a mortality rate of 15.9 %, and a blood transfusion rate of 45.8 %. The multivariate logistic regression showed that decreased Glasgow Coma Scale (GCS) score (Odds ratio (OR) = 0.72, 95 % confidence interval (95%CI): 0.63-0.83, P < 0.001), decreased base excess (BE) (OR = 0.77, 95%CI: 0.67-0.87, P < 0.001), and increased Injury Severity Score (ISS) (OR = 1.12, 95%CI: 1.06-1.17, P < 0.001) were independent risk factors for the mortality. In addition, increased GCS score (OR = 1.17, 95%CI: 1.03-1.35, P = 0.020), increased heart rate (OR = 1.05, 95%CI: 1.04-1.07, P < 0.001), decreased systolic blood pressure (SBP) (OR = 0.97, 95%CI: 0.96-0.99, P < 0.001), increased peripheral oxygen saturation (SpO2) (OR = 1.10, 95%CI: 1.04-1.16, P = 0.002), decreased serum lactate (OR = 0.58, 95%CI: 0.42-0.79, P = 0.001), decreased BE (OR = 0.49, 95%CI: 0.39-0.62, P < 0.001), and increased ISS (OR = 1.25, 95%CI: 1.18-1.33, P < 0.001) were independent risk factors for blood transfusion. The area under receiver operating characteristic curves (AUROCs) of the model to predict mortality and blood transfusion were 0.976 (95%CI: 0.960-0.992, P < 0.001) and 0.973 (95%CI: 0.958-0.987, P < 0.001). In conclusion, decreased BE level was significantly associated with all-cause mortality in polytrauma patients. BE, ISS, and GCS might be independent important predictors for mortality and blood transfusion of polytrauma patients.
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Affiliation(s)
| | | | | | - Hua Yuan
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, 215300, China
| | - Zhiqiang Guo
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, 215300, China
| | - Qiupeng Feng
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, 215300, China
| | - Jin Ma
- Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, 215300, China
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Gunning AC, Niemeyer MJS, van Heijl M, van Wessem KJP, Maier RV, Balogh ZJ, Leenen LPH. Inter-rater reliability of the Abbreviated Injury Scale scores in patients with severe head injury shows good inter-rater agreement but variability between countries. An inter-country comparison study. Eur J Trauma Emerg Surg 2023; 49:1183-1188. [PMID: 35974196 PMCID: PMC10229665 DOI: 10.1007/s00068-022-02059-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/09/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Substantial difference in mortality following severe traumatic brain injury (TBI) across international trauma centers has previously been demonstrated. This could be partly attributed to variability in the severity coding of the injuries. This study evaluated the inter-rater and intra-rater reliability of Abbreviated Injury Scale (AIS) scores of patients with severe TBI across three international level I trauma centers. METHODS A total 150 patients (50 per center) were randomly selected from each respective trauma registry: University Medical Center Utrecht (UMCU), the Netherlands; John Hunter Hospital (JHH), Australia; and Harborview Medical Center (HMC), the United States. Reliability between coders and trauma centers was measured with the intraclass correlation coefficient (ICC). RESULTS The reliability between the coders and the original trauma registry scores was 0.50, 0.50, and 0.41 in, respectively, UMCU, JHH, and HMC. The AIS coders at UMCU scored the most AIS codes of ≥ 4. Reliability within the trauma centers was substantial in UMCU (ICC = 0.62) and HMC (ICC = 0.78) and almost perfect in JHH (ICC = 0.85). Reliability between trauma centers was 0.70 between UMCU and JHH, 0.70 between JHH and HMC, and 0.59 between UMCU and HMC. CONCLUSION The results of this study demonstrated a substantial and almost perfect reliability of the AIS coders within the same trauma center, but variability across trauma centers. This indicates a need to improve inter-rater reliability in AIS coders and quality assessments of trauma registry data, specifically for patients with head injuries. Future research should study the effect of differences in AIS scoring on outcome predictions.
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Affiliation(s)
- Amy C Gunning
- Department of Trauma Surgery, University Medical Center Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Menco J S Niemeyer
- Department of Trauma Surgery, University Medical Center Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Mark van Heijl
- Department of Trauma Surgery, University Medical Center Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Karlijn J P van Wessem
- Department of Trauma Surgery, University Medical Center Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Ronald V Maier
- Department of Trauma Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Zsolt J Balogh
- Department of Traumatology and Surgery, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Luke P H Leenen
- Department of Trauma Surgery, University Medical Center Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Validation of the Trauma and Injury Severity Score for Prediction of Mortality in a Greek Trauma Population. J Trauma Nurs 2022; 29:34-40. [PMID: 35007249 DOI: 10.1097/jtn.0000000000000629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although the Trauma and Injury Severity Score (TRISS) has been extensively used for mortality risk adjustment in trauma, its applicability in contemporary trauma populations is increasingly questioned. OBJECTIVE The study aimed to evaluate the predictive performance of the TRISS in its original and revised version and compare these with a recalibrated version, including current data from a Greek trauma population. METHODS This is a retrospective cohort study of admitted trauma patients conducted in two tertiary Greek hospitals from January 2016 to December 2018. The model algorithm was calculated based on the Major Trauma Outcome Study coefficients (TRISSMTOS), the National Trauma Data Bank coefficients (TRISSNTDB), and reweighted coefficients of logistic regression obtained from a Greek trauma dataset (TRISSGrTD). The primary endpoint was inhospital mortality. Models' prediction was performed using discrimination and calibration statistics. RESULTS A total of 8,988 trauma patients were included, of whom 854 died (9.5%). The TRISSMTOS displayed excellent discrimination with an area under the curve (AUC) of 0.912 (95% CI 0.902-0.923) and comparable with TRISSNTDB (AUC = 0.908, 95% CI 0.897-0.919, p = .1195). Calibration of both models was poor (Hosmer-Lemeshow test p < .001), tending to underestimate the probability of mortality across almost all risk groups. The TRISSGrTD resulted in statistically significant improvement in discrimination (AUC = 0.927, 95% CI 0.918-0.936, p < .0001) and acceptable calibration (Hosmer-Lemeshow test p = .113). CONCLUSION In this cohort of Greek trauma patients, the performance of the original TRISS was suboptimal, and there was no evidence that it has benefited from its latest revision. By contrast, a strong case exists for supporting a locally recalibrated version to render the TRISS applicable for mortality prediction and performance benchmarking.
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Isles S, McBride P, Sawyer M, Campbell A, Speed G, O’Leary K, Evans M, Rider S, Gabbe B. Accuracy of injury coding in a trauma registry. TRAUMA-ENGLAND 2021. [DOI: 10.1177/14604086211041877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Abbreviated Injury Scale has significant advantages over administrative coding systems for trauma analytics as it was developed specifically for injury, provides greater depth of characterisation of injury and has an integrated severity measure. It is used by trauma registries globally as it allows benchmarking between registries and is used to drive quality improvement. However, the consistency of scoring between individuals is not well understood. An audit was undertaken in six tertiary trauma centres in New Zealand to determine variation between AIS coders. Methods Each of six sites was audited by two experienced auditors. A random selection of case was identified in ISS categories 13–24, 25–44 and 45+. The case notes were pulled, and the auditors independently audited the notes,and then compared their results for a consensus result. The consensus result was then compared with the original coders. Results 111 cases were audited. Coding concordance was found in 31% of cases. Of the 69% of cases where discordant coding was observed, the discordance was attributed to incorrect coding (49%), missed injuries (43%) and other reasons (7%). Head and chest body regions were associated with the greatest number, and largest differences in coding scores. The overall mean difference across all cases was an ISS score of 1. Conclusions The overall accuracy of data held in the New Zealand Trauma Registry (NZTR) is suitable for quality improvement and benchmarking purposes, but more work is needed to improve the accuracy of individual cases, particularly those with head/neck and chest injury. Standardised tools to ensure the accuracy of data in a trauma registry is a gap which needs to be addressed to maintain confidence in a contemporary trauma system.
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Affiliation(s)
| | - Paul McBride
- Health Quality and Safety Commission, Wellington, New Zealand
| | | | | | | | | | - Melisa Evans
- Christchurch Hospital, Christchurch, New Zealand
| | - Sonya Rider
- Palmerston North Hospital, Palmerston North, New Zealand
| | - Belinda Gabbe
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
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Bolierakis E, Schick S, Sprengel K, Jensen KO, Hildebrand F, Pape HC, Pfeifer R. Interobserver variability of injury severity assessment in polytrauma patients: does the anatomical region play a role? Eur J Med Res 2021; 26:35. [PMID: 33858510 PMCID: PMC8051093 DOI: 10.1186/s40001-021-00506-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) are widely used to assess trauma patients. In this study, the interobserver variability of the injury severity assessment for severely injured patients was analyzed based on different injured anatomical regions, and the various demographic backgrounds of the observers. METHODS A standardized questionnaire was presented to surgical experts and participants of clinical polytrauma courses. It contained medical information and initial X-rays/CT-scans of 10 cases of severely injured patients. Participants estimated the severity of each injury based on the AIS. Interobserver variability for the AIS, ISS, and New Injury Severity Score (NISS) was calculated by employing the statistical method of Krippendorff's α coefficient. RESULTS Overall, 54 participants were included. The major contributing medical specialties were orthopedic trauma surgery (N = 36, 67%) and general surgery (N = 13, 24%). The measured interobserver variability in the assessment of the overall injury severity was high (α ISS: 0.33 / α NISS: 0.23). Moreover, there were differences in the interobserver variability of the maximum AIS (MAIS) depending on the anatomical region: αhead and neck: 0.06, αthorax: 0.45, αabdomen: 0.27 and αextremities: 0.55. CONCLUSIONS Interobserver agreement concerning injury severity assessment appears to be low among clinicians. We also noted marked differences in variability according to injury anatomy. The study shows that the assessment of injury severity is also highly variable between experts in the field. This implies the need for appropriate education to improve the accuracy of trauma evaluation in the respective trauma registries.
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Affiliation(s)
- Eftychios Bolierakis
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH University of Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Sylvia Schick
- Institute of Legal Medicine, Ludwig Maximilians Universitaet LMU, University of Munich, Munich, Germany
| | - Kai Sprengel
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kai Oliver Jensen
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Frank Hildebrand
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, RWTH University of Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Roman Pfeifer
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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8
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The GERtality Score: The Development of a Simple Tool to Help Predict in-Hospital Mortality in Geriatric Trauma Patients. J Clin Med 2021; 10:jcm10071362. [PMID: 33806240 PMCID: PMC8037079 DOI: 10.3390/jcm10071362] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/11/2021] [Accepted: 03/22/2021] [Indexed: 12/19/2022] Open
Abstract
Feasible and predictive scoring systems for severely injured geriatric patients are lacking. Therefore, the aim of this study was to develop a scoring system for the prediction of in-hospital mortality in severely injured geriatric trauma patients. The TraumaRegister DGU® (TR-DGU) was utilized. European geriatric patients (≥65 years) admitted between 2008 and 2017 were included. Relevant patient variables were implemented in the GERtality score. By conducting a receiver operating characteristic (ROC) analysis, a comparison with the Geriatric Trauma Outcome Score (GTOS) and the Revised Injury Severity Classification II (RISC-II) Score was performed. A total of 58,055 geriatric trauma patients (mean age: 77 years) were included. Univariable analysis led to the following variables: age ≥ 80 years, need for packed red blood cells (PRBC) transfusion prior to intensive care unit (ICU), American Society of Anesthesiologists (ASA) score ≥ 3, Glasgow Coma Scale (GCS) ≤ 13, Abbreviated Injury Scale (AIS) in any body region ≥ 4. The maximum GERtality score was 5 points. A mortality rate of 72.4% was calculated in patients with the maximum GERtality score. Mortality rates of 65.1 and 47.5% were encountered in patients with GERtality scores of 4 and 3 points, respectively. The area under the curve (AUC) of the novel GERtality score was 0.803 (GTOS: 0.784; RISC-II: 0.879). The novel GERtality score is a simple and feasible score that enables an adequate prediction of the probability of mortality in polytraumatized geriatric patients by using only five specific parameters.
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9
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Dijkink S, van Zwet EW, Krijnen P, Leenen LPH, Bloemers FW, Edwards MJR, Hartog DD, Leenhouts PA, Poeze M, Spanjersberg WR, Wendt KW, De Wit RJ, Van Zuthpen SWAM, Schipper IB. The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands. Eur J Trauma Emerg Surg 2021; 48:1035-1043. [PMID: 33712892 PMCID: PMC9001217 DOI: 10.1007/s00068-021-01615-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/05/2021] [Indexed: 11/18/2022]
Abstract
Background Twenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time. Methods All severely injured patients (Injury Severity Score [ISS] ≥ 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008–2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS. Results The documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63–74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC. Conclusion Since the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.
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Affiliation(s)
- Suzan Dijkink
- Department of Trauma Surgery, Leiden University Medical Center, Post zone K6-R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Erik W van Zwet
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieta Krijnen
- Department of Trauma Surgery, Leiden University Medical Center, Post zone K6-R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Luke P H Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank W Bloemers
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Michael J R Edwards
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dennis Den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter A Leenhouts
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Martijn Poeze
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Klaus W Wendt
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ralph J De Wit
- Department of Trauma Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Inger B Schipper
- Department of Trauma Surgery, Leiden University Medical Center, Post zone K6-R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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10
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Abstract
BACKGROUND Impaired psychological state, such as anxiety and depressive symptoms, occurs in up to 40% of patients hospitalized for traumatic injury. These symptoms, in the acute period, may delay engagement in activity, such as ambulation, following injury. The purpose of this study was to determine whether baseline anxiety and depressive symptoms predicted delayed (>48 hr from admission) ambulation in patients hospitalized for major traumatic injury. METHODS Adults (n = 19) admitted for major trauma (Injury Severity Score [ISS] = 15) provided a baseline measure of anxiety and depressive symptoms (Hospital Anxiety and Depression Scale [HADS]). Logistic regression was used to determine the predictive power of baseline HADS Anxiety and HADS Depression subscale scores for delayed ambulation while controlling for ISS. RESULTS At baseline, anxiety was present in 32% of patients; 21% reported depressive symptoms. Baseline HADS Anxiety score did not predict the ambulation group. However, for each 1 point increase in baseline HADS Depression score, the likelihood of patients ambulating after 48 hr from admission increased by 67% (odds ratio = 1.67; 95% CI [1.02, 2.72]; p = .041). CONCLUSION Worsening depressive symptoms were associated with delayed ambulation in the acute period following injury. Future, larger scale investigations are needed to further elucidate the relationship between psychological symptoms and the acute recovery period from trauma to better inform clinicians and guide development of interventions to improve patient outcomes.
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11
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Schwartz AM, Staley CA, Wilson JM, Reisman WM, Schenker ML. High acuity polytrauma centers in orthopaedic trauma: Decreasing patient mortality with effective resource utilization. Injury 2020; 51:2235-2240. [PMID: 32620327 DOI: 10.1016/j.injury.2020.06.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/12/2020] [Accepted: 06/24/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is a select number of massive-volume, high-acuity trauma centers (HACs) in the United States. Expertise in polytrauma care has been associated with improved mortality in general surgery trauma, though has not been investigated in orthopaedic trauma. With complex polytrauma proficiency comes the inherent risk of intensive care, complications, and prolonged inpatient stays, without a commensurate increase in allocated resources. The purpose of this study was to compare mortality, complications, and length of stay in polytraumatized orthopaedic patients treated at HACs vs. low-acuity trauma centers (LACs). METHODS The National Trauma Data Bank was queried for orthopaedic injuries with injury severity score (ISS)>15 and mortality, complications, hospital length of stay, ICU length of stay, ventilation duration, and demographics. Hospitals where at least 13% (median percentage of patients with ISS > 15 admitted to all hospitals) of total admissions had an ISS>15 were classified as HAC; all others were LACs. RESULTS HACs admitted 86.8% of 28,314 patients with ISS>15. On univariate analysis, patients at HACs have 16% decreased odds of in-hospital mortality vs. LACs (p=0.005); the effect increased to 27% (p=0.002) on multivariate analysis. Patients at HACs have 63% greater odds of ICU admission (p<0.001), 48% higher odds of ventilatory support (p=<0.001), 38% increased odds of unplanned reoperation (p=0.007), and 37% increased odds of medical complications (p<0.001). On multivariate analysis, secondary outcome measures showed no significant difference between HACs and LACs. Patients at HACs had 2.8 days longer length-of-stay (p<0.001). CONCLUSION Severely injured orthopaedic trauma patients have decreased mortality at HACs, despite having a higher average ISS and a higher prevalence of obesity and active smoking. While there is a higher incidence of ICU admission, mechanical ventilation, complications, and unplanned reoperation on univariate analysis, correction for ISS and patient factors enhances the effect of HACs on mortality, but removes the effect on secondary measures. Thus, HACs are life-saving institutions for polytraumatized orthopaedic patients, and the known resource demand of these hospitals is supported by their favorable outcome profile. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Andrew M Schwartz
- Emory University School of Medicine. Atlanta, GA.100 Woodruff Circle, Atlanta, GA 30322, USA.
| | - Christopher A Staley
- Emory University School of Medicine. Atlanta, GA.100 Woodruff Circle, Atlanta, GA 30322, USA.
| | - Jacob M Wilson
- Emory University School of Medicine. Atlanta, GA.100 Woodruff Circle, Atlanta, GA 30322, USA.
| | - William M Reisman
- Emory University School of Medicine. Atlanta, GA.100 Woodruff Circle, Atlanta, GA 30322, USA; Grady Memorial Hospital. Atlanta, GA. 49 Jesse Hill Drive, Atlanta, GA 30303, USA.
| | - Mara L Schenker
- Emory University School of Medicine. Atlanta, GA.100 Woodruff Circle, Atlanta, GA 30322, USA; Grady Memorial Hospital. Atlanta, GA. 49 Jesse Hill Drive, Atlanta, GA 30303, USA.
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12
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Dinh MM, Singh H, Sarrami P, Levesque JF. Correlating injury severity scores and major trauma volume using a state-wide in-patient administrative dataset linked to trauma registry data-A retrospective analysis from New South Wales Australia. Injury 2020; 51:109-113. [PMID: 31547965 DOI: 10.1016/j.injury.2019.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/04/2019] [Accepted: 09/12/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Trauma registries are used to analyse and report activity and benchmark quality of care at designated facilities within a trauma system. These capabilities may be enhanced with the incorporation of administrative and electronic medical record datasets, but are currently limited by the use of different injury coding systems between trauma and administrative datasets. OBJECTIVES Use an Abbreviated Injury Scale to International Classification of Disease (AIS-ICD) mapping tool to correlate estimated injury severity scores and major trauma volume based on administrative data collections with trauma registry data. METHODS Adult trauma cases were identified from the New South Wales Trauma Registry between 2012 and 2016 and linked probabilistically using age, facility and date of facility arrival to the Admitted Patient Data Collection (APDC). Estimated Injury Severity Scores (ISS) were derived using the AIS-ICD mapping tool applied to diagnoses contained in the APDC. RESULTS A total of eligible 13,439 cases were analysed. The overall correlation between trauma registry ISS and ISS estimated from APDC using the AIS-ICD mapping tool was low to moderate (Spearman Rho 0.41 95%CI 0.40, 0.43). Based on an estimated ISS cut-off value of 8, there was high correlation between estimated trauma volume and the number of major trauma cases at each facility (Spearman Rho 0.98, 95%CI 0.95, 0.99). Trauma Revised Injury Severity Score (TRISS) was associated with only slightly higher mortality prediction performance compared to estimated ISS (AUROC 0.76 95%CI 0.75, 0.78 versus AUROC 0.74 95%CI 0.73, 0.76). CONCLUSION A low to moderate correlation exists between individual patient ISS scores based on AIS to ICD mapping of in-patient data collection, but a high correlation for overall major trauma volume using the AIS-ICD mapping at facility level with comparable TRISS mortality prediction.
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Affiliation(s)
- Michael M Dinh
- New South Wales Institute of Trauma and Injury Management, Australia; Sydney Medical School, the University of Sydney, Australia.
| | - Hardeep Singh
- New South Wales Institute of Trauma and Injury Management, Australia
| | - Pooria Sarrami
- New South Wales Institute of Trauma and Injury Management, Australia; South Western Sydney Clinical School, University of New South Wales, Australia
| | - Jean-Frederic Levesque
- Centre for Primary Health Care and Equity, University of New South Wales, Australia; Agency for Clinical Innovation, Australia
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13
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Comparison of Injury Severity Score, Glasgow Coma Scale, and Revised Trauma Score in Predicting the Mortality and Prolonged ICU Stay of Traumatic Young Children: A Cross-Sectional Retrospective Study. Emerg Med Int 2019; 2019:5453624. [PMID: 31885926 PMCID: PMC6914995 DOI: 10.1155/2019/5453624] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/03/2019] [Accepted: 10/26/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction The purpose of this study was to examine the capacity of commonly used trauma scoring systems such as the Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) to predict outcomes in young children with traumatic injuries. Methods This retrospective study was conducted for the period from 2009 to 2016 in Kaohsiung Chang Gung Memorial Medical Hospital, a level I trauma center. We included all children under the age of 6 years admitted to the hospital via the emergency department with any traumatic injury and compared the trauma scores of GCS, ISS, and RTS on patients' outcome. The primary outcomes were mortality and prolonged Intensive Care Unit (ICU) stay, with the latter defined as an ICU stay longer than 14 days. The secondary outcome was the hospital length of stay (HLOS). Receiver operating characteristic (ROC) analysis was also adopted with the value of the area under the ROC curve (AUC) for comparing trauma score prediction with patient mortality. Cutoff values from each trauma score for mortality prediction were also measured by determining the point along the ROC curve where Youden's index was maximum. Results We included a total of 938 patients in this study, with a mean age of 3.1 ± 1.82 years. The mortality rate was 0.9%, and 93 (9.9%) patients had a prolonged ICU stay. An elevated ISS (34 ± 19.9 vs. 5 ± 5.1, p=0.004), lower GCS (8 ± 5.0 vs. 15 ± 1.3, p=0.006), and lower RTS (5.58 ± 1.498 vs. 7.64 ± 0.640, p=0.006) were all associated with mortality. All three scores were considered to be independent risk factors of mortality and prolonged ICU stay and had a linear correlation with increased HLOS. With regard to predicting mortality, ISS has the highest AUC value (ISS: 0.975; GCS: 0.864; and RTS: 0.899). The prediction cutoff values of ISS, GCS, and RTS on mortality were 15, 11, and 7, respectively. Conclusion Regarding traumatic injuries in young children, worse ISS, GCS, and RTS were all associated with increased mortality, prolonged ICU stay, and longer hospital LOS. Of these scoring systems, ISS was the best at predicting mortality.
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Pfeifer R, Halvachizadeh S, Schick S, Sprengel K, Jensen KO, Teuben M, Mica L, Neuhaus V, Pape HC. Are Pre-hospital Trauma Deaths Preventable? A Systematic Literature Review. World J Surg 2019; 43:2438-2446. [PMID: 31214829 DOI: 10.1007/s00268-019-05056-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The first and largest peak of trauma mortality is encountered on the trauma site. The aim of this study was to determine whether these trauma-related deaths are preventable. We performed a systematic literature review with a focus on pre-hospital preventable deaths in severely injured patients and their causes. METHODS Studies published in a peer-reviewed journal between January 1, 1990 and January 10, 2018 were included. Parameters of interest: country of publication, number of patients included, preventable death rate (PP = potentially preventable and DP = definitely preventable), inclusion criteria within studies (pre-hospital only, pre-hospital and hospital deaths), definition of preventability used in each study, type of trauma (blunt versus penetrating), study design (prospective versus retrospective) and causes for preventability mentioned within the study. RESULTS After a systematic literature search, 19 papers (total 7235 death) were included in this literature review. The majority (63.1%) of studies used autopsies combined with an expert panel to assess the preventability of death in the patients. Pre-hospital death rates range from 14.6 to 47.6%, in which 4.9-11.3% were definitely preventable and 25.8-42.7% were potentially preventable. The most common (27-58%) reason was a delayed treatment of the trauma victims, followed by management (40-60%) and treatment errors (50-76.6%). CONCLUSION According to our systematic review, a relevant amount of the observed mortality was described as preventable due to delays in treatment and management/treatment errors. Standards in the pre-hospital trauma system and management should be discussed in order to find strategies to reduce mortality.
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Affiliation(s)
- Roman Pfeifer
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Sylvia Schick
- Institute of Legal Medicine, Ludwig-Maximillians-Universität (LMU) Munich, Munich, Germany
| | - Kai Sprengel
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Kai Oliver Jensen
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Michel Teuben
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Ladislav Mica
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Valentin Neuhaus
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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