Revised Trauma Score Scores Research Articles

Utilizing injury severity score, Glasgow coma scale, and revised trauma score for trauma-related in-hospital mortality and ICU admission prediction; originated from 7-year results of a nationwide multicenter registry

Objective: During the past few decades, many scoring systems have been developed to evaluate the severity of injury and predict the outcome in trauma patients. This study aimed to assess the capacity of three common trauma scoring systems: injury severity score (ISS), Glasgow coma scale (GCS), and revised trauma score (RTS) in predicting in-hospital mortality and ICU admission in patients with traumatic injury. Methods: This is a multicenter study of the hospital-based national trauma registry of Iran (NTRI), an ongoing registry-based trauma database. This study included trauma cases from 12 major trauma centers throughout the country admitted between July 2016 and November 2023. The inclusion criteria were all patients admitted to the emergency department due to trauma, hospitalized for at least 24 hours, deceased within the first 24 hours of admission, and patients transferred from the intensive care unit (ICU)s of other hospitals. Results: A total of 50,458 traumatic patients, with 38,740 (76.9%) being male, were included in this study. After adjustment for confounders, head, face, and neck injuries were associated with the highest odds of death (OR: 7.51, P-value<0.001), whereas abdominal injuries were associated with the highest odds of ICU admission (OR: 4.58, P-value<0.001). Each Unit increase in RTS score was accompanied by a 61% decrease in odds of death (OR: 0.39, P-value<0.001). The area under the ROC curve for predicting in-hospital mortality was 0.81 (0.79 to 0.82) in ISS, 0.78 (0.77 to 0.80) in GCS, and 0.75 (0.73 to 0.76) in RTS. There was a significant difference between RTS and GCS, as well as RTS and ISS for in-hospital mortality prediction (P-values< 0.001). The area under the ROC curve for the prediction of ICU admission was 0.75 (0.74 to 0.75) in ISS, 0.63 (0.62 to 0.63) in GCS, and 0.62 (0.61 to 0.63) in RTS. There was a statistically significant difference between ISS and GCS, as well as ISS and RTS, for ICU admission prediction (P-value<0.001). Conclusion: ISS is the best predictor of in-hospital mortality and ICU admission, compared to GCS and RTS.

Prognosis and assessment of the predictive value of severity scores in paediatric abdominal trauma: A French national cohort study.

Paediatric closed abdominal trauma is common, however, its severity and influence on survival are difficult to determine. No prognostic score integrating abdominal involvement exists to date in paediatrics. To evaluate the severity and short-term and medium-term prognosis of closed abdominal trauma in children, and the performance of severity scores in predicting mortality. Retrospective, cohort, observational study. Patients aged 0 to 18 years presenting at the trauma room of a French paediatric Level I Trauma Centre over the period 2015 to 2019 with an isolated closed abdominal trauma or as part of a polytrauma. Primary outcome was the six months mortality. Secondary outcomes were related complications and therapeutic interventions, and performance for predicting mortality of the scores listed. Paediatric Trauma Score (PTS), Revised Trauma Score (RTS), Shock Index Paediatric Age-adjusted (SIPA) score, Reverse shock index multiplied by Glasgow Coma Scale score (rSIG), Base Deficit, International Normalised Ratio, and Glasgow Coma Scale (BIG), Injury Severity Score (ISS) and Trauma Score and the Injury Severity (TRISS) score. Data collected include clinical, biological and CT scan data at admission, first 24 h management and prognosis. The PTS, RTS, SIPA, rSIG, BIG and ISS scores were calculated and mortality was predicted according to BIG score and TRISS methodology. Of 1145 patients, 149 met the inclusion criteria and 12 (8.1%) died. Of the 12 deceased patients, 11 (91.7%) presented with severe head injury, 11 (91.7%) had blood products transfusion and 7 received tranexamic acid. ROC curves analysis concluded that PTS, RTS, rSIG and BIG scores accurately predict mortality in paediatric closed abdominal trauma with AUCs at least 0.92. The BIG score offered the best predictive performance for predicting mortality at a threshold of 24.8 [sensitivity 90%, specificity 92%, negative-predictive value (NPV) 99%, area under the curve (AUC) 0.93]. PEVALPED is the first French study to evaluate the prognosis of paediatric closed abdominal trauma. The use of PTS, rSIG and BIG scores are relevant from the acute phase and the pathophysiological interest and accuracy of the BIG score make it a powerful tool for predicting mortality of closed abdominal trauma in children.

Evaluation of emergency department admissions of mass casualty patients using the revised trauma score, injury severity score, and trauma and injury severity score.

There is a need for studies evaluating prognostic scoring systems in mass trauma patients in conflict regions to predict patient prognosis for emergency surgical prioritization. In this study, we aimed to evaluate scoring systems such as the Revised Trauma Score (RTS), Injury Severity Score (ISS), and Trauma and Injury Severity Score (TRISS) in trauma patients admitted due to mass trauma in Northern Syria. This study was a retrospective evaluation of patients admitted due to mass trauma to the emergency departments of hospitals in Northern Syria. The diagnostic efficiency of RTS, ISS, and TRISS scoring systems was evaluated in these admissions in the first half of 2021. The most common causes of mass trauma were bomb blast (67.3%), gunshot (28.8%), and 14 (3.9%) patients admitted with other causes. When the odds ratio (OR) was analyzed, a one-unit increase in the RTS score increased the odds of survival by a factor of 6.133, and a one-unit increase in the TRISS score increased the odds of survival by a factor of 1.057. Differently, it was found that each 1-unit increase in ISS decreased the patient's probability of survival by 0.856 units. When RTS, TRISS, and ISS scores were analyzed, the area under the ROC curve was statistically significant for all of them (p<0.001) and all of them had a diagnostic value for mortality with sensitivities of 99.0%, 94.8%, and 91.9%; specificities of 87.8%, 90.5%, and 88.6; AUC of 0.958, 0.975, and 0.958, respectively. The use of trauma scoring systems, especially TRISS, may be useful for prioritizing patients in mass casualty settings in the presence of overcapacity.

Karayolu Trafik Kazaları Nedeniyle Yoğun Bakım Ünitesinde Takip Ve Tedavi Edilen Hastaların Retrospektif Olarak Değerlendirilmesi

Aim:We aimed to investigate intensive care unit (ICU) treatments and factors associated with mortality in patients admitted to the ICU after road traffic accidents(RTAs). Methods:This study retrospectively analyzed patient comorbidities,features of traumas,alcohol use,Revised Trauma Score(RTS), interventions performed,ICU and hospital stays,the presence and extent of invasive mechanical ventilation(IMV),Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Scores (SAPS II), as well as Glasgow Coma Scale (GCS) and NRS 2002 (Nutritional Risk Screening 2002) scores upon admission to the ICU. Brain death rates, transfusion rates, and ICU death rates were analyzed. Results: 90 of the 109 patients treated in the ICU for RTAs survived, and 19 patients (17.4%) died.GCS scores were lower and APACHE II scores were greater in the non-surviving patients than in the surviving patients (p &amp;lt; 0.0001). The number of patients who received cardiopulmonary resuscitation (CPR) was significantly higher in the non-surviving patient group(p &amp;lt; 0.0001).The most frequent etiology of trauma was non-vehicle traffic accidents(45%).The head was the most common site of traumas(71.5%).The GCS and RTS scores of non-survivor patients were significantly lower(p = 0.013,p = 0.001,respectively), and the APACHE II and SAPS II scores were higher(p &amp;lt; 0.001).It was found that the rates of intubation(100%),CPR(47.4%), and IMV(100%) in non-surviving patients outweighed in surviving patients( p= 0.005,p &amp;lt; 0.001, and p = 0.012,respectively). Conclusion:Multiple parameters are influential for determining the prognoses of patients treated in the ICU for traumas caused by RTAs.In particular,a high APACHE II score and CPR requirement are associated with mortality.

Evaluation of the predictive effects of trauma scoring systems in colorectal injuries.

Colorectal injuries following traumas are significant causes of morbidity and mortality. This study aimed to evaluate the predictive effect of trauma scoring systems on mortality and morbidity in patients with post-traumatic colon injury. The records of 145 patients with colon trauma treated at Seyhan State Hospital between January 1, 2010, and January 1, 2020, were retrospectively analyzed. Injury Seriousness Score (ISS), Revised Trauma Score (RTS), Trauma Injury Severity Score (TRISS), and Colon Injury Score (CIS) scores were calculated for all patients. The predictive effects of scoring systems on primary outcomes of surgical treatment, complication rates, mortality, and anastomotic leaks were evaluated. The mean age of the patients was 36.1 (SD ± 16.6), and the female/male ratio was 37/108. Anastomotic leakage occurred in 12 (8.2%) patients, and complications were observed in 57 (39.3%) patients. Seven (4.7%) patients died. A statistically significant relationship was observed between the increase in CIS and anastomotic leakage, morbidity, and mortality. Increases in ISS and decreases in RTS and TRISS were associated with increased morbidity and mortality, but these relationships were not statistically significant. A significant relationship was observed between the increase in CIS and anastomotic leakage, morbidity, and mortality. The study suggests the need for a specific scoring system for evaluating the prognostic status in colon traumas, as ISS, RTS, and TRISS scores were not found to be significantly predictive of outcomes in this patient population.

Predictive value of the Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate and Systolic blood pressure score (TRIAGES) and Revised Trauma Score (RTS) for the short-term mortality of patients with isolated traumatic brain injury

BackgroundEnsuring rapid and precise mortality prediction in patients with traumatic brain injury (TBI) at the emergency department (ED) is paramount in patient triage and enhancing their outcomes. We aimed to estimate and compare the predictive power of the Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate, and Systolic blood pressure score (TRIAGES) and Revised Trauma Score (RTS) for 24-h in-hospital mortality in patients with isolated TBI. MethodsWe conducted a retrospective single-center study analyzing clinical data from 1156 patients with isolated acute TBI treated in the ED of the Affiliated Hospital of Nantong University from January 1, 2020, to December 31, 2020. We calculated each patient's TRIAGES and RTS scores and estimated their predictive value for short-term mortality using receiver operating characteristic (ROC) curves. Results87 patients (7.53%) died within 24 h of admission. The non-survival group had higher TRIAGES and lower RTS than the survival group. Compared to non-survivors, survivors exhibited higher Glasgow Coma Scale scores (GCS) with a median score of 15 (12, 15) compared to a median score of 4.0 (3.0, 6.0). The crude and adjusted odds ratios (ORs) for TRIAGES were 1.79, 95% CI (1.62 to 1.98) and 1.79, 95% CI (1.60 to 2.00), respectively. The crude and adjusted ORs for RTS were 0.39, 95% CI (0.33 to 0.45) and 0.40, 95% CI (0.34 to 0.47), respectively. The area under the ROC (AUROC) curve of TRIAGES, RTS, and GCS was 0.865 (0.844 to 0.884), 0.863 (0.842 to 0.882), and 0.869 (0.830 to 0.909), respectively. The optimal cut-off values for predicting 24-h in-hospital mortality were 3 for TRIAGES, 6.08 for RTS, and 8 for GCS. The subgroup analysis showed a higher AUROC in TRIAGES (0.845) compared to GCS (0.836) and RTS (0.829) among patients aged 65 and above, although the difference was not statistically significant. ConclusionsTRIAGES and RTS have shown promising efficacy in predicting 24-h in-hospital mortality in patients with isolated TBI, with comparable performance to GCS. However, improving the comprehensiveness of assessment does not necessarily translate into an overall increase in predictive ability.

Use of the Trauma and Injury Severity Score (TRISS) as a Predictor of Patient Outcome in Cases of Trauma Presenting in the Trauma and Emergency Department of a Tertiary Care Institute.

In this study, we used the anatomic scoring system Abbreviated Injury Scale (AIS) to calculate the Injury Severity Score (ISS) and the physiological scoring system for the Revised Trauma Score (RTS) on the arrival of patients. Both scores were used to calculate the Trauma and Injury Severity Score (TRISS) for predicting the patient outcome in a case of trauma. This prospective, cross-sectional, observational study was carried out at the trauma centre of a tertiary care institute and included patients of either sex, age ≥18 years, and ISS ≥15. A total of 2084 cases of trauma over a period of 18 months were assessed, and 96 cases of blunt trauma meeting the inclusion criteria were studied. Patients injured in road traffic accidents constituted the maximum caseload. Out of a sample size of 96 patients with ISS ≥15, 77 died during the treatment and 19 survived. The ISS ranged from 15 to 66, with a mean ± SD score of 27.48 ± 8.79. Non-survivors had a statistically higher significant ISS than survivors (p<0.001). The RTS ranged from <1 to 7.84, with a mean ± SD score of 4.52 ± 2.08. Non-survivors had low RTS (RTS <5, n=52) compared to survivors, and the difference was statistically significant (p<0.001). The mean ± SD TRISS (Ps) score was 0.69 ± 2.288. In the non-survivor (NS) group, 15 patients had TRISS (Ps) between 0.26-0.50, followed by 0.51-0.75 (n=18), 0.76-0.90 (n=12), and 0.90-0.95 (n=11). While 16 survivors had TRISS (Ps) between 0.96 and 1, a statistically significant association was found between TRISS and patient outcome (p-value <0.001). On the receiver operating characteristic (ROC) curve analysis, the sensitivity of TRISS (94.7%) and RTS was found to be comparable (94.7%), whereas ISS was less sensitive (36.8%) in predicting the patient outcome. RTS (79.2%) and TRISS (76.6%) scores were more specific than ISS (5.2%) for outcome analysis. The TRISS score is useful in the management of trauma patients as it can satisfactorily predict mortality in a case of trauma. The trauma scores are of immense help in determining the nature of injury in medicolegal cases.

Association between BUN/creatinine ratio and the risk of in-hospital mortality in patients with trauma-related acute respiratory distress syndrome: a single-centre retrospective cohort from the MIMIC database

ObjectiveRecent studies have shown that blood urea nitrogen to creatinine (BUN/Cr) ratio might be an effective marker for the prognosis of patients with respiratory diseases. Herein, we aimed to assess...

Evaluation of the Revised Trauma Score, MGAP, and GAP scoring systems in predicting mortality of adult trauma patients in a low-resource setting

BackgroundNumerous trauma scoring systems have been developed in an attempt to accurately and efficiently predict the prognosis of emergent trauma cases. However, it has been questioned as to whether the accuracy and pragmatism of such systems still hold in lower-resource settings that exist in many hospitals in lower- and middle-income countries (LMICs). In this study, it was hypothesized that the physiologically-based Revised Trauma Score (RTS), Mechanism/Glasgow Coma Scale/Age/Pressure (MGAP) score, and Glasgow Coma Scale/Age/Pressure (GAP) score would be effective at predicting mortality outcomes using clinical data at presentation in a representative LMIC hospital in Upper Egypt.MethodsThis was a retrospective analysis of the medical records of trauma patients at Beni-Suef University Hospital. Medical records of all trauma patients admitted to the hospital over the 8-month period from January to August 2016 were reviewed. For each case, the RTS, MGAP, and GAP scores were calculated using clinical data at presentation, and mortality prediction was correlated to the actual in-hospital outcome.ResultsThe Area Under the Receiver Operating Characteristic (AUROC) was calculated to be 0.879, 0.890, and 0.881 for the MGAP, GAP, and RTS respectively, with all three scores showing good discriminatory ability. With regards to prevalence-dependent statistics, all three scores demonstrated efficacy in ruling out mortality upon presentation with negative predictive values > 95%, while the MGAP score best captured the mortality subgroup with a sensitivity of 94%. Adjustment of cutoff scores showed a steep trade-off between optimizing the positive predictive values versus the sensitivities.ConclusionThe RTS, MGAP, and GAP all showed good discriminatory capabilities per AUROC. Given the relative simplicity and potentially added clinical benefit in capturing critically ill patients, the MGAP score should be further studied for stratifying risk of incoming trauma patients to the emergency department, allowing for more efficacious triage of patients in lower-resource healthcare settings.

Predicting factors associated with in-hospital mortality in severe multiple-trauma patients

Background and Objectives: Traumatic injuries have become a health problem worldwide, especially in low- to middle-income countries. Therefore, this study was conducted to identify predicting factors of death in adult severe multiple trauma patients. Methods: This retrospective cross-sectional study was performed on 1397 adult multiple trauma patients referred to the emergency department (ED) of Poursina Hospital between June 2019 and August 2021. The demographic characteristics, on admission clinical parameters, laboratory tests, the need for packed red blood cell transfusion, and the need for endotracheal intubation were recorded. The revised trauma score (RTS) was calculated according to the physiological variables collected on admission to ED. The primary outcome was 1-day mortality after admission. Results: The mean age of subjects was 37.12 ± 13.61 (18–60) years, and 1250 (89.5%) subjects were male. The 1-day mortality was 339 patients (24.3%). Initial RTS score and the mean Glasgow coma scale (GCS) scores were significantly higher in the survived group than in the nonsurvived group (6.6 ± 1.2 vs. 4.9 ± 1.0, 10.2 ± 3.7 vs. 4.9 ± 2.4, P < 0.001). The multivariate analysis resulted in low GCS (odds ratio [OR] = 1.527, 95%CI 1.434–1625, P < 0.001), low O2 saturation (OR = 1.023, 95%CI 1.003–1.043, P = 0.022), and need for intubation in the ED (OR = 0.696, 95%CI 0.488–0.993, P = 0.046) as predictors of 1-day mortality. The area under the curves receiver operating characteristics of RTS and GCS scores to predict mortality were 0.853 (95% CI: 0.831–0.874) and 0.866 (95% CI: 0.846–0.887), respectively. Conclusion: Multiple factors associated with 1-day mortality were reduced GCS score, decreased oxygen saturation, and need for intubation in the ED. The RTS and GCS scores are good predictors of mortality survival in multiple trauma patients.

Mortality Prediction in Multiple Trauma Patients Using GAP, RTS and NTS Models

Introduction: There are several models to predict the prognosis of trauma patients. The present study aimed to evaluate age, systolic blood pressure (GAP), revised trauma score (RTS), and new trauma score (NTS) to predict mortality rate in multiple trauma patients referring to Imam Reza Hospital, Tabriz, Iran. Methods: The present descriptive-analytical study was carried out on 544 multiple trauma patients from July 2018 to Aug 2019. GAP, RTS, and NTS models were adopted to collect data on the variables. The GAP, RTS, and NTS scores were calculated, and their relationship with hospital outcome was then assessed. Result: In total, 31 patients out of the selected sample died during the study. The cut-off point (sensitivity and specificity) of RTS, NTS, and GAP models for hospital survival rates was equal to 6.07 (0.97 and 0.98), 5.59 (0.94 and 0.99), and 15.5 (0.97 and 0.97), respectively. A logistic regression test was run to determine the effects of GCS, GAP, RTS, and NTS models. The results showed that the RTS and NTS scores had the highest value in determining the chances of survival, with the respective odds ratios (OR) of 13.74 and 10.207. Conclusion: Considering the high sensitivity and specificity of RTS, GAP, and NTS models in determining patient survival rates, these models have good predictive value in determining hospital outcomes. The effect of these models on the patient outcome based on OR values, RTS and NTS models showed high values.

Prevalence of Stress Cardiomyopathy in Polytrauma Patients

Background: Polytrauma is a leading cause of death globally and usually involving young victims. Takotsubo cardiomyopathy (TCM) is a serious clinical presentation of myocardial dysfunction characterized by acute, transient, and reversible heart failure syndrome owing to regional wall abnormalities of the ventricular myocardium associated with ECG changes and rising of myocardial biomarkers in the absence of cardiac condition causing the temporary ventricular dysfunction. Objective: To detect the prevalence of stress cardiomyopathy among polytrauma patients attending to Emergency Hospital Mansoura University. Patients and methods: The current study was a cross sectional study conducted on 500 patients who attended to Emergency Department, Emergency Hospital Mansoura University, suffering from polytrauma within the period from August 2019 to August 2020. Results: Prevalence of cardiomyopathy among the studied trauma patients was 4.4%. Mode of trauma (either blunt or penetrating) had no effect in the incidence of cardiomyopathy. Sequential organ failure assessment (SOFA) score and revised trauma score (RTS) demonstrated positive correlation with incidence of cardiomyopathy among polytrauma cases (P<0.001). Cardiomyopathy group was associated with marked affection of all echocardiographic parameters (Stroke volume, end diastolic volume, ejection fraction and fractional shortening) except end systolic volume. Cardiomyopathy group was associated with marked increase in ICU admission, ICU length of stay, total length of stay and mortality rate. Conclusion: Presence of stress cardiomyopathy in trauma cases may be used as an indicator of poor outcomes. Both SOFA and RTS scores were considered as reliable tools used to describe organ dysfunction/failure in polytrauma cases and have a positive correlation with stress cardiomyopathy.

Comparative evaluation of revised trauma score and injury severity score as prognosis predictor among polytrauma patients

Background and Objectives: The trauma is a major reason for various disabilities and even death around the world. Prompt actions and appropriate management are needed to minimize the level of injuries and mortality. An effective tool is needed to assess the prognosis of the patient in trauma. The objective of the study was to compare the evaluation of RTS and injury severity score (ISS) as a prognosis predictor among trauma patients. Methodology: A cross-sectional clinical observational study was conducted in the emergency department. A total of 88 samples were selected by random sampling technique. The data collection was done using demographic and clinical tools, Glasgow Coma Scale, Revised Trauma Score (RTS), and ISS. Data analysis was performed using SPSS 18. Results: In the present study, the majority of the participants (79.54%) were male. The most common mode of injury among the patients was road traffic accidents (54.54%) with blunt trauma. The findings revealed a negative correlation (‒0.368) between RTS and ISS scores with significant P = 0.0004. RTS (<10) and ISS (≥20) have significant association with mortality and hospital stay. The sensitivities of ISS and RTS with mortality were 84.2% and 89.4%, respectively. Conclusion: RTS is a comparatively better predictor of prognosis than ISS among trauma patients. Lower RTS and higher ISS are significantly associated with mortality and long hospital stay. Early evaluation of the injury level can be effective in patient management.

Evaluation of Risk Factors for Septic Complications after Laparotomy for Abdominal Trauma: A Longitudinal Cohort Study

Introduction: Septic complications are the most common cause of death in trauma patients who survive beyond 48 hours. Early diagnosis and treatment of infectious complications is essential to prevent life-threatening complications like Systemic Inflammatory Response Syndrome (SIRS) and Multi-Organ Dysfunction Syndrome (MODS). Aim: To study the various risk factors for septic abdominal complications following laparotomy for trauma. Materials and Methods: A prospective longitudinal cohort single-center study was conducted from November 2016 to March 2018. Sixty patients above the age of 12 years, who underwent laparotomy for abdominal trauma in the Surgical Department of our hospital, were included in the study. Various patient variables were compared with postoperative septic abdominal complications like wound infection, wound dehiscence, anastomotic leak and intra-abdominal abscess. Data was analysed using Statistical Package for Social Sciences (SPSS) version 21.0. Results: In the total 60 patients (35.60±16.54), significant association was seen between wound infection and dehiscence with the time interval between trauma and surgery (p&lt;0.001), lesser Revised Trauma Score (RTS) (p&lt;0.001) and greater Injur Severity Score (ISS) (p&lt;0.001). A significant association of all septic complications was seen with the need for Intensive Care Unit (ICU) stay (p&lt;0.001) and the presence of associated injuries (p&lt;0.001). Variables such as age, gender, co morbidities, Body Mass Index (BMI), pre-hospital care received, intraoperative findings and duration of ICU stay had no association with outcomes (p&gt;0.05). Conclusion: In trauma patients, factors like low RTS score, high ISS score, need for ICU stay and the presence of associated injuries may help the surgeons to decide in which patients to go for techniques like delayed closure of the wound, stoma instead of bowel anastomosis, etc., which may help to reduce postoperative septic complications.

The characteristics of the patients in mass public shootings among coup attempt in Turkey: A single-center hospital response.

Turkey is an experienced country for both military and civilian mass casualties that arise from explosions and shootings by various terrorist groups. In this study, we aimed to investigate the characteristics of patient flow admitted to our hospital caused by primarily gunshot wounds during the coup attempts on the 15th of July. This descriptive, retrospective study included a total of 50 patients who were injured during a coup attempt on the date of July 15, 2016, and admitted to our emergency department (ED). Demographic characteristics, anatomical injury sites, postoperative clinical outcomes, and hospitalization settings were recorded. The Glasgow Coma Scale (GCS), Trauma and Injury Severity Score (TRISS), Abbreviated Injury Scale (AIS), Revised Trauma Score (RTS) and Injury Severity Score (ISS) were used to measure the severity of injuries. A total of 63 medical personnel voluntarily reached the ED within two hours. Extremity injuries were the most common injuries. The mean RTS, GCS, and TRISS scores did not differ significantly between the patients discharged from the ED and the patients who were hospitalized (p>0.05). However, there was a statistically significant difference in the ISS scores (p<0.001, independent t-test). There was no statistically significant difference in the GCS and RTS scores between the discharged and hospitalized patients, although the ISS scores were higher in hospitalized patients (p>0.05 and p<0.001, respectively). A total of 33 patients (66%) were admitted to the hospital for follow-up and/or surgical intervention. Five (10%) of the patients were hospitalized for more than 14 days. The management of each disaster is unique. Armed conflicts result in gunshot wounds, and preparations must be focused on surge capacity and a prolonged hospital stay of the patients. In our study, the length of stay in the hospital decreased after the arrival of volunteer staff to the ED, but we should note that the ISS increased. Hospital disaster plans should be reorganized not only for ED but also for the whole hospital.

Study of risk factors, clinical spectrum, and outcome for head injury in pediatric age group in Western India.

Aim:To study various risk factors which leads to head injury, severity of head injury and to compare survival as predicted by the Revised Trauma Score (RTS) and Pediatric Trauma Score (PTS) in pediatric patients admitted in a tertiary care hospital.Methods:300 consecutive pediatric patients below 12 years of age with head injury admitted in our institute were analysed as per a set proforma. Data pertaining to patient's demographic details, mode of injury, computed tomography (CT) findings, type of management, severity of head injury, and outcome were recorded. The results were tabulated and analyzed. RTS and PTS scores were calculated to predict the survival of an individual patient.Results:The most commonly affected age group was 1–5 years. Boys outnumbered girls in the incidence. Fall was the most common injury, with road traffic accident being the most common cause of mortality. Skull fracture was the most common CT scan finding. Most of the patients presented with mild head injury (Glasgow Coma Scale 13–15), and they improved with conservative management only. RTS and PTS scores were calculated and were equally effective in predicting the outcome for a particular patient.Conclusion:Head injury occurs more commonly in 1–5 years' age group due to fall from unprotected roof tops. The overall prognosis in majority of the cases is excellent. However, road traffic accident shows the highest mortality and hence, we propose to include mode of injury as a variable for designing future predictive outcome models.

The importance of the injury severity scores and revised trauma scores for moderate traumas: A state hospital experience.

The degree of damage presents a pressing issue in determining trauma severity. Various trauma-scoring systems, such as the injury severity and revised trauma scores, are used worldwide. In this study, we aimed to evaluate the functionalities of these two trauma scoring systems, which are presently used frequently and have scientifically evolved at the state hospital level. Following approval from the ethics committee to conduct clinical studies with retrospective archive screening, data between January 1, 2012, and December 31, 2017, were retrospectively analysed for determining the factors affecting mortality in all patients diagnosed with traumatic injury in 29 Mayıs State Hospital. Incomplete or unclear data were excluded from this study. Mean and standard deviation were used for continuous variables; percentage and frequency values were used for binary variables. For evaluating continuous variables, Student's t-test or Mann-Whitney U-test was used in independent groups based on their distribution status. Dichotomous variables were evaluated using the chi-square test. The results and significant in univariate analyses were evaluated again by the linear and binary logistic regression model. Mean age of all patients was 37.53±14.47 years [male (35.68±13.9) versus female (40.61±15.1) (p=0.116)]. Mean injury trauma score for the general population was 3.18±8.46. No dissimilarity was noted regarding gender for the injury severity score (ISS) [(3.93±10.49 versus 1.91±2.34) (p=0.727)]. Regarding age, for revised trauma score (RTS), no statistical significance was noted [(7.60±0.91 versus 7.81±0.16) (p=0.207)]. Regarding the injury mechanism, we detected a difference between the two trauma scores; both ISS and RTS also had statistical significance. The results were found for ISS [penetrant (6.56±6.47) versus blunt (2.45±8.68) (p=0.002)] and for RTS [penetrant (7.41±0.54) versus blunt (7.74±0.79) (p=0.001)]. After the final statistics with logistic linear regression, the respiratory rate was statistically significant for penetrant injury [AOR 0.22 (0.001, 0.47) (p≤0.05)]. In the detailed subanalysis for RTS score components, respiratory rate was also significant in moderate traumas [AOR 0.22 (0.001, 0.47) (p=0.004)]. Both ISS and RTS are nonsignificant in all moderate injury types. On the other hand, respiratory rate is an important marker, especially in penetrant moderate injuries.

Score revisado de trauma como predictor de mortalidad en accidentes de tránsito

Introducción:La presente investigación se basa en la aplicación de la escala Revised Trauma Score (RTS) basada en escala Glasgow, frecuencia respiratoria y presión arterial sistólica que pronostica de acuerdo al cálculo de puntuación posibilidad de mortalidad en pacientes atendidos por accidentes de tránsito en el Servicio de Emergencia del Hospital General Latacunga, Enero – Marzo 2017.&#x0D; Objetivo: Aplicar la escala RTS para mejorar la calidad de la atención de pacientes con trauma&#x0D; Metodología: Se realizó un estudio descriptivo prospectivo, cuali-cuantitativa no experimental y transversal, utilizando como instrumentos de investigación fichas con la información de historias clínicas y hojas 008 de Emergencia..&#x0D; Resultados: La muestra calculada fue 87 pacientes; de los cuales 64,3% correspondió al género masculino predominando las edades entre 19 a 59 años. El mayor porcentaje de lesiones fue trauma de cabeza (30%), seguido miembros superiores-inferiores (23%). La puntuación de la escala RTS demostró 31% tenían traumas severos que necesitaron atención inmediata. En Emergencia la mortalidad fue 32%, demostrando su alta incidencia en los accidentes de tránsito.&#x0D; Conclusiones: La escala RTS es un buen predictor de mortalidad, ayuda al manejo médico y facilita la aplicación de guías clínicas para traumatizados, evitando substraje y sobretriaje, con atención médica inmediata.

Derivation and validation of an easy-to-compute trauma score that improves prognostication of mortality or the Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate and Systolic blood pressure (TRIAGES) score

BackgroundMultiple trauma scores have been developed and validated, including the Revised Trauma Score (RTS) and the Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP) score. However, these scores are complex to calculate or have low prognostic abilities for trauma mortality. Therefore, we aimed to develop and validate a trauma score that is easier to calculate and more accurate than the RTS and the MGAP score.MethodsThe study was a retrospective prognostic study. Data from patients registered in the Japan Trauma Databank (JTDB) were dichotomized into derivation and validation cohorts. Patients’ data from the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage-2 (CRASH-2) trial were assigned to another validation cohort. We obtained age and physiological variables at baseline, created ordinal variables from continuous variables, and defined integer weighting coefficients. Score performance to predict all-cause in-hospital death was assessed using the area under the curve in receiver operating characteristics (AUROC) analyses.ResultsBased on the JTDB derivation cohort (n = 99,867 with 12.5% mortality), the novel score ranged from 0 to 14 points, including 0–2 points for age, 0–6 points for the Glasgow Coma Scale, 0–4 points for systolic blood pressure, and 0–2 points for respiratory rate. The AUROC of the novel score was 0.932 for the JTDB validation cohort (n = 76,762 with 10.1% mortality) and 0.814 for the CRASH-2 cohort (n = 19,740 with 14.6% mortality), which was superior to RTS (0.907 and 0.808, respectively) and MGAP score (0.918 and 0.774, respectively) results.ConclusionsWe report an easy-to-use trauma score with better prognostication ability for in-hospital mortality compared to the RTS and MGAP score. Further studies to test clinical applicability of the novel score are warranted.

The Predictive Role of Red Cell Distribution Width (RDW) in Blood Transfusion in Multiple Trauma

Background: To reduce mortality in patients with multiple-trauma, rapid diagnosis for blood transfusion is of great importance. Objectives: The current study aimed at investigating the predictive role of red cell distribution width (RDW) in comparison with other multivariate systems to determine the need for blood transfusions in patients with trauma referred to hospital. Methods: The follow-up study was conducted on patients with multiple-trauma aged ≥ 18 years with an injury severity score (ISS) ≥ 16 referred to the emergency department within the study period. All patients were evaluated based on the ATLS (the advanced trauma life support) guideline; then, blood samples were taken at arrival and 24 hours later to measure RDW. According to the questionnaire, age, gender, ISS, RTS (the revised trauma score), and TASH (the trauma-associated severe hemorrhage) score were recorded by a senior emergency medicine resident. Results: Finally, 200 patients were enrolled in the study, of which 87 (43.5%) received blood transfusion. In the univariate analysis, there was a significant association between the first-day RDW, ∆ RDW (RDW on arrival - the first-day RDW), ISS, RTS, and TASH score, and blood transfusion. However, in the multivariate analysis, only TASH had a significant relationship with the need for blood transfusion (P < 0.0001). Conclusions: In multiple trauma patients, rapid diagnosis of hemorrhage and the need for blood transfusion is crucial. Monitoring the patients based on the RDW test is not helpful in predicting the need for blood transfusion. Multivariate systems such as TASH score are more valuable in determining the need for blood transfusion.