Assessment Of Injury Severity Research Articles

Systematic assessment of early brain injury severity at admission with aneurysmal subarachnoid hemorrhage

Early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (aSAH) has been increasingly recognized as a risk factor for delayed cerebral ischemia (DCI). While several clinical and radiological EBI biomarkers have been identified, no tool for systematic assessment of EBI severity has been established so far. This study aimed to develop an EBI grading system based on clinical signs and neuroimaging for estimation of EBI severity at admission. This is a retrospective observational study assessing imaging parameters (intracranial blood amount, global cerebral edema (GCE)), and clinical signs (persistent loss of consciousness [LOC]) representative for EBI. The intracranial blood amount was semi-quantitatively assessed. One point was added for GCE and LOC, respectively. All points were summed up resulting in an EBI grading ranging from 1 to 5. The estimated EBI severity was correlated with progressive GCE requiring decompressive hemicraniectomy (DHC), DCI-associated infarction, and outcome according to the modified Rankin scale (mRS) at 3-month-follow up. A consecutive cohort including 324 aSAH-patients with a mean age of 55.9 years, was analyzed. The probability of developing progressive GCE was 9% for EBI grade 1, 28% for EBI grade 2, 43% for EBI grade 3, 61% for EBI grade 4, and 89% for EBI grade 5. The EBI grading correlated significantly with the need for DHC (r = 0.25, p < 0.0001), delayed infarction (r = 0.30, p < 0.0001), and outcome (r = 0.31, p < 0.0001). An EBI grading based on clinical and imaging parameters allowed an early systematic estimation of EBI severity with a higher EBI grade associated not only with a progressive GCE but also with DCI and poor outcome.

Gunshot Wounds to the Head: 29 Cases of Monocenter Children's Trauma Hospital Experience and Predictor Scales in Pediatric Population

Gunshot wounds to the head (GSWTH) in children remain an underexplored area, and all clinical guidelines extrapolated from adult experiences. A key challenge in treating these patients is age stratification, as pediatric survival rates are notably higher than in adults. The objective of the study is to compare 2 groups of patients based on the severity of their condition and to analyze the impact of various factors on the outcomes of these conditions. A single-center retrospective cohort study was conducted. Patient records of individuals (from birth to 18years old) with craniocerebral injuries caused by GSWTH and treated at Morozov Children's City Hospital between 1992 and 2015 were comprehensively reviewed. Data analysis included clinical presentation, computed tomography scan findings, injury site and trajectory, Glasgow Coma Scale and Glasgow Outcome Scale scores, and the St. Louis Scale. A total of 29 pediatric patients (79% male, 21% female, median age 8years) with GSWTH were analyzed. The mortality rate was 17%. A transventricular wound trajectory was found in 17% of patients and was associated with a poor prognosis (P < 0.001). The Glasgow Coma Scale showed insufficient specificity in injury severity assessment. A multiple logistic regression model predicting injury severity based on bullet type, gender, and time to admission had an accuracy of 80%, while a Decision Tree model improved accuracy to 96.6%. A stacking model combining multiple logistic regression and Decision Tree increased sensitivity to 87.5% and explained 65.5% of the variance. The findings emphasize the importance of a multifactorial approach in children with GSWTH, highlighting its effectiveness for precise outcome prediction.

Association of early blood-based biomarkers and six-month functional outcomes in conventional severity categories of traumatic brain injury: capturing the continuous spectrum of injury

Traumatic brain injury is conventionally categorised as mild, moderate, or severe on the Glasgow Coma Scale (GCS). Recently developed biomarkers can provide more objective and nuanced measures of the extent of brain injury. Exposure-response relationships were investigated in 2479 patients aged ≥16 enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study. Neurofilament protein-light (NFL), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and glial fibrillary acidic protein (GFAP) were assayed from serum sampled in the first 24h; concentrations were divided into quintiles within GCS severity groups. Relationships with the Glasgow Outcome Scale-Extended were examined using modified Poisson regression including age, sex, major extracranial injury, time to sample, and log biomarker concentration as covariates. Within severity groups there were associations between biomarkers and outcomes after adjustment for covariates: GCS 13-15 and negative CT imaging (relative risks [RRs] from 1.28 to 3.72), GCS 13-15 and positive CT (1.21-2.81), GCS 9-12 (1.16-2.02), GCS 3-8 (1.09-1.94). RRs were associated with clinically important differences in expectations of prognosis. In patients with GCS 3 (RRs 1.51-1.80) percentages of unfavourable outcome were 37-51% in the lowest quintiles of biomarker levels and reached 90-94% in the highest quintiles. Similarly, for GCS 15 (RRs 1.83-3.79), the percentages were 2-4% and 19-28% in the lowest and highest biomarker quintiles, respectively. Conventional TBI severity classification is inadequate and underestimates heterogeneity of brain injury and associated outcomes. The adoption of circulating biomarkers can add to clinical assessment of injury severity. European Union 7th Framework program (EC grant 602150), Hannelore Kohl Stiftung, One Mind, Integra LifeSciences, Neuro-Trauma Sciences, NIHR Rosetrees Trust.

Blood glucose and β-hydroxybutyrate predict significant brain injury after hypoxia-ischemia in neonatal mice.

The Vannucci procedure is widely used to model cerebral hypoxic-ischemic (HI) injury in neonatal rodents. Identifying minimally invasive biomarkers linked to brain injury would improve stratification of pups to experimental treatments. We hypothesized that extreme blood glucose (BG) and β-hydroxybutyrate (bHB) levels immediately after HI will correlate with severity of brain injury in this model. C57BL6 mice of both sexes underwent the Vannucci procedure with BG and bHB measured immediately after hypoxia. GFAP and α-fodrin were measured to assess injury severity at 4h, P11, P18 and P40. Open field (OF), Y-maze (YM), and Object-location task (OLT) were tested at P40. Clinical seizures-like stereotypies during hypoxia were associated with lower post-hypoxia BG in HI-injured mice. Low BG after HI was related to higher GFAP expression, higher α-fodrin breakdown, lower residual regional volume, and worse working memory. BG was superior to bHB in ROC analysis with BG threshold of <111 mg/dL providing 100% specificity with 72% sensitivityfor hippocampal HI-injury. Post-hypoxic BG is a minimally invasive screening tool to identify pups with significant HI brain injury in the Vannucci model modified for mice improving our ability to stratify pups to experimental treatments to assess effectiveness. End hypoxic-ischemic blood glucose levels are a reliable and inexpensive biomarker to detect hypoxic-ischemic brain injury in mice. Screening with blood glucose levels post-hypoxia allows appropriate stratification of those mouse pups most likely to be injured to experimental treatments improving validity and translatability of the results. These findings provide biological plausibility to the clinical observation that extreme blood glucose levels relate to worse outcomes after hypoxia-ischemia.

Relationship Between Brain CT Scan Findings, Consciousness Levels, and Outcomes in Brain Trauma Patients: A Cross-Sectional Study

Background: Trauma is the fourth leading cause of mortality worldwide. The Glasgow Coma Scale (GCS) is a crucial tool for evaluating the consciousness levels of trauma patients, serving as a diagnostic instrument for assessing injury severity and the condition of brain trauma patients. Additionally, Computed Tomography (CT) Scans are the most practical and accurate imaging modality for diagnosing the types and locations of lesions in cases of brain trauma in the emergency department. The study was designed to explore the correlation between pathological findings in Brain CT scans and the consciousness levels of brain trauma patients, as assessed by the GCS. Methods: This cross-sectional descriptive-analytical study investigated 200 brain trauma patients admitted to the emergency department of Khatam Al-Anbia Hospital in Zahedan. Upon arrival, an emergency medicine specialist recorded the patients’ consciousness levels based on the GCS criteria. After performing a CT scan and determining the type and location of the lesion, a radiologist, emergency medicine, and neurosurgery specialists determined the continuation of the treatment process. Subsequently, patients requiring admission to the neurosurgery department or intensive care unit were monitored. The final patient status (deceased/survivor) was tracked at the end of the treatment period and added to the checklist. Following data coding and entry into the computer, descriptive statistics, including mean, standard deviation, and confidence intervals, were used for evaluation. Additionally, the Chi-square and independent t-tests, along with SPSS 22, were employed to examine the relationship between consciousness levels and CT scan results. Results: Three out of 200 patients were excluded from the study due to transfers to other medical facilities during treatment. The mean age of the remaining patients was 27.94 ± 11.25. Results showed that 67.5% of all patients survived, while 32.4% succumbed to injuries. The initial GCS score was 14-15 for 83 patients (42.1%), 9-13 for 69 patients (35%), and 3-8 for 45 patients (22.8%). Brain CT scans of trauma patients predominantly revealed subdural hematomas in 48 patients (24.3%). In the examination of the relationship between the mechanism of brain trauma and mortality, 75% of patients involved in falls and 65.5% in accidents survived, while all patients who experienced other causes of trauma survived. Ultimately, no significant difference was observed between the mechanism of brain trauma and patient mortality (p=0.318). Furthermore, all patients with a GCS score of 14-15 (100%), 85.6% with a GCS score of 9-13, and 35.5% with a GCS score of 3-8 survived. A significant relationship between initial consciousness levels and mortality rates in the emergency department was evident (p=0.001). Statistical analysis indicated that 66.7% of patients with subdural hematomas, 75% with epidural hematomas, 81% with cerebral contusions, 35.3% with intracerebral hemorrhages (ICH), and 92.3% with diffuse axonal injuries (DAI) ultimately survived, signifying a significant relationship between CT scan results and mortality rates (p=0.01). Moreover, the highest mortality rate was observed in patients with ICH, with a frequency of 64.7%. Conclusions: Simultaneously evaluating consciousness levels using the GCS, along with considering the type of pathology identified in CT scans of brain trauma patients admitted to the emergency department, significantly aids in determining patient mortality rates. Promptly initiating the patient’s treatment process can lead to reduced complications from brain trauma and, in some cases, decreased mortality.

Injury severity bias in missing prehospital vital signs: Prevalence and implications for trauma registries

BackgroundVital signs are important factors in assessing injury severity and guiding trauma resuscitation, especially among severely injured patients. Despite this, physiological data are frequently missing from trauma registries. This study aimed to evaluate the extent of missing prehospital data in a hospital-based trauma registry and to assess the associations between prehospital physiological data completeness and indicators of injury severity. MethodsA retrospective review was conducted on all adult trauma patients brought directly to a level 1 trauma center in Toronto, Ontario by paramedics from January 1, 2015, to December 31, 2019. The proportion of missing data was evaluated for each variable and patterns of missingness were assessed. To investigate the associations between prehospital data completeness and injury severity factors, descriptive and unadjusted logistic regression analyses were performed. ResultsA total of 3,528 patients were included. We considered prehospital data missing if any of heart rate, systolic blood pressure, respiratory rate or oxygen saturation were incomplete. Each individual variable was missing from the registry in approximately 20 % of patients, with oxygen saturation missing most frequently (n = 831; 23.6 %). Over 25 % (n = 909) of patients were missing at least one prehospital vital sign, of which 69.1 % (n = 628) were missing all four of these variables. Patients with incomplete data were more severely injured, had higher mortality, and more frequently received lifesaving interventions such as blood transfusion and intubation. Patients were most likely to have missing prehospital physiological data if they died in the trauma bay (unadjusted OR: 9.79; 95 % CI: 6.35–15.10), did not survive to discharge (unadjusted OR: 3.55; 95 % CI: 2.76–4.55), or had a prehospital GCS less than 9 (OR: 3.24; 95 % CI: 2.59–4.06). ConclusionIn this single center trauma registry, key prehospital variables were frequently missing, particularly among more severely injured patients. Patients with missing data had higher mortality, more severe injury characteristics and received more life-saving interventions in the trauma bay, suggesting an injury severity bias in prehospital vital sign missingness. To ensure the validity of research based on trauma registry data, patterns of missingness must be carefully considered to ensure missing data is appropriately addressed.

Pathophysiological changes and injury markers for acute lung injury from blunt impact in infant rabbits.

Traffic accidents, particularly blunt impacts, cause serious injuries in children. We aimed to assess inflammatory and injury responses in infant rabbits subjected to acute lung injury resulting from blunt impact, with the goal of identifying potential circulatory injury markers. Forty 4-week-old infant rabbits were subjected to a right chest impact using a Hopkinson bar with 2,600 g. Computed tomography was employed to assess injury severity. Pathological changes were observed using hematoxylin and eosin staining in the control, 0, 24, and 72 h groups, post-injury. Immunohistochemistry was used to examine surfactant protein A (SP-A) changes in right lung tissues and upper main bronchi. Serum levels of interleukin-6 (IL-6), IL-8, and SP-A were measured using ELISA within 24 h post-injury in the control, 0 h, and 24 h groups. Following blunt injury, significant increases were observed in blood white blood cell count (F = 101.556, P < 0.01) and neutrophil percentage (F = 104.228, P < 0.01), which gradually decreased after 24 and 72 h. The lung wet/dry weight ratio indicated significant edema (F = 79.677, P < 0.01), corroborated by hematoxylin and eosin staining showing edema, exudation, and marked granulocyte infiltration in the control, 0 h, 24 h and 72 h groups. SP-A levels decreased rapidly at 0 h, and recovered between 24 and 72 h in the right lung tissues (F = 6.7, P < 0.05), left lung (F = 15.825, P < 0.05) and upper main bronchi (F = 59.552, P < 0.01). The ELISA results showed increasing trends for the control and 0 h groups, while decreasing trends were observed in 24 h group for IL-6 (F = 58.328, P < 0.01) and IL-8 (F = 41.802, P < 0.01). Conversely, SP-A exhibited a decreasing trend in the control and 0 h groups but increased in the serum of 24 h group (F = 52.629, P < 0.01). In cases of direct chest trauma in infant rabbits, particularly mild injuries without rib fractures. SP-A levels correlated with pathological changes across all groups and may serve as biomarkers for pediatric blunt lung impact.

Settlement Is at the End-Common Trauma Scores Require a Critical Reassessment Due to the Possible Dynamics of Traumatic Brain Injuries in Patients' Clinical Course.

Background: Scientific studies on severely injured patients commonly utilize the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) for injury assessment and to characterize trauma cohorts. However, due to potential deterioration (e.g., in the case of an increasing hemorrhage) during the clinical course, the assessment of injury severity in traumatic brain injury (TBI) can be challenging. Therefore, the aim of this study was to investigate whether and to what extent the worsening of TBI affects the AIS and ISS. Methods: We retrospectively evaluated 80 polytrauma patients admitted to the trauma room of our level I trauma center with computed-tomography-confirmed TBI. The initial AIS, ISS, and Trauma and Injury Severity Score (TRISS) values were reevaluated after follow-up imaging. Results: A total of 37.5% of the patients showed a significant increase in AIShead (3.7 vs. 4.1; p = 0.002) and the ISS (22.9 vs. 26.7, p = 0.0497). These changes resulted in an eight percent reduction in their TRISS-predicted survival probability (74.82% vs. 66.25%, p = 0.1835). Conclusions: The dynamic nature of intracranial hemorrhage complicates accurate injury severity assessment using the AIS and ISS, necessitating consideration in clinical studies and registries to prevent systematic bias in patient selection and subsequent data analysis.

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.

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.

A Four-Country Study of Strangulation-Related Alterations in Consciousness in Women Who Have Experienced Intimate Partner Violence: Co-Occurrence with Traumatic Brain Injuries and Measures of Psychological Distress.

At least one in three women experience intimate partner violence (IPV) in their lifetime. The most commonly sustained IPV-related brain injuries include strangulation-related alterations in consciousness (S-AICs) and traumatic brain injuries (TBIs). Moreover, survivors of IPV-related S-AICs and/or TBIs often demonstrate psychological distress such as depression, anxiety, and post-traumatic stress. However, the co-occurrence of S-AICs and TBIs, and whether such TBIs may be moderate to severe, has not been systematically examined, and most data have been collected from women in North America. The purpose of this study was to examine the co-occurrence of IPV-related S-AICs and TBIs across a range of geographical locations and to determine the extent to which these S-AICs are related to psychological distress. Women who had experienced physical IPV (n = 213) were included in this secondary analysis of retrospectively collected data across four countries (Canada, the United States, Spain, and Colombia). The Brain Injury Severity Assessment (BISA) was used to assess IPV-related BI across all sites. Because various questionnaires were employed to assess levels of depression, anxiety, and post-traumatic stress disorder at each site, we created a standardized composite score by converting raw scores into Z-scores for analysis. Mann-Whitney U tests and chi-square tests were conducted to examine differences between women with and without experience of S-AICs and to discover if there was a relationship between the occurrence of S-AICs and TBIs. Analysis of variance and analysis of covariance (to control for the potential confounding effects of age, education, and non IPV-related TBI) were used to compare levels of psychological distress in women who had or had not experienced S-AICs. Approximately, 67% of women sustained at least one IPV-related BI (i.e., TBI and/or S-AIC). In a subsample of women who sustained at least one IPV-related BI, approximately 37% sustained both S-AICs and TBIs, 2% sustained only S-AICs (with no TBIs), and 61% sustained TBIs exclusively (with no S-AICs). Furthermore, women who had sustained S-AICs (with or without a TBI) were more likely to have experienced a moderate-to-severe BI than those who had not sustained an S-AIC (BISA severity subscale: U = 3939, p = 0.006). In addition, women who experienced S-AICs (with or without a TBI) reported higher levels of psychological distress compared with women who never experienced S-AICs, irrespective of whether they occurred once or multiple times. These data underscore the importance of assessing for S-AIC in women who have experienced IPV and when present, to also assess for TBIs and the presence of psychological distress. Unfortunately, there were methodological differences across sites precluding cross-site comparisons. Nonetheless, data were collected across four culturally and geographically diverse countries and, therefore, highlight IPV-related BIs as a global issue that needs to be aggressively studied with policies established and then implemented to address findings.

Centiles for the shock index among injured children in the prehospital setting

ObjectiveThe shock index (SI), the ratio of heart rate to systolic blood pressure, is a clinical tool for assessing injury severity. Age-adjusted SI models may improve predictive value for injured children in the out-of-hospital setting. We sought to characterize the proportion of children in the prehospital setting with an abnormal SI using established criteria, describe the age-based distribution of SI among injured children, and determine prehospital interventions by SI. MethodsWe performed a multi-agency retrospective cross-sectional study of children (<18 years) in the prehospital setting with a scene encounter for suspected trauma and transported to the hospital between 2018 and 2022 using the National Emergency Medical Services (EMS) Information System datasets. Our exposure of interest was the first calculated SI. We identified the proportion of children with an abnormal SI when using the SI, pediatric age-adjusted (SIPA); and the pediatric SI (PSI) criteria. We developed and internally validated an age-based distributional model for the SI using generalized additive models for location, scale, and shape to describe the age-based distribution of the SI as a centile or Z-score. We evaluated EMS interventions (basic airway interventions, advanced airway interventions, cardiac interventions, vascular access, intravenous fluids, and vasopressor use) in relation to both the SIPA, PSI, and distributional SI values. ResultsWe analyzed 1,007,863 pediatric EMS trauma encounters (55.0% male, median age 13 years [IQR, 8–16 years]). The most common dispatch complaint was for traffic/transport related injury (32.9%). When using the PSI and SIPA, 13.1% and 16.3% were classified as having an abnormal SI, respectively. There were broad differences in the percentage of encounters classified as having an abnormal SI across the age range, varying from 5.1 to 22.8% for SIPA and 3.7–20.1% for PSI. The SIPA values ranged from the 75th to 95th centiles, while the PSI corresponded to an SI greater than the 90th centile, except in older children. The centile distribution for SI declined during early childhood and stabilized during adolescence and demonstrated a difference of <0.1% at cutoff values. An abnormal PSI, SIPA and higher SI centiles (>90th centile and >95th centiles) were associated with interventions related to basic and advanced airway management, cardiac procedures, vascular access, and provision of intravenous fluids occurred with greater frequency at higher SI centiles. Some procedures, including airway management and vascular access, had a smaller peak at lower (<10th) centiles. DiscussionWe describe the empiric distribution of the pediatric SI across the age range, which may overcome limitations of extant criteria in identifying patients with shock in the prehospital setting. Both high and low SI values were associated with important, potentially lifesaving EMS interventions. Future work may allow for more precise identification of children with significant injury using cutpoint analysis paired to outcome-based criteria. These may additionally be combined with other physiologic and mechanistic criteria to assist in triage decisions.

A differentiated approach to comprehensive surgical treatment of combined combat thermomechanical injuries

In recent years, there has been a notable increase in the incidence of thermomechanical injuries, which frequently manifest as a combination of various types of damage. The majority of these injuries require long‑term treatment and result in the development of decompensated (critical) conditions during the early stages, with a substantial death rate ranging from 75% to 80%.&#x0D; Objective — to improve the results of surgery for combined combat thermomechanical injuries by developing and implementing a differentiated surgical approach that incorporates the assessment of injury severity within the context of medical support.&#x0D; Materials and methods. A retrospective‑prospective study was carried out to determine the effectiveness of medical care provided for wounded individuals with combined combat thermomechanical injuries sustained during combat operations between 2017 and 2023. The study included a cohort of 97 wounded individuals, who were subsequently divided into two separate clinical groups. The main group (n=56) underwent treatment according to a differentiated surgical approach that included the assessment of the severity of the patient’s condition using the admission trauma scale (AdTS) and the perfusion index (PI). The control group (n=41) received treatment based on established protocols using conventional treatment approaches for combined combat thermomechanical injuries without considering prioritisation.&#x0D; Results. A differentiated surgical strategy for managing combined combat thermomechanical injuries, which included an objective assessment of injury severity using the AdTS and the perfusion index (PI), allowed for a notable decrease in the occurrence of late purulent‑septic complications as well as a significant reduction in the mortality rate in the main group to 21.4%, compared to 38.8% in the control group (p=0.038). This was related to a decrease in the frequency of fatal outcomes among individuals with serious injuries: 21.2% in the main group, 37.0% in the control group (p=0.013). Furthermore, surgical treatment improved anatomical and functional outcomes in the main group compared to the control group. Group 1 had a higher specific weight of favourable outcomes 52.0±14.2% and a lower specific weight of unsatisfactory outcomes (17.6), [8.7;28.7] %, compared to group 2 20.6±13.4% and 47.3±14.7%. The difference was statistically significant at p=0.001.&#x0D; Conclusions. The implementation of a differentiated surgical approach with an objective assessment of injury severity resulted in a reduction in mortality from 7.3% to 1.8%, specific weight of amputations from 34.2% to 8.9%, and contractures from 26.8% to 10.5% (p&lt;0.05). Early vacuum therapy in the surgical treatment of combined combat thermomechanical injuries reduced treatment time and allowed for early reconstructive and restorative operations, leading to better functional outcomes. The specific weight of favourable outcomes increased from 20.6% to 52.0%, while the relative number of unsatisfactory outcomes decreased from 47.3% to 17.6% (p&lt;0.05).&#x0D; &#x0D;

Neurovascular coupling is altered in women who have a history of brain injury from intimate partner violence: a preliminary study.

Intimate partner violence (IPV) is a global health crisis with 30% of women over the age of 15 experiencing at least one event in their lifetime. Brain injury (BI) due to head impacts and/or strangulation is a common but understudied part of this experience. Previous research has shown BI from other injury mechanisms can disrupt neurovascular coupling (NVC). To gain further insight into whether similar changes occur in this population, we assessed NVC responses in women with a history of IPV-BI. NVC responses were measured for the middle and posterior cerebral arteries (MCA, PCA) using transcranial Doppler ultrasound while participants performed a complex visual search task. The lifetime history of previous exposure to IPV-BI was captured using the Brain Injury Severity Assessment (BISA) along with measures of post-traumatic stress disorder (PTSD), anxiety, depression, substance use, and demographic information. Initial analyses of NVC metrics were completed comparing participants who scored low vs. high on the BISA or did or did not experience non-fatal strangulation followed by a stepwise multiple regression to examine the impact of PTSD, anxiety, and depression on the relationship between the NVC metrics and IPV-BI. Baseline and peak cerebral blood velocity were higher and the percentage increase was lower in the PCA in the low compared to the high BISA group whereas no differences between the groups were apparent in the MCA. In addition, those participants who had been strangled had a lower initial slope and area under the curve in the PCA than those who had not experienced strangulation. Finally, the stepwise multiple regression demonstrated the percentage increase in the PCA was significantly related to the BISA score and both depression and anxiety significantly contributed to different components of the NVC response. This preliminary study demonstrated that a lifetime history of IPV-BI leads to subtle but significant disruptions to NVC responses which are modulated by comorbid depression and anxiety. Future studies should examine cerebrovascular function at the acute and subacute stages after IPV episodes to shed additional light on this experience and its outcomes.

Contextualizing injury severity from occupational accident reports using an optimized deep learning prediction model.

This study introduced a novel approach for predicting occupational injury severity by leveraging deep learning-based text classification techniques to analyze unstructured narratives. Unlike conventional methods that rely on structured data, our approach recognizes the richness of information within injury narrative descriptions with the aim of extracting valuable insights for improved occupational injury severity assessment. Natural language processing (NLP) techniques were harnessed to preprocess the occupational injury narratives obtained from the US Occupational Safety and Health Administration (OSHA) from January 2015 to June 2023. The methodology involved meticulous preprocessing of textual narratives to standardize text and eliminate noise, followed by the innovative integration of Term Frequency-Inverse Document Frequency (TF-IDF) and Global Vector (GloVe) word embeddings for effective text representation. The proposed predictive model adopts a novel Bidirectional Long Short-Term Memory (Bi-LSTM) architecture and is further refined through model optimization, including random search hyperparameters and in-depth feature importance analysis. The optimized Bi-LSTM model has been compared and validated against other machine learning classifiers which are naïve Bayes, support vector machine, random forest, decision trees, and K-nearest neighbor. The proposed optimized Bi-LSTM models' superior predictability, boasted an accuracy of 0.95 for hospitalization and 0.98 for amputation cases with faster model processing times. Interestingly, the feature importance analysis revealed predictive keywords related to the causal factors of occupational injuries thereby providing valuable insights to enhance model interpretability. Our proposed optimized Bi-LSTM model offers safety and health practitioners an effective tool to empower workplace safety proactive measures, thereby contributing to business productivity and sustainability. This study lays the foundation for further exploration of predictive analytics in the occupational safety and health domain.

Surgical tactics for chest trauma accombined by flail chest

Thoracic trauma, often characterised as closed, comprises 23% to 56.9% of polytrauma cases.According to our research, flail chest in thoracic trauma occurs in approximately 7.9—8.9% of cases. The primary factors contributing to this instability are car accidents or falls from a height. Objective — to enhance the outcomes of surgical treatment for patients with flail chest by applying novel techniques for assessing the severity of injuries and implementing improved surgical tactics. Materials and methods. The study included a total sample of 123 patients who had flail chest. The participants were divided into 2 groups: the control group (n=56) and the comparison group (n=67). The ATS scale was used to assess the severity of the condition in the groups. The injury severity score was determined using a point‑based system and categorised as minor, severe, or extremely severe. The control group was additionally evaluated using the AdTS scale, while the perfusion index was measured. Results. The injury severity score determined using the AdTS scale and the perfusion index formed the basis of an algorithm for differential diagnosis that influenced the indication area and scope of diagnostic procedures. The choice of surgical tactics was based on the results of an additional examination and the injury severity score. For a minor injury, the full range of medical procedures was carried out. For a severe injury, a shortened list of procedures was prescribed. In the case of an extremely severe injury, care was provided using the principles of DCS technology. The chest stabilisation procedure was conducted using the suggested approach for assessing the severity of the injury: less traumatic operations were performed for severe injuries, while full‑scale operations were carried out for minor injuries. The selection of the method for stabilising floating segments was based on the established classification of chest instability. The stabilisation of flail chest was carried out either during the first or third phase of the DCS technology or after the patient had been brought out of a state of shock, in accordance with delayed indications. Conclusions. The application of the AdTS anatomical and functional scale and the determination of the perfusion index allowed for a rapid and objective evaluation of the injury severity score (minor, severe, and extremely severe). Additionally, these tools helped in identifying the appropriate diagnostic procedures and deciding on the method for stabilising the flail chest. The differential diagnostic programme implemented in the control group made it possible to reduce the examination time for patients with an extremely severe injury by 9.8±1.1 minutes. Implementing the proposed injury severity assessment and stabilisation tactics decreased the number of late purulent‑septic complications by 19.8% and mortality by 17.4% (from 38.8% to 21.4%).

The new injury severity score underestimates true injury severity in a resource-constrained setting

BackgroundThe new injury severity score (NISS) is widely used within trauma outcomes research. NISS is a composite anatomic severity score derived from the Abbreviated Injury Scale (AIS) protocol. It has been postulated that NISS underestimates trauma severity in resource-constrained settings, which may contribute to erroneous research conclusions. We formally compare NISS to an expert panel's assessment of injury severity in South Africa. MethodsThis was a retrospective chart review of adult trauma patients seen in a tertiary trauma center. Randomly selected medical records were reviewed by an AIS-certified rater who assigned an AIS severity score for each anatomic injury. A panel of five South African trauma experts independently reviewed the same charts and assigned consensus severity scores using a similar scale for comparability. NISS was calculated as the sum of the squares of the three highest assigned severity scores per patient. The difference in average NISS between rater and expert panel was assessed using a multivariable linear mixed effects regression adjusted for patient demographics, injury mechanism and type. ResultsOf 49 patients with 190 anatomic injuries, the majority were male (n = 38), the average age was 36 (range 18–80), with either a penetrating (n = 23) or blunt (n = 26) injury, resulting in 4 deaths. Mean NISS was 16 (SD 15) for the AIS rater compared to 28 (SD 20) for the expert panel. Adjusted for potential confounders, AIS rater NISS was on average 11 points (95 % CI: 7, 15) lower than the expert panel NISS (p < 0.001). Injury type was an effect modifier, with the difference between the AIS rater and expert panel being greater in penetrating versus blunt injury (16 vs. 7; p = 0.04). Crush injury was not well-captured by AIS protocol. ConclusionNISS may under-estimate the ‘true’ injury severity in a middle-income country trauma hospital, particularly for patients with penetrating injury.

Fibroblast Activation Protein–Targeted PET/CT With Al18F-NODA-FAPI-04 for In Vivo Imaging of Tendon Healing in Rat Achilles Tendon Injury Models

Background: Fibroblast activation protein (FAP) has shown high expression in inflammatory responses and fibrosis. Hypothesis: We speculated that FAP could serve as a diagnostic and monitoring target in the tendon healing process. Study Design: Controlled laboratory study. Methods: A total of 72 Sprague-Dawley rats were randomly divided into a tendon crush group and a half-partial tendon laceration group. Four rats in each group were injected with radiotracers weekly for 4 weeks after surgery, with aluminum fluoride–labeled 1,4,7-triazacyclononane-N,N′,N″-triacetic acid–conjugated FAP inhibitor (Al18F-NODA-FAPI-04) administered on the first day of each week and 18F-fludeoxyglucose (18F-FDG) on the next day. Small animal positron emission tomography (PET) imaging was performed, and tendon tissue was collected for pathology and quantitative reverse transcription polymerase chain reaction (qRT-PCR) analysis each week after surgery. Results: One week after surgery, both radiotracers showed signal concentration at the lesion site, which was the highest radioactive uptake observed during 4 weeks postoperatively, consistent with the severity of the lesion. Consistent trends were observed for inflammatory cytokines during qRT-PCR analysis. Additionally, Al18F-NODA-FAPI-04 PET exhibited a more precise lesion pattern, attributed to its high specificity for naive fibroblasts when referring to histological findings. Over time, the uptake of both radiotracers at the injury site gradually decreased, with 18F-FDG experiencing a more rapid decrease than Al18F-NODA-FAPI-04. In the fourth week after surgery, the maximum standardized uptake values of Al18F-NODA-FAPI-04 in the injured lesion almost reverted to the baseline levels, indicating a substantial decrease in naive fibroblasts and inflammatory cells and a reduction in inflammation and fibrosis, especially compared with the first week. Corresponding trends were also revealed in pathological and qRT-PCR results. Conclusion: Our findings suggest that inflammation is a prominent feature during the early stage of tendon injury. Al18F-NODA-FAPI-04 PET allows accurate localization and provides detailed morphological imaging, enabling continuous monitoring of the healing progress and assessment of injury severity.

On Scene Injury Severity Prediction (OSISP) model for trauma developed using the Swedish Trauma Registry

BackgroundProviding optimal care for trauma, the leading cause of death for young adults, remains a challenge e.g., due to field triage limitations in assessing a patient’s condition and deciding on transport destination. Data-driven On Scene Injury Severity Prediction (OSISP) models for motor vehicle crashes have shown potential for providing real-time decision support. The objective of this study is therefore to evaluate if an Artificial Intelligence (AI) based clinical decision support system can identify severely injured trauma patients in the prehospital setting.MethodsThe Swedish Trauma Registry was used to train and validate five models – Logistic Regression, Random Forest, XGBoost, Support Vector Machine and Artificial Neural Network – in a stratified 10-fold cross validation setting and hold-out analysis. The models performed binary classification of the New Injury Severity Score and were evaluated using accuracy metrics, area under the receiver operating characteristic curve (AUC) and Precision-Recall curve (AUCPR), and under- and overtriage rates.ResultsThere were 75,602 registrations between 2013–2020 and 47,357 (62.6%) remained after eligibility criteria were applied. Models were based on 21 predictors, including injury location. From the clinical outcome, about 40% of patients were undertriaged and 46% were overtriaged. Models demonstrated potential for improved triaging and yielded AUC between 0.80–0.89 and AUCPR between 0.43–0.62.ConclusionsAI based OSISP models have potential to provide support during assessment of injury severity. The findings may be used for developing tools to complement field triage protocols, with potential to improve prehospital trauma care and thereby reduce morbidity and mortality for a large patient population.

Cardiac magnetic resonance imaging in patients with history of COVID-19

BACKGROUND: Myocarditis is among the most common complications arising from coronavirus infection (COVID-19).&#x0D; AIM: This study aims to find the differences in the patterns of myocardial injury between patients who had COVID-19 and those from the pre-pandemic period, as determined by contrast-enhanced cardiac magnetic resonance imaging.&#x0D; MATERIALS AND METHODS: The study encompassed a retrospective analysis of 47 patients who underwent contrast-enhanced cardiac magnetic resonance imaging to rule out acute myocarditis. Group 1 comprised 34 patients with a confirmed history of COVID-19 through PCR testing (nasal and/or throat swabs), while Group 2 comprised 13 individuals who underwent contrast-enhanced cardiac magnetic resonance imaging in 2017 prior to the onset of the COVID-19 pandemic. All patients enrolled in the study had clinical manifestation of cardiac injury without signs of coronary artery disease as an underlying cause of condition.&#x0D; RESULTS: The mean time from the onset of heart symptoms to the administration of contrast-enhanced cardiac magnetic resonance imaging was 166 days. In group 1, a decrease in exercise tolerance was observed in 77% of patients, and 14 (42%), 30 (88%), and 28 (85%) of patients complained of chest pain, shortness of breath, and heart palpitations, respectively. In group 2, four patients (30%) had dyspnea, nine patients (69%) complained of chest pain, and six patients (46%) had heart palpitations and/or feeling of arrhythmia. Myocardial injury in group 1 was more generalized. The third of them had displayed preserved increased pulmonary vascularity and pleural effusion. Within group 1, men had significantly lower left ventricular ejection fraction, lower values of global longitudinal deformation, and higher values of left atrial function compared with the corresponding parameters in women. Differences in women were found only in the number of the affected segments in the left ventricular myocardium.&#x0D; CONCLUSION: SARS-CoV-2 virus caused extended myocardial injury, affecting a significant number of myocardial segments. Men had more frequent postinflammatory complications, characterized by abnormal function of the left ventricle and left atrium. Obtained results require continuous efforts for further assessment of long-term consequences of previous COVID-19 to the cardiovascular system. In this regard, contrast-enhanced cardiac magnetic resonance imaging may represent a sensitive imaging tool for the assessment of cardiac injury severity.

Relationship between systolic blood pressure and mortality in older vs younger trauma patients – a retrospective multicentre observational study

BackgroundThe population of older trauma patients is increasing. Those patients have heterogeneous presentations and need senior-friendly triaging tools. Systolic blood pressure (SBP) is commonly used to assess injury severity, and some authors advocated adjusting SBP threshold for older patients. We aimed to describe and compare the relationship between mortality and SBP in older trauma patients and their younger counterparts.MethodsWe included patients admitted to three level-I trauma centres and performed logistic regressions with age and SBP to obtain mortality curves. Multivariable Logistic regressions were performed to measure the association between age and mortality at different SBP ranges. Subgroup analyses were conducted for major trauma and severe traumatic brain injury admissions.ResultsA total of 47,661 patients were included, among which 12.9% were aged 65–74 years and 27.3% were ≥ 75 years. Overall mortality rates were 3.9%, 8.1%, and 11.7% in the groups aged 16–64, 65–74, and ≥ 75 years, respectively. The relationship between prehospital SBP and mortality was nonlinear (U-shape), mortality increased with each 10 mmHg SBP decrement from 130 to 50 mmHg and each 10-mmHg increment from 150 to 220 mmHg across all age groups. Older patients were at higher odd for mortality in all ranges of SBP. The highest OR in patients aged 65–74 years was 3.67 [95% CI: 2.08–6.45] in the 90–99 mmHg SBP range and 7.92 [95% CI: 5.13–12.23] for those aged ≥ 75 years in the 100–109 mmHg SBP range.ConclusionThe relationship between SBP and mortality is nonlinear, regardless of trauma severity and age. Older age was associated with a higher odd of mortality at all SBP points. Future triage tools should therefore consider SBP as a continuous rather than a dichotomized predictor.