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Blok B, Slagt C, van Geffen GJ, Koch R. Characteristics of trauma patients treated by Helicopter Emergency Medical Service and transported to the hospital by helicopter or ambulance. BMC Emerg Med 2024; 24:173. [PMID: 39333895 DOI: 10.1186/s12873-024-01088-6] [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: 03/27/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
INTRODUCTION Trauma patients treated by the Helicopter Emergency Medical Services (HEMS) can be transported to the hospital either by helicopter or by ambulance, in both cases accompanied by the HEMS physician. The objectives of this study are first to compile an overview of patients treated and transported by the HEMS team with either the helicopter (patients transported by helicopter, PTH) or with the ambulance (patients transported by ambulance, PTA). In addition, to evaluate whether the existing information systems obtain relevant data for researching the decision-making process. The second objective is to identify potentially influencing factors that could be significant for further research. METHODS All patients in the period from 1 January 2011 until 31 December 2020, treated by HEMS and subsequently transported to hospitals were included in the study. To avoid overrepresentation of the PTA group, a random sample was taken, creating two groups in a 1:2 ratio (PTH n = 724, PTA n = 1448). Differences in patient and treatment characteristics between PTH and PTA were compared using t-tests, Mann-Whitney U tests, and chi-square tests. RESULTS PTH accounted for 12.2% of all transports. Approximately two-third of the patients were male and the mean age was around 40 years. PTH had lower iEMV (initial Eye opening, best Motor response, best Verbal response) and iRTS (initial Revised Trauma Score) scores, were more frequently transported to a level 1 trauma centre, underwent more prehospital treatments and were roughly twice as far from their hospital of arrival compared to PTA. CONCLUSION The current dataset is, after some modifications, suitable to provide a comprehensive overview of patients treated by HEMS in the Netherlands. A predictive model could be developed using this dataset, which should include factors such as the patient's location, age, distance to the hospital, physician on duty, mechanism of injury and overall injury severity.
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Affiliation(s)
- Bas Blok
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands.
| | - Cor Slagt
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
| | - Geert-Jan van Geffen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
| | - Rebecca Koch
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
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Aalberg I, Nordseth T, Klepstad P, Rosseland LA, Uleberg O. Incidence, severity and changes of abnormal vital signs in trauma patients: A national population-based analysis. Injury 2024:111884. [PMID: 39327112 DOI: 10.1016/j.injury.2024.111884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 08/28/2024] [Accepted: 09/12/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Physiological criteria are used to assess the potential severity of injury in the early phase of a trauma patient's care trajectory. Few studies have described the extent of abnormality in vital signs and different combinations of these at a national level. Aim of the study was to identify physiologic abnormalities in trauma patients and describe different combinations of abnormalities and changes between the pre-hospital and emergency department (ED) settings. METHOD Norwegian Trauma Registry (NTR) data between 01.01.15 - 31.12.18, where evaluated on the prevalence and characteristics of abnormal physiologic variables. Primary outcome were rates of hypoventilation (respiratory rate [RR] < 10 breaths per min), hyperventilation (RR > 29 breaths per min), hypotension (systolic blood pressure [SBP] < 90 mmHg), and reduced level of consciousness (Glasgow Coma Scale [GCS] < 13). RESULTS A total of 24,482 patients were included. Documented values for RR, SBP and GCS were 77.6%, 78.5% and 81.9% in the pre-hospital phase, and the corresponding percentages in the ED were 95.5%, 99.2% and 98.6%, respectively. In the pre-hospital phase, 3,615 (14.8%) patients had at least one abnormal vital sign, whereas the corresponding numbers in the ED, were 3,616 (14.8%) patients. The most frequent combination was low GCS and hyperventilation. A worsened RTS-score from pre-hospital phase to the ED was observed for RR, SBP and GCS in 3.9%, 1.2% and 1.9% of incidents, respectively. Overall 30-day mortality was 3.1% (n=752). Of these, 60.8% had abnormal vital signs, with decreased GCS as the most prevalent (61.3%). CONCLUSION Most trauma patients had normal vital signs. According to the RTS-score, there were few deteriorations in RR, SBP and GCS between pre-hospital phase and the ED. The most frequent abnormality was low GCS, with a higher proportion in those who died within 30 days.
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Affiliation(s)
- Ingrid Aalberg
- Department of Circulation and Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway.
| | - Trond Nordseth
- Department of Circulation and Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Department of Anesthesia and Intensive Care, St. Olav`s University Hospital, NO-7006 Trondheim, Norway.
| | - Pål Klepstad
- Department of Circulation and Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway; Department of Anesthesia and Intensive Care, St. Olav`s University Hospital, NO-7006 Trondheim, Norway.
| | - Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, NO-0318 Oslo, Norway.
| | - Oddvar Uleberg
- Department of Circulation and Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Department of Emergency Medicine and Pre-hospital Services, St. Olav's University Hospital, NO-7006 Trondheim, Norway.
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Lenart EK, Byerly SE, Gross MG, Ali YM, Evans CR, Easterday TS, Howley IW, Kerwin AJ, Fischer PE, Filiberto DM. Clinical Implications of Over- and Under-Triage Using Need for Trauma Intervention and Cribari Indices. Am Surg 2024; 90:2176-2181. [PMID: 38613475 DOI: 10.1177/00031348241246181] [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] [Indexed: 04/15/2024]
Abstract
BACKGROUND Need for Trauma Intervention (NFTI) score was proposed to help identify injured trauma patients while minimizing under (UT) and over triage (OT). Using a national database, we aimed to describe UT and OT of NFTI vs standard Cribari method (CM) and hypothesized triage sensitivity remains poor. METHODS The 2021 Trauma Quality Improvement Program (TQIP) database was queried. Demographics, mechanism, verification level, interfacility transfer (IF), and level of activation were collected. Patients were stratified by both NFTI [+ vs -] and CM [Injury severity score (ISS) < 15 vs > 15]. UT was defined as NFTI + or ISS >15 without full trauma activation. RESULTS 1,030,526 patients were identified in TQIP. 84,969 were UT and 97,262 were OT using NFTI while 94,020 were UT and 108,823 were OT using CM. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of NFTI is 49%, 89%, 45%, and 90%, respectively vs 43%, 87%, 39%, and 89% of CM, respectively. Age was higher in the UT group using both scores (52 vs 42, P < .0001 and 54 vs 42, P < .0001, respectively). Using MLR, level 2 and 3 verification, blunt mechanism, female, IF, and older age were associated with UT in both NFTI and CM. Level 1 verification, penetrating mechanism, male, no IF, and younger age were associated with OT. CONCLUSIONS Current prehospital triage criteria have poor sensitivity for identifying severely injured trauma patients by both NFTI and CM. UT increases as age of the patient increases. Further studies are needed to improve triage.
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Affiliation(s)
- Emily K Lenart
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Saskya E Byerly
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Megan G Gross
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Yasmin M Ali
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Cory R Evans
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Thomas S Easterday
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Isaac W Howley
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andy J Kerwin
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Peter E Fischer
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Dina M Filiberto
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
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Moreno-Blanco D, Alonso E, Sanz-García A, Aramendi E, López-Izquierdo R, Perez García R, Del Pozo Vegas C, Martín-Rodríguez F. Spanish vs USA cohort comparison of prehospital trauma scores to predict short-term mortality. Clin Med (Lond) 2024; 24:100208. [PMID: 38643832 PMCID: PMC11101846 DOI: 10.1016/j.clinme.2024.100208] [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: 11/03/2023] [Accepted: 04/07/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND This study aimed to evaluate three prehospital early warning scores (EWSs): RTS, MGAP and MREMS, to predict short-term mortality in acute life-threatening trauma and injury/illness by comparing United States (US) and Spanish cohorts. METHODS A total of 8,854 patients, 8,598/256 survivors/nonsurvivors, comprised the unified cohort. Datasets were randomly divided into training and test sets. Training sets were used to analyse the discriminative power of the scores in terms of the area under the curve (AUC), and the score performance was assessed in the test set in terms of sensitivity (SE), specificity (SP), accuracy (ACC) and balanced accuracy (BAC). RESULTS The three scores showed great discriminative power with AUCs>0.90, and no significant differences between cohorts were found. In the test set, RTS/MREMS/MGAP showed SE/SP/ACC/BAC values of 86.0/89.9/89.6/87.1%, 91.0/86.9/87.5/88.5%, and 87.7/82.9/83.4/85.2%, respectively. CONCLUSIONS All EWSs showed excellent ability to predict the risk of short-term mortality, independent of the country.
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Affiliation(s)
- Diego Moreno-Blanco
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Spain; Biomedical Engineering and Telemedicine Centre, ETSI de Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
| | - Erik Alonso
- Department of Applied Mathematics, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, University of Castilla - La Mancha (UCLM), Talavera, Spain.
| | - Elisabete Aramendi
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Raúl López-Izquierdo
- Faculty of Medicine, University of Valladolid, Valladolid, Spain; CIBER of Respiratory Diseases, Instituto de Salud Carlos III, Madrid, Spain; Emergency Department. Hospital Universitario Rio Hortega. Valladolid, Spain
| | - Rubén Perez García
- Emergency Department. Hospital Universitario Rio Hortega. Valladolid, Spain
| | - Carlos Del Pozo Vegas
- Faculty of Medicine, University of Valladolid, Valladolid, Spain; Emergency Department. Hospital Clínico Universitario. Valladolid, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, University of Valladolid, Valladolid, Spain; Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
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Hetz M, Rosch J, Unger T, Struck MF, Schaser KD, Kleber C. Interobserver variability in preclinical assessment of collision variables following traffic accidents. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02528-5. [PMID: 38613681 DOI: 10.1007/s00068-024-02528-5] [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: 01/04/2024] [Accepted: 04/04/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE Traffic accidents persist as a leading cause of death. European law mandates the integration of automatic emergency call systems (eCall). Our project focuses on an automated injury prediction device for car accidents, correlating technical and epidemiological input data, such as age, gender, seating position, impact on the passenger compartment, seatbelt usage, impact direction, EES, vehicle class, and airbag deployment. This study aims to explore interobserver variability in data collection quality in real accident scenarios. The assessment will evaluate the impact of user training and measure the time needed for data collection to inform user recommendations for the prehospital assessment. Insights from this study can aid in evaluating the ability of different professional groups to identify potential accident-independent parameters at accident scenes. This includes, among other things, relaying information to dispatchers at rescue control centers, also within the context of telemedicine approaches. METHODS During group sessions, real accident scenarios were presented both before and after a training presentation. Participants, including laypersons, accident research staff, emergency services, hospital physicians, and emergency physicians, visually assessed injury prediction parameters within a time limit. Training involved defining and explaining parameters using accident images. The study analyzed participant demographics, prediction accuracy, and time required, comparing assessment quality between professional groups and before and after training. RESULTS In summary, the study demonstrates that training had a significantly positive impact on the quality of assessment for technical accident parameters. The processing time decreased significantly after training. A notable training effect was observed, particularly for the parameters of rigid collision object, affected passenger compartment, energy equivalent speed (EES), and front and side airbags. It was recommended that individuals without prior knowledge should receive training on assessing EES. Overall, it was evident that technical parameters following a traffic accident can be well assessed through training, irrespective of the professional group. CONCLUSION Significant differences in the assessment quality of technical accident parameters were observed based on technical and medical expertise. After user training, interdisciplinary differences were reconciled, and all professional groups yielded comparable results, indicating that training can enhance the assessment abilities of all participants in the rescue chain, while the time required for assessing accident parameters was significantly reduced with training.
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Affiliation(s)
- Michael Hetz
- Department of Operative Medicine (DOPM), Clinic and Polyclinic for Orthopedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
| | - Julius Rosch
- Department of Orthopedics and Trauma Surgery, St Josef Hospital Essen-Werden, University Hospital Essen, Essen, Germany
| | - Thomas Unger
- Verkehrsunfallforschung an der TU Dresden GmbH, Dresden, Germany
| | - Manuel F Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Klaus-Dieter Schaser
- University Center for Orthopedics, Traumatology, and Plastic Surgery, Carl Gustav Carus University Hospital Dresden, Dresden, Germany
| | - Christian Kleber
- Department of Operative Medicine (DOPM), Clinic and Polyclinic for Orthopedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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Tiyawat G, Liu JM, Huabbangyang T, Roza-Alonso CL, Castro-Delgado R. Comparative Analysis of META and SALT Disaster Triage in an Adult Trauma Population: A Retrospective Observational Study. Prehosp Disaster Med 2024; 39:142-150. [PMID: 38404235 PMCID: PMC11035921 DOI: 10.1017/s1049023x24000098] [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: 11/29/2023] [Revised: 01/17/2024] [Accepted: 01/24/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Medical professionals can use mass-casualty triage systems to assist them in prioritizing patients from mass-casualty incidents (MCIs). Correct triaging of victims will increase their chances of survival. Determining the triage system that has the best performance has proven to be a difficult question to answer. The Advanced Prehospital Triage Model (Modelo Extrahospitalario de Triaje Avanzado; META) and Sort, Assess, Lifesaving Interventions, Treatment/Transport (SALT) algorithms are the most recent triage techniques to be published. The present study aimed to evaluate the META and SALT algorithms' performance and statistical agreement with various standards. The secondary objective was to determine whether these two MCI triage systems predicted patient outcomes, such as mortality, length-of-stay, and intensive care unit (ICU) admission. METHODS This retrospective study used patient data from the trauma registry of an American College of Surgeons Level 1 trauma center, from January 1, 2018 through December 31, 2020. The sensitivity, specificity, and statistical agreement of the META and SALT triage systems to various standards (Revised Trauma Score [RTS]/Sort Triage, Injury Severity Score [ISS], and Lerner criteria) when applied using trauma patients. Statistical analysis was used to assess the relationship between each triage category and the secondary outcomes. RESULTS A total of 3,097 cases were included in the study. Using Sort triage as the standard, SALT and META showed much higher sensitivity and specificity in the Immediate category than for Delayed (Immediate sensitivity META 91.5%, SALT 94.9%; specificity 60.8%, 72.7% versus Delayed sensitivity 28.9%, 1.3%; specificity 42.4%, 28.9%). With the Lerner criteria, in the Immediate category, META had higher sensitivity (77.1%, SALT 68.6%) but lower specificity (61.1%) than SALT (71.8%). For the Delayed category, SALT showed higher sensitivity (META 61.4%, SALT 72.2%), but lower specificity (META 75.1%, SALT 67.2%). Both systems showed a positive, though modest, correlation with ISS. For SALT and META, triaged Immediate patients tended to have higher mortality and longer ICU and hospital lengths-of-stay. CONCLUSION Both META and SALT triage appear to be more accurate with Immediate category patients, as opposed to Delayed category patients. With both systems, patients triaged as Immediate have higher mortality and longer lengths-of-stay when compared to Delayed patients. Further research can help refine MCI triage systems and improve accuracy.
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Affiliation(s)
- Gawin Tiyawat
- Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand
| | - J. Marc Liu
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WisconsinUSA
| | - Thongpitak Huabbangyang
- Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand
| | - Cesar Luis Roza-Alonso
- Health Service of the Principality of Asturias (SAMU-Asturias), Health Research Institute of the Principality of Asturias (Research Group on Prehospital Care and Disasters, GIAPREDE), Oviedo, Spain
| | - Rafael Castro-Delgado
- Health Service of the Principality of Asturias (SAMU-Asturias), Health Research Institute of the Principality of Asturias (Research Group on Prehospital Care and Disasters, GIAPREDE), Oviedo, Spain
- Department of Medicine, Oviedo University, Oviedo, Spain
- RINVEMER-SEMES (Research Network on Prehospital Care-Spanish Society of Emergency Medicine), Madrid, Spain
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Salcido DD, Zikmund CW, Weiss LS, Schoenling A, Martin-Gill C, Guyette FX, Pinsky MR. Severity-Driven Trends in Mortality in a Large Regionalized Critical Care Transport Service. Air Med J 2024; 43:116-123. [PMID: 38490774 PMCID: PMC10988775 DOI: 10.1016/j.amj.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/03/2023] [Accepted: 11/12/2023] [Indexed: 03/17/2024]
Abstract
OBJECTIVE The epidemiology accompanying helicopter emergency medical services (HEMS) transport has evolved as agencies have matured and become integrated into regionalized health systems, as evidenced primarily by nationwide systems in Europe. System-level congruence between Europe and the United States, where HEMS is geographically fragmentary, is unclear. In this study, we provide a temporal, epidemiologic characterization of the largest standardized private, nonprofit HEMS system in the United States, STAT MedEvac. METHODS We obtained comprehensive timing, procedure, and vital signs data from STAT MedEvac prehospital electronic patient care records for all adult patients transported to UPMC Health System hospitals in the period of January 2012 through October 2021. We linked these data with hospital electronic health records available through June 2018 to establish length of stay and vital status at discharge. RESULTS We studied 90,960 transports and matched 62.8% (n = 57,128) to the electronic health record. The average patient age was 58.6 years ( 19 years), and most were male (57.9%). The majority of cases were interfacility transports (77.6%), and the most common general medical category was nontrauma (72.7%). Sixty-one percent of all patients received a prehospital intervention. Overall, hospital mortality was 15%, and the average hospital length of stay (LOS) was 8.8 days ( 10.0 days). Observed trends over time included increases in nontrauma transports, level of severity, and in-hospital mortality. In multivariable models, case severity and medical category correlated with the outcomes of mortality and LOS. CONCLUSION In the largest standardized nonprofit HEMS system in the United States, patient mortality and hospital LOS increased over time, whereas the proportion of trauma patients and scene runs decreased.
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Affiliation(s)
- David D Salcido
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Chase W Zikmund
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Leonard S Weiss
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Andrew Schoenling
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Francis X Guyette
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Michael R Pinsky
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Góes AMDO, de Albuquerque FBA, Feijó MO, de Albuquerque FBA, Corrêa LRDV, de Andrade MC. Prognostic factors for femoropopliteal vascular injuries: surgical decisions matter. J Vasc Bras 2023; 22:e20230050. [PMID: 38021276 PMCID: PMC10647908 DOI: 10.1590/1677-5449.202300502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/04/2023] [Indexed: 12/01/2023] Open
Abstract
Background Lower limbs are frequently involved in vascular trauma, but it is still not clear which factors lead to unfavorable clinical outcomes. Objectives To determine the clinical profile of patients with femoropopliteal injuries, the trauma mechanisms, and treatment and identify which factors led to unfavorable outcomes. Methods A retrospective study based on the medical records of patients treated from 2017 to 2021. The following data were assessed: sex, age, distance to reach the hospital, trauma mechanism, hypovolemic shock, additional injuries, treatment of vascular injuries, whether fasciotomy was needed, inappropriate intraoperative decisions, and injury severity score. Need for surgical reintervention, amputation, and death were defined as unfavorable outcomes. Univariate, bivariate, and logistic regression analyses were conducted. Results The sample comprised 94 patients; 83% were men; mean age was 30.8 years; combined arterial and venous injuries prevailed (57.5%); and superficial femoral vessels were the most affected (61.7%). Penetrating mechanisms prevailed (80.9%). Arterial injuries were most frequently treated with venous graft (59.6%) and venous injuries underwent ligation (81.4%). In 15% of cases, inappropriate surgical decisions were detected; most often use of the ipsilateral great saphenous vein for arterial reconstruction. Unfavorable outcomes occurred in 44.7%: surgical reintervention was necessary in 21.3% and limb amputation in 25.5%, while 9.5% of the patients died. Conclusions These injuries mainly involved young men, victims of gunshot wounds. Superficial femoral vessels were the most injured; concomitant non-vascular trauma was frequent, mainly fractures. Inappropriate surgical decisions increased the need for reinterventions by 34 times. Need for fasciotomy, presence of fracture/dislocation, blunt trauma mechanism, and popliteal artery injury increased the risk of amputation.
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Xu L, Kang Z, Wang D, Liu Y, Wang C, Li Z, Bai X, Wang Y. Development and validation of a nomogram for predicting persistent inflammation, immunosuppression, and catabolism syndrome in trauma patients. Front Med (Lausanne) 2023; 10:1249724. [PMID: 37692780 PMCID: PMC10483122 DOI: 10.3389/fmed.2023.1249724] [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: 06/29/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
Background Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PIICS) is a significant contributor to adverse long-term outcomes in severe trauma patients. Objective The objective of this study was to establish and validate a PIICS predictive model in severe trauma patients, providing a practical tool for early clinical prediction. Patients and methods Adult severe trauma patients with an Injury Severity Score (ISS) of ≥16, admitted between October 2020 and December 2022, were randomly divided into a training set and a validation set in a 7:3 ratio. Patients were classified into PIICS and non-PIICS groups based on diagnostic criteria. LASSO regression was used to select appropriate variables for constructing the prognostic model. A logistic regression model was developed and presented in the form of a nomogram. The performance of the model was evaluated using calibration and ROC curves. Results A total of 215 patients were included, consisting of 155 males (72.1%) and 60 females (27.9%), with a median age of 51 years (range: 38-59). NRS2002, ISS, APACHE II, and SOFA scores were selected using LASSO regression to construct the prognostic model. The AUC of the ROC analysis for the predictive model in the validation set was 0.84 (95% CI 0.72-0.95). The Hosmer-Lemeshow test in the validation set yielded a χ2 value of 14.74, with a value of p of 0.098. Conclusion An accurate and easily implementable PIICS risk prediction model was established. It can enhance risk stratification during hospitalization for severe trauma patients, providing a novel approach for prognostic prediction.
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Affiliation(s)
- Ligang Xu
- Division of Trauma Surgery, Emergency Surgery and Surgical Critical, Tongji Trauma Center, Wuhan, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhaofeng Kang
- Division of Trauma Surgery, Emergency Surgery and Surgical Critical, Tongji Trauma Center, Wuhan, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongfang Wang
- Division of Trauma Surgery, Emergency Surgery and Surgical Critical, Tongji Trauma Center, Wuhan, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yukun Liu
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuntao Wang
- Division of Trauma Surgery, Emergency Surgery and Surgical Critical, Tongji Trauma Center, Wuhan, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhanfei Li
- Division of Trauma Surgery, Emergency Surgery and Surgical Critical, Tongji Trauma Center, Wuhan, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangjun Bai
- Division of Trauma Surgery, Emergency Surgery and Surgical Critical, Tongji Trauma Center, Wuhan, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuchang Wang
- Division of Trauma Surgery, Emergency Surgery and Surgical Critical, Tongji Trauma Center, Wuhan, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Matsui M, Sugita K, Kawano T, Nishida N, Nagano A, Murakami M, Yano K, Harumatsu T, Onishi S, Yamada K, Yamada W, Muto M, Kaji T, Ieiri S. Cases of pediatric intra-abdominal solid organ injury induced by blunt trauma experienced over a 15-year period at two centers in Japan. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000560. [PMID: 37342728 PMCID: PMC10277529 DOI: 10.1136/wjps-2023-000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/19/2023] [Indexed: 06/23/2023] Open
Abstract
Objective The present study attempts to clarify the clinical features of pediatric intra-abdominal solid organ injury at two institutions. Methods The injured organ, patient age, sex, injury grade, imaging findings, intervention, length of hospital stay, and complications were retrospectively reviewed using medical records at two centers from 2007 to 2021. Results There were 25 cases of liver injury, 9 of splenic injury, 8 of pancreatic injury, and 5 of renal injury. The mean age of all patients was 8.6±3.8 years old, with no difference between organ injury types. Radiological intervention was performed in four cases of liver injury (16.0%) and one case of splenic injury (11.1%), and surgery was performed in two cases of liver injury (8.0%) and three cases of pancreatic injury (37.5%). All other cases were treated conservatively. Complications included adhesive ileus in one case of liver injury (4.0%), splenic atrophy in one case of splenic injury (11.1%), pseudocysts in three cases of pancreatic injury (37.5%), atrophy of the pancreatic parenchyma in one case of pancreatic injury (12.5%), and urinoma in one case of renal injury (20.0%). No mortalities were observed. Conclusion Pediatric patients with blunt trauma had favorable outcomes at two pediatric trauma centers covering a broad medical area, including remote islands.
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Affiliation(s)
- Mayu Matsui
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Koshiro Sugita
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Nanako Nishida
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Ayaka Nagano
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Masakazu Murakami
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Keisuke Yano
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Toshio Harumatsu
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Koji Yamada
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Mitsuru Muto
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
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Jokšić-Mazinjanin R, Marić N, Đuričin A, Gojković Z, Vasović V, Rakić G, Jokšić-Zelić M, Saravolac S. Prehospital Trauma Scoring Systems for Evaluation of Trauma Severity and Prediction of Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050952. [PMID: 37241183 DOI: 10.3390/medicina59050952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/22/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Trauma scoring systems in prehospital settings are supposed to ensure the most appropriate in-hospital treatment of the injured. AIM OF THE STUDY To determine the sensitivity and specificity of the CRAMS scale (circulation, respiration, abdomen, motor and speech), RTS score (revised trauma score), MGAP (mechanism, Glasgow Coma Scale, age, arterial pressure) and GAP (Glasgow Coma Scale, age, arterial pressure) scoring systems in prehospital settings in order to evaluate trauma severity and to predict the outcome. MATERIALS AND METHODS A prospective, observational study was conducted. For every trauma patient, a questionnaire was initially filled in by a prehospital doctor and these data were subsequently collected by the hospital. RESULTS The study included 307 trauma patients with an average age of 51.7 ± 20.9. Based on the ISS (injury severity score), severe trauma was diagnosed in 50 (16.3%) patients. MGAP had the best sensitivity/specificity ratio when the obtained values indicated severe trauma. The sensitivity and specificity were 93.4 and 62.0%, respectively, for an MGAP value of 22. MGAP and GAP were strongly correlated with each other and were statistically significant in predicting the outcome of treatment (OR 2.23; 95% Cl 1.06-4.70; p = 0.035). With a rise of one in the MGAP score value, the probability of survival increases 2.2 times. CONCLUSION MGAP and GAP, in prehospital settings, had higher sensitivity and specificity when identifying patients with a severe trauma and predicting an unfavorable outcome than other scoring systems.
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Affiliation(s)
- Radojka Jokšić-Mazinjanin
- Department of Emergency Medicine, Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute for Emergency Medical Services Novi Sad, 21000 Novi Sad, Serbia
| | - Nikolina Marić
- Institute for Emergency Medical Services Novi Sad, 21000 Novi Sad, Serbia
| | - Aleksandar Đuričin
- Department of Emergency Medicine, Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute for Emergency Medical Services Novi Sad, 21000 Novi Sad, Serbia
| | - Zoran Gojković
- Department of Surgery, Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Velibor Vasović
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Goran Rakić
- Department of Emergency Medicine, Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
- Department of Intensive Surgical Therapy, Institute for Child and Youth Health Care Vojvodina, Pediatric Surgery Clinic, 21000 Novi Sad, Serbia
| | | | - Siniša Saravolac
- Institute for Emergency Medical Services Novi Sad, 21000 Novi Sad, Serbia
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Yu JY, Heo S, Xie F, Liu N, Yoon SY, Chang HS, Kim T, Lee SU, Hock Ong ME, Ng YY, Do shin S, Kajino K, Cha WC. Development and Asian-wide validation of the Grade for Interpretable Field Triage (GIFT) for predicting mortality in pre-hospital patients using the Pan-Asian Trauma Outcomes Study (PATOS). THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 34:100733. [PMID: 37283981 PMCID: PMC10240358 DOI: 10.1016/j.lanwpc.2023.100733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/24/2023] [Accepted: 02/19/2023] [Indexed: 03/07/2023]
Abstract
Background Field triage is critical in injury patients as the appropriate transport of patients to trauma centers is directly associated with clinical outcomes. Several prehospital triage scores have been developed in Western and European cohorts; however, their validity and applicability in Asia remains unclear. Therefore, we aimed to develop and validate an interpretable field triage scoring systems based on a multinational trauma registry in Asia. Methods This retrospective and multinational cohort study included all adult transferred injury patients from Korea, Malaysia, Vietnam, and Taiwan between 2016 and 2018. The outcome of interest was a death in the emergency department (ED) after the patients' ED visit. Using these results, we developed the interpretable field triage score with the Korea registry using an interpretable machine learning framework and validated the score externally. The performance of each country's score was assessed using the area under the receiver operating characteristic curve (AUROC). Furthermore, a website for real-world application was developed using R Shiny. Findings The study population included 26,294, 9404, 673 and 826 transferred injury patients between 2016 and 2018 from Korea, Malaysia, Vietnam, and Taiwan, respectively. The corresponding rates of a death in the ED were 0.30%, 0.60%, 4.0%, and 4.6% respectively. Age and vital sign were found to be the significant variables for predicting mortality. External validation showed the accuracy of the model with an AUROC of 0.756-0.850. Interpretation The Grade for Interpretable Field Triage (GIFT) score is an interpretable and practical tool to predict mortality in field triage for trauma. Funding This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant Number: HI19C1328).
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Affiliation(s)
- Jae Yong Yu
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Digital & Smart Health Office, Tan Tock Seng Hospital, Singapore
| | - Sejin Heo
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Feng Xie
- Programme in Health Services and Systems Research, Duke–National University of Singapore Medical School, Singapore
- Department of Biomedical Data Science, Stanford University, Stanford, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, USA
| | - Nan Liu
- Programme in Health Services and Systems Research, Duke–National University of Singapore Medical School, Singapore
- Health Service Research Centre, Singapore Health Services, Singapore
- Institute of Data Science, National University of Singapore, Singapore
| | - Sun Yung Yoon
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Han Sol Chang
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Taerim Kim
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Marcus Eng Hock Ong
- Programme in Health Services and Systems Research, Duke–National University of Singapore Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Yih Yng Ng
- Digital & Smart Health Office, Tan Tock Seng Hospital, Singapore
| | - Sang Do shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Kentaro Kajino
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Moriguchi, Japan
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Digital Innovation Center, Samsung Medical Center, Seoul, South Korea
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Shiber J, Fontane E, Patel J, Akinleye A, Kerwin A, Chiu W, Scalea T. Gestalt clinical severity score (GCSS) as a predictor of patient severity of illness or injury. Am J Emerg Med 2023; 66:11-15. [PMID: 36640694 DOI: 10.1016/j.ajem.2023.01.005] [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: 10/10/2022] [Revised: 11/26/2022] [Accepted: 01/02/2023] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To determine if clinical judgement is accurate to predict the severity of injury or illness, and can be used at patient arrival when other formal scoring systems are not yet available. DESIGN A multicenter pilot study using a prospective observational convenience sample of patients arriving by EMS to the emergency department (ED) or Trauma Center. SETTING Two urban, Level 1 trauma centers at academic tertiary care hospitals. PATIENTS Medical and trauma patients age 18 and older transported by EMS (N = 216). Exclusion criteria (prior to arrival): intubation, assisted ventilation (BVM or NPPV), CPR in progress, prisoners, or previously present motor or speech deficits. MEASUREMENTS Completion of a novel 15-point scale of Verbal, Motor, and Facial Expression within 1-2 min of arrival by a clinician outside of the treatment team. Primary endpoint was the immediate disposition from the ED or Trauma Center: Home, Brief Observation (<24 h), Admission to Floor, ICU (OR and IR as surrogates since these patients ultimately go to the ICU), or Morgue. RESULTS Univariate analysis revealed a strong, positive monotonic correlation between GCSS and disposition (Rho = 0.693, p < .0001). Multivariable logistic regression revealed the "best" model included GCSS and age (group 18-44 years old versus all the other age groups) (p < .0001). There was a 156% increase in the odds of being discharged home (versus being admitted) for a one-unit increase in GCSS (OR = 2.56, 95% CI 1.94, 3.37). CONCLUSIONS Physicians can make accurate predictions of severity of injury and illness using a gestalt method and the scoring system we have developed as patient disposition correlates well with GCSS score. GCSS is most accurate with the 18-44 age group.
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Affiliation(s)
| | | | - Jignesh Patel
- Houston Methodist Hospital, Houston, TX, United States of America
| | | | - Andy Kerwin
- UT HSC, Memphis, TN, United States of America.
| | - William Chiu
- UMMS/R Adams Cowley STC, Baltimore, MD, United States of America.
| | - Thomas Scalea
- UMMS/R Adams Cowley STC, Baltimore, MD, United States of America.
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Larkin EJ, Jones MK, Young SD, Young JS. Interest of the MGAP score on in-hospital trauma patients: Comparison with TRISS, ISS and NISS scores. Injury 2022; 53:3059-3064. [PMID: 35623955 DOI: 10.1016/j.injury.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/16/2022] [Accepted: 05/06/2022] [Indexed: 02/02/2023]
Abstract
Trauma scoring systems were created to predict mortality and enhance triage capabilities. However, efficacy of scoring systems to predict mortality and accuracy of originally reported severity thresholds remains uncertain. A single-center, retrospective study was conducted at University of Virginia (UVA), an American College of Surgeons verified Level I trauma center. We compared four scoring systems: MGAP (Mechanism, Glasgow Coma Scale, Age, and arterial pressure), Injury Severity Score (ISS), New Injury Severity Score (NISS), and Trauma Related Injury Severity Score (TRISS) to predict in-hospital mortality and disposition from the emergency department to higher acuity level of care including mortality (i.e. operating room, intensive care unit, morgue) versus standard floor admission using area under the curve (AUC) for receiver operating characteristic analysis. Second, we examined sensitivity of these scores at standard thresholds to determine if adjustments were needed to minimize under-triage (sensitivity ≥95%). TRISS was the best predictor of mortality in a cohort of n = 16,265 with AUC of 0.920 (95% CI: 0.911-0.929, p<0.0001), followed by MGAP with AUC of 0.900 (95% CI: 0.889-0.911, p<0.0001), and finally ISS and NISS (0.830 (95% CI: 0.814-0.847) and 0.827 (95% CI: 0.809-0.844) respectively). NISS was the best predictor of high acuity disposition with an AUC of 0.729 (95% CI: 0.721-0.736, p<0.0001), followed by ISS with AUC of 0.714 (95% CI: 0.707-0.722, p<0.0001), and finally TRISS and MGAP (0.673 (95% CI: 0.665-0.682) and 0.613 (95% CI: 0.604-0.621) respectively (p<0.0001). At historic thresholds, no scoring system displayed adequate sensitivity to predict mortality, with values ranging from 73% for ISS to 80% for NISS. In conclusion, in the reported study cohort, TRISS was the best predictor of mortality while NISS was the best predictor of high acuity disposition. We also stress updating scoring system thresholds to achieve ideal sensitivity, and investigating how scoring systems derived to predict mortality perform when predicting indicators of morbidity such as disposition from the emergency department.
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Affiliation(s)
- Emily J Larkin
- Department of Surgery, University of Virginia, Charlottesville, VA, United States.
| | - Marieke K Jones
- Claude Moore Health Sciences Library, University of Virginia, Charlottesville, Virginia, United States
| | - Steven D Young
- Department of Surgery, University of Virginia, Charlottesville, VA, United States
| | - Jeffrey S Young
- Department of Surgery, University of Virginia, Charlottesville, VA, United States
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Liu Z, Fu B, Xu W, Liu F, Dong J, Li L, Zhou D, Hao Z, Lu S. Incidence of Traumatic Sciatic Nerve Injury in Association with Acetabular Fracture: A Retrospective Observational Single-Center Study. Int J Gen Med 2022; 15:7417-7425. [PMID: 36172087 PMCID: PMC9512635 DOI: 10.2147/ijgm.s385995] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients and Methods Results Conclusion
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Affiliation(s)
- Zhigang Liu
- Department of Orthopaedics Surgery, Haining People’s Hospital, Jiaxing, People’s Republic of China
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Baisheng Fu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Weicheng Xu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Fanxiao Liu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Jinlei Dong
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Lianxin Li
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Dongsheng Zhou
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Zhenhai Hao
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Shun Lu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
- Correspondence: Shun Lu, Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China, Tel +8618653189700, Email
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Agudelo-Ledezma HH, Ruiz-Mazuera LC, Valencia-Amaya N, Bravo-Realpe KA, Hurtado-Burbano YV, Cabrera-Correal MC, Rojas-Díaz AB, Ortiz-Martínez RA. Rendimiento de escalas de trauma ISS, NISS y RTS en accidentes de tránsito para predecir mortalidad en un hospital de alta complejidad. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.2200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La población mundial crece y con ello los accidentes de tránsito, incrementando la morbimortalidad. La combinación de factores clínicos y paraclínicos mediante las escalas de trauma impacta en los desenlaces al permitir tomar acciones oportunas.
Métodos. Estudio de corte transversal en el que se incluyeron pacientes con lesiones por colisión en accidentes de tránsito, atendidos entre 2017 y 2018, en urgencias del Hospital Universitario San José de Popayán, Colombia, un hospital de alta complejidad. Se recolectaron variables sociodemográficas y biológicas y se aplicaron tres escalas de trauma, Revised Trauma Score, Injury Severity Score y New Injury Severity Score. Posteriormente, se evaluó su rendimiento para predecir mortalidad.
Resultados. Se atendieron en el servicio de urgencias 650 pacientes con lesiones en accidentes de tránsito y se presentaron 16 muertes. Al evaluar el rendimiento de las escalas de trauma se encontró que la sensibilidad para mortalidad varía entre el 75 % para Revised Trauma Score y el 93,8 % para Injury Severity Score y New Injury Severity Score, con una especificidad que varía entre 89,1 % y 96,8 %. Se identificó que la mejor razón de verosimilitud positiva fue para Revised Trauma Score, mientras que la mejor razón de verosimilitud negativa fue para Injury Severity Score y New Injury Severity Score.
Conclusiones. Los resultados evidencian un adecuado rendimiento de las escalas de trauma evaluadas para predecir mortalidad. La escala que presentó mejor rendimiento fue Injury Severity Score por su sensibilidad, especificidad y razón de verosimilitud positiva.
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Spirollari E, Beaudreault C, Ng C, Vazquez S, Chapman E, Clare K, Wang R, Naftchi A, Das A, Lui A, Sacknovitz A, Dominguez JF, Gandhi CD, Tyagi R, Houten JK, Kinon MD. Cervical fusion for adult patients with atlantoaxial rotatory subluxation. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:224-233. [PMID: 35875625 PMCID: PMC9263735 DOI: 10.21037/jss-22-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Atlantoaxial rotatory subluxation (AARS) is a rare injury of the C1/C2 junction. It is often associated with trauma in adults. Treatment may depend on the duration of symptoms and clinical presentation, but there is no consensus regarding the ideal management of these injuries. Our objective is to ascertain the prevalence of neurological deficit, complications, and outcomes of patients diagnosed with AARS undergoing cervical fusion (CF) versus those treated without CF. METHODS The 2016-2019 National Inpatient Sample (NIS) was queried using International Classification of Diseases, 10th revision (ICD-10) for adult patients with C1/C2 subluxation. Patients undergoing CF were defined through ICD-10 procedure codes. Baseline health and acute illness severity was calculated using the 11-point modified frailty index (mFI-11). Presenting characteristics, treatment complications, and outcomes were evaluated of CF vs. non-CF patients. RESULTS Of 990 adult patients with AARS, 720 were treated without CF and 270 were treated with CF. CF patients were more often myelopathic. Patients that had undergone CF treatment were negatively associated with having had extensive trauma. Patients undergoing CF experienced significantly longer length of stay (LOS), increased healthcare resource utilization, and decreased inpatient mortality. Sepsis had a negative association with patients that underwent CF treatment while pneumonia had a positive association. CONCLUSIONS Adult patients undergoing CF for AARS demonstrated an increase in healthcare resource utilization but also a significant decrease in mortality. Extent of acute injury appears to have a strong influence on decision making for CF. Further study of decision making for treatment of this rare injury in adults is warranted.
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Affiliation(s)
| | | | | | | | - Emily Chapman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Ankita Das
- New York Medical College, Valhalla, NY, USA
| | - Aiden Lui
- New York Medical College, Valhalla, NY, USA
| | | | - Jose F. Dominguez
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Chirag D. Gandhi
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Rachana Tyagi
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - John K. Houten
- Department of Neurosurgery, Maimonides Medical Center, Zucker School of Medicine at Hofstra-Northwell, Brooklyn, NY, USA
| | - Merritt D. Kinon
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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Mohammed Z, Saleh Y, AbdelSalam EM, Mohammed NBB, El-Bana E, Hirshon JM. Evaluation of the Revised Trauma Score, MGAP, and GAP scoring systems in predicting mortality of adult trauma patients in a low-resource setting. BMC Emerg Med 2022; 22:90. [PMID: 35643425 PMCID: PMC9148470 DOI: 10.1186/s12873-022-00653-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Numerous trauma scoring systems have been developed in an attempt to accurately and efficiently predict the prognosis of emergent trauma cases. However, it has been questioned as to whether the accuracy and pragmatism of such systems still hold in lower-resource settings that exist in many hospitals in lower- and middle-income countries (LMICs). In this study, it was hypothesized that the physiologically-based Revised Trauma Score (RTS), Mechanism/Glasgow Coma Scale/Age/Pressure (MGAP) score, and Glasgow Coma Scale/Age/Pressure (GAP) score would be effective at predicting mortality outcomes using clinical data at presentation in a representative LMIC hospital in Upper Egypt. Methods This was a retrospective analysis of the medical records of trauma patients at Beni-Suef University Hospital. Medical records of all trauma patients admitted to the hospital over the 8-month period from January to August 2016 were reviewed. For each case, the RTS, MGAP, and GAP scores were calculated using clinical data at presentation, and mortality prediction was correlated to the actual in-hospital outcome. Results The Area Under the Receiver Operating Characteristic (AUROC) was calculated to be 0.879, 0.890, and 0.881 for the MGAP, GAP, and RTS respectively, with all three scores showing good discriminatory ability. With regards to prevalence-dependent statistics, all three scores demonstrated efficacy in ruling out mortality upon presentation with negative predictive values > 95%, while the MGAP score best captured the mortality subgroup with a sensitivity of 94%. Adjustment of cutoff scores showed a steep trade-off between optimizing the positive predictive values versus the sensitivities. Conclusion The RTS, MGAP, and GAP all showed good discriminatory capabilities per AUROC. Given the relative simplicity and potentially added clinical benefit in capturing critically ill patients, the MGAP score should be further studied for stratifying risk of incoming trauma patients to the emergency department, allowing for more efficacious triage of patients in lower-resource healthcare settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00653-1.
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Adeyemi OJ, Paul R, DiMaggio CJ, Delmelle EM, Arif AA. An assessment of the non-fatal crash risks associated with substance use during rush and non-rush hour periods in the United States. Drug Alcohol Depend 2022; 234:109386. [PMID: 35306398 DOI: 10.1016/j.drugalcdep.2022.109386] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Understanding how substance use is associated with severe crash injuries may inform emergency care preparedness. OBJECTIVES This study aims to assess the association of substance use and crash injury severity at all times of the day and during rush (6-9 AM; 3-7 PM) and non-rush-hours. Further, this study assesses the probabilities of occurrence of low acuity, emergent, and critical injuries associated with substance use. METHODS Crash data were extracted from the 2019 National Emergency Medical Services Information System. The outcome variable was non-fatal crash injury, assessed on an ordinal scale: critical, emergent, low acuity. The predictor variable was the presence of substance use (alcohol or illicit drugs). Age, gender, injured part, revised trauma score, the location of the crash, the road user type, and the geographical region were included as potential confounders. Partially proportional ordinal logistic regression was used to assess the unadjusted and adjusted odds of critical and emergent injuries compared to low acuity injury. RESULTS Substance use was associated with approximately two-fold adjusted odds of critical and emergent injuries compared to low acuity injury at all times of the day and during the rush and non-rush hours. Although the proportion of substance use was higher during the non-rush hour period, the interaction effect of rush hour and substance use resulted in higher odds of critical and emergent injuries compared to low acuity injury. CONCLUSION Substance use is associated with increased odds of critical and emergent injury severity. Reducing substance use-related crash injuries may reduce adverse crash injuries.
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Affiliation(s)
- Oluwaseun J Adeyemi
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA; Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA.
| | - Rajib Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA; School of Data Science, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA
| | - Charles J DiMaggio
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA; Department of Surgery, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA; Department of Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Eric M Delmelle
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA; Department of Geographical and Historical Studies, University of Eastern Finland, Joensuu Campus, P.O. Box 111, FI-80101 Finland.
| | - Ahmed A Arif
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA
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Construction of Prediction Model of Deep Vein Thrombosis Risk after Total Knee Arthroplasty Based on XGBoost Algorithm. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3452348. [PMID: 35116072 PMCID: PMC8807042 DOI: 10.1155/2022/3452348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/14/2021] [Accepted: 12/31/2021] [Indexed: 11/19/2022]
Abstract
Objective Based on the XGBoost algorithm, the prediction model of the risk of deep vein thrombosis (DVT) in patients after total knee arthroplasty (TKA) was established, and the prediction performance was compared. Methods A total of 100 patients with TKA from January 2019 to December 2020 were retrospectively selected as the study subjects and randomly divided into a training set (n = 60) and a test set (n = 40). The training set data was used to construct the XGBoost algorithm prediction model and to screen the predictive factors of postoperative DVT in TKA patients. The prediction effect of the model was evaluated by using the test set data. An independent sample T-test was used for comparison between groups, and the χ2 test was used for comparison between counting data groups. Results The top five items were combined with multiple injuries (35 points), time from injury to operation (28 points), age (24 points), combined with coronary heart disease (21 points), and D-dimer 1 day after operation (16 points). In the training set, the area under the curve of the XGBoost algorithm model was 0.832 (95% CI: 0.748-0.916). Conclusion The model based on the XGBoost algorithm can predict the incidence of DVT in patients after TKA with good performance.
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AKÇA HŞ, ALGIN A, ÖZDEMİR S, KOÇKARA E, EROĞLU SE. Comparison of the efficacy of trauma scores in predicting prognosis and hospitalization. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.982675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Predicting mortality in trauma patients - A retrospective comparison of the performance of six scoring systems applied to polytrauma patients from the emergency centre of a South African central hospital. Afr J Emerg Med 2021; 11:453-458. [PMID: 34765431 PMCID: PMC8567159 DOI: 10.1016/j.afjem.2021.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/10/2021] [Accepted: 09/16/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Over 90% of trauma-related deaths worldwide, ensue in low- and middle-income countries. Multiple useful trauma scoring systems have been devised. Although validated in high-income countries, they cannot always be replicated in resource-limited countries. This study compares six trauma scores to identify the best-suited system to use for polytrauma patients in a hospital in Pretoria, South Africa. Methods This is an observational retrospective analysis of polytrauma admissions from 1 July 2016 to 31 December 2016. Data collected from patients' records from the EC of Steve Biko Academic Hospital, was analysed using Stata Release 14. Outcomes were recorded as 30-day survival, ICU– and overall hospital LOS. Scores pertaining to patient mortality, were compared in terms of sensitivity, specificity, and cut-off points based on ROC curve. Finally, for LOS Pearson correlation analysis was used. Results At the best calculated mortality prediction cut-points for the scores, the sensitivities and specificities were respectively 87% and 68% for TRISS, 81% and 61% for ISS, RTS yielded 81% and 60%, while for REMS it was 61% and 69%. The SI and RSI (cut-points used in agreement with the literature) produced sensitivities 58% and only 48%, and specificities of 73% and 83%, respectively. 45(41,7%) patients required ICU admission. Though the ICU LOS best correlated with ISS(r = 0.2710), the ICU LOS correlation coefficient was weak for all trauma scores. None of the scores had a significant p value for hospital LOS. Discussion Among the scores compared, TRISS had the highest sensitivity and NPV for mortality prediction in this South African polytrauma population. ISS correlated best with ICU LOS. However, compared to developed countries, ROC analyses & predictability of these scores fare relatively worse, and no correlation was found with hospital LOS. Therefore, we conclude that further studies are needed to ascertain a more suitable system for resource-limited settings.
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Güllüpınar B, Aytemiz F, Karagöz A, Tandon S, Sağlam C, Şehitoğlu Alpağut G, Turhan A, Serin S, Keskinoğlu P, Ünlüer EE. The role of tricuspite annular plane systolic excursion as a marker of hypovolemia in healthy blood donor volunteers. Am J Emerg Med 2021; 51:320-324. [PMID: 34800904 DOI: 10.1016/j.ajem.2021.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/15/2021] [Indexed: 01/02/2023] Open
Abstract
AIM The aim of this study is to compare the diameter of the inferior vena cava with tricuspid annular plane systolic excursion (TAPSE) measurement in order to determine the volume loss before and after blood donation in healthy volunteers. METHODS This Institutional Review Board-approved single center, prospective, cross-sectional study included 60 healthy blood donors donating in a tertiary care hospital's blood bank. After obtaining written consent, systolic, diastolic, and mean arterial blood pressures along with pulse rate of the donors were measured in sitting and supine positions by the attending physician, then, inferior vena cava (IVC) and TAPSE measurements were made before and after blood donation. RESULTS Statistically significant differences was found between standing systolic blood pressure and pulse rate, lying systolic blood pressure and pulse rate, IVC and TAPSE values before and after blood donation (p < 0.05). There was no difference between the other variables before and after blood donation. CONCLUSION Our study revealed that, low IVC and TAPSE values correlated in determining blood loss after blood donation. TAPSE may be useful to predict blood loss in early stages of hypovolemic shock.
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Affiliation(s)
- Birdal Güllüpınar
- Izmir Bozyaka Training and Resarch Hospital, Department of Emergency Medicine, İzmir, TURKEY.
| | - Fatih Aytemiz
- Manisa City Hospital, Department of Cardiology, Manisa-İzmir, Turkey
| | - Arif Karagöz
- Izmir Çiğli Training Hospital, Department of Emergency Medicine, İzmir, Turkey
| | | | - Caner Sağlam
- Izmir Bozyaka Training and Resarch Hospital, Department of Emergency Medicine, İzmir, TURKEY
| | - Gülşah Şehitoğlu Alpağut
- Buca Seyfi Demirsoy Training and Resarch Hospital, Department of Emergency Medicine, İzmir, Turkey
| | | | - Sezen Serin
- Buca Seyfi Demirsoy Training and Resarch Hospital, Department of Emergency Medicine, İzmir, Turkey
| | - Pembe Keskinoğlu
- Dokuz Eylul University Faculyt of Medicine, Department of Biostatistics and Medical Informatics, İzmir, TURKEY
| | - Erden Erol Ünlüer
- Izmir Bozyaka Training and Resarch Hospital, Department of Emergency Medicine, İzmir, TURKEY
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Omar A, Winkelmann M, Liodakis E, Clausen JD, Graulich T, Omar M, Krettek C, Macke C. Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries. Diagnostics (Basel) 2021; 11:diagnostics11112156. [PMID: 34829503 PMCID: PMC8617692 DOI: 10.3390/diagnostics11112156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Most patients with blunt aortic injuries, who arrive alive in a clinic, suffer from traumatic pseudoaneurysms. Due to modern treatments, the perioperative mortality has significantly decreased. Therefore, it is unclear how exact the prediction of commonly used scoring systems of the outcome is. Methods: We analyzed data on 65 polytraumatized patients with blunt aortic injuries. The following scores were calculated: injury severity score (ISS), new injury severity score (NISS), trauma and injury severity score (TRISS), revised trauma score coded (RTSc) and acute physiology and chronic health evaluation II (APACHE II). Subsequently, their predictive value was evaluated using Spearman´s and Kendall´s correlation analysis, logistic regression and receiver operating characteristics (ROC) curves. Results: A proportion of 83% of the patients suffered from a thoracic aortic rupture or rupture with concomitant aortic wall dissection (54/65). The overall mortality was 24.6% (16/65). The sensitivity and specificity were calculated as the area under the receiver operating curves (AUC): NISS 0.812, ISS 0.791, APACHE II 0.884, RTSc 0.679 and TRISS 0.761. Logistic regression showed a slightly higher specificity to anatomical scoring systems (ISS 0.959, NISS 0.980, TRISS 0.957, APACHE II 0.938). The sensitivity was highest in the APACHE II with 0.545. Sensitivity and specificity for the RTSc were not significant. Conclusion: The predictive abilities of all scoring systems were very limited. All scoring systems, except the RTSc, had a high specificity but a low sensitivity. In our study population, the RTSc was not applicable. The APACHE II was the most sensitive score for mortality. Anatomical scoring systems showed a positive correlation with the amount of transfused blood products.
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Affiliation(s)
- Alexander Omar
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (M.W.); (E.L.); (J.-D.C.); (T.G.); (M.O.); (C.K.)
- Bundeswehr Joint Medical Service, 26384 Wilhelmshaven, Germany
| | - Marcel Winkelmann
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (M.W.); (E.L.); (J.-D.C.); (T.G.); (M.O.); (C.K.)
| | - Emmanouil Liodakis
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (M.W.); (E.L.); (J.-D.C.); (T.G.); (M.O.); (C.K.)
| | - Jan-Dierk Clausen
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (M.W.); (E.L.); (J.-D.C.); (T.G.); (M.O.); (C.K.)
| | - Tilman Graulich
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (M.W.); (E.L.); (J.-D.C.); (T.G.); (M.O.); (C.K.)
| | - Mohamed Omar
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (M.W.); (E.L.); (J.-D.C.); (T.G.); (M.O.); (C.K.)
| | - Christian Krettek
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (M.W.); (E.L.); (J.-D.C.); (T.G.); (M.O.); (C.K.)
| | - Christian Macke
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (M.W.); (E.L.); (J.-D.C.); (T.G.); (M.O.); (C.K.)
- Correspondence:
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Influencing Factors and Prevention of Sepsis or Acute Kidney Injury in 85 Patients with Severe Trauma. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5754114. [PMID: 34777535 PMCID: PMC8580668 DOI: 10.1155/2021/5754114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/29/2021] [Indexed: 11/18/2022]
Abstract
Severe trauma can cause systemic reactions, leading to massive bleeding, shock, asphyxia, and disturbance of consciousness. At the same time, patients with severe trauma are at high risk of sepsis and acute renal injury. The occurrence of complications will increase the difficulty of clinical treatment, improve the mortality rate, and bring heavy physical and mental burdens and economic pressure to patients and their families. It is of great clinical significance to understand the high risk factors of sepsis and AKI and actively formulate prevention and treatment measures. In this study, the clinical data of 85 patients with severe trauma were analyzed by univariate and multivariate logistic regression to identify the risk factors leading to sepsis or AKI and analyze the prevention and treatment strategies. The results showed that multiple injuries, APACHE II score on admission, SOFA score on admission, and mechanical ventilation were independent influencing factors of sepsis in patients with severe trauma, while hemorrhagic shock, APACHE II score on admission, CRRT, and sepsis were independent influencing factors of AKI in patients with severe trauma. Severe trauma patients complicated with sepsis or AKI will increase the risk of death. In the course of treatment, prevention and intervention should be given as far as possible to reduce the incidence of complications.
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Hakkenbrak NAG, Mikdad SY, Zuidema WP, Halm JA, Schoonmade LJ, Reijnders UJL, Bloemers FW, Giannakopoulos GF. Preventable death in trauma: A systematic review on definition and classification. Injury 2021; 52:2768-2777. [PMID: 34389167 DOI: 10.1016/j.injury.2021.07.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Trauma-related preventable death (TRPD) has been used to assess the management and quality of trauma care worldwide. However, due to differences in terminology and application, the definition of TRPD lacks validity. The aim of this systematic review is to present an overview of current literature and establish a designated definition of TRPD to improve the assessment of quality of trauma care. METHODS A search was conducted in PubMed, Embase, the Cochrane Library and the Web of Science Core Collection. Including studies regarding TRPD, published between January 1, 1990, and April 6, 2021. Studies were assessed on the use of a definition of TRPD, injury severity scoring tool and panel review. RESULTS In total, 3,614 articles were identified, 68 were selected for analysis. The definition of TRPD was divided in four categories: I. Clinical definition based on panel review or expert opinion (TRPD, trauma-related potentially preventable death, trauma-related non-preventable death), II. An algorithm (injury severity score (ISS), trauma and injury severity score (TRISS), probability of survival (Ps)), III. Clinical definition completed with an algorithm, IV. Other. Almost 85% of the articles used a clinical definition in some extend; solely clinical up to an additional algorithm. A total of 27 studies used injury severity scoring tools of which the ISS and TRISS were the most frequently reported algorithms. Over 77% of the panels included trauma surgeons, 90% included other specialist; 61% emergency medicine physicians, 46% forensic pathologists and 43% nurses. CONCLUSION The definition of TRPD is not unambiguous in literature and should be based on a clinical definition completed with a trauma prediction algorithm such as the TRISS. TRPD panels should include a trauma surgeon, anesthesiologist, emergency physician, neurologist, and forensic pathologist.
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Affiliation(s)
- N A G Hakkenbrak
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands; Department of Trauma surgery, Amsterdam University Medical Centre, location VU medical centre, Amsterdam, the Netherlands.
| | - S Y Mikdad
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands; Department of Trauma surgery, Amsterdam University Medical Centre, location VU medical centre, Amsterdam, the Netherlands
| | - W P Zuidema
- Department of Trauma surgery, Amsterdam University Medical Centre, location VU medical centre, Amsterdam, the Netherlands
| | - J A Halm
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | - L J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, the Netherlands
| | - U J L Reijnders
- Department of Forensic Medicine, Public Health Service of Amsterdam, the Netherlands
| | - F W Bloemers
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands; Department of Trauma surgery, Amsterdam University Medical Centre, location VU medical centre, Amsterdam, the Netherlands
| | - G F Giannakopoulos
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
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Maish G, Horst M, Ting Brown C, Morgan M, Bradburn E, Cook A, Rogers FB. A comprehensive analysis of undertriage in a mature trauma system using geospatial mapping. J Trauma Acute Care Surg 2021; 91:77-83. [PMID: 33605697 DOI: 10.1097/ta.0000000000003113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The correct triage of trauma patients to trauma centers (TCs) is essential. We sought to determine the percentage of patients who were undertriaged within the Pennsylvania (PA) trauma system and spatially analyze areas of undertriage (UTR) in PA for all age groups: pediatric, adult, and geriatric. We hypothesized that there would be certain areas that had high UTR for all age groups. METHODS From 2003 to 2015, all admissions from the Pennsylvania Trauma Systems Foundation registry and those meeting trauma criteria (International Classification of Diseases, Ninth Diseases: 800-959) from the Pennsylvania Health Care Cost Containment Council (PHC4) database were included. Admissions were divided into age groups: pediatric (<15 years), adult (15-64 years), and geriatric (≥65 years). All pediatric trauma cases were included from the Pennsylvania Trauma Systems Foundation and PHC4 registry, while only cases with Injury Severity Score of >9 were included in adult and geriatric age groups. Undertriage was defined as patients not admitted to level I/II adult TCs (n = 24), pediatric (n = 3), or adult and pediatric combined facility (n = 3) divided by the total number of patients from the PHC4 database. ArcGIS Desktop (version 10.7; ESRI, Redlands, CA) and GeoDa (version 1.14.0; CSDS, Chicago, IL) open source license were used for geospatial mapping of UTR with a spatial empirical Bayesian smoothed UTR by zip code tabulation area (ZCTA) and Stata (version 16.1; Stata Corp., College Station, TX) for statistical analyses. RESULTS There were significant percentages of UTR for all age groups. One area of high UTR for all age groups had TCs and large nontrauma centers in close proximity. There were high rates of UTR for all ages in rural areas, specifically in the upper central regions of PA, with limited access to TCs. CONCLUSION It appears there are two patterns leading to UTR. The first is in areas where TCs are in close proximity to large competing nontrauma centers, which may lead to inappropriate triage. The second has to do with lack of access to TCs. Geospatial mapping is a valuable tool that can be used to ascertain where trauma systems should focus scarce resources to decrease UTR. LEVEL OF EVIDENCE Epidemiological, level III; Care management, level III.
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Affiliation(s)
- George Maish
- From the Trauma and Acute Care Surgery (G.M., M.H., C.T.B., M.M., E.B., F.B.R.), Penn Medicine Lancaster General Health, Lancaster, Pennsylvania; and Department of Surgery, University of Texas Health Science Center at Tyler (A.C.), UT Health East Texas, Tyler, Texas
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Klopper J, Moola H, Venter J, Cheddie D, Luzulane S, Muchenje T, van Zyl J, Chambers J. Outcomes of patients with thoraco-abdominal gunshot wounds operatively managed at a district hospital in Cape Town, South Africa. Afr J Emerg Med 2021; 11:60-64. [PMID: 33489735 PMCID: PMC7808920 DOI: 10.1016/j.afjem.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/24/2020] [Accepted: 11/30/2020] [Indexed: 11/26/2022] Open
Abstract
AIM Trauma is a leading cause of morbidity and mortality in the first four decades of life. Thoracoabdominal gunshot wounds carry a significant risk of mortality. This risk of death is reduced if patients are managed in dedicated units. This study examines the outcome of these patients managed in a district level hospital. METHOD In this retrospective review, patients with thoracoabdominal gunshot wounds were identified from operating room registry for the period of January 2015 to December 2018. Data was collected retrospectively from folders and analysed for the primary outcome of mortality. RESULTS Sixty-eight thoracoabdominal gunshot wounds were managed operatively over the period described. Only six patients were female. The median age was 29.5 years. Fourteen patients required postoperative transfer to a level 1 trauma unit. Thirteen patients died, nine at the district hospital and four at the level 1 unit. Significant differences in organ injuries were noted in the patients that died compared to the survivors. DISCUSSION The in-hospital mortality rate of patients managed at the district hospital was 13.2% which is comparable to international rates of 12-18%. However, the subset of patients that required postoperative transfer to a level 1 trauma unit had a high mortality rate of 28.6%. The DH is committed to managing unstable and unresponsive patients once they present. Improved mortality rates will only occur with better prehospital transport policies and by equipping the DH to manage these patients postoperatively. CONCLUSION Management of these patients can be successful at a district hospital. However, significant obstacles exist to their optimal care, as demonstrated by the high mortality patients requiring postoperative transfer.
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Affiliation(s)
- Juan Klopper
- Department of Health, Western cape, Cape Town, South Africa
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Husna Moola
- Department of Health, Western cape, Cape Town, South Africa
| | - Jeremy Venter
- Department of Health, Western cape, Cape Town, South Africa
| | - Dylan Cheddie
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Samukele Luzulane
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Tinashe Muchenje
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Joshua van Zyl
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jessica Chambers
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Crowe RP, Bourn SS, Fernandez AR, Myers JB. Initial Prehospital Rapid Emergency Medicine Score (REMS) as a Predictor of Patient Outcomes. PREHOSP EMERG CARE 2021:1-11. [PMID: 33320716 DOI: 10.1080/10903127.2020.1862944] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
Background: A standardized objective measure of prehospital patient risk of hospitalization or death is needed. The Rapid Emergency Medicine Score (REMS), a validated risk-stratification tool, has not been widely tested for prehospital use. This study's objective was to assess predictive characteristics of initial prehospital REMS for ED disposition and overall patient mortality. Methods: This retrospective analysis used linked prehospital and hospital data from the national ESO Data Collaborative. All 911 responses from 1/1/2019-12/31/2019 were included. REMS (0-26) was calculated using age and first prehospital values for: pulse rate, mean arterial pressure, respiratory rate, oxygen saturation, and Glasgow Coma Scale. Non-transports, patients <18 and cardiac arrests prior to EMS arrival were excluded. The primary outcome was ED disposition, dichotomized to discharge versus admission, transfer, or death. The secondary outcome was overall survival to discharge (ED or inpatient). Transfers and records without inpatient disposition were excluded from the secondary analysis. Predictive ability was assessed using area under the receiver operating curve (AUROC). Optimal REMS cut points were determined using test characteristic curves. Univariable logistic regression modeling was used to quantify the association between initial prehospital REMS and each outcome. Results: Of 579,505 eligible records, 94,640 (16%) were excluded due to missing data needed to calculate REMS. Overall, 62% (n = 298,223) of patients were discharged from the ED, 36% (n = 175,212) were admitted, 2% (n = 10,499) were transferred, and 0.2% (n = 931) died in the ED. A REMS of 5 or lower demonstrated optimal statistical prediction for ED discharge versus not discharged (admission/transfer/death) (AUROC: 0.68). Patients with initial prehospital REMS of 5 or lower showed a three-fold increase in odds of ED discharge (OR: 3.28, 95%CI: 3.24-3.32). Of the 457,226 patients included in overall mortality analysis, >98% (n = 450,112) survived. AUROC of initial prehospital REMS for overall mortality was 0.79. A score 7 or lower was statistically optimal for predicting survival. Initial prehospital REMS of 7 or lower was associated with a five-fold increase in odds of overall survival (OR:5.41, 95%CI:5.15-5.69). Conclusion: Initial prehospital REMS was predictive of ED disposition and overall patient mortality, suggesting value as a risk-stratification measure for EMS agencies, systems and researchers.
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Affiliation(s)
- Remle P Crowe
- ESO, Inc, Austin, Texas (RPC, SB, ARF, JBM); Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (ARF)
| | - Scott S Bourn
- ESO, Inc, Austin, Texas (RPC, SB, ARF, JBM); Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (ARF)
| | - Antonio R Fernandez
- ESO, Inc, Austin, Texas (RPC, SB, ARF, JBM); Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (ARF)
| | - J Brent Myers
- ESO, Inc, Austin, Texas (RPC, SB, ARF, JBM); Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (ARF)
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The Impact of the COVID-19 Pandemic on Immunization Campaigns and Programs: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030988. [PMID: 33499422 PMCID: PMC7908591 DOI: 10.3390/ijerph18030988] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/07/2021] [Accepted: 01/20/2021] [Indexed: 02/08/2023]
Abstract
The COVID-19 pandemic has had an impact on health service delivery, including immunization programs, and this review assesses the impact on vaccine coverage across the globe and identifies the potential underlying factors. A systematic search strategy was employed on PubMed, Embase, MedRxiv, BioRxiv, and WHO COVID-19 databases from December 2019 till 15 September 2020. Two review authors independently assessed studies for inclusion, assessed quality, and extracted the data (PROSPERO registration #CRD42020182363). A total of 17 observational studies were included. The findings suggest that there was a reduction in the vaccination coverage and decline in total number of vaccines administered, which led to children missing out on their vaccine doses. An approximately fourfold increase was also observed in polio cases in polio endemic countries. Factors contributing to low vaccine coverage included fear of being exposed to the virus at health care facilities, restriction on city-wide movements, shortage of workers, and diversion of resources from child health to address the pandemic. As the world re-strategizes for the post-2020 era, we should not let a crisis go to waste as they provide an opportunity to establish guidelines and allocate resources for future instances. High-quality supplementary immunization activities and catch-up programs need to be established to address gaps during the pandemic era.
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Verma D, Kumar N, Jain A, Gouda B, Kumawat S. Comparative evaluation of revised trauma score and injury severity score as prognosis predictor among polytrauma patients. ARCHIVES OF TRAUMA RESEARCH 2021. [DOI: 10.4103/atr.atr_54_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jiang X. An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity. PeerJ 2020; 8:e10242. [PMID: 33194421 PMCID: PMC7597630 DOI: 10.7717/peerj.10242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/05/2020] [Indexed: 11/20/2022] Open
Abstract
Background Rapid identification of trauma severity is essential for the timely triage of multiple trauma patients. Tools such as the modified early warning score (MEWS) are used for determining injury severity. Although the conventional MEWS is a good predictor of mortality, its performance assessing injury severity is moderate. This study hypothesized that adding an injury site severity-related score (e.g., abdomen score) may enhance the capability of the MEWS for identifying severe trauma. Method To validate the hypothesis, we propose an improved modified early warning score called MEWS-A, which incorporates an injury site-specific severity-related abdomen score to MEWS. The utility of MEWS and MEWS-A were retrospectively evaluated and compared for identifying trauma severity in adult multiple trauma patients admitted to the emergency department. Results We included 1,230 eligible multiple trauma patients and divided them into minor and severe trauma groups based on the injury severity score. Results of logistic regression and receiver operating characteristic (ROC) curve analyses showed that the MEWS-A had a higher area under the ROC curve (AUC: 0.81 95% CI [0.78-0.83]) than did the MEWS (AUC: 0.77 95% CI [0.74-0.79]), indicating that the MEWS-A is superior to the MEWS in identifying severe trauma. The optimal MEWS-A cut-off score is 4, with a specificity of 0.93 and a sensitivity of 0.54. MEWS-A ≥ 4 can be used as a protocol for decision-making in the emergency department. Conclusions Our study suggests that while the conventional MEWS is sufficient for predicting mortality risk, adding an injury site-specific score (e.g., abdomen score) can enhance its performance in determining injury severity in multiple trauma patients.
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Affiliation(s)
- Xiaobin Jiang
- Emergency Department 1, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Sahin T, Batın S. A descriptive study of orthopaedic injuries due to parachute jumping in soldiers. BMC Emerg Med 2020; 20:58. [PMID: 32736526 PMCID: PMC7395398 DOI: 10.1186/s12873-020-00354-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/23/2020] [Indexed: 11/22/2022] Open
Abstract
Background While parachute jumping, soldiers may suffer minor or life-threatening injuries in various parts of the body. Several trauma scoring systems assess the severity of such injuries. The primary goal of this study was to assess clinical characteristics and the severity of orthopaedic, musculoskeletal, and other injuries from military training-related parachute jumping using two trauma scoring systems (AIS and ISS). Our secondary goal was to assess whether there was an increase in injury rates with age. Methods In total, 185 military personnel between 19 and 51 years old who were injured as a result of daytime static parachute jumping during 44 months between January 2016 and August 2019 were included in the study. Demographic data; vital signs; the level of consciousness; the Glasgow Coma Scale; ISS trauma region classifications; anatomical injury sites; AIS and ISS scores; diagnoses; treatment methods; hospitalization status; and duration of hospital stay were examined descriptively. Results There were 184 male and one female participant. The most commonly injured body site was the foot (33.5%), and the most common diagnosis was soft tissue trauma (64.3%). The most commonly injured body site was the foot (33.5%), and the most common diagnosis was soft tissue trauma (64.3%). Regarding treatment methods, 51.4% received analgesic pills and cold pack application, 42.7% received a plaster splint, and 5.9% had orthopaedic surgery. The mean ISS score was 5.16 ± 3.92. The hospitalization rate was significantly higher for patients with a critical AIS score than those with a severe AIS score (p < 0.001). Conclusions The use of trauma scoring systems to assess injury severity among patients admitted to an ED due to a parachute jumping injury may facilitate treatment selection. We found that AIS and ISS were useful in determining injury severity. Therefore, we recommend the use of trauma scoring systems for assessing the injury severity and the therapeutic approach, and we advocate for the use of the 17 anatomical regions we used in this study. We also found that with increasing age, the severity of injury could increase.
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Affiliation(s)
- Taner Sahin
- Emergency Medicine Clinic Kayseri City Education and Research Hospital affiliated with University of Health Sciences Turkey, 38090, Kayseri, Turkey.
| | - Sabri Batın
- Orthopedist, Orthopedic Clinic Kayseri City Education and Research Hospital affiliated with University of Health Sciences Turkey, 38090, Kayseri, Turkey
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Fu CY, Bajani F, Bokhari M, Butler C, Starr F, Messer T, Kaminsky M, Tatebe LC, Dennis A, Schlanser V, Poulakidas S, Cheng CT, Toor R, Mis J, Bokhari F. Obesity May Require a Higher Level of Trauma Care: A Propensity-Matched Nationwide Cohort Study. PREHOSP EMERG CARE 2020; 25:361-369. [PMID: 32286928 DOI: 10.1080/10903127.2020.1755754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Stable patients with less severe injuries are not necessarily triaged to high-level trauma centers according to current guidelines. Obese patients are prone to comorbidities and complications. We hypothesized that stable obese patients with low-energy trauma have lower mortality and fewer complications if treated at Level-I/II trauma centers. Methods: Blunt abdominal trauma (BAT) patients with systolic blood pressures ≥90mmHg, Glasgow coma scale ≥14, and respiratory rates at 10-29 were derived from the National Trauma Data Bank between 2013-2015. Per current triage guidelines, these patients are not necessarily triaged to high-level trauma centers. The relationship between obesity and mortality of stable BAT patients was analyzed. A subset analysis of patients with injury severity scores (ISS) <16 was performed with propensity score matching (PSM) to evaluate outcomes between Level-I/II and Level-III/IV trauma centers. Outcomes of obese patients were compared between Level-I/II and Level-III/IV trauma centers. Non-obese patients were analyzed as a control group using a similar PSM cohort analysis. Results: 48,043 stable BAT patients in 707 trauma centers were evaluated. Non-survivors had a significantly higher body mass index (BMI) (28.7 vs. 26.9, p < 0.001) and higher proportion of obesity (35.6% vs. 26.5%, p < 0.001) than survivors. After a PSM (1,502 obese patients: 751 in Level-I/II trauma centers and 751 in Level-III/IV trauma centers), obese patients treated in Level-I/II trauma centers had significantly lower complication rates than obese patients treated in other trauma centers (20.2% vs. 26.6%, standardized difference = 0.151). The complication rate of obese patients treated at Level-I/II trauma centers was 20.6% lower than obese patients treated at other trauma centers. Conclusion: Obesity plays a role in the mortality of stable BAT patients. Obese patients with ISS < 16 have lower complication rates at Level-I/II trauma centers compared to obese patients treated at other trauma centers. Obesity may be a consideration for triaging to Level-I/II trauma centers.
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Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study. Prehosp Disaster Med 2019; 34:610-618. [PMID: 31648657 DOI: 10.1017/s1049023x19005041] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION In cases of mass-casualty incidents (MCIs), triage represents a fundamental tool for the management of and assistance to the wounded, which helps discriminate not only the priority of attention, but also the priority of referral to the most suitable center. HYPOTHESIS/PROBLEM The objective of this study was to evaluate the capacity of different prehospital triage systems based on physiological parameters (Shock Index [SI], Glasgow-Age-Pressure Score [GAP], Revised Trauma Score [RTS], and National Early Warning Score 2 [NEWS2]) to predict early mortality (within 48 hours) from the index event for use in MCIs. METHODS This was a longitudinal prospective observational multi-center study on patients who were attended by Advanced Life Support (ALS) units and transferred to the emergency department (ED) of their reference hospital. Collected were: demographic, physiological, and clinical variables; main diagnosis; and data on early mortality. The main outcome variable was mortality from any cause within 48 hours. RESULTS From April 1, 2018 through February 28, 2019, a total of 1,288 patients were included in this study. Of these, 262 (20.3%) participants required assistance for trauma and injuries by external agents. Early mortality within the first 48 hours due to any cause affected 69 patients (5.4%). The system with the best predictive capacity was the NEWS2 with an area under the curve (AUC) of 0.891 (95% CI, 0.84-0.94); a sensitivity of 79.7% (95% CI, 68.8-87.5); and a specificity of 84.5% (95% CI, 82.4-86.4) for a cut-off point of nine points, with a positive likelihood ratio of 5.14 (95% CI, 4.31-6.14) and a negative predictive value of 98.7% (95% CI, 97.8-99.2). CONCLUSION Prehospital scores of the NEWS2 are easy to obtain and represent a reliable test, which make it an ideal system to help in the initial assessment of high-risk patients, and to determine their level of triage effectively and efficiently. The Prehospital Emergency Medical System (PhEMS) should evaluate the inclusion of the NEWS2 as a triage system, which is especially useful for the second triage (evacuation priority).
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Cassignol A, Marmin J, Cotte J, Cardinale M, Bordes J, Pauly V, Kerbaul F, Demory D, Meaudre E. Correlation between field triage criteria and the injury severity score of trauma patients in a French inclusive regional trauma system. Scand J Trauma Resusc Emerg Med 2019; 27:71. [PMID: 31382982 PMCID: PMC6683531 DOI: 10.1186/s13049-019-0652-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/26/2019] [Indexed: 11/17/2022] Open
Abstract
Background In France, the pre-hospital field triage of trauma patients is currently based on the Vittel criteria algorithm. This algorithm was originally created in 2002 before the stratification of trauma centers and, at the national level, has not been revised since. This could be responsible for the overtriage of trauma patients in Level I Trauma Centers. The principal aim of this study was to evaluate the correlation between each Vittel field triage criterion and trauma patients’ Injury Severity Score. Methods Our Level I Trauma Center receives an average of 300 trauma patients per year. Demographic and physiological data, along with the entire trauma patient management process and Vittel field triage criteria, are recorded in a local trauma registry. The Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) are calculated after a complete assessment of the trauma victim during their in-hospital management. Results were concerned with the presence of an ISS of greater than 15, which defined a major trauma patient; mortality within 30 days; and admission to the intensive care unit. This study is a registry analysis from January 2013 to September 2017. Results Of the 1373 patients in the registry, 1151 were included in the analysis with a mean age of 43 years (± 19) and a median ISS of 13 (IQR = 5–22), where 887 (77%) were male. Nine of the 24 Vittel criteria were associated with an ISS > 15. In a multivariate analysis, no criterion related to kinetic elements was significantly correlated with an ISS > 15, mortality within 30 days, or admission to intensive care. Three algorithm categories were predictive of a major trauma patient (ISS > 15): physiological variables, pre-hospital resuscitation, and physical injuries, while kinetic elements were not. Conclusions Criteria related to physiological variables, pre-hospital resuscitation, and physical injuries are the most relevant to predicting the severity of a trauma patient’s condition. A revision of the VCA could potentially have beneficial effects on the over and undertriage phenomena, which constitute ongoing medical and financial concerns.
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Affiliation(s)
- Arnaud Cassignol
- SMUR Department, Sainte-Musse Public Hospital, 83100, Toulon, cedex 9, France.
| | - Julien Marmin
- Prehospital Emergency Medical Services of Marine Fire Battalion, Marseille, France
| | - Jean Cotte
- Anesthesia and Intensive Care Department, Sainte-Anne Military Hospital, 83041, Toulon, France
| | - Mickael Cardinale
- Anesthesia and Intensive Care Department, Sainte-Anne Military Hospital, 83041, Toulon, France
| | - Julien Bordes
- Anesthesia and Intensive Care Department, Sainte-Anne Military Hospital, 83041, Toulon, France
| | - Vanessa Pauly
- Public Health and Medical Information Service, Conception Hospital, Aix-Marseille University, 13005, Marseille, France
| | - François Kerbaul
- SMUR department, Timone Hospital, Aix-Marseille University, 13005, Marseille, France.,UMR MD 2, Aix-Marseille University, Marseille, France
| | - Didier Demory
- Clinical research unit, Sainte-Musse Public Hospital, 83100, Toulon, cedex 9, France
| | - Eric Meaudre
- Anesthesia and Intensive Care Department, Sainte-Anne Military Hospital, 83041, Toulon, France
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Cassignol A, Markarian T, Cotte J, Marmin J, Nguyen C, Cardinale M, Pauly V, Kerbaul F, Meaudre E, Bobbia X. Evaluation and Comparison of Different Prehospital Triage Scores of Trauma Patients on In-Hospital Mortality. PREHOSP EMERG CARE 2019; 23:543-550. [DOI: 10.1080/10903127.2018.1549627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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