Evaluation of Trauma Severity Scores in Electric Scooter Related Injuries

Trauma severity scoring systems are routinely used to monitor trauma patient outcomes. Yet, the most accurate scoring system remains an elusive target. We aim to compare trauma severity scales (ISS, NISS, RTS, TRISS, and BIG) in multitrauma patients and investigate BIG as one of the new trauma severity scoring systems. The demographic data of the patients, vital signs, injury mechanisms, body regions exposed to trauma, final diagnosis, the injury severity scales-Injury Severity Score (ISS), New Injury Severity Score (NISS), Revised Trauma Score (RTS), base deficit, international normalized ratio, and Glasgow Coma Scale (BIG), and Trauma and Injury Severity Score (TRISS)-the length of stay in hospital, and the progress of the patients were examined. A total of 426 cases were included in the study. The best performing score in determining mortality was TRISS (area under the curve [AUC]: 0.93, sensitivity 97.1% and specificity 76.7%). This was followed by the NISS, BIG, ISS, and RTS, respectively. For the prediction of intensive care unit admission, the NISS was the most successful with an AUC value of 0.81. There was a significant relationship in terms of the length of stay in all trauma scores (p < .05). The most successful score in predicting mortality in trauma patients was the TRISS, whereas the NISS was the most successful in predicting intensive care unit admission. The newly developed BIG score can be used as a strong scoring method for predicting prognosis in trauma patients.

Background: The problem that is central to trauma research is the prediction of survival rate after trauma. Trauma and Injury Severity Score is being used for predicting survival rate after trauma. Many countries have conducted a study on the classification, characteristics of variables, and the validity of the Trauma and Injury Severity Score model. However, few investigations have been made on the characteristics of coefficients or variables related to Trauma and Injury Severity Score in Korea. Objectives: There is a need for coefficient analysis of Trauma and Injury Severity Score which was created based on the United States database to be optimized for the situation in Korea. Methods: This study examined how the currently used Trauma and Injury Severity Score coefficients were developed and created for trauma patients visiting the emergency department in a hospital in Korea using the analytical method. A total of 34,340 trauma patients who were hospitalized into an emergency center from January 2012 to December 2014 for 3 years were analyzed with trauma registry established on August 2006. Results: Trauma and Injury Severity Score coefficients were transformed with the methods that were used to make the existing Trauma and Injury Severity Score coefficients using the trauma patients’ data. Regression coefficients (B) were drawn by building up a logistic regression analysis model that used variables such as Injury Severity Score, Revised Trauma Score, and age depending on survival with Trauma and Injury Severity Score. Conclusion: With regard to Trauma and Injury Severity Score established in the United States differing from Korea in injury types, it seems possible to realize significant survival rate by deriving coefficients with data in Korea and reanalyzing them.

Analysis of prognosis and medical resource utilization in elderly patients with trauma: A retrospective cohort study in one trauma center.

Bayesian averaging over decision tree models: An application for estimating uncertainty in trauma severity scoring

In this study, we aimed to determine the effects of trauma severity on cardiac involvement through evaluating the trauma severity score together with diagnostic tests in multiple trauma patients. A trauma score was determined using various trauma severity scales. After obtaining the approval of the ethics committee of the faculty, this prospective study was performed through evaluating 100 multiple trauma patients, aged over 15 years, who applied to our Emergency Department (ED). After determining the trauma severity score using instruments such as the Injury Severity Score (ISS), Glasgow Coma Scale (GCS), and Revised Trauma Score (RTS), the cardiac condition was evaluated using biochemical and radiological diagnostic tests. During the study period, 100 patients were evaluated (78 male, 22 female; mean age: 33.2±15.4; range 15 to 70 years). It was determined that 92 (92%) were blunt trauma cases, and 77 (77%) of them were due to traffic accidents. The majority of cases showed electrocardiogram (ECG) abnormalities (63%) and sinus tachycardia (36%). Abnormal echocardiogram (ECHO) findings, mostly accompanied by ventricular defects (n=24), were determined in 31 of the cases. Nineteen cases with high trauma severity score resulted in death, and 14 of all deaths were secondary to traffic accidents. Trauma scores were found to show a significant difference between the two groups. The ISS trauma scale was determined to be the most effective in terms of indicating heart involvement in patients with multiple traumas. Close follow-up and cardiac monitoring should be applied to patients with high trauma severity scores considering possible cardiac rhythm changes and hemodynamic disturbances due to cardiac involvement.

The search for a simple injury score to reliably discriminate the risk of in-hospital mortality in South Africa

Limb amputation and death are devastating sequelae of acute compartment syndrome (ACS), and have been posited to result either from the initial injury burden or from pathophysiologic sequelae, such as rhabdomyolysis leading to acute renal failure. We aimed to test the hypothesis that severity of trauma is associated with limb amputation and death in patients with traumatic leg ACS. We retrospectively reviewed 302 patients with ACS of 302 legs treated with fasciotomies from 2000 to 2015 at two tertiary trauma centers. Our response variables were death and limb amputation during inpatient hospital admission. Three common trauma severity scores, injury severity score (ISS), revised trauma score (RTS), and Glasgow coma scale (GCS), were studied. Patient- and injury-related explanatory variables were studied. Bivariate analyses were used to identify factors associated with limb amputation and death. Of 302 patients, 13 (4%) underwent limb amputation and 10 (3%) died during the inpatient admission. Only one of 10 patients who expired died secondary to acute renal failure. ISS and GCS were significantly associated with limb amputation, and RTS was marginally associated. ISS, RTS, and GCS were significantly associated with death. Moreover, smoking and open fracture were significantly associated with limb amputation, and diabetes mellitus, presence of fracture, closed head injury, and chest or abdominal injury were associated with death. Trauma severity scores are associated with both limb amputation and death during inpatient admission for traumatic leg ACS. These adverse sequelae of leg ACS are likely driven by the initial injury burden.

Trauma is a leading global cause of mortality, and systemic inflammatory response syndrome (SIRS) remains a significant complication, contributing to adverse outcomes. Neutrophils, as first responders to tissue injury, undergo substantial phenotypic and functional changes following trauma. This study investigates neutrophil subpopulations defined by CD16 and CD62L expression in trauma patients, focusing on their correlation with clinical biomarkers, trauma severity, and functional properties. We included 50 non-infectious trauma patients, categorized into SIRS and Non-SIRS groups, and 43 elective surgery patients as controls. Neutrophil subsets were analyzed at two time points (TP1 and TP2) using flow cytometry. Functional assays evaluated phagocytosis, oxidative burst, mitochondrial function, and degranulation. Correlations between neutrophil subpopulations and clinical markers, including lactate, creatine kinase, Injury Severity Score, and Trauma and Injury Severity Score, were examined. Patients with SIRS exhibited higher proportions of banded neutrophils and CD16lowCD62Llow neutrophils at TP1, alongside reduced levels of mature neutrophils. Elevated lactate and creatine kinase levels positively correlated with banded neutrophils and CD16lowCD62Llow neutrophils, while negatively correlating with mature neutrophils CD16highCD62Lhigh and hypersegmented neutrophils CD16highCD62Llow. Hypersegmented neutrophils were more prevalent in Non-SIRS patients at TP1 and in SIRS patients at TP2. Banded neutrophils showed a positive correlation with Injury Severity Score and an inverse correlation with Trauma and Injury Severity Score (TRISS), whereas hypersegmented neutrophils were negatively associated with ISS and positively correlated with TRISS. These correlations likely reflect the pro-inflammatory role of banded neutrophils and the inflammation-resolving function of hypersegmented neutrophils. CD16lowCD62Llow neutrophils displayed impaired phagocytosis, oxidative burst, and degranulation capacity, indicating functional deficiencies. This study highlights the dynamic changes in neutrophil subpopulations in trauma and their association with systemic inflammation and clinical severity. Increased banded neutrophils correlate with SIRS and metabolic stress, whereas hypersegmented neutrophils may contribute to resolving inflammation. CD16lowCD62Llow neutrophils exhibit functional impairments, warranting further investigation. Monitoring neutrophil subpopulations could aid in identifying trauma patients at risk for non-infectious SIRS and guide therapeutic interventions.

Background. Severe combined trauma is a pressing issue in modern medicine. Victims with a severe combined trauma receive constant monitoring for the severity of their condition. There is no commonly adopted uniform model for assessing the severity of injuries.Objectives. To review existing scoring methods for assessing the severity of combined craniofacial trauma.Мethods. A search of Russian and foreign publications in the PubMed and Elibrary databases at the depth of 10 years was conducted. The query terms were: injury severity, trauma severity [тяжесть травм], trauma severity score [шкалы оценки тяжести травм], cranio-facial trauma severity [тяжесть черепно-лицевой травмы]. The record selection was based on its scientifi c value in this research topic.Results. This systematic review covered 49 scientifi c papers reporting methods for assessing the severity of combined craniofacial trauma. Depending on the main applied principle, the severity scoring methods were classifi ed into 3 groups: anatomical, physiological and combined. Along with the history of creation, main advantages and disadvantages of the methods in terms of scoring performance in combined craniofacial trauma were outlined. Severity scoring models in isolated maxillofacial trauma were described in detail.Conclusion. There is no generally accepted best clinical practice for trauma severity scoring, including craniofacial trauma. The majority of scoring models are developed for survival chance estimation. At the same time, dynamic monitoring in hospitals most commonly relies on non-specifi c methods for the general severity estimation in trauma victims.

Presently, no trauma system exists in Ohio. Since 1993, all hospitals in Cuyahoga County (CUY), northeast Ohio (n = 22) provide data to a trauma registry. In return, each received hospital-specific data, comparison data by trauma care level and a county-wide aggregate summary. This report describes the results of this approach in our region. All cases were entered by paper abstract or electronic download. Interrater reliability audits and z score analysis was performed by using the Major Trauma Outcome Study and the CUY 1994 baseline groups. Risk adjustment of mortality data was performed using statistical modeling and logistic regression (Trauma and Injury Severity Score, Major Trauma Outcome Study, CUY). Trauma severity measures were defined. In 1995, 3,375 patients were entered. Two hundred ninety-one died (8.6%). Severity measures differed by level of trauma care, indicating differences in case mix. Probability of survival was lowest in the Level I centers, highest in the acute care hospitals. Outcomes z scores demonstrated survival differences for all levels. In a functioning trauma system, the most severely injured patients should be cared for at the trauma centers. A low volume at acute care hospitals is desirable. By using Trauma and Injury Severity Score with community-specific constants, NE Ohio is accomplishing these goals. The Level I performance data are an interesting finding compared with the data from the Level II centers in the region

This prospective cohort study aimed to compare the predictive accuracy of outcome (survival/death) among trauma patients using various prognostic scores. Over 3 months, 240 trauma patients in a tertiary care hospital were assessed for demographic details, trauma characteristics, vital signs, Glasgow coma scale, arterial blood gas values, and lab markers. Injury severity score (ISS), revised trauma score (RTS), trauma and injury severity score (TRISS), and acute physiology and chronic health evaluation II (APACHE II) were applied at admission, 24 hours, and 48 hours post-admission. Road traffic accidents (55.83%) were the primary cause of trauma, followed by falls (33.75%) and violence (10.41%). The all-cause mortality rate was 23.33%, with 34.16% requiring ICU admission. Head injuries (65.83%) were both the most frequent injury site and cause of mortality. Analysis indicated that APACHE II outperformed other scores in predicting outcomes, with ISS following closely. The study concludes that trauma severity correlates with ICU admission and mortality, emphasizing APACHE II as a superior predictor, particularly for traumatic brain injuries leading to ICU admission and mortality. This study contributes to the existing body of knowledge by addressing the gap in comparing prognostic abilities among scoring systems for trauma patients. The unexpected superiority of APACHE II suggests its potential as a valuable tool in predicting outcomes in this specific patient population. Gupta J, Kshirsagar S, Naik S, Pande A. Comparative Evaluation of Mortality Predictors in Trauma Patients: A Prospective Single-center Observational Study Assessing Injury Severity Score Revised Trauma Score Trauma and Injury Severity Score and Acute Physiology and Chronic Health Evaluation II Scores. Indian J Crit Care Med 2024;28(5):475-482.

Objective The aim was to evaluate the performance of thorax trauma severity score (TTSS) in predicting hospital mortality in thoracic trauma and comparing its performance with the trauma and injury severity score (TRISS). Background Because the great risk of thoracic trauma that may be life-threatening especially if uncontrolled, early management of it reduces mortality of polytraumatized patients. TTSS and TRISS were developed for the purpose of prediction of hospital mortality in thoracic trauma. Patients and methods This is a prospective comparative study done on 100 patients with chest trauma, either isolated chest trauma or as a part of polytrauma, who presented to the Emergency Department of Menoufia University Hospital during the period from April 2019 to April 2020. TTSS score was applied to assess its performance and comparing it with TRISS score. Results TTSS and TRISS scores were applied on 100 patients with trauma meeting inclusion criteria to predict the hospital mortality in thoracic trauma. The area under the receiver operating characteristics curve was 0.88 for TTSS score and 0.892 for TRISS score. Conclusion This study demonstrates that the TRISS, and the TTSS, can be used to predict hospital mortality in patients with thoracic trauma; hence, additional prospective studies are required. We believe that the study provides important information regarding validation of the TTSS, as it had a direct correlation with need for oxygenation, ventilator, duration of hospital stay, mortality, or outcome in patients with chest trauma.

Comparison of the Thoracic Trauma Severity Score (TTSS) and Trauma and Injury Severity Score (TRISS) in predicting clinical outcomes in chest trauma patients: protocol for a prospective cohort study from Iraq

Despite electric scooter use has proliferated in Italy since 2019, actionable data regarding injury incidence and patterns associated with electric scooter accidents are limited. This study aims at analyzing the rate, clinical, and demographic features of electric scooter accidents accessed to the Emergency Department (ED) of Fondazione Policlinico Universitario A. Gemelli IRCSS (Rome, Italy). This retrospective study included all patients older than 18 years riding an electric scooter in the ED from June 2019 to April 2022. Personal data, injury circumstances, helmet use, and health data were collected. Abbreviated Injury Scale (AIS) codes of all diagnoses were recorded, and the Injury Severity Score (ISS) was calculated for each patient. The analysis includes 92 patients admitted to the ED due to an e-scooter accident during the study period, with an increase in years. Thirty-two patients presented bone fractures especially concerning the extremities and the face districts. The median Injury Severity Score in the study cohort was 3, with the highest AIS represented by AIS Pelvic-Extremity and AIS External. Moreover, statistical significance was found between AIS Head-Neck and severity of trauma. E-scooters have become a familiar sight in cities worldwide recently, with many new companies renting them for use. But their arrival has also brought new safety concerns. Although most injuries reported are minor, the meager rate of helmet use is critical. Implementing compulsory helmet use for electric scooters for all ages could be a protective factor for being patient with head trauma on urban streets.

Objective To evaluate the trauma care effect and the value of trauma and injury severity score (TRISS) in prediction of the mortality by using TRISS to calculate the survival probability of trauma patients in five hospitals from Zhejiang province in 2009. Methods A retrospective study was done on trauma patients (study group) firstly admitted to Emergency Department of five hospitals from Zhejiang province in 2009.The relevant information was collected,including demographic data,trauma types and injury causes.The TRISS score was obtained through calculating injury severity score (ISS) and revised trauma score (RTS) on admission into emergency department.With the major trauma outcome study (MTOS) as control group,M value,standardized Ws value and 95％ confidence interval (CI) were calculated to compare actual survival rate and anticipation survival rate. Results A total of 2 193 patients at mean age of 44.39 years were enrolled in the study,including 1 661 male patients (75.74％).Traffic accident injury was the most common,followed by fall injury.The mortality rate according to TRISS was 13.22％,but the actual mortality rate was 9.75％.For all the patients,M =0.80 indicated that the injury severity of the study group was significantly different from that of the control group.At the same time,Ws =2.15,95％ CI for Ws:1.54-2.77 showed that the actual survival rate of the study group was significantly higher than that of the control group.Besides,the survival rate of trauma patients in the affiliated hospitals and three hospitals at class A grade was significantly higher fian that of the control group,but there was no significant difference between three hospitals at class B grade and control group. Conclusions TRISS overestimates the mortality of the study group,which is probably associated with the rapid development of traumatology and the old coefficients of TRISS.Setting up local trauma database and renewing coefficients of TRISS may improve the ability of TRISS in predicting mortality of the trauma patients. Key words: Wounds and injuries; Research design; Mortality; Trauma and injury severity score