Factors affecting morbidity and mortality in traumatic colorectal injuries and reliability and validity of trauma scoring systems

Evaluation of the predictive effects of trauma scoring systems in colorectal injuries

INTRODUCTION

Colorectal injuries following traumas are significant causes of morbidity and mortality. This study aimed to evaluate the predictive effect of trauma scoring systems on mortality and morbidity in patients with post-traumatic colon injury.

METHODS

The records of 145 patients with colon trauma treated at Seyhan State Hospital between January 1, 2010, and January 1, 2020, were retrospectively analyzed. Injury Seriousness Score (ISS), Revised Trauma Score (RTS), Trauma Injury Severity Score (TRISS), and Colon Injury Score (CIS) scores were calculated for all patients. The predictive effects of scoring systems on primary outcomes of surgical treatment, complication rates, mortality, and anastomotic leaks were evaluated.

RESULTS

The mean age of the patients was 36.1 (SD ± 16.6), and the female/male ratio was 37/108. Anastomotic leakage occurred in 12 (8.2%) patients, and complications were observed in 57 (39.3%) patients. Seven (4.7%) patients died. A statistically significant relationship was observed between the increase in CIS and anastomotic leakage, morbidity, and mortality. Increases in ISS and decreases in RTS and TRISS were associated with increased morbidity and mortality, but these relationships were not statistically significant.

CONCLUSION

A significant relationship was observed between the increase in CIS and anastomotic leakage, morbidity, and mortality. The study suggests the need for a specific scoring system for evaluating the prognostic status in colon traumas, as ISS, RTS, and TRISS scores were not found to be significantly predictive of outcomes in this patient population.

Prognosis of the Trauma Patients According to the Trauma and Injury Severity Score (TRISS); A Diagnostic Accuracy Study

Objective

To investigate the prognosis and survival rates of a group of Iranian patients with traumatic injuries using the trauma and injury severity score (TRISS) model.

Methods

In this prospective cohort study, all the patients with multi-trauma referring to the Yasuj Shahid Beheshti hospital during 2018 were included. The patients' demographic information, trauma and history of previous illness were recorded. Vital symptoms including respiratory rate, heart rate, hypertension, pulse rate and Glasgow coma scale (GCS) score were assessed. The injury severity score (ISS) was calculated based on the type and location of the injuries and according to the abbreviated injury scale (AIS) classification. The survival probability of the patients was assessed according to the TRISS model.

Results

Overall, 252 trauma patients were evaluated out of whom, 195 (77.4%) were men and 57 (22.6%) women. If we consider the TRISS score probability above 0.5 as the chance of being alive, the mortality rate was 6.75%, that was lower than our series (7.1%). The ISS score and GCS had a positive significant relationship with other variables except respiratory rate, body temperature and hospitalization. Revised trauma score (RTS) was significantly associated with other variables including age, GCS, hemoglobin, systolic blood pressure and respiratory rate. TRISS had an area under curve (AUC) of 0.988 indicating a high prognostic accuracy.

Conclusion

The mortality rate was lower than that of being predicted by TRISS. This might be due to treatment effectiveness and care for traumatic patients leading to decreased mortality. TRISS had high prognostic accuracy in trauma patients. We also reported an association between hemoglobin and survival rate. Therefore, it seems that considering the laboratory parameters can be useful in patients with trauma.

Patient and injury characteristics associated with road traffic mortality in general hospitals in southern Thailand

Background

Road traffic injuries are a major public health burden in developing countries. Thailand has the highest fatality rate from road traffic injuries in southeast Asia so that prevention of unintentional injuries is important.

Objective

To identify patient and injury characteristics associated with road traffic mortality in the southern provinces of Thailand.

Methods

Data on a total of 78,862 road traffic injuries recorded by the general hospitals in 5 southern provinces of Thailand, during 2008–2013, were obtained from the Office of Disease Prevention and Control. Chi-squared test was used to determine the association between patient/injury characteristics and road traffic mortality, and logistic regression was used to identify the strength of associations.

Results

In this study, road traffic mortality was found to be 1.8% of all injuries. Most of the deaths occurred in males (61.7%), who were aged 25–44 years (35.8%), being drivers (68.6%), using motorcycle (78.4%), and not wearing a helmet (61.0%). Road traffic mortality was higher among males, older age people, those who were not wearing a helmet or not fastening a seat belt, pedestrians and when people crashed with or by motor car, with wound being penetrating or blunt with penetrating, and when they were having head or neck, chest, or abdominal or pelvic cavity injuries.

Conclusion

Policies and measures for reducing road traffic mortality should focus on males and older aged persons, use of safety devices, and occurrence of multiple injuries.

A study of mortality risk factors among trauma referrals to trauma center, Shiraz, Iran, 2017

PURPOSE

Trauma is well known as one of the main causes of death and disability throughout the world. Identifying the risk factors for mortality in trauma patients can significantly improve the quality of care and patient outcomes, as well as reducing mortality rates.

METHODS

In this retrospective cohort study, systematic randomization was used to select 849 patients referred to the main trauma center of south of Iran during a period of six months (February 2017-July 2017); the patients' case files were evaluated in terms of demographic information, pre- and post-accident conditions, clinical conditions at the time of admission and finally, accident outcomes. A logistic regression model was used to analyze the role of factors affecting mortality among subjects.

RESULTS

Among subjects, 60.4% were in the age-group of 15-39 years. There was a 10.4% mortality rate among patients and motor-vehicle accidents were the most common mechanism of injury (66.7%). Aging led to increased risk of fatality in this study. For each unit increase in Glasgow coma scale (GCS), risk of death decreased by about 40% (odds ratio (OR) = 0.63, 95% confidence interval (CI): 0.59-0.67). For each unit increase in injury severe score (ISS), risk of death increased by 10% (OR = 1.11%, 95% CI: 1.08-1.14) and for each unit increase in trauma revised injury severity score (TRISS), there was 18% decrease in the risk of fatality (OR = 0.82, 95% CI: 0.71-0.88).

CONCLUSION

The most common cause of trauma and the most common cause of death from trauma was traffic accidents. It was also found that an increase in the ISS index increases the risk of death in trauma patients, but the increase in GCS, revised trauma score (RTS) and TRISS indices reduces the risk of death in trauma patients. The TRISS indicator is better predictor of traumatic death than other indicators.