Higher Injury Severity Score Scores Research Articles

Scapular fractures and concomitant injuries

ObjectiveThe association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized. Few studies have investigated this presumed association. In this study, we investigated the incidence of significant associated injuries with scapular fracture and their outcomes. MethodsA retrospective study was conducted from 2005 to 2009 in a level I trauma center in Thailand. All blunt trauma patients were identified. Patients’ demographics, injury mechanism, associated injuries, Injury Severity Score (ISS), and survival outcomes were recorded. The management of associated injuries with scapular fracture was reviewed, and the risk factors for mortality were identified. ResultsAmong the 7 345 trauma patients admitted, scapular fractures occurred in 84 cases (1.1%). The mean age was (37.98±15.21) years. Motorcycle crash was the most frequent mechanism of injury, occurring in 51 cases (60.7%). Seventy-four patients (88.1%) suffering from scapular fractures had associated injuries: 5 (6.0%) had significant chest injuries, but none of them had blunt thoracic aortic injury. Two patients (2.4%) with scapular fractures died. Factors determining the likelihood of mortality were: (1) ISS>25 (LR=8.5, P<0.05); (2) significant associated chest injury (AIS>3, LR=5.3, P<0.05) and (3) significant associated abdominal injury (AIS>3, LR=5.3, P<0.05). ConclusionA blunt scapular fracture may not accompany a blunt thoracic aortic injury but it is strongly related to other injuries like chest injury, extremity injury, head injury, etc. If a scapular fracture is found with a high ISS score, high chest or abdomen AIS score, the patient would have a high risk of mortality.

Traumatic atlantooccipital dislocation: comprehensive assessment of mortality, neurologic improvement, and patient-reported outcomes at a Level 1 trauma center over 15 years

Background contextOnly Level 3 evidence exists for the diagnosis and treatment of atlantooccipital dislocation (AOD) with few studies examining mortality, neurologic improvement, and patient-reported outcomes (PROs). PurposeFirst, the aim was to determine: the incidence of AOD, 90-day surgical morbidity and mortality after AOD, patient factors that may be associated with delayed or missed diagnosis, and factors that were associated with mortality and neurologic improvement after AOD. Secondly, the aim was to quantify the pain, disability, and quality of life experienced by patients surviving AOD. Study design/settingThis was a retrospective cohort study. Patient sampleA total of 5,337 consecutive spine computed tomography traumagrams from 1997 to 2012 were included. Outcome measuresMortality, neurologic improvement, complications, EuroQol five dimensions (EQ-5D), Neck Disability Index (NDI), Numeric Rating Scale (NRS)-neck, NRS-arm, and return-to-work were the outcome measures. MethodsPatients were considered to have AOD if they met one of the following radiographic criteria: basion-dens interval greater than 10 mm; basion-axial interval: anterior displacement greater than 12 mm or posterior displacement greater than 4 mm between the basion and posterior C2 line; and condyle to C1 interval greater than 1.4 mm. Linear regression analysis was performed to identify factors associated with 90-day mortality, neurologic improvement, and missed diagnosis. Patient-reported outcomes were assessed via phone interview. ResultsThirty-one patients met radiographic criteria for AOD; an incidence of 0.6% over 15 years. Twenty-one (68%) patients were treated with occipital cervical fusion. At 90 days postoperatively, there were no new neurologic deficits or reoperations. Eight (26%) patients died within 90 days. All patients who died had no documented AOD diagnosis and were not treated surgically. Missed AOD diagnosis was the strongest predictor of mortality. Younger age, lower Glasgow Coma Score, lower Injury Severity Score (ISS) score, and worse initial American Spinal Injury Association (ASIA) score were significantly associated with greater neurologic improvement. Higher ISS score and better ASIA score were significantly associated with missed AOD diagnosis. The average PROs metrics at time of telephone follow-up were as follows: EQ-5D=0.73±0.19, NDI=30.89±18.57, NRS-neck=2.33±2.21, NRS-arm=2.00±2.54. Of the patients with follow-up data, four were employed full-time, and five were receiving disability. ConclusionsOur work suggests that failure to diagnose AOD is a powerful predictor of mortality. Higher ISS scores and better neurologic presentation were significantly associated with missed diagnosis. Craniocervical arthrodesis preserved neurologic function with low complication rate and unexpectedly high PROs and return-to-work. These results must be carefully interpreted because it is unclear whether missed AOD diagnosis accompanies another death-causing injury (eg, traumatic brain injury) or if failure to treat AOD contributes to mortality in a multifactorial manner.

MP18-08 ADRENAL INJURIES: A NATIONAL TRAUMA DATA BANK ANALYSIS

You have accessJournal of UrologyTrauma/Reconstruction: Ureter, Bladder, External Genitalia and Urotrauma I1 Apr 2015MP18-08 ADRENAL INJURIES: A NATIONAL TRAUMA DATA BANK ANALYSIS Jairam R. Eswara, Valary T. Raup, Julio Geminiani, Joel Vetter, and Steven B. Brandes Jairam R. EswaraJairam R. Eswara More articles by this author , Valary T. RaupValary T. Raup More articles by this author , Julio GeminianiJulio Geminiani More articles by this author , Joel VetterJoel Vetter More articles by this author , and Steven B. BrandesSteven B. Brandes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1040AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Adrenal trauma is extremely rare and current literature is lacking in data from large case series. In this study, we analyze adrenal injuries using the National Trauma Data Bank (NTDB). METHODS We performed a retrospective analysis of the NTDB from the years 2007–2011. Patient demographics, Injury Severity Score (ISS), mechanism of injury, blunt versus penetrating trauma, associated injuries and hypovolemic shock were assessed. Multivariable models were used to determine associations with outcomes such as need for surgery, type of surgery mean length of stay, need for ICU, and death. RESULTS Of the 1,766,606 trauma cases in the data set, 8683 were identified as involving one or both adrenal glands. There were 7835 blunt and 663 penetrating injuries, and 184 of these injures were isolated to the adrenal glands. Of the 8683 adrenal injuries, 80 (0.9%) required surgery. However, none of the 184 isolated adrenal injures required surgery (p=0.42). Factors associated with isolated adrenal injury include lower ISS (p<0.001), younger age (p<0.001), and penetrating injury (p<0.001). No isolated adrenal injuries were associated with death (12% vs. 0%, p<0.0001). The most common associated organ injuries were ribs (50.9%), thoracic (50.0%), liver (41.6%), vertebrae (30.9%), kidney (27.8%), and spleen (22.0%). Logistic regression showed that injures to the thorax (p=0.0014) and multiple abdominal injuries (p<0.001) were associated with a lower rate of undergoing adrenal surgery. Higher ISS score (p=0.007), penetrating injury (p<0.001), race (Black) (p=0.029) and concurrent injuries to the spleen (p<0.001) and intestines (p=0.016) were associated with a higher likelihood of requiring adrenal surgery. Older age (p<0.001), higher ISS score (p<0.001), race (Black, Other) (p=0.03, p=0.02), penetrating injuries (p<0.001) and injuries to the aorta/vena cava (p=0.008), vessels (p=0.001), thorax (p=0.03), ribs (p=0.005), stomach (p=0.02), liver (p=0.03), multiple abdominal injuries (p=0.002), and brain/spinal cord (p<0.001) were associated with a higher mortality rate. CONCLUSIONS Adrenal injuries are rare, comprising 0.49% of all traumatic injuries. In our database, isolated adrenal injuries were not fatal and did not require surgery. Younger age, race (Black), higher ISS score, penetrating injury, and concurrent injuries to the spleen/intestines were associated with a higher likelihood of requiring an adrenalectomy. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e208 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jairam R. Eswara More articles by this author Valary T. Raup More articles by this author Julio Geminiani More articles by this author Joel Vetter More articles by this author Steven B. Brandes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

ATLS adherence in the transfer of rural trauma patients to a level I facility

BackgroundInjury sustained in rural areas has been shown to carry higher mortality rates than trauma in urban settings. This disparity is partially attributed to increased distance from definitive care and underscores the importance of proper primary trauma management prior to transfer to a trauma facility. The purpose of this study was to assess Advanced Trauma Life Support (ATLS) guideline adherence in the management of adult trauma patients transferred from rural hospitals to a level I facility. MethodsWe performed a retrospective analysis of all adult major trauma patients transferred ≥50km from an outlying hospital to a level I trauma centre from 2007 through 2009. Transfer practices were evaluated using ATLS guidelines. Results646 patients were analyzed. Mean age was 40.5years and 94% sustained blunt injuries with a median Injury Severity Score (ISS) of 22. Median transport distance was 253km. Among all patients, there were notable deficiencies (<80% adherence) in 8 of 11 ATLS recommended interventions, including patient rewarming (8% adherence), chest tube insertion (53%), adequate IV access (53%), and motor/sensory exam (72%). Patients with higher ISS scores, and those transferred by air were more likely to receive ATLS recommended interventions. ConclusionsKey aspects of ATLS resuscitation guidelines are frequently missed during transfer of trauma patients from the periphery to level I trauma centres. Comprehensive quality improvement initiatives, including targeted education, telemedicine and trauma team training programmes could improve quality of care.

Predictors of New Findings on Repeat Head CT Scan in Blunt Trauma Patients with an Initially Negative Head CT Scan

Our goal was to determine the need for a repeat head CT scan when the initial CT was negative. Data were collected from January 1, 2002 to December 31, 2008. There were 281 patients admitted to the trauma center with an initial negative head CT, who had a repeat CT during the same hospitalization. Repeat CTs were categorized into negative/negative (NNG) and negative/positive (NPG) groups. There were 281 patients who underwent a repeat head CT for changes in neurologic status, persistent symptoms, follow-up, decreased mental status, or suspected bleed. Of these, 241 patients remained negative (NNG) and new abnormal findings were noted in 40 patients (NPG). There were no differences in sex (NNG, 63% males vs NPG, 75% females; p = 0.14) or average age (NNG, 51.6 ± 22.5 years vs NPG, 45.2 ± 24.6 years; p = 0.07). There was no difference in positive toxicology (NNG, 29% vs NPG, 30%; p = 0.94) or mechanism of injury (NNG, 51% motor vehicle crash [MVC] vs NPG, 62% MVC; p = 0.18). There was a significant difference in Injury Severity Score (ISS) (NNG, 10.7 ± 8.1 vs NPG, 17.9 ± 11.0; p = 0.0002) and initial Glasgow Coma Scale (GCS) (NNG, 12.7 ± 3.5 vs NPG, 10.9 ± 4.2; p = 0.006). Patients with an ISS > 15 and who were intubated were associated with an increased odds of having a positive repeat CT scan (odds ratio [OR] 2.6; 95%CI 1.2, 5.5 and OR 3.5; 95% CI, 1.7, 7.3, respectively). Patients with a high ISS score and/or those who are intubated have significantly higher odds of having a positive repeat head CT when repeated for follow-up or when clinically warranted.

193 Prevalence of Hypoxemia and Oxygen Use in Trauma Patients Prior to Hospital Arrival

193 Prevalence of Hypoxemia and Oxygen Use in Trauma Patients Prior to Hospital Arrival

Cost Analysis of Vertical Deceleration Injury in the Acute Setting.

Vertical deceleration injury is a known but not well understood form of blunt injury in both the urban and rural environment. The purpose of this study was to investigate the financial cost of treatment for this specific mechanism of injury in the acute care setting, and to continue to expand a fall prevention program from our unit. This is a prospective review of vertical deceleration injuries admitted over a 2-year period to a Level I trauma center. Patients were followed until discharge to either home or rehabilitation facilities. Ninety-nine patients who sustained a vertical deceleration injury from a height of ≥ 6 ft were identified from our Trauma Registry database. The length of hospital stay, including rehabilitation, ranged from 1 to 78 days (mean, 13.1 days). The mean injury severity score (ISS) was 16.4 (range, 4-75). The average height of fall was 19.5 ft (range, 6-110 ft) with a mean impact velocity of 23 mph (range, 13-58). The cost of hospitalization was significantly correlated to the ISS score (correlation = 0.558, p < 0.001); and as expected, higher ISS scores yielded higher costs (χ(2) = 34.7, p < 0.001). We found that the best predictor variable for the cost of treatment for vertical deceleration injury is the ISS score with a regression equation of: Cost = $19,578 + ($6,609 × ISS). The average cost per fall incident was $91,435 (range $5,006-$948,957) for vertical deceleration injuries. The cost of treatment of vertical deceleration injuries is very high. Hospital stays are prolonged and rehabilitation needs frequent. Overall, ISS is the best predictor of cost of treatment and length of hospital stay.