RTS Scores Research Articles

Efficiency of RTS and TRISS Scores on Prognosis Evaluation in ICU Trauma Patients

Efficiency of RTS and TRISS Scores on Prognosis Evaluation in ICU Trauma Patients

Factors Influencing Mortality in Pediatric Trauma Patients

Objective: In our study, we aimed to research the factors we thought might be affect mortality in a pediatric age group (0-15 y) with multiple trauma. Materials and Methods: In our study of 1658 pediatric patients suffering from falling events, burns, cutting and perforating instrument injuries, gunshot injuries and vehicle accidents admitted to Dicle University. hospital ED between March 2003 and December 2006 were analyzed and included to the study consecutively. The patients were divided in two groups, the patients who survived were in group 1, and the patients who died were in group 2. Results: Of the 1658 patients, 70.5% (n= 1169) were male, 29.5% (n= 489) were female and 107 patient died (6.46 %). Mean age was 6.75+-0.397 in group 2 (who died) and 7.00+-0.99 in group 1, (survived). Low RTS score (OR (odds ratio)=1.565, CI=1.297-1.889, p<0.05). Falling down from height OR=0.637, CI=0.4080.995, p<0.05), postulated admission (OR=2.035 CI=1.267-3.267, p<0.05) and medical treatment (OR=0.451, CI=0.273-0.744, p<0.05) were found to be the effective factors in pediatric patients with multiple trauma. Conclusion: The falling events, abdominal and thoracic trauma with low ISS, RTS, TRISS and postulated admission to ED are the factors that affect the mortality in pediatric trauma patients. (JAEM 2012; 11: 161-6)

Aortic injuries in crush trauma patients: Different mechanism, different management

BackgroundThe objective of this study is to report the clinical and radiological characteristics and early and long-term survival of a series of acute traumatic aortic injuries (ATAI) in crush trauma patients, and to compare such data with our last 30 years experience managing ATAI in deceleration non-crush trauma patients. MethodsFrom January 1980 to December 2010, 5 consecutive ATAI in crush trauma and 69 in non-crush trauma patients were admitted at our institution. ISS, RTS and TRISS scores were similar in both groups. ResultsOverall in-hospital mortality was 24.3%. There was no in-hospital mortality in crush patients and 26.1% in non-crush patients (p=0.32).All aortic-related complications occurred in non-crush patients. Median follow-up was 129 months (range 3–350 months). Non-crush group survival was 76.8% at 1 year, 73.6% at 5 years, and 71.2%% at 10 years. There was no mortality during follow-up in the crush group. Mean (SD) peak creatine phosphokinase was significantly higher in crush group than in non-crush group: 7598 (3690)IU/L vs. 3645 (2506)IU/L; p=0.041. Incidence of acute renal injury was higher in crush trauma patients (100% vs. 36.2%; p=0.018). Low-severity injuries were more common in crush trauma patients (100% in crush patients vs. 43.5% in non-crush patients, p=0.04). ConclusionsAortic injuries in crush thoracic trauma patients seem to present in a different clinical scenario from aortic injuries in high-speed thoracic trauma thus requiring distinct considerations. When planning the initial management of aortic injuries in crush trauma, the increased risk of rhabdomiolysis and subsequent acute renal failure, as well as a tendency to develop lower-risk aortic wall injuries, must be considered.

What Do Prehospital Trauma Scores Predict Besides Mortality?

Little information is available concerning the ability of prehospital triage scores to predict endpoints other than mortality. We evaluated two cohorts (a national cohort of 1,360 patients during 2002 and a single center cohort of 1,003 patients in 2003-2005) of trauma patients receiving care from a prehospital mobile intensive care unit (ICU). We tested the ability of prehospital triage scores (MGAP, Revised Trauma Score [RTS], and triage RTS [T-RTS]) to predict a severe injury, the need for a prolonged ICU period, the occurrence of massive hemorrhage, and the need for emergency procedures, and compared them with a reference score (Trauma-Related Injury Severity Score [TRISS]). The areas under the receiver operating characteristic (AUC(ROC)) curves were measured. The MGAP, RTS, and T-RTS scores were able to predict an Injury Severity Score >15 (AUC(ROC): 0.75, 0.75, and 0.74, respectively), the need for a stay in ICU >2 days or death (AUC(ROC) of 0.85, 0.83, and 0.83, respectively), and the massive hemorrhage (AUC(ROC): 0.70, 0.72, and 0.73, respectively). In contrast, MGAP, RTS, T-RTS, and TRISS scores were not predictors of the need of an emergency procedure (AUC(ROC): 0.53, 0.51, and 0.52, respectively). Four independent predictors of emergency procedure were noted: penetrating trauma, intravenous colloid administration >750 mL, systolic arterial blood pressure <100 mm Hg, and heart rate >100 bpm. Prehospital triage scores were predictors of Injury Severity Score >15, prolonged ICU stay, and massive hemorrhage but not of emergency procedure requirement.

Use of Focused Assessment with Sonography in Trauma in Emergency Department Patients for Triage, Diagnosis and Disposition: A Series of Cases

Objective: The aim of this study was to determine the effectiveness of fo cused assessment with sonography in blunt trauma (FAST) patients as an initial diagnostic and observational tool. Material and Methods: This descriptive prospective study was performed by collecting data from patients with blunt trauma who presented to our tertiary university hospital emergency department (ED) between October 2008 and December 2008 and who were evaluated with ultrasound by the treating emergency medicine physician (GE Proseries Logic 200 machine with a 3.5 MHz large curved array probe). Demographic, clinical, laboratory, and imaging data were collected prospectively and ISS, RTS, TRISS, and Glasgow scores were calculated. Results: During the study period, 28 patients presented with blunt trauma and they were evaluated with a bedside ultrasound within 10 minutes. Only one patient had splenic trauma and two had pleural fluid on FAST exam. The FAST results correlated positively with the decrease in hematocrit (Htc) values, ISS, TRISS, and duration of admission (p=0.006, 0.01, 0.034, 0.009). 96.4% (n=27) of the patients were discharged, and 3.6% (n=1) died. Conclusion: FAST was the first and an observational clue for trauma before Htc, or even physical examination. (JAEM 2011; 10: 119-22)

Treatment of Penetrating Hepatic Injuries: A Retrospective Analysis of 50 Patients

Aim: The aim of this study was to determine the possibility of non-operative treatment via retrospective analysis of our patients. Methods: Fifty patients with penetrating hepatic injuries were examined retrospectively with respect to trauma scores, associated injuries, complications, and mortality parameters. Results: Thirteen injuries were caused by firearms, whereas 37 injuries were caused by stab wounds. Forty-three patients (86%) underwent laparotomy and 7 patients (14%) were monitored by CT and clinical findings (nonoperative group, NO group). The laparotomies were evaluated as non-therapeutic in 11 patients (22%) (NTL group) and therapeutic in 32 patients (64%) (TL group). The morbidity and mortality rates were 40 and 10%, respectively. RTS and ISS scores of the nonsurviving and the surviving patients were significantly different. The rates of major venous, grade IV–V hepatic injuries, and gunshot wounds were significantly higher in the nonsurviving patients when compared to the surviving patients. Conclusion: Major venous and grade IV–V hepatic injuries were the primary factors determining mortality and these injuries generally occurred as a result of firearm injuries. NTL occurring at a rate of 22% would decrease to 2% if ‘RTS <7’ criteria was added to the hemodynamic instability and/or peritoneal irritation findings determining surgical candidacy.

Multicenter Comparison of GCS and RTS Scores at the Scene vs at the Trauma Hospital

Multicenter Comparison of GCS and RTS Scores at the Scene vs at the Trauma Hospital