Major Trauma Outcome Research Articles

The influence of socioeconomic status on management and outcomes in major trauma: A systematic review and meta-analysis.

Major trauma is a leading cause of death and disability in younger individuals and poses a significant public health concern. There is a growing interest in understanding the complex relationships between socioeconomic deprivation and major trauma. Anecdotal evidence suggests that deprivation is associated with more violent and debilitating injuries. There remains a paucity in literature evaluating major trauma outcomes in relation to socioeconomic deprivation. A comprehensive search of MEDLINE, Embase, and CENTRAL databases was performed to identify studies from 1947 to March 2024. The primary outcome was to establish the distribution of injuries based on deprivation, with secondary outcomes evaluating surgical intervention rates, length of stay, and mortality. Quantitative pooling of data was based on the random-effects model. Fourteen studies and 878,872 trauma patients were included. A substantial proportion (28%) of trauma incidents occurred in the most deprived group. Patients from the lowest socioeconomic group were considerably younger (weighted mean difference [WMD] -9.85years and 95% confidence intervals [CI] -9.99 to -9.70) and more likely to be male (odds ratio [OR] 1.36 and 95% CI 1.14-1.63). There were no differences in surgical intervention (OR 1.74 and 95% CI 0.97-3.13), length of stay (WMD 1.15days and 95% CI -0.32-2.62), and mortality (OR 1.04 and 95% CI 0.95-1.14) regardless of background. Major trauma is prevalent in deprived areas and in younger individuals, with an increasing trend of deprivation in male patients. Although the rates of surgery, length of stay, and mortality did not differ between groups, planning of public health interventions should target areas of higher deprivation.

ThP7.1 - The effect of socioeconomic status on outcomes in major trauma: a systematic review and meta-analysis

Abstract Background Major trauma poses a significant public health concern, with survivors often suffering long-term disability. There is growing interest in understanding the complex relationships between socioeconomic deprivation and major trauma in recent years. Anecdotal evidence suggests that social deprivation leads to more violent and debilitating injuries. There remains, however, a paucity in literature evaluating major trauma outcomes in relation to socioeconomic deprivation. Methods A comprehensive search of MEDLINE, EMBASE, and Cochrane databases was performed to identify eligible studies from 1947 to March 2024. The primary outcome is to establish the proportion of patients with the highest socioeconomic deprivation, with secondary outcomes evaluating surgical intervention rates, length of stay, and mortality. Quantitative pooling of data was based on the random effects model. Results Fourteen studies reporting on 878,872 major trauma patients were included. A substantial proportion of major trauma incidents occurred in the most deprived group at 28%. There were more male patients in the most deprived compared to the least deprived group (OR 1.36, 95% CI 1.14-1.63, I2=99%). There were no differences in surgical intervention (OR 1.74, 95% CI 0.97-3.13, I2=0%) and length of stay (WMD 1.15 days, 95% CI -0.32-2.62, I2=82%) regardless of background. Interestingly, mortality was higher in the most deprived group (OR 2.02, 95% CI 1.14-3.57, I2=80%). Conclusion Major trauma is more prevalent in deprived areas. Although rates of surgery and length of stay did not differ, mortality is higher in the most deprived group. The planning of public health interventions should target areas of higher deprivation.

EGS P06 Pattern of oesophago-gastric injuries and its outcome in major trauma and tertiary UGI centre

Abstract Background Oesophago-gastric injuries in major trauma are relatively rare. These injuries are known to be associated with high morbidity and mortality. Major trauma involving oesophagus and stomach are linked with high velocity, high impact blunt or penetrating force. There is also a strong association between oesophago-gastric injuries and other systemic injuries including thoracic, major vessels, skull, brain and abdominal viscerae. In this study we aimed to evaluate the pattern of injury in oesophageal and gastric major trauma its association with widely used injury severity score (ISS), multi organ system involvement, survival and factors affecting mortality. Methods Patients presenting between January 2012 and December 2022 as major trauma as moderate / severe trauma (ISS > 9) with oesophageal and gastric injuries were included in this study. Retrospective analysis was carried out on prospectively maintained trauma data base in an urban major trauma centre with specialist tertiary upper GI cover. Mechanism of injury, ISS and mortality were calculated. Analysis was carried out on variables to identify factors contributing to overall index admission mortality. MedCalc ® was used to perform statistical analysis. Results A total of 8984 patients presented in urban major trauma centre with moderate to severe trauma (ISS >9). Among them 13 had gastric injuries and 3 had oesophageal injuries (total n=16). Mechanism of injury in gastric patients was blunt force in 8 (61.5%) and penetrating force was in 5 (38.5%) patients whereas all oesophageal injuries were linked with penetrating trauma. Median ISS in gastric injuries was 17 and in oesophageal injuries was 34. Overall mortality was 31.2%(n=5). Variables including high ISS, thoracic injury, diaphragmatic rupture, skull injuries & blood transfusion were linked with mortality on multivariate logistic regression. Conclusions Our study finds an association of oesophago-gastric injuries with high impact penetrating and blunt trauma. Presence of oesophageal and gastric injuries are surrogate indicators of severity of trauma, it is not only associated with high ISS but also has relatively high mortality. Therefore, early involvement of specialist senior decision maker in time critical setting is recommended. Due to scarce volume of OG trauma, national UGI trauma collaborative can be helpful to share experience, learn lessons and promote research.

Does frailty status predict outcome in major trauma in older people? A systematic review and meta-analysis.

The incidence of major trauma in older people is increasing. Frailty is likely to be a factor that influences the outcomes of trauma. We conducted a systematic review aiming to investigate whether frailty affects major trauma outcomes in older people and whether it is more predictive than age. Observational studies investigating frailty, major trauma severity and outcomes were eligible. We searched electronic databases (Ovid MEDLINE, PubMed, Ovid EMBASE and CINAHL) from 2010 to 01 January 2023. We used Joanna Briggs Institute software to assess the risk of bias and conduct meta-analyses of the relationships between frailty status and outcomes. We used a narrative synthesis to compare the predictive value of frailty and age. Twelve studies were eligible for meta-analyses. In-hospital mortality (odds ratio (OR) = 1.12, 95% confidence interval (CI) 1.05, 1.19), length of stay (OR = 2.04, 95% CI 1.51, 2.56), discharge to home (OR = 0.58, 95% CI 0.53, 0.63) and in-hospital complications (OR = 1.17, 95% CI 1.10, 1.24) were all associated with frailty. Frailty was found to be a more consistent predictor of adverse outcomes and mortality in older trauma patients than injury severity and age in six studies that reported multivariate regression analysis. Older trauma patients with frailty have higher in-hospital mortality rates, prolonged hospital stays, in-hospital complications and adverse discharge disposition. Frailty is a better predictor of adverse outcomes than age in these patients. Frailty status is likely to be a useful prognostic variable in guiding patient management and stratifying clinical benchmarks and research trials.

Does Antithrombotic Therapy Affect Outcomes in Major Trauma Patients? A Retrospective Cohort Study from a Tertiary Trauma Centre.

Antithrombotic therapy may affect outcomes in major trauma but its role is not fully understood. We aimed to investigate adverse outcomes among those with and without antithrombotic treatment in major trauma. Material and methods: This is a retrospective study conducted at the Emergency Department (ED) of the University Hospital of Genoa, a tertiary trauma center, including all major trauma between January 2019 and December 2020. Adverse outcomes were reviewed among those without antithrombotic treatment (Group 0), on antiplatelet treatment (Group 1), and on anticoagulant treatment (Group 2). Results: We reviewed 349 electronic charts for full analysis. Group 0 were n = 310 (88.8%), Group 1 were n = 26 (7.4%), and Group 2 were n = 13 (3.7%). In-hospital death and ICU admission, respectively, were: n = 16 (5.6%) and n = 81 (26%) in Group 0, none and n = 6 (25%) in Group 1, and n = 2 (15.8%) and n = 4 (30.8%) in Group 2 (p = 0.123-p = 0.874). Altered INR (OR 5.2) and increasing D-dimer levels (AUC: 0.81) correlated to increased mortality. Discussion: Group 2 showed higher mortality than Group 0 and Group 1, however Group 2 had fewer active treatments. Of clotting factors, only altered INR and elevated D-dimer levels were significantly correlated to adverse outcomes. Conclusions: Anticoagulant but not antiplatelet treatment seems to produce the worst outcomes in major trauma.

The Detrimental Impact of the COVID-19 Pandemic on Major Trauma Outcomes in the Netherlands: A Comprehensive Nationwide Study.

Objective:To evaluate the impact of the COVID-19 pandemic on the outcome of major trauma patients in the Netherlands.Summary Background Data:Major trauma patients highly rely on immediate access to specialized services, including ICUs, shortages caused by the impact of the COVID-19 pandemic may influence their outcome.Methods:A multi-center observational cohort study, based on the Dutch National Trauma Registry was performed. Characteristics, resource usage, and outcome of major trauma patients (injury severity score ≥16) treated at all trauma-receiving hospitals during the first COVID-19 peak (March 23 through May 10) were compared with those treated from the same period in 2018 and 2019 (reference period).Results:During the peak period, 520 major trauma patients were admitted, versus 570 on average in the pre-COVID-19 years. Significantly fewer patients were admitted to ICU facilities during the peak than during the reference period (49.6% vs 55.8%; P=0.016). Patients with less severe traumatic brain injuries in particular were less often admitted to the ICU during the peak (40.5% vs 52.5%; P=0.005). Moreover, this subgroup showed an increased mortality compared to the reference period (13.5% vs 7.7%; P=0.044). These results were confirmed using multivariable logistic regression analyses. In addition, a significant increase in observed versus predicted mortality was recorded for patients who had a priori predicted mortality of 50% to 75% (P=0.012).Conclusions:The COVID-19 peak had an adverse effect on trauma care as major trauma patients were less often admitted to ICU and specifically those with minor through moderate brain injury had higher mortality rates.

Initial neutrophil and lymphocyte ratio as a predictor of mortality and ICU admission after major trauma

Introduction The neutrophil-to-lymphocyte ratio (NLR) has been proposed as a marker of systemic inflammation in major trauma patients that is associated with in-hospital mortality. We aimed to determine the discriminative ability of initial NLR as a predictor of outcomes following major trauma. Methods This was a registry-based cohort study involving all major trauma patients meeting criteria for inclusion into the Alfred Health Trauma Registry who presented directly from the scene of injury over a 24-month period (January 2018 to December 2019). The initial NLR was calculated for each patient and was compared against the Shock Index (SI), lactate and Revised Trauma Score (RTS). Outcomes observed were mortality at hospital discharge and intensive care unit (ICU) admission. We assessed the predictive capacity of each test using the receiver operating characteristic (ROC) curve and performed area under the ROC curve (AUROC) analysis to compare their performance. Results Data were extracted for 1687 major trauma patients, of which 72% were male, the median age was 49 years (IQR 31–68) and most (90%) of patients presented after a blunt mechanism of injury. In-hospital mortality occurred in 165 (9.77%) patients, and 725 (42.92%) patients required ICU admission. The median NLR was 6.84 (IQR 3.89–11.52). Initial NLR performed poorly with an AUROC of 0.46 (95% confidence interval (CI): 0.40–0.52) for prediction of mortality and AUROC of 0.53 (95% CI: 0.50–0.56) for prediction of ICU admission. The AUROCs of initial NLR for both mortality at hospital discharge and ICU admission were significantly lower than SI, lactate and RTS. Conclusion Initial NLR was not predictive of outcomes in major trauma. NLR at other time-points may provide better predictive capacity for outcomes.

Measuring functional outcomes in major trauma: can we do better?

There is relatively limited large scale, long-term unified evidence to describe how quality of life (QoL) and functional outcomes are affected after polytrauma. The aim of this study is to review validated measures available to assess QoL and functional outcomes and make recommendations on how best to assess patents after major trauma. PubMed and EMBASE databases were interrogated to identify suitable patient-reported outcome measures (PROMs) for use in major trauma, and current practice in their use globally. Overall, 81 papers met the criteria for inclusion and evaluation. Data from these were synthesised. A full set of validated PROMs tools were identified for patients with polytrauma, as well as critique of current tools available, allowing us to evaluate practice and recommend specific outcome measures for patients following polytrauma, and system changes needed to embed this in routine practice moving forward. To achieve optimal outcomes for patients with polytrauma, we will need to focus on what matters most to them, including their needs (and unmet needs). The use of appropriate PROMs allows evaluation and improvement in the care we can offer. Transformative effects have been noted in cases where they have been used to guide treatment, and if embedded as part of the wider system, it should lead to better overall outcomes. Accordingly, we have made recommendations to this effect. It is time to seize the day, bring these measures even further into our routine practice, and be part of shaping the future.

The Detrimental Impact of the COVID‐19 Pandemic on Major Trauma Outcomes in the Netherlands: A Comprehensive Nationwide Study

Background: The COVID-19 pandemic had a profound impact on healthcare in general and on the availability of emergency services. Immediate access to specialised services, including intensive care unit (ICUs), is potentially endangered during a pandemic. Severely injured patients highly rely on these resources, shortage may influence their outcome. We therefore evaluated the impact of the COVID-19 pandemic on the outcome of major trauma patients.Methods: A nationwide comprehensive multi-centre prospective observational cohort study, based on the Dutch National Trauma Registry was performed to compare the patient characteristics, resource usage, and outcome of major trauma patients treated at all trauma-receiving hospitals during the first COVID-19 peak (March 23rd through May 10th) in 2020 versus pre–COVID-19 reference periods in 2018 and 2019.Findings: During the COVID-19 peak period, 502 major trauma patients were admitted, versus 566 on average in the pre-COVID-19 years. Significantly fewer patients were admitted to ICU facilities during the peak than during the reference period (46·1% versus 53·3%; p=0·008). The subgroup of 155 major trauma patients with less severe brain injuries (abbreviated injury score ≤3) were in particular less often admitted to the ICU during the peak (36·1% vs 52 ·1%; p=0·001). Moreover, this subgroup showed increased mortality compared to the reference group (14·2% vs 7·7%; p=0·023). In addition, a significant increase in observed versus predicted mortality was also recorded for patients who had a priori predicted mortality of 50% to 75% (p=0·012).Interpretation: We speculate that the restricted availability of ICU beds negatively influenced the outcome of major trauma patients during the COVID-19 peak in 2020. In particular for patients with less severe traumatic brain injuries or with a high mortality probability.Funding: None to declare. Declaration of Interest: All authors declare no conflict of interest, including financial, consultant, institutional, and other relationships that might lead to bias or conflict of interestEthical Approval: This study was approved by the Scientific Advisory Board, as well as the Board of the Dutch Emergency Care Network.

Does prehospital management by doctors affect outcome in major trauma? A systematic review.

There is substantial variation worldwide in prehospital management of trauma and the role of doctors is controversial. The objective of this review was to determine whether prehospital management by doctors affects outcomes in major trauma, including the prespecified subgroup of severe traumatic brain injuries when compared with management by other advanced life support providers. EMBASE, MEDLINE(R), PubMed, SciELO, Trip, Web of Science, and Zetoc were searched for published articles. HSRProj, OpenGrey, and the World Health Organization International Clinical Trials Registry Platform were searched for unpublished data. Relevant reference lists were hand-searched. There were no limits on publication year, but articles were limited to the English language. Authors were contacted for further information as required. Quality was assessed using the Downs and Black criteria. Mortality was the primary outcome, and disability was the secondary outcome of interest. Studies were subjected to a descriptive analysis alone without a meta-analysis due to significant study heterogeneity. All searches, quality assessment, data abstraction, and data analysis was performed by two reviewers independently. Two thousand thirty-seven articles were identified, 49 full-text articles assessed and eight studies included. The included studies consisted of one randomized controlled trial with 375 participants and seven observational studies with over 4,451 participants. All included studies were at a moderate to high risk of bias. Six of the eight included studies showed an improved outcome with prehospital management by doctors, five in terms of mortality and one in terms of disability. Two studies found no significant difference. There appears to be an association between prehospital management by doctors and improved survival in major trauma. There may also be an association with improved survival and better functional outcomes in severe traumatic brain injury. Further high-quality evidence is needed to confirm these findings. Systematic review, level III.

Who should lead a trauma team: surgeon or non surgeon? A systematic review and meta-analysis

:Background:Presence of a trauma team leader (TTL) in the trauma team is associated with positive patient outcomes in major trauma. The TTL is traditionally a surgeon who coordinates the resuscitation and ensures adherence to Advanced Trauma Life Support (ATLS) guidelines. The necessity of routine surgical leadership in the resuscitative component of trauma care has been questioned by some authors. Therefore, it remains controversial who should lead the trauma team. We aimed to evaluate outcomes associated with surgeon versus non-surgeon TTLs in management of trauma patients.Methods:In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we performed a systematic review. Electronic databases MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify randomized and non-randomized studies investigating outcomes associated with surgeon versus non-surgeon TTL in management of trauma patients. The Newcastle-Ottawa scale was used to assess the methodological quality and risk of bias of the selected studies. Fixed-effect model was applied to calculate pooled outcome data.Results:Three retrospective cohort studies, enrolling 2,519 adult major trauma patients, were included. Our analysis showed that there was no difference in survival [odds ratio (OR): 0.82, 95% confidence interval (CI) 0.61-1.10, P=0.19] and length of stay when trauma team was led by surgeon or non-surgeon TTLs; however, fewer injuries were missed when the trauma team was led by a surgeon (OR: 0.48, 95% CI 0.25-0.92, P=0.03).Conclusions:Despite constant debate, the comparative evidence about outcomes associated with surgeon and non-surgeon trauma team leader is insufficient. The best available evidence suggests that there is no significant difference in outcomes of surgeon or non-surgeon trauma team leaders. High quality randomized controlled trials are required to compare the effectiveness of surgeon and non-surgeon trauma team leaders in order to resolve the controversy about who should lead the trauma team. Clinically significant missed injuries should be considered as important outcome in future studies.

Postoperative outcome in major abdominal trauma: is the treatment of hypoalbuminemia beneficial?

Background It had been suggested that the use of fluids containing albumin in critically ill patients may increase the absolute risk for death when compared with crystalloids. Objective The aim of this study was to compare the effect of albumin infusion versus conservative therapy on both serum albumin concentration (SAC) and patient outcome in case of postoperative hypoalbuminemia after exploration laparotomy for major abdominal trauma. Patients and methods Sixty-four patients with major abdominal trauma who had undergone exploration laparotomy were studied. In addition to patient’s demographic data, serial postoperative SAC and intra-abdominal pressure up to the seventh day were measured. Moreover, clinical, laboratory, and radiological follow-up was conducted to evaluate the morbidity until patient discharge from the hospital. The mortality rate was also recorded. Results There were no significant differences between patients who received albumin (group A) for the treatment of hypoalbuminemia and those who did not receive albumin (group B) as regards length of ICU stay (P=0.33), first postoperative day SAC (P=0.99), total complications (P=1), and individual postoperative complications [hemodynamic instability with vasopressor requirement (P=0.74), abdominal compartment syndrome (P=1), multiple organ dysfunction syndrome (P=1), and anastomotic leak (P=1), acute respiratory distress (P Conclusion Postoperative treatment of hypoalbuminemia in major abdominal trauma had no benefit as regards morbidity and mortality.

Impact of the introduction of an integrated adult retrieval service on major trauma outcomes

ObjectivesThe primary aim of this study was to examine the impact of the introduction of an integrated adult critical care patient retrieval system in Victoria, Australia, on early clinical outcomes...

Saving lives, limbs and livelihoods: considerations in restructuring a national trauma service.

Level 1 trauma centers reduce mortality and improve functional outcomes in major trauma. Despite this, many countries, including Ireland, do not have officially designated major trauma centers (MTC). This study aimed to examine international trauma systems, and determine how to "best fit" trauma care in a small country (Ireland) to international models. The literature was reviewed to examine international models of trauma systems. An estimate of Irish trauma burden and distribution was made using data from the Road Safety Authority (RSA) on serious or fatal RTAs. Models of a restructured trauma service were constructed and compared with international best practice. Internationally, a major trauma center surrounded by a regional trauma network has emerged as the gold standard in trauma care. In Ireland, there are no nationally coordinated trauma networks and care is provided by 26 acute hospitals with a mean distance to hospital from RTAs of 20.6 km ± 15.6. Based on our population, Ireland needs two Level 1 MTCs (in the two areas of major population density in the east and south), with robust surrounding trauma networks including Level 2 or 3 trauma centers. With this model, the estimated mean number of cases per Level 1 MTC per year would be 628, with a mean distance to MTC of 80.5 ± 59.2 km, (maximum distance 263.5 km). Clearly designated and adequately resourced MTCs with trauma networks are needed to improve trauma outcomes, with concomitant investment in pre-hospital infrastructure.

Impacts on Long-Term Outcome after Major Trauma-Traumatic Brain and Orthopedic Injuries

Mortality of severely injured patients has decreased during the last decades due to improved clinical experience and optimized treatment algorithms [1]. Referring to those patients surviving major trauma, a considerable influence on patients’ social, functional and financial circumstances has been proven [1-3]. To date, outcomes in major trauma have commonly been evaluated in terms of mortality and short term health process measures. But as functional recovery following major trauma is known to be a long-term process, measures and perceptions of long-term morbidity, functional deficits and well-being are required [4,5].

Acid-base disorders as predictors of early outcomes in major trauma in a resource limited setting: An observational prospective study.

IntroductionMortality from trauma remains a major challenge despite recent substantial improvements in acute trauma care. In trauma care patient resuscitation to correct hypotension from volume loss still majorly relies on use of physiological parameters such as blood pressure, pulse rate, respiratory rate, urine output and oxygen saturation. In resource limited settings these methods may not be sufficient to detect occult tissue hypoxia and the accompanying metabolic derangements.MethodsA prospective observational study carried out at a level I urban Trauma centre; Accident and Emergency unit. Major trauma patients were consecutively recruited into the study. Venous blood samples were drawn for analysis of serum electrolytes, serum PH and anion gap. The venous blood gas findings were correlated with patients’ clinical outcome at two weeks. Ethical approval was obtained.ResultsNinety three major trauma patients were recruited, patients’ age ranged from 12 months to 50 years. Forty nine patients (53%) were acidotic (PH less than 7.32), 39 patients (42%) had low bicarbonate (bicarbonate level less than 21 mmol), 54 patients (58%) had high corrected anion gap (anion gap corrected of 16 or more). Fourteen patients (15%) developed secondary organ failure and 32 (34%) patients died.ConclusionMetabolic acidosis is common among major trauma patients, its severity may be related to delay in initiating care. Acid base derangements were predictors of mortality among major trauma patients in this resource limited setting.

Potential value of pharmacological protocols in trauma

Diagnosis and treatment of trauma-induced coagulopathy (TIC) presents a challenge for trauma care providers. Viscoelastic tests (VETs) including thromboelastometry and thrombelastography are increasingly used to diagnose TIC and guide hemostatic therapy. We summarize the concept of individualized, goal-directed coagulation management using coagulation factor concentrates. Early and aggressive treatment is mandatory to improve the survival of severely bleeding trauma patients. High ratios of fresh frozen plasma to red blood cells are linked to improved outcome in coagulopathic patients; however, treatment is often delayed because most blood products must first be thawed. Lyophilized plasma potentially overcomes these problems. However, until now only limited data on the use of lyophilized plasma in major trauma are available. VETs provide a rapid and comprehensive overview of the coagulation process. Low maximum clot firmness is associated with increased transfusion requirements, and premature lysis of the clot is indicative of poor outcome. Improvement in clot firmness can be achieved by the administration of fibrinogen concentrate or platelet concentrate, depending on the cause of coagulopathy. Early administration of tranexamic acid improves clot stability and outcome in major trauma. Prothrombin complex concentrate increases thrombin generation, but is potentially associated with increased risk of thromboembolic complications. VETs are useful in the diagnosis of TIC, allowing precise deficits in the coagulation process to be identified and specifically targeted with coagulation factor concentrates.

Epidemiological characteristics and care outcome of the elderly patients with severe chest trauma

Objective To further improve level of severe chest trauma care in the elderly pa-tients. Methods A retrospective study was done on data of 148 elderly patients (≥65 years with se-vere chest trauma (AIS≥3 points) (elderly group) treated in Chongqing Emergency Medical Center from June 1995 to May 2005. A total of 1669 patients at age less than 65 years and with AIS≥3 points were set as control group in the same research period (control group). Results The main injury mechanism was blunt trauma, which aceouted for 83.8% (124/148) in elderly group, higher than 69.3% (1 157/ 1 669) in control group (P 0.05). The fatality rate and indicence rate of complication in the elerly group were 15.5% (23/148) and 25.7% (38/148), which was significantly higher than 6.5% (108/1 669) and 10.4% (174/1 669) respectively in control group (P 0. 05). Conclusions The patient' s age and complications are relative independent factors to es-timate the trauma care outcome. To raise risk awareness and strengthen the management of complications and supportive treatments for organ function are key to improve survival rate of the elderly patients with se-vere chest trauma. Key words: Thoracic injuries, aged; Injury severity score; Major trauma outcome

Assessment of the injury severity score in evaluation of multiple maxillofacial injuries

To compare the superiority of abbreviated injury scale (AIS) 2005 and AIS 1998 for evaluation of maxillofacial injury severity and major trauma outcome. A total of 450 trauma patients evaluated by AIS 2005 and AIS 1998 from July 2005 to January 2007 were analyzed retrospectively. The mortality and morbidity of complications in trauma patients were ascending with the increase of injuries severity score (ISS). The ascending tendency in mortality was more notable in injuries severity score (ISS) > 20 in AIS 2005. The mortality in trauma patients in AIS 2005 was significantly lower than those in AIS 1998 in ISS > 15, < 20 (P = 0.001). The ascending tendency to morbidity of complications was more notable in other ISS groups in AIS 2005 than those in AIS 1998. The evaluation of injury severity and major trauma outcome by ISS based on AIS 2005 is superior to based on AIS 1998. It is reasonable to definite severe trauma by ISS value greater than 20 in AIS 2005.

Short-term outcome in major trauma: land versus air emergency medical rescue in Tuscany

Trauma is the major cause of death for people younger than 40 years in developed counties. In Italy an incidence of 120 deaths per 100,000 inhabitants for trauma is reported. An efficient emergency medical response system (EMRS) must therefore be assured in order to provide adequate treatment on the scene and allow a quick rescue to a referral hospital centre.