RTS Scores Research Articles

Pattern of admission and outcome of patients admitted to dedicated trauma intensive care unit (ticu), emergency department, teaching hospital, north-eastern malaysia

Background: The role of dedicated Trauma ICU (TICU) in Emergency Department is vital in the chain of trauma care to ensure rehabilitation and sustainable critical care for a better survival outcome. This study is conducted to find out demographic patterns and predictors that can affect the outcomes of trauma patients. Methods: A retrospective review of all patients admitted to TICU, Hospital Universiti Sains Malaysia (HUSM) was carried out from January 1st, 2016 till December 31st, 2018. Data were collected from TICU admission and discharge registers and were analyse using SPSS version 23.0. Results: A total of 108 trauma patients were included in this study. All cases were exclusively blunt trauma (99.1%) and mainly attributed by road traffic injuries (92.6%). In terms of trauma clinical scoring, 25%(p= 0.001) presented with GCS score < 4, 46.9% (p=0.001) with RTS score <5.5 and 15.6% (p=0.012) with APACHE II score > 28had demonstrated prolonged ICU stay (> 7 days). Meanwhile 62.5% (p= 0.000) with GCS < 4, 75% (p= 0.000) with RTS < 5.5 and 75% (p= 0.000) with APACHE II > 28 were died in TICU. Besides that, those who had prolonged ICU stay (> 7 days) were 8.5 times higher odds to get sepsis (adj OR= 8.532; 95% CI: 2.710, 26.863; p= 0.000) and 7 times higher odds to get acute kidney injury (AKI) (adj OR= 7.131; 95% CI: 1.464, 34.733; p= 0.015). Meanwhile, patient who received blood transfusion led to 5 folds higher odds ofassociation with rhabdomyolysis (adj OR= 4.968; 95% CI: 1.821, 13.549; p= 0.002). Conclusion: In the midst of pandemic COVID-19 it is important for ED physician to early identify and prioritise high risk trauma patient based on predictors and allows for targeted monitoring and intervention that may improve their outcome and also optimise resources accordingly. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 795-800

Outcomes of traumatic extremity vascular injuries from a Malaysian level 1 trauma center

BackgroundIn Malaysia, management of traumatic vascular injuries is at the discretion of the treating surgeon (trauma or vascular surgery). This study was conducted to report on the epidemiology, mechanism of injury and outcomes of vascular injuries managed in a regional level 1 trauma center. MethodsThis is a retrospective cohort study of all patients treated for traumatic extremity vascular injuries from January 2018 to December 2020. Demography, mechanism of injury, pre-operative physiologic vital signs, vessel injured, injury severity (NISS, RTS and TRISS score), type of revascularization surgery, fasciotomy, post-operative blood investigations, operative outcomes (amputation, length of stay and ICU admission) and long-term rehabilitation follow-up were recorded and analyzed. ResultsAmongst the 35 recorded vascular injuries only 28 patients had adequate data that were included in the analysis. Majority of patients were males (23/28patients; 82%). Blunt injury to vessels was more likely in motorcycle crashes (16/28patients; 76%) than in automobile crashes (5/28patients; 24%). There were three lower limb amputees (3/3patients; 100%) that had early fasciotomy and were associated with three-fold higher post-operative median (interquartile range) CK levels of 16740 (8157 to 23116) u/l. Only two thirds (16/28 patients) had active rehabilitation follow-up and were back to work after a median duration of four months. ConclusionMale gender, blunt injury, road traffic crashes and motorcycles were the majority of vascular injuries. Lower limb vascular injuries had poorer outcome with three amputations performed after attempts at revascularization. Fasciotomy and high CK level may be related to higher risk of limb loss. Our study highlights the importance of rehabilitation and long-term follow-up in this cohort of patients.

A Selection of Trauma Scores Might Not Correlate with Coagulation Factor Activity following Multiple Injuries: A Retrospective Observational Study from a Level 1 Trauma Center.

Loss and dilution of coagulation factors have been observed following multiple trauma. Timely recognition of reduced clotting factor activity might facilitate therapeutic action to restore normal coagulation function. This study investigates the potential role of some well-known trauma scores in predicting coagulation factor activity after multiple injuries. A dataset comprising the coagulation factor activities of 68 multiply injured adult patients was analyzed. The following trauma scores were evaluated: AIS, ISS, NISS, GCS, RTS, TRISS, RISC, and TASH score. To investigate the effect of trauma severity with respect to a single anatomic injury location, two groups according to the AIS (<3 vs. ≥3 points) were formed. Differences between these two groups were analyzed for five different body regions (head, thorax, abdomen, pelvis, extremities) using the Mann–Whitney U-test. Spearman's rank correlation coefficient rho was calculated to reveal possible relationships between trauma scores and clotting factor activities. The analysis showed clearly reduced clotting factor activities with a significant reduction of FII (83 vs. 50%; P = .021) and FV (83 vs. 46%; P = .008) for relevant (AIS ≥ 3 points) pelvic injuries. In contrast, traumatic brain injury according to the AIS head or the GCS does not appear to lead to a significant decrease in coagulation factor activities. Furthermore, the other scores studied show at best a fair correlation with coagulation factor activity. In this context, the RTS score seems to be the most suitable. Additionally, the predictive value of the TASH score, which was specifically developed to predict the need for mass transfusion, was also limited in this study. We would like to explicitly point out that this is not a criticism of the trauma scores, since they were developed in a completely different context.

Predictors for an unsuccessful conservative treatment of patients with medial patellar plica syndrome.

In several cases persistent medial knee pain remains after conservative treatment in patients with medial patellar plica syndrome. In recent literature accepted criteria for surgical indication are lacking. In this retrospective study patients after conservative treatment were evaluated to identify predictors for an unsuccessful outcome. 117 Patients with medial patellar plica syndrome between 2016 and 2019 were retrospectively evaluated. All patients received conservative treatment for three months. Surgery was indicated due to failed conservative treatment (n = 76) with persistent medial knee pain and restriction of activity after 3months. Preoperative MRI analysis, Lysholm score, pain by the visual analog scale (VAS), postoperative sports participation (RTS) and Tegner activity score were collected at least 12months after definite treatment. Statistical analysis was performed to evaluate differences between patients with successful and unsuccessful conservative treatment. There were significant differences in the clinical and radiological findings between patients with successful and unsuccessful conservative treatment. Patients with failed conservative treatment showed a significant larger diameter of the medial patellar plica (0.8 ± 0.3mm vs. 1.6 ± 0.4mm; p < 0.05) and a significant higher rate of contact of the plica to the adjacent cartilage. Furthermore, these patients reported a significant higher rate of medial knee pain from flexion to extension and snapping symptoms. At final follow-up the patient-reported outcome by means of Lysholm score (96.25 vs. 95.93), RTS (96.2% vs. 97%) and Tegner activity score (6.0 vs. 6.01) was excellent after conservative and surgical treatment. There were no statistical differences in the preoperative and postoperative outcomes between both. The diameter of a medial patellar plica and contact of the plica to the retropatellar cartilage as well as clinical signs like persistent medial knee pain from flexion to extension with snapping symptoms might be predictors for an unsuccessful conservative treatment and the need for surgical intervention in patients with painful medial patellar plica syndrome.

Performance validation of different trauma scoring systems among polytrauma patients having predominantly blunt abdominal trauma.

Introduction:Blunt abdominal trauma substantially contributes to mortality and morbidity in patients with polytrauma. Appropriate clinical assessment is important in setups lacking facilities of advanced diagnostics (abdominal computed tomography scans and ultrasonography) to decide if the patients’ needs exceed the facilities available. This study aimed to assess the utility of the commonly used trauma scores in predicting the outcome (favorable or unfavorable) in patients with predominantly blunt abdominal trauma.Study Design and Methods:In this prospective observational study of 12-month duration, we calculated three scores (Glasgow Coma Scale [GCS], Revised Trauma Score [RTS], and Injury Severity Score [ISS]) in patients brought to emergency department and fulfilling the inclusion criteria. These patients were categorized into two categories (favorable and unfavorable) depending on their treatment outcome. The difference in the mean scores for both outcomes in each score was calculated and further inferences were obtained by using the unpaired t test. A receiver-operating characteristic curve for each score was drawn to understand the trade-off between sensitivity and specificity at each cutoff value and for determining area under curve (AUC) for all three scores.Result:A total of 103 patients were recruited in the study (88 men and 15 women) with the mean age of 31.03 (±13.40) years and 34.47 (±18.04) years, respectively. The difference in the scores was maximum for ISS and minimal for RTS. The visual impression, as well as AUC values, shows that ISS performed well to discriminate between the favorable and unfavorable outcomes in each cutoff values (AUC –0.806, lower bound 0.678 to upper bound 0.934) compared to GCS and RTS scores. The Youden's J statistic for ISS value of 42 was maximum (0.298) and corresponding sensitivity and specificity were 0.651 and 0.647.Conclusion:ISS is superior as compared to GCS and RTS in predicting outcome in polytrauma patients with a blunt abdominal injury. ISS value of <42 predicts a favorable outcome.

Physicians' Risk Tolerance and Head Computed Tomography Use for Pediatric Patients With Minor Head Injury.

Traumatic brain injury is the leading cause of death and disability in children worldwide. The objective of this study was to determine the association between physician risk tolerance and head computed tomography (CT) use in patients with minor head injury (MHI) in the emergency department (ED). We retrospectively analyzed pediatric patients (<17 years old) with MHI in the ED and then administered 2 questionnaires (a risk-taking subscale [RTS] of the Jackson Personality Inventory and a malpractice fear scale [MFS]) to attending physicians who had evaluated these patients and made decisions regarding head CT use. The primary outcome was head CT use during ED evaluation; the secondary outcome was ED length of stay and final diagnosis of intracranial injury (ICI). Of 523 patients with MHI, 233 (44.6%) underwent brain CT, and 16 (3.1%) received a final diagnosis of ICI. Among the 16 emergency physicians (EPs), the median scores of the MFS and RTS were 22 (interquartile range, 17-26) and 23 (interquartile range, 19-25), respectively. Emergency physicians who were most risk averse tended to order more head CT scans compared with the more risk-tolerant EPs (56.96% vs 37.37%; odds ratio, 8.463; confidence interval, 2.783-25.736). The ED length of stay (P = 0.442 and P = 0.889) and final diagnosis (P = 0.155 and P = 0.835) of ICI were not significantly associated with the RTS and MFS scores. Individual EP risk tolerance, as measured by RTS, was predictive of CT use in pediatric patients with MHI.

PROGNOSIS OF THE ACUTE PHASE COURSE OF TRAUMATIC DISEASE AND TRANSPORTABILITY IN POLYTRAUMA PATIENTS

OBJECTIVE. The aim of the study was to substantiate the criteria for predicting of the acute phase course of traumatic disease and transportability in polytrauma patients. MATERIAL AND METHODS. The course of traumatic disease was studied in 233 patients. The prognostic value of the ISS, RTS, TRISS scores and Russian VPH-P, VPH-SP and Tsybin scores was studied using the method of binary logistic regression, Roc analysis and correlation analysis. RESULTS. RTS (AUC=0.93), TRISS (AUC=0.86) and Russian VPH-P (AUC=0.74) scores have the highest prognostic value. There is a strong correlation between the RTS and TRISS scores (r =+0.90). CONCLUSION. It is advisable to use the RTS score and Russian VPH-P score to predict the acute phase course of traumatic disease and transportability in polytrauma patients.

Mortality determiners for fall from height cases

The aim of the present study was to investigate the role of body mass index (BMI) and trauma severity score systems on the mortality rates of patients undergoing surgery due to falls from height. This retrospective study included 45 consecutive adult patients with multitrauma who were admitted and operated on due to a fall from height between January 2008 and December 2016. Patients were divided into mortality and recovery groups (n=10 and n=35, respectively). The groups were compared in terms of age, gender, weight, cause of the fall, height of the fall, location of the fall, BMI, trauma scores (Injury Severity Score [ISS], New Injury Severity Score [NISS], Glasgow Coma Scale [GCS], Abbreviated Injury Score [AIS], Revised Trauma Score [RTS]), hospital stay, and postoperative complications. There was no statistically significant difference between the two groups in terms of age, gender, and height or cause of the fall (p>0.05), whereas there was a statistically significant difference with respect to weight and BMI values (p<0.01). A statistically significant difference was determined between the groups in terms of hospital stay and postoperative complications (p<0.01) and ISS, NISS, GCS, AIS, and RTS scores (p<0.05). The effect of weight and BMI on the mortality rate of patients presenting with trauma as a result of a fall from height was objectively demonstrated in the present study.

Prognostic value of 2-hour lactate level and lactate clearance for 30-day mortality and comparison with trauma scores in multi-trauma patients.

Objective:Trauma scores are prone to misreading. Therefore, a readily available, objective way to estimate the mortality of the trauma patients is needed. We aimed to evaluate the prognostic utility of lactate levels, and clearance for 30-days mortality, and compare with the physiological trauma scores.Methods:All adult trauma patients (two hundred) admitted to ED were enrolled. Initial and 2-hour serum lactate levels were measured and components of GAP, MGAP, RTS, VIEWS and VIEWS-L trauma scores were calculated.Results:Final study population was 200 patients with a median age of 33 years. Mortality was 7/200 (3.5%) in 30-days. Both initial (2.3 vs. 7.7 mmol/L) and 2h-lactate (1.7 vs. 8.4 mmol/L) levels were significantly lower, and lactate clearance was significantly higher (23.8% vs. -12.0%) in survivors. Also, the change in the lactate level from 0h to 2h (2.3 vs. 1.7mmol/L) was significant in survivors, contrary to non-survivors (7.7 vs. 8.4mmol/L). VIEWS-L, VIEWS, two hour-lactate level and EMTRAS showed high specificity at the 100% sensitivity cut-offs, therefore, were the most valuable prognostic parameters in this study.Conclusion:Calculation of 2h-lactate clearance and evaluation of a 2h-lactate level may not be needed to predict long-term mortality if the initial lactate level is below 2.8mmol/L.

Clasificación de lesionados en tránsito, oportunidad en la atención y gasto hospitalario en una institución de salud de alta complejidad en el departamento de Santander (Colombia)

Objetivo: Calcular la escala de severidad de trauma RTS Revised Trauma Score y realizar un análisis comparativo con la clasificación de los pacientes según el sistema de Triage. Describir los indicadores de oportunidad en la atención y el gasto hospitalario. El Estado, establece el sistema de priorización de pacientes que consultan al servicio de urgencias y define tiempos de espera según la clasificación. Se aplica con el fin de optimizar los recursos institucionales. Materiales y métodos: Estudio observacional descriptivo retrospectivo. La población estuvo conformada por 6401 pacientes, la muestra por 248 pacientes. Resultados: 81% Triage II (Paciente Agudo). Según la escala de trauma RTS, el 92.7% correspondían a Trauma leve y 1.6% trauma grave. El 40% de los lesionados fueron poli-traumatizados, 56% presentaron lesión en pelvis y extremidades inferiores. La mortalidad fue del 2.4%. El 48.4% de los lesionados accedió a urgencias en ambulancia, el tiempo promedio para el acceso fue de 60 minutos, 39.1% de las víctimas, 61% requirió interconsulta por Ortopedia y 26% de los pacientes requirieron recursos del Sistema de Seguridad Social. Conclusiones: La escala de trauma RTS score utiliza parámetros fisiológicos medibles, clasificó el 1.6% de los lesionados como graves, lo cual se relaciona con el 2.4% de mortalidad de las víctimas del estudio. La medición de los indicadores de accesibilidad y oportunidad en la atención en salud, mostró en esta institución de salud de alta complejidad que los tiempos son acordes a la normatividad vigente del Ministerio de Salud.

COMPARATIVE ANALYSIS OF ACCURACY AMONG GLASGOW COMA SCALE, TRAUMA SCORE, AND REVISED TRAUMA SCORE AS PREDICTORS OF MORTALITY HEAD INJURY PATIENTS

Measurement of severity and mortality predictions in cases of head injury is an important step to support appropriate, effective and efficient clinical decision-making. Glasgow Coma Score, Trauma Score, and Revised Trauma Score are physiologycal scoring systems that can be used as predictors of mortality of head injury patients. The objective of the study was to know which scoring systems had the best accuracy as a predictor of mortality of head injured patients. The observational analytic study with this retrospective cohort design approach was carried out at dr. Iskak Tulungagung on Medical Record. Data taken from all patient medical records from January 2016 to July 2017 amounted to 150 medical records. Variables used were GCS, RTS, and TS scores when patients were admitted to hospital IGD as well as patient mortality data within 7 days of treatment. The data obtained is then processed with SPSS 20 using Mann Whitney Test, logistic regression and ROC curve comparison. Based on the results of multivariate logistic regression analysis, GCS accuracy results: sensitivity= 0.7586, specificity= 0.7934, PPV= 0.468, NPV= 0.932; RTS accuracy: sensitivity= 0.766, specificity= 0.8, PPV= 0.489, and NPV= 0.932; TS accuracy: sensitivity= 0.7, specificity= 0.783, PPV= 0.4468, NPV= 0.9126. The comparison graph analysis of ROC curve showed no significant difference of AUC between GCS, RTS, and TS because the difference was too low (&lt;15%). There was no significant difference of accuracy between RTS, GCS, and TS use in predicting head injury mortality

STUDY ON THE APPLICATION OF ISS AND RTS FOR THE EVALUATION OF SEVERITY OF TRAUMATIC PATIENTS TREATED IN BACH MAI HOSPITAL

Background: Injury is a common surgical emergency causing serious burden for patients and the society. Accurate diagnosis and prognosis of trauma patients are helpful in the treatment of these patients. Objectives: To apply ISS and RTS for the evaluation of the severity of trauma patients admitted Emergency room of Surgery Department, Bach Mai Hospital. Subjects and methods: A retrospective study on 194 trauma patients treated at the Emergency room of the Surgery Department, Bach Mai Hospital from 8/2015 to 12/2016. Results: There were total 194 patients, 131 males (67.5%), 63 females (32.5%). The average age was 41.7±18.7. Median RTS score was 7.84 in 96.6% of the patients with corresponding survival probability was 0.988. There was 114 minor case (59.7%), 59 moderate case (30.9%), 16 severe case (8.4%), 2 critical case (1.1%) and 0 unsurvivable case based on the ISS classification. There was no significant difference in ISS between preservation and surgical group. Conclusion: Most of our patients was mild and moderate. Severity scores such as RTS and ISS were useful in these patients. Key words: Injury, ISS, RTS, preservation, surgery

The Association Between Physician Empathy and Variation in Imaging Use.

Variation in emergency physician computed tomography (CT) imaging utilization is well described, but little is known about what drives it. Physician empathy has been proposed as a potential characteristic affecting CT utilization. The objective was to describe empathy in a cohort of emergency physicians and evaluate its association with CT utilization. We also sought to compare emergency physician performance on an empathy psychometric test with performance on other psychometric tests previously proposed as predictors of CT utilization. This cross-sectional study included two parts: 1) a secondary analysis of emergency department (ED) CT imaging utilization data in a large health system from July 2013 to June 2014 and 2) a survey study of the cohort of physicians responsible for this imaging using four psychometric scales: the Jefferson Scale of Empathy (JSE), a risk-taking subset of the Jackson Personality Index (RTS), the Stress from Uncertainty Scale (SUS), and the Malpractice Fear Scale (MFS). The study included data and physicians from four EDs: one urban, academic ED, two community, and one free-standing. A hierarchical, mixed-effects regression model was used to evaluate the association between emergency physician performance on the four scales and risk-adjusted CT imaging utilization. The model incorporated physician-specific CT utilization rates adjusted for propensity scores that were calculated using over 500 patient-level variables via random forest methods, physician demographics, and a random provider effect to account for the clustering of observations. CT variation analysis included 113,517 patients seen during the study period by the 74 eligible emergency physician survey respondents; 20,972 (18.5%) of these patients had at least one CT. The survey response rate was 74 of 82 (90.2%). Correlation coefficients between JSE and the other scales were not statistically significant. In subset analysis, there was a trend toward a physician's number of years in practice and RTS score contributing to CT utilization for traumatic head CT. There were no significant associations between performance on any of the psychometric scales and CT utilization. Performance on the JSE, RTS, SUS, or MFS was not predictive of risk-adjusted CT utilization in the ED. The underlying physician-based factors that mediate interphysician variation remain to be clearly identified.

Can APACHE II, SOFA, ISS, and RTS Severity Scores be used to Predict Septic Complications in Multiple Trauma Patients?

Physiological composite scores are used to predict mortality in multiple trauma patients. Sepsis is the leading cause of late mortality in trauma victims brought about by immune suppression due to homeostasis dysregulation. To determine whether APACHE II, SOFA, ISS and RTS scores can predict the occurrence of sepsis in multiple trauma patients. APACHE II, SOFA, ISS, and RTS scores were calculated during the first twenty-four hours after the injury for sixty-four adult poly-traumatic patients. The occurrence of infectious complications was investigated over a fourteen-day period. The infection-free rates for the multiple trauma patients were considered as end-points in the Kaplan-Meier plot analysis. For SOFA, a cutoff score of 4 points was identified as a predictor of the occurrence of sepsis, with 89% of the patients with SOFA<4 being infection-free, while 37% of those with SOFA>4 were infection-free (p<0.01). None of the patients with APACHE II≤5 points developed infections. Eighty-four percent of patients with APACHE II scores of 5-10 did not develop sepsis, while 49% with APACHE II≥11 were infection-free (p<0.01). A cutoff of 7 points was found to be most discriminative for RTS. Eighty-eight percent of the patients with RTS≤7 and 43% of those with RTS<7 were infection-free (p<0.01). Eighty-eight percent of patients with ISS≥22 did not develop sepsis and 56% with ISS>22 did not develop sepsis (p<0.01). APACHE II, SOFA, ISS, and RTS functional severity scores can predict mortality as well as the occurrence of sepsis in multiple trauma patients.

Blunt aortic injury: risk factors and impact of surgical approaches.

This study reviews our 17-year experience of managing blunt traumatic aortic injury (BTAI). We analyzed information collected retrospectively from a tertiary trauma center. Between October 1995 and June 2012, 88 patients (74 male and 14 female) with a mean age of 39.9±17.9years (range 15-79years) with proven BTAI were enrolled in this study. Their GCS, ISS, and RTS scores were 12.9±3.7, 29.2±9.8, and 6.9±1.4, respectively. Twenty-one (23.8%) patients were managed non-operatively, 49 (55.7%) with open surgical repair, and 18 (20.5%) with endovascular repair. The in-hospital mortality rate was 17.1% (15/81) and there were no deaths in the endovascular repair group. The mean follow-up period was 39.9±44.2months. The survivors of blunt aortic injury had lower ISS, RTS, TRISS, and serum creatinine level and lower rate of massive blood transfusion, shock, and intubation than the patients who died, despite higher rates of endovascular repair, hemoglobin, and GCS on presentation. The degree of aortic injury, different therapeutic options, GCS, shock presentation, and intubation on arrival all had significant impacts on outcome. Shock, aortic injury severity, coexisting trauma severity, and different surgical approaches impact survival. Endovascular repair achieves a superior mid-term result and is a reasonable option for treating BTAI.

Accuracy of mechanism, glasgow coma scale, age and arterial pressure (MGAP) score in predicting mortality in Polytrauma patients

The purpose of this investigation was to evaluate the accuracy of the MGAP score and its components in prediction of in-hospital mortality versus the accuracy of the Revised trauma score RTS in Emergency department. This study included 220 patients; all were polytrauma patients subjected to Blunt and Penetrating trauma including head injuries. Mortality rate in low risk group according to MGAP and RTS scores was (8.5% and 1% respectively) it was significant (p=0.01), in moderate risk group (47.7% and 66.3% respectively) it was significant (p=0.04). Meanwhile, in High risk group (96.6% and 100% respectively) it wasn't significant (p=1.000). RTS is better than MGAP in predicting mortality in low risk group, MGAP is better than RTS in intermediate risk group and no difference between both scores in high risk group.

Surgical Treatment of Blunt Liver Trauma, Indications for Surgery and Results

IntroductionThe liver is the most frequently injured organ in blunt abdominal trauma. Patients who are hemodynamically unstable must undergo immediate surgical treatment. There are 2 surgical approaches for these patients: Anatomical Liver resection and non-anatomic liver resection. Around 80%–90% of patients are candidates for non-operative management. Several risk factors have been studied to select the patients most suited for a non-operative management. Materials and methodsWe performed a retrospective study based on a prospective database. We searched for risk factors related to immediate surgical management and failed non-operative management. We also described the surgical procedures that were undertaken in this cohort of patients and their outcomes and complications. ResultsDuring the study period 117 patients presented with blunt liver trauma. 19 patients (16.2%) required a laparotomy during the initial 24h after their admission. There were eleven deaths (58%) amongst these patients. Peri-hepatic packing and suturing were the most common procedures performed. An RTS Score<7.8 (RR: 7.3; IC 95%: 1.8–30.1), and ISS Score >20 (RR 2,5 IC 95%: 1.0–6.7), and associated intra-abdominal injuries (RR: 2.95; IC 95%: 1.25–6.92) were risk factors for immediate surgery. In 98 (83.7%) patients a non-operative management was performed. 7 patients had a failed non-operative management. ConclusionThe need for immediate surgical management is related to the presence of associated intra-abdominal injuries, and the ISS and RTS scores. In this series the most frequently performed procedure for blunt liver trauma was peri-hepatic packing.

Early trauma induced coagulopathy (ETIC): Prevalence across the injury spectrum

IntroductionNewer studies have hypothesised about a coagulopathy that occurs early after trauma, early trauma induced coagulopathy, ETIC, and is defined by an elevated admission prothrombin time (PT). Also, referred to by some authors as acute traumatic coagulopathy, it has been most often studied in cohorts of severely injured or hypotensive patients. However, we wanted to prospectively investigate ETIC in a large all-comers cohort to confirm its prevalence across the entire spectrum of injury, to evaluate its risk pattern and to determine a possible relationship to reduced survival. MethodsWe conducted a prospective cohort study at a Level I trauma centre from July 15, 2008 to November 15, 2009. Demographics, injury mechanism, time from injury and to hospital arrival, fluid and blood administration and vital signs were collected at hospital arrival and to the time of first blood sample collection for all patients admitted for 24h or longer. Our primary outcome was the incidence of mortality by the 28th hospital day, referred to as 28 day in-hospital mortality. Results701 patients were included in the final study cohort. There was 75.3% male, 25.7% penetrating, with a mean age of 39 years. The overall mortality was 7.3%. ETIC occurred in 114 patients (16.3%) and was found to be independently associated with death (odds of death (per 0.10s increase in PT): 1.10, p=0.001). ETIC patients, as a group, were more severely injured, had more hypotension and head injury and used more crystalloid and blood products than non-ETIC patients. However, even mildly injured patients, who had an ISS<16, normal RTS score, and no fluid resuscitation, had an ETIC prevalence of 11.7% (11/94). ConclusionsETIC is an early, primary post-injury coagulopathy that occurs in 16.3% of admitted trauma patients. It is associated with an increase in mortality, even when controlling for crystalloids, vital signs, injury severity and head injury. It can also be found in approximately 11% of mildly injured patients (patients without physiological derangement or blood product administration). Therefore, further elucidation of ETIC is strategic to impacting trauma patient outcome.

Tratamiento del traumatismo cerrado de hígado, indicaciones de cirugía y desenlaces

IntroductionThe liver is the most frequently injured organ in blunt abdominal trauma. Patients that are hemodynamically unstable must undergo inmmediate surgical treatment. There are 2 surgical approaches for these patients; Anatomical Liver resection or non-anatomic liver resection. Around 80-90% of patients are candidates for non-operative management. -Several risk factors have been studied to select the patients most suited for a non operative management. Materials and methodsWe performed a retrospective study based on a prospective database. We searched for risk factors related to immediate surgical management and failed non-operative management. We also described the surgical procedures that were undertaken in this cohort of patients and their outcomes and complications. ResultsDuring the study period 117 patients presented with blunt liver trauma. 19 patients (16.2%) required a laparotomy during the initial 24h after their admission. There were 11 deaths (58%) amongst these patients. Peri-hepatic packing and suturing were the most common procedures performed. A RTS Score<7.8 (RR: 7.3; IC 95%: 1.8-30.1), and ISS Score >20 (RR 2,5 IC 95%: 1.0-6.7), and associated intra-abdominal injuries (RR: 2.95; IC 95%: 1.25-6.92) were risk factors for immediate surgery. In 98 (83.7%) patients a non-operative management was performed. 7 patients had a failed non-operative management. ConclusionThe need for immediate surgical management is related to the presence of associated intra-abdominal injuries, and the ISS and RTS scores. In this series the most frequently performed procedure for blunt liver trauma was peri-hepatic packing.

Porovnání RTS a ISS skórovacích systémů v predikci naděje na přežití u pacientů s mnohočetným poraněním

Porovnání RTS a ISS skórovacích systémů v predikci naděje na přežití u pacientů s mnohočetným poraněním