1
|
Whitten TA, Loyola Sanchez A, Gyawali B, Papathanassoglou EDE, Bakal JA, Krysa JA. Predicting inpatient rehabilitation length of stay for adults with traumatic spinal cord injury. J Spinal Cord Med 2024:1-11. [PMID: 38466871 DOI: 10.1080/10790268.2024.2325165] [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] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION Most post-injury traumatic spinal cord injury (TSCI) care occurs in the inpatient rehabilitation setting. The inpatient rehabilitation length of stay (R-LOS) has been shown to be a significant predictor of motor function restoration in persons with TSCI. Due to the complexity, and heterogeneity of individuals with TSCI, the R-LOS is challenging to predict at admission. PURPOSE To identify the main predictors of R-LOS and derive an equation to estimate R-LOS in persons with TSCI. METHODS This is a retrospective analysis of data from adults with TSCI from The Rick Hansen Spinal Cord Injury Registry in Alberta, Canada, who received rehabilitation care between May 10, 2005, and January 28, 2020. Multiple linear regression analysis was used to determine significant relationships between R-LOS and measures of participant demographics, length of stay, impairment and injury classification, and comorbidities. RESULTS The analysis included 736 adults with TSCI from an eligible cohort of 1365. The median R-LOS was 65 days (IQR 39-99 days), ranging from 1 to 469 days. Multivariate linear regression analysis identified two significant predictors of R-LOS, total FIM score and the injury classification. This model was used to derive a R-LOS prediction equation, which explained 34% of the variance in R-LOS. CONCLUSION We developed a simple equation to predict R-LOS based on the level of impairment and total FIM scores in persons with TSCI. These data have implications for health system planning, improvement, and innovation, and provide insights to support further research into the predictors of R-LOS, identification of higher-risk individuals.
Collapse
Affiliation(s)
- Tara A Whitten
- Alberta Strategy for Patient Oriented Research Support Unit (AbSPORU) Data Platform, Alberta Health Services, Calgary, Canada
| | - Adalberto Loyola Sanchez
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Canada
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
| | - Bina Gyawali
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Canada
| | - Elisavet D E Papathanassoglou
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Jeffrey A Bakal
- Alberta Strategy for Patient Oriented Research Support Unit (AbSPORU) Data Platform, Alberta Health Services, Calgary, Canada
| | - Jacqueline A Krysa
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Canada
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
| |
Collapse
|
2
|
Wang SA, Chang CJ, Do Shin S, Chu SE, Huang CY, Hsu LM, Lin HY, Hong KJ, Jamaluddin SF, Son DN, Ramakrishnan TV, Chiang WC, Sun JT, Huei-Ming Ma M. Development of a prediction model for emergency medical service witnessed traumatic out-of-hospital cardiac arrest: A multicenter cohort study. J Formos Med Assoc 2024; 123:23-35. [PMID: 37573159 DOI: 10.1016/j.jfma.2023.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/04/2023] [Accepted: 07/17/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND/PURPOSE To develop a prediction model for emergency medical technicians (EMTs) to identify trauma patients at high risk of deterioration to emergency medical service (EMS)-witnessed traumatic cardiac arrest (TCA) on the scene or en route. METHODS We developed a prediction model using the classical cross-validation method from the Pan-Asia Trauma Outcomes Study (PATOS) database from 1 January 2015 to 31 December 2020. Eligible patients aged ≥18 years were transported to the hospital by the EMS. The primary outcome (EMS-witnessed TCA) was defined based on changes in vital signs measured on the scene or en route. We included variables that were immediately measurable as potential predictors when EMTs arrived. An integer point value system was built using multivariable logistic regression. The area under the receiver operating characteristic (AUROC) curve and Hosmer-Lemeshow (HL) test were used to examine discrimination and calibration in the derivation and validation cohorts. RESULTS In total, 74,844 patients were eligible for database review. The model comprised five prehospital predictors: age <40 years, systolic blood pressure <100 mmHg, respiration rate >20/minute, pulse oximetry <94%, and levels of consciousness to pain or unresponsiveness. The AUROC in the derivation and validation cohorts was 0.767 and 0.782, respectively. The HL test revealed good calibration of the model (p = 0.906). CONCLUSION We established a prediction model using variables from the PATOS database and measured them immediately after EMS personnel arrived to predict EMS-witnessed TCA. The model allows prehospital medical personnel to focus on high-risk patients and promptly administer optimal treatment.
Collapse
Affiliation(s)
- Shao-An Wang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nan Ya South Rd, Banqiao Dist, New Taipei City, Taiwan
| | - Chih-Jung Chang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nan Ya South Rd, Banqiao Dist, New Taipei City, Taiwan
| | - Shan Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea
| | - Sheng-En Chu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nan Ya South Rd, Banqiao Dist, New Taipei City, Taiwan
| | - Chun-Yen Huang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nan Ya South Rd, Banqiao Dist, New Taipei City, Taiwan
| | - Li-Min Hsu
- Department of Traumatology and Critical Care, National Taiwan University Hospital, Taipei, Taiwan
| | - Hao-Yang Lin
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea
| | | | - Do Ngoc Son
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam
| | - T V Ramakrishnan
- Emergency Medicine, Sri Ramachandra Medical College, Chennai, India
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Yun-Lin Branch, Taipei, Taiwan.
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nan Ya South Rd, Banqiao Dist, New Taipei City, Taiwan; Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, Yilan, Taiwan.
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Yun-Lin Branch, Taipei, Taiwan
| |
Collapse
|
3
|
Liu Y, Deng X, Zhu F, Zhu W, Wang Z. High fibrinogen and mixed proximal and distal thrombosis are associated with the risk of residual venous thrombosis in patients with posttraumatic deep vein thrombosis. Front Cardiovasc Med 2023; 10:1003197. [PMID: 36818330 PMCID: PMC9928750 DOI: 10.3389/fcvm.2023.1003197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
Background The risk factors for residual venous thrombosis (RVT) in patients with post-trauma deep vein thrombosis (DVT) are unknown. Methods We evaluated 127 patients with DVT after trauma, all of whom were treated with conventional anticoagulation and assessed for the presence of RVT with venous compression ultrasound (CUS), using an internal diameter of the venous lumen ≥ 4 mm after compression as the criterion. Results RVT was present in 59 (46%) patients, and complete thrombus dissolution was present in 68 (54%) patients. Among them, mixed proximal and distal thrombosis (OR, 4.292; 95% CI, 1.253-14.707), diabetes (OR, 6.345; 95% CI, 1.125-35.786), fibrinogen > 4.145 g/L (OR, 2.858; 95% CI, 1.034-7.897), the time between detection of thrombus and initiation of antithrombotic therapy > 2.5 days (OR, 3.470; 95% CI, 1.085-11.094) was an independent risk factor for RVT in patients with posttraumatic DVT. Conclusion A mixed proximal and distal thrombosis, diabetes mellitus, late initiation of antithrombotic therapy, and high fibrinogen levels increase the risk of RVT in patients with posttraumatic DVT. Therefore, treatment regimens for patients with posttraumatic DVT can be adjusted according to the site of thrombosis, the presence of diabetes mellitus, and the level of fibrinogen, and antithrombotic therapy can be started as early as possible after the detection of thrombosis to prevent the development of RVT and its serious complications.
Collapse
Affiliation(s)
- Yating Liu
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China,Central South University, Changsha, Hunan, China
| | - Xiaozhi Deng
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China,Central South University, Changsha, Hunan, China
| | - Fang Zhu
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wenhui Zhu
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China,*Correspondence: Wenhui Zhu,
| | - Zheng Wang
- Department of Vascular Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China,Zheng Wang,
| |
Collapse
|
4
|
Maleitzke T, Zhou S, Zocholl D, Fleckenstein FN, Back DA, Plewe JM, Weber J, Winkler T, Stöckle U, Tsitsilonis S, Märdian S. Routine laboratory parameters predict intensive care unit admission and hospitalization in patients suffering stab injuries. Front Immunol 2023; 13:959141. [PMID: 36685486 PMCID: PMC9851079 DOI: 10.3389/fimmu.2022.959141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/21/2022] [Indexed: 01/07/2023] Open
Abstract
Background Knife crime has increased considerably in recent years in Northern Europe. Affected patients often require immediate surgical care due to traumatic organ injury. Yet, little is known about clinically relevant routine laboratory parameters in stab injury patients and how these are associated with intensive care unit (ICU) admission, hospitalization and number of surgeries. Methods We retrospectively analyzed 258 stab injury cases between July 2015 and December 2021 at an urban Level I Trauma Center. Annual and seasonal incidences, injury site, injury mechanism, Injury Severity Score (ISS), and surgical management were evaluated. First, correlations between routine laboratory parameters for hematology, coagulation, and serum biochemistry (peak, and Δ (change from admission to peak within 3 days following admission)) and length of hospital stay, ICU stay, and number of surgeries were assessed using Spearman's rank correlation coefficients. Second, multivariable Least Absolute Shrinkage and Selection Operator (LASSO) regression analyses were conducted to identify parameters predictive of clinical outcomes. Third, longitudinal developments of routine laboratory parameters were assessed during hospital admission. Results In 2021, significantly more stab injuries were recorded compared with previous years and occurred less during winter compared with other seasons. Mean ISS was 8.3 ± 7.3, and ISS was positively correlated with length of hospital and ICU stay (r = 0.5-0.8, p < 0.001). Aspartate transaminase (AST) (Δ) (r = 0.690), peak C-reactive protein (CrP) (r = 0.573), and erythrocyte count (Δ) (r = 0.526) showed the strongest positive correlations for length of ICU stay for penetrating, thoracoabdominal, and organ injuries, respectively. No correlations were observed between routine laboratory parameters and number of surgeries. For patients with penetrating injuries, LASSO-selected predictors of ICU admission included ISS, pH and lactate at admission, and Δ values for activated partial thromboplastin time (aPTT), K+, and erythrocyte count. CrP levels on day 3 were significantly higher in patients with penetrating (p = 0.005), thoracoabdominal (p = 0.041), and organ injuries (p < 0.001) compared with those without. Conclusion Our data demonstrate an increase in stab injury cases in 2021 and an important link between changes in routine laboratory parameters and ICU admission and hospitalization. Monitoring ISS and changes in AST, CrP, erythrocyte count, pH, lactate, aPTT, and K+ may be useful to identify patients at risk and adjust surgical and ICU algorithms early on.
Collapse
Affiliation(s)
- Tazio Maleitzke
- Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Julius Wolff Institute, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
- BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
| | - Sijia Zhou
- Julius Wolff Institute, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Dario Zocholl
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Florian Nima Fleckenstein
- Department of Diagnostic and Interventional Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - David Alexander Back
- Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Traumatology and Orthopaedics, Septic and Reconstructive Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Julius Maximilian Plewe
- Department of Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jérôme Weber
- Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Julius Wolff Institute, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Winkler
- Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Julius Wolff Institute, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Stöckle
- Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Serafeim Tsitsilonis
- Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Julius Wolff Institute, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Sven Märdian
- Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
5
|
Aneja A, Landy DC, Mittwede PN, Albano AY, Teasdall RJ, Isla A, Kavolus M. Inflammatory cytokines associated with outcomes in orthopedic trauma patients independent of New Injury Severity score: A pilot prospective cohort study. J Orthop Res 2022; 40:1555-1562. [PMID: 34729810 DOI: 10.1002/jor.25183] [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: 05/31/2021] [Revised: 08/30/2021] [Accepted: 09/30/2021] [Indexed: 02/04/2023]
Abstract
Traumatic injury is the leading cause of mortality in patients under 50. It is associated with a complex inflammatory response involving hormonal, immunologic, and metabolic mediators. The marked elevation of cytokines and inflammatory mediators subsequently correlates with the development of posttraumatic complications. The aim was to determine whether elevated cytokine levels provide a predictive value for orthopedic trauma patients. A prospective cohort study of patients with New Injury Severity Score (NISS) > 5 was undertaken. IL-6, IL-8, IL-10, and migration inhibitory factor levels were measured within 24-h of presentation. Demographic covariates and clinical outcomes were obtained from the medical records. Fifty-eight patients (83% male, 40 years) were included. Addition of IL-6 to baseline models significantly improved prediction of pulmonary complication (LR = 6.21, p = 0.01), ICU (change in R2 = 0.31, p < 0.01), and hospital length of stay (change in R2 = 0.16, p < 0.01). The addition of IL-8 significantly improved the prediction of acute kidney injury (LR = 9.15, p < 0.01). The addition of postinjury IL-6 level to baseline New Injury Severity Score model is better able to predict the occurrence of pulmonary complications as well as prolonged ICU and hospital length of stay.
Collapse
Affiliation(s)
- Arun Aneja
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - David C Landy
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Peter N Mittwede
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ashley Y Albano
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Robert J Teasdall
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Alexander Isla
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Matthew Kavolus
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
6
|
Zhu Z, Xu B, Shao J, Wang S, Jin R, Weng T, Xia S, Zhang W, Yang M, Han C, Wang X. Use of the Braden Scale to Predict Injury Severity in Mass Burn Casualties. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022; 28:e934039. [PMID: 35105848 PMCID: PMC8820233 DOI: 10.12659/msm.934039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Mass burn casualties impose an enormous burden on triage systems. The triage capacity of the Braden Scale for detecting injury severity has not been evaluated in mass burn casualties. Material/Methods The New Injury Severity Score (NISS) was used to dichotomize the injury severity of patients. The Braden Scale and other potentially indicative measurement tools were evaluated using univariate analysis and multivariate logistic regression. The relationships between the Braden Scale and other continuous variables with injury severity were further explored by correlation analysis and fitted with regression models. Receiver operating characteristic (ROC) curve analysis was used to validate triage capacity and compare prognostic accuracy. Results A total of 160 hospitalized patients were included in our study; 37 were severely injured, and 123 were not. Injury severity was independently associated with the Numerical Rating Scale (adjusted OR, 1.816; 95% CI, 1.035–3.187) and Braden Scale (adjusted OR, 0.693; 95% CI, 0.564–0.851). The ROC curve of the fitted quadratic model of the Braden Scale was 0.896 (0.840–0.953), and the cut-off value was 17. The sensitivity was 81.08% (64.29–91.44%) and the specificity was 82.93% (74.85–88.89%). Comparison of ROC curves demonstrated an infinitesimal difference between the Braden Scale and NISS for predicting 30-day hospital discharge (Z=0.291, P=0.771) and Intensive Care Unit admission (Z=2.016, P=0.044). Conclusions The Braden Scale is a suitable triage tool for predicting injury severity and forecasting disability-related outcomes in patients affected by mass burn casualty incidents.
Collapse
Affiliation(s)
- Zhikang Zhu
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Bin Xu
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Jiaming Shao
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Shuangshuang Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland).,Wenling First People's Hospital, Taizhou, Zhejiang, China (mainland)
| | - Ronghua Jin
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Tingting Weng
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Sizhan Xia
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Wei Zhang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Min Yang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Chunmao Han
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Xingang Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| |
Collapse
|
7
|
El-Abbassy I, Mohamed W, El-Hariri HM, El-Setouhy M, Hirshon JM, El-Shinawi M. Delay in hospital discharge of trauma patients in a University Hospital in Egypt: A prospective observational study. Afr J Emerg Med 2021; 11:459-463. [PMID: 34765432 PMCID: PMC8567154 DOI: 10.1016/j.afjem.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/12/2021] [Accepted: 06/26/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION "Delayed discharge" is defined as patients who remain hospitalised beyond the time of being fit for discharge after a decision of discharge has been made by the managing team. There is no standardised amount of time defining delayed discharge documented in the literature, and there is a lack of evidence about this topic in Egypt. This study is a quality improvement project aiming to identify the factors associated with discharge delays at a single centre in Egypt in order to address this issue. METHODS A prospective observational study included all trauma patients admitted to a University Hospital in Egypt over two months. The time of the decision of discharge and actual discharge time were recorded by reviewing patients' medical records. The patients and their caregivers were asked to fill in a questionnaire about the reasons for delayed discharge. Potential reasons for the delayed discharge were classified into system-related, medical and family-related factors. RESULTS The study included 498 patients with a median age of 41 years (9-72). The median time from discharge decision until actual discharge was 3 h. System-related factors were documented in 48.8% of cases, followed by medical factors (36.3%), and family-related factors (28.1%). When controlling for age, gender and injury severity score using a logistic regression analysis, longer time to discharge (≥3 h) showed a stronger association with medical factors [adjusted OR (95% CI) = 5.44 (2.73-10.85)] and family-related factors [adjusted OR (95% CI) = 7.94 (3.40-18.54)] compared to system-related factors [adjusted OR (95% CI) = 2.20 (1.12-4.29)]. DISCUSSION Although system-related factors were more prevalent, medical and family-related factors appear to be associated with longer discharge delays compared to system-related factors.
Collapse
Affiliation(s)
- Islam El-Abbassy
- General Surgery Department, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
- Raigmore Hospital, NHS Highland, Old Perth Road, Inverness, UK
- Institute of Medical Sciences, University of Aberdeen, King's College, Aberdeen, UK
| | - Wafaa Mohamed
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | | | - Maged El-Setouhy
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jon Mark Hirshon
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Mohamed El-Shinawi
- General Surgery Department, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Galala University for International Cooperation Community Services and Environmental Department, Galala University, Sokhna, Suez Governorate, The city of Galala Plateau, Governorate of Suez on the coast of the Red sea El Galala Maritime Plateau, Egypt
| |
Collapse
|
8
|
Anwar F, Mee H, Allanson J, Mendis E, Hamilton C. Pattern of injuries and management of adolescent trauma in a combined adult and paediatric major trauma centre in United Kingdom. TRAUMA-ENGLAND 2021. [DOI: 10.1177/1460408620921709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Major trauma is a leading cause of death and disability in 16–18-year olds in the UK. Since the launch of major trauma centres (MTCs) in 2012 in UK, survival rates have improved on the whole. The aim of this study was to look at the pathways of 16–18-year olds through one MTC and patterns of rehabilitation provision. Material and methods A retrospective case notes review of all trauma patients aged between 16 and 18 years admitted to one MTC between October 2012 and May 2018. Results One hundred forty-seven young people were identified. 67.3% were male with a mean age of 17.1 years. Motor vehicle accidents were the most common cause of injury (59.2%). Thirty-nine percent had a Glasgow Coma Scale at scene >13. Sixty-three percent were admitted to an adult intensive care unit (ICU), 5.4% to paediatric ICU and 31.3% directly to a ward. Admissions to rehabilitation ward came through adult services with no commissioned equivalent in those admitted to paediatrics. Mean length of stay was 18.1 days. 75.5% of patients were discharged home from the MTC. Discussion The majority of young people were admitted on to adult wards and were able to access commissioned services. However, such services do not provide for the specialist needs of young people, with no access to schooling or parent’s accommodation. Those who were admitted to children’s services missed out on commissioned rehabilitation pathways. Conclusion Young people of transition age often fall between services. For the first time, we illustrate injury patterns and the fragmented services seen in this vulnerable patient group.
Collapse
Affiliation(s)
- Fahim Anwar
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - Harry Mee
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - Judith Allanson
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - Elly Mendis
- Major Trauma Service, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Colin Hamilton
- Department of Physiotherapy, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
9
|
Smith AR, Karim SA, Reif RR, Beck WC, Taylor JR, Davis BL, Bhavaraju AV, Jensen HK, Kimbrough MK, Sexton KW. ROTEM as a Predictor of Mortality in Patients With Severe Trauma. J Surg Res 2020; 251:107-111. [PMID: 32114212 DOI: 10.1016/j.jss.2020.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 01/10/2020] [Accepted: 01/25/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hemorrhage, especially when complicated by coagulopathy, is the most preventable cause of death in trauma patients. We hypothesized that assessing hemostatic function using rotational thromboelastometry (ROTEM) or conventional coagulation tests can predict the risk of mortality in patients with severe trauma indicated by an injury severity score greater than 15. METHODS We retrospectively reviewed trauma patients with an injury severity score >15 who were admitted to the emergency department between November 2015 and August 2017 in a single level I trauma center. Patients with available ROTEM and conventional coagulation data (partial thromboplastin time [PTT], prothrombin time [PT], and international normalized ratio) were included in the study cohort. Logistic regression was performed to assess the relationship between coagulation status and mortality. RESULTS The study cohort included 301 patients with an average age of 47 y, and 75% of the patients were males. Mortality was 23% (n = 68). Significant predictors of mortality included abnormal APTEM (thromboelastometry (TEM) assay in which fibrinolysis is inhibited by aprotinin (AP) in the reagent) parameters, specifically a low APTEM alpha angle, a high APTEM clot formation time, and a high APTEM clotting time. In addition, an abnormal international normalized ratio significantly predicted mortality, whereas abnormal PT and PTT did not. CONCLUSIONS A low APTEM alpha angle, an elevated APTEM clot formation time, and a high APTEM clotting time significantly predicted mortality, whereas abnormal PT and PTT did not appear to be associated with increased mortality in this patient population. Viscoelastic testing such as ROTEM appears to have indications in the management and stabilization of trauma patients.
Collapse
Affiliation(s)
- Alaina R Smith
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Saleema A Karim
- The Department of Health Policy and Management, Fay W. Boozman College of Public Health, Little Rock, Arkansas
| | - Rebecca R Reif
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - William C Beck
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - John R Taylor
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Benjamin L Davis
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Avi V Bhavaraju
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Hanna K Jensen
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mary K Kimbrough
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kevin W Sexton
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| |
Collapse
|
10
|
Sorensen M, Sercy E, Salottolo K, Waxman M, West TA, Tanner A, Bar-Or D. The effect of discharge destination and primary insurance provider on hospital discharge delays among patients with traumatic brain injury: a multicenter study of 1,543 patients. Patient Saf Surg 2020; 14:2. [PMID: 31911820 PMCID: PMC6945617 DOI: 10.1186/s13037-019-0227-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background Hospital length of stay (HLOS) is a commonly used measure of hospital quality and is influenced by clinical and non-clinical factors. To reduce HLOS, it is key to identify factors placing patients at increased risk of lengthy HLOS and discharge delays. Methods This was a retrospective cohort study of patients age ≥ 18 admitted to four level 1 trauma centers between 1/1/2015 and 3/31/2018 with traumatic brain injury (TBI). The primary outcome was discharge delay, defined as discharge ≥24 h after case management notes indicated the patient was ready for discharge. The independent variables of interest were primary insurance provider and discharge destination. Chi-square, Fisher exact, and unadjusted and adjusted logistic regression analyses were used to assess associations between discharge delay and the two primary independent variables, as well as other patient demographic and clinical characteristics. Complications developing during the delay period were also examined. Results A total of 1543 patients with TBI were included. The median age was 61 years, and the median HLOS was 5 days. Approximately half of patients were discharged home (54%). The most common insurance providers were Medicare (35%) and commercial/private (35%). Two-hundred ten (14%) patients experienced a discharge delay. The median delay period was 3 days, and the most common reasons for delay were insurance authorization (52%) and lack of accepting bed (41%). Compared to being discharged home, patients discharged to a skilled nursing facility (adjusted odds ratio (AOR) = 10.35) or intermediate care facility (AOR = 10.64) had the highest odds of discharge delay. Compared to Medicare patients, uninsured/self-pay patients (AOR = 2.98) and those with Medicaid (AOR = 2.83) or commercial/private insurance (AOR = 2.22) had higher odds of delay. Thirty-two patients (15% of those delayed) experienced at least one complication during the delay, some of which were clinically severe. Conclusions A substantial portion of TBI patients in this study experienced discharge delays, and discharge destination and primary insurance provider were significant drivers of these delays. Evaluation of a facility's quality of care should consider the specific causes of these delays.
Collapse
Affiliation(s)
- Melissa Sorensen
- 1Trauma Services Department, Swedish Medical Center, Englewood, CO USA
| | - Erica Sercy
- 2Trauma Research Department, Swedish Medical Center, Englewood, CO USA.,Trauma Research Department, Medical City Plano, Plano, TX USA.,4Trauma Research Department, Research Medical Center, Kansas City, MO USA.,5Trauma Research Department, Penrose Hospital, Colorado Springs, CO USA
| | - Kristin Salottolo
- 2Trauma Research Department, Swedish Medical Center, Englewood, CO USA.,Trauma Research Department, Medical City Plano, Plano, TX USA.,4Trauma Research Department, Research Medical Center, Kansas City, MO USA.,5Trauma Research Department, Penrose Hospital, Colorado Springs, CO USA
| | - Michael Waxman
- 6Medical/Surgical Intensive Care Unit, Research Medical Center, Kansas City, MO USA
| | - Thomas A West
- Trauma Services Department, Medical City Plano, Plano, TX USA
| | - Allen Tanner
- 8Trauma Services Department, Penrose Hospital, Colorado Springs, CO USA
| | - David Bar-Or
- 2Trauma Research Department, Swedish Medical Center, Englewood, CO USA.,Trauma Research Department, Medical City Plano, Plano, TX USA.,4Trauma Research Department, Research Medical Center, Kansas City, MO USA.,5Trauma Research Department, Penrose Hospital, Colorado Springs, CO USA.,Injury Outcomes Network Research Group, 501 E Hampden Ave, Englewood, CO 80113 USA
| |
Collapse
|
11
|
Nordgarden T, Odland P, Guttormsen AB, Ugelvik KS. Undertriage of major trauma patients at a university hospital: a retrospective cohort study. Scand J Trauma Resusc Emerg Med 2018; 26:64. [PMID: 30107855 PMCID: PMC6092794 DOI: 10.1186/s13049-018-0524-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 07/02/2018] [Indexed: 12/12/2022] Open
Abstract
Background Studies show increased mortality among severely injured patients not met by trauma team. Proper triage is important to ensure that all severely injured patients receive vital trauma care. In 2017 a new national trauma plan was implemented in Norway, which recommended the use of a modified version of “Guidelines for Field Triage of Injured Patients” to identify severely injured patients. Methods A retrospective study of 30,444 patients admitted to Haukeland University Hospital in 2013, with ICD-10 injury codes upon discharge. The exclusion criteria were department affiliation considered irrelevant when identifying trauma, patients with injuries that resulted in Injury Severity Score < 15, patients that did receive trauma team, and patients admitted > 24 h after time of injury. Information from patient records of every severely injured patient admitted in 2013 was obtained in order to investigate the sensitivity of the new guidelines. Results Trauma team activation was performed in 369 admissions and 85 patients were identified as major trauma. Ten severely injured patients did not receive trauma team resuscitation, resulting in an undertriage of 10.5%. Nine out of ten patients were men, median age 54 years. Five patients were 60 years or older. All of the undertriaged patients experienced fall from low height (< 4 m). Traumatic brain injury was seen in six patients. Six patients had a Glasgow Coma Scale score ≤ 13. The new trauma activation guidelines had a sensitivity of 95.0% in our 2013 trauma population. The degree of undertriage could have been reduced to 4.0% had the guidelines been implemented and correctly applied. Conclusions The rate of undertriage at Haukeland University Hospital in 2013 was above the recommendations of less than 5%. Use of the new trauma guidelines showed increased triage precision in the present trauma population.
Collapse
Affiliation(s)
- Terje Nordgarden
- Faculty of Medicine, University of Bergen, Haukelandsveien 28, 5009, Bergen, Norway.
| | - Peter Odland
- Faculty of Medicine, University of Bergen, Haukelandsveien 28, 5009, Bergen, Norway
| | - Anne Berit Guttormsen
- Department of Clinical Medicine 1, Jonas Lies vei 65, 5021, Bergen, Norway.,Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
| | - Kristina Stølen Ugelvik
- Regional Trauma Center, Surgical Department, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
| |
Collapse
|
12
|
Chang YC, Huang JL, Hsia SH, Lin KL, Lee EP, Chou IJ, Hsin YC, Lo FS, Wu CT, Chiu CH, Wu HP. Child protection medical service demonstration centers in approaching child abuse and neglect in Taiwan. Medicine (Baltimore) 2016; 95:e5218. [PMID: 27858867 PMCID: PMC5591115 DOI: 10.1097/md.0000000000005218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Child abuse includes all forms of physical and emotional ill treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child's health, development, or dignity. In Taiwan, the Child Protection Medical Service Demonstration Center (CPMSDC) was established to protect children from abuse and neglect. We further analyzed and compared the trends and clinical characteristics of cases reported by CPMSDC to evaluate the function of CPMSDC in approaching child abuse and neglect in Taiwan. We prospectively recorded children with reported child abuse and neglect in a CPMSDC in a tertiary medical center from 2014 to 2015. Furthermore, we analyzed and compared age, gender, scene, identifying settings, time of visits, injury type, injury severity, hospital admission, hospitalization duration, and outcomes based on the different types of abuse and the different settings in which the abuse or neglect were identified. Of 361 child abuse cases (mean age 4.8 ± 5.36 years), the incidence was highest in 1- to 6-year-old children (n = 198, 54.85%). Physical abuse and neglect were predominant in males, while sexual abuse was predominant in females (P < 0.001). Neglect was most common (n = 279, 75.85%), followed by physical (n = 56, 15.51%) and sexual abuse (n = 26, 7.2%). The most common identifying setting was the emergency department (n = 320, 88.64%), with neglect being most commonly reported. Head, neck, and facial injuries were more common in physically abused children than in neglected and sexual abused children (P < 0.005), leading to longer hospitalization (P = 0.042) and a higher Injury Severity Score (P = 0.043). There were more skin injuries in neglect (P < 0.001). The mortality rate was 2.49% (n = 9). The CPMSDC could enhance the ability, alertness, and inclination of professionals to identify suspected cases of child abuse, and to increase the rate of registry. Cases of physical abuse had a higher Injury Severity Score, longer duration of hospitalization, and more injuries of head, face, and neck compared with other types of abuse. The reported rate of neglect was highly elevated after the CPMSDC established during the study period. Recognition of neglect is not easy, but the consequent injury, especially asphyxia, may lead to mortality.
Collapse
Affiliation(s)
- Yu-Ching Chang
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan
- College of Medicine, Chang Gung University
| | - Jing-Long Huang
- College of Medicine, Chang Gung University
- Division of Pediatric Allery, Asthma, and Rheumatology, Department of Pediatrics
| | - Shao-Hsuan Hsia
- College of Medicine, Chang Gung University
- Division of Pediatric Critical Care Medicine, Department of Pediatrics
| | - Kuang-Lin Lin
- College of Medicine, Chang Gung University
- Division of Pediatric Neurology, Department of Pediatrics
| | - En-Pei Lee
- Division of Pediatric Critical Care Medicine, Department of Pediatrics
| | - I-Jun Chou
- College of Medicine, Chang Gung University
- Division of Pediatric Neurology, Department of Pediatrics
| | - Yi-Chen Hsin
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan
- College of Medicine, Chang Gung University
| | - Fu-Song Lo
- College of Medicine, Chang Gung University
- Divsion of Pediatric Endocrinology, Department of Pediatrics
| | - Chang-Teng Wu
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan
- College of Medicine, Chang Gung University
| | - Cheng-Hsun Chiu
- College of Medicine, Chang Gung University
- Division of Pediatric infectious diseases, Department of Pediatrics
| | - Han-Ping Wu
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan
- College of Medicine, Chang Gung University
- Correspondence: Han-Ping Wu, Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan (e-mail: )
| |
Collapse
|
13
|
Kurt A, Turut H, Acipayam A, Kirbas A, Yuce S, Cumhur Cure M, Cure E. Investigation of surfactant protein-D and interleukin-6 levels in patients with blunt chest trauma with multiple rib fractures and pulmonary contusions: a cross-sectional study in Black Sea Region of Turkey. BMJ Open 2016; 6:e011797. [PMID: 27733410 PMCID: PMC5073616 DOI: 10.1136/bmjopen-2016-011797] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Multiple rib fractures (RFs) and pulmonary contusions (PCs), with resulting systemic lung inflammation, are the most common injuries caused by blunt chest trauma (BCT) in motor vehicle accidents. This study examined levels of the inflammation marker interleukin (IL)-6 and those of the acute-phase reactant surfactant protein (SP)-D in patients with BCT. DESIGN Prospective, cross-sectional, observational study. SETTING Single-centre, tertiary care hospital in the Black Sea Region of Turkey. PARTICIPANTS The study included 60 patients with BCT who were hospitalised in our thoracic surgery department. PARAMETERS MEASURES The SP-D and IL-6 serum levels of patients with RFs (two or more RFs) (n=30) and patients with PCs (n=30) were measured after 6 hours, 24 hours and 7 days, and compared with those of age-matched and gender-matched healthy participants. RESULTS The 6-hour serum SP-D levels of the RFs (p=0.017) and PCs (p<0.001) groups were significantly higher than those of the healthy controls. The 24-hour and 7-day SP-D levels of both groups were also higher than the control group. The serum IL-6 levels of both groups were significantly higher than those of the control group. We have found Injury Severity Score to be independently related to 6-hour IL-6 (β=1.414, p<0.001) and 24-hour IL-6 levels (β=1.067, p<0.001). The development of complications was independently related to 6-hour SP-D level (β=0.211, p=0.047). CONCLUSIONS RFs and PCs after BCT lead to local and systemic inflammation due to lung injury. The levels of the systemic inflammation marker IL-6 and those of the acute-phase reactant SP-D were elevated in the present study. The SP-D level may be used as a marker in the follow-up of BCT-related complications.
Collapse
Affiliation(s)
- Aysel Kurt
- Department of Thoracic Surgery, School of Medicine, Recep Tayyip Erdogan University,Rize, Turkey
| | - Hasan Turut
- Department of Thoracic Surgery, School of Medicine, Recep Tayyip Erdogan University,Rize, Turkey
| | - Ahmet Acipayam
- Department of Thoracic Surgery, Burdur State Hospital, School of Medicine, Burdur, Turkey
| | - Aynur Kirbas
- Department of Biochemistry, School of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Suleyman Yuce
- Department of Internal Medicine, Kumru State Hospital, Ordu, Turkey
| | - Medine Cumhur Cure
- Department of Biochemistry, School of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Erkan Cure
- Department of Internal Medicine, School of Medicine, Recep Tayyip Erdogan University,Rize, Turkey
| |
Collapse
|
14
|
Comparison of the Ability to Predict Mortality between the Injury Severity Score and the New Injury Severity Score: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13080825. [PMID: 27537902 PMCID: PMC4997511 DOI: 10.3390/ijerph13080825] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/30/2016] [Accepted: 08/10/2016] [Indexed: 11/17/2022]
Abstract
Background: Description of the anatomical severity of injuries in trauma patients is important. While the Injury Severity Score has been regarded as the “gold standard” since its creation, several studies have indicated that the New Injury Severity Score is better. Therefore, we aimed to systematically evaluate and compare the accuracy of the Injury Severity Score and the New Injury Severity Score in predicting mortality. Methods: Two researchers independently searched the PubMed, Embase, and Web of Science databases and included studies from which the exact number of true-positive, false-positive, false-negative, and true-negative results could be extracted. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies checklist criteria. The meta-analysis was performed using Meta-DiSc. Meta-regression, subgroup analyses, and sensitivity analyses were conducted to determine the source(s) of heterogeneity and factor(s) affecting the accuracy of the New Injury Severity Score and the Injury Severity Score in predicting mortality. Results: The heterogeneity of the 11 relevant studies (total n = 11,866) was high (I2 > 80%). The meta-analysis using a random-effects model resulted in sensitivity of 0.64, specificity of 0.93, positive likelihood ratio of 5.11, negative likelihood ratio of 0.27, diagnostic odds ratio of 27.75, and area under the summary receiver operator characteristic curve of 0.9009 for the Injury Severity Score; and sensitivity of 0.71, specificity of 0.87, positive likelihood ratio of 5.22, negative likelihood ratio of 0.20, diagnostic odds ratio of 24.74, and area under the summary receiver operating characteristic curve of 0.9095 for the New Injury Severity Score. Conclusion: The New Injury Severity Score and the Injury Severity Score have similar abilities in predicting mortality. Further research is required to determine the appropriate use of the Injury Severity Score or the New Injury Severity Score based on specific patient condition and trauma type.
Collapse
|