Cases Of Severe Trauma Research Articles

The Incidence and Severity of Pediatric Injuries Sustained by Electric Bikes and Powered Scooters: The Experience of an Urban, Tertiary Pediatric Emergency Department.

This study aimed to describe the incidence and severity of electrical bicycle (E-bike)- and power scooter (P-scooter)-related injuries and their secular trends among pediatric patients presenting to a pediatric emergency department (ED). This retrospective cohort study of patients aged <18 years who sustained E-bike and P-scooter injuries was performed between 2018 and 2023. We explored trends of severe trauma cases, ED visits, hospitalizations, and surgical interventions. Severity of trauma was rated by either an injury severity score (ISS) of >15 or the patient's need for acute care as defined by intensive care unit (ICU) admission, direct disposition to the operating room, acute interventions performed in the trauma room, and in-hospital death. Of the 1466 pediatric patients who presented to our pediatric ED following P-scooter and E-bike injuries, 216 (14.7%) were hospitalized, with a median age of 14.0 years (interquartile range, 10.5-16.0 years) and male predominance (69.0%). The number of ED visits increased 3.5-fold by study closure, with a parallel increase in hospitalizations, surgical interventions, and severe trauma cases. The relative percentages of severe trauma cases were not significantly different over time. Among hospitalized patients, 3 patients (1.4%) died and 9 (4.1%) required rehabilitation care. The incidence and severity of E-bike and P-scooter injuries and fatalities continue to increase within the pediatric population. Current personal and road safety regulations are providing inadequate in preventing these injuries, highlighting an urgent need for revision and stricter enforcement.

Frailty and 6-month trajectory of elderly trauma patients over the age of 65 years admitted to intensive care unit for severe trauma: experience of a level 1 trauma center

BackgroundThe aging global population forecasts a significant rise in severe trauma cases among individuals aged 65 and above. Frailty emerges as a paramount predictor of post-traumatic outcomes, surpassing age and trauma severity indices. Despite this, scant attention is given to the trajectory of elderly patients post-intensive care unit (ICU) stay following severe trauma, justifying this study. The objective of this study was to analyze trajectories (frailty, place of residence) following a major trauma requiring an ICU stay.Materials and methodsAn observational cohort study was conducted, leveraging data from a level 1 trauma center spanning 2018 to 2023. Inclusion criteria included elderly patients aged 65 and above admitted to the ICU for severe trauma. Data encompassed demographic profiles, trauma severity scores, clinical parameters, and frailty assessments sourced from the Traumabase database.ResultsAmong 293 patients included 190 were non-frail, frailty was correlated with elevated mortality rates (114 (38.9%) at 6 months), heightened incidence of traumatic brain injuries, and notable declines in post-traumatic autonomy. Only 39.2% of patients had resumed residence at home six months post-injury, with a conspicuous trend towards institutionalization, particularly among frail individuals.ConclusionThis study highlights the role of frailty in determining the outcomes of elderly patients following severe trauma. Frailty is associated with higher mortality, increased rates of institutionalization, and a decline in functional status. These results highlight the importance of assessing frailty in the trajectory of severely injured patients over the age of 65 years-old.

The epidemiology and outcomes of severe road traffic injury by road user type in Korea: A nationwide retrospective observational study

ObjectivesRoad traffic injuries (RTIs) pose a significant public health burden, and more than half of these fatalities are attributed to vulnerable road users (VRUs). This study aimed to evaluate the epidemiology and outcomes of severe RTIs in Korea by focusing on different types of road users. MethodsThis is nationwide retrospective observational study. Using data from the Korean Nationwide Severe Trauma Registry, this study analyzed severe RTI cases from 2016 to 2020. The study included EMS-treated severe trauma patients, defining severe RTI as cases with an injury severity score (ISS) ≥16 or out-of-hospital cardiac arrest (OHCA). The main variable of interest was the road user type, classified as motor vehicle occupants (MVOs), pedestrians, motorcyclists, and bicyclists. Trends and injury characteristics by road user type were analyzed, and multivariate logistic regression was conducted to calculate the adjusted odds ratios (AORs) and 95 % confidence intervals (CIs) of road user type for in-hospital mortality. ResultsOf the 143,021 EMS-treated severe trauma cases, 24,464 were included in this study. Pedestrians represented the largest group (n = 8,782; 35.9 %). More than half of the patients died (n = 12,620, 51.6 %), and a high proportion of patients had OHCA (n = 10,048, 41.1 %). There was no significant change in the overall severe RTI numbers from 2016 to 2020, but a decrease in pedestrian cases and an increase in motorcyclist cases were noted (both p for trend<0.05). Low usage of safety devices was observed (28.2 % of motor vehicle occupants used seat belts, 35.9 % of motorcyclists used helmets, and 9.6 % of bicyclists used helmets). Head injuries were most common, particularly among bicyclists (77.0 %) and motorcyclists (69.8 %). Compared to motor vehicle occupants, pedestrians (AOR [95 % CI] 1.12 [1.04–1.20]) and others (AOR [95 % CI] 1.30 [1.02–1.65]) had higher odds of mortality, while motorcyclists (AOR [95 % CI] 0.64 [0.59–0.69]) and bicyclists (AOR [95 % CI] 0.68 [0.60–0.76]) had lower odds of mortality. ConclusionWe found varying trends and injury characteristics in severe RTIs according to road user type. Adapting prevention strategies for evolving road user patterns, with particular attention to increasing safety device usage and addressing the high mortality associated with severe RTIs are warranted.

TraumaFlow-development of a workflow-based clinical decision support system for the management of severe trauma cases.

The treatment of severely injured patients in the resuscitation room of an emergency department requires numerous critical decisions, often under immense time pressure, which places very high demands on the facility and the interdisciplinary team. Computer-based cognitive aids are a valuable tool, especially in education and training of medical professionals. For the management of polytrauma cases, TraumaFlow, a workflow management-based clinical decision support system, was developed. The system supports the registration and coordination of activities in the resuscitation room and actively recommends diagnosis and treatment actions. Based on medical guidelines, a resuscitation room algorithm was developed according to the cABCDE scheme. The algorithm was then modeled using the process description language BPMN 2.0 and implemented in a workflow management system. In addition, a web-based user interface that provides assistance functions was developed. An evaluation study was conducted with 11 final-year medical students and three residents to assess the applicability of TraumaFlow in a case-based training scenario. TraumaFlow significantly improved guideline-based decision-making, provided more complete therapy, and reduced treatment errors. The system was shown to be beneficial not only for the education of low- and medium-experienced users but also for the training of highly experienced physicians. 92% of the participants felt more confident with computer-aided decision support and considered TraumaFlow useful for the training of polytrauma treatment. In addition, 62% acknowledged a higher training effect. TraumaFlow enables real-time decision support for the treatment of polytrauma patients. It improves guideline-based decision-making in complex and critical situations and reduces treatment errors. Supporting functions, such as the automatic treatment documentation and the calculation of medical scores, enable the trauma team to focus on the primary task. TraumaFlow was developed to support the training of medical students and experienced professionals. Each training session is documented and can be objectively and qualitatively evaluated.

The application of electrical impedance tomography and surgical outcomes of thoracoscope-assisted surgical stabilization of rib fractures in severe chest trauma

Serious blunt chest trauma usually induces hemothorax, pneumothorax, and rib fractures. More studies have claimed that early video-assisted thoracoscopic surgery with surgical stabilization of rib fractures (SSRF) results in a good prognosis in patients with major trauma. This study aimed to verify the outcomes in patients with chest trauma whether SSRF was performed. Consecutive patients who were treated in a medical center in Taiwan, for traumatic events between January 2015 and June 2020, were retrospectively reviewed. This study focused on patients with major trauma and thoracic injuries, and they were divided into groups based on whether they received SSRF. We used electrical impedance tomography (EIT) to evaluate the change of ventilation conditions. Different scores used for the evaluation of trauma severity were also compared in this study. Among the 8396 patients who were included, 1529 (18.21%) had major trauma with injury severity score > 16 and were admitted to the intensive care unit initially. A total of 596 patients with chest trauma were admitted, of whom 519 (87%) survived. Younger age and a lower trauma score (including injury severity scale, new injury severity score, trauma and injury severity score, and revised trauma score) account for better survival rates. Moreover, 74 patients received SSRF. They had a shorter intensive care unit (ICU) stay (5.24, p = 0.045) and better performance in electrical impedance tomography (23.46, p < 0.001). In patients with major thoracic injury, older age and higher injury survival scale account for higher mortality rate. Effective surgical stabilization of rib fractures shortened the ICU stay and helped achieve better performance in EIT. Thoracoscope-assisted rib fixation is suggested in severe trauma cases.

EFFECT OF GENDER ON 28-DAY SURVIVAL RATES AND TRANSFUSION VOLUME IN SEVERE TRAUMA PATIENTS: A MULTICENTER OBSERVATIONAL STUDY.

Background: This study clarified the relationship between sex with survival and transfusion volume in severe trauma cases. Methods: A multicenter, collaborative post hoc analysis of patients with trauma in Japan was conducted. Patients aged ≥18 years with severe trauma indicated by an Injury Severity Score (ISS) of 16 or higher were enrolled. Patients were matched and analyzed by gender based on propensity score with factors determined at the time of injury. Subgroup analysis was performed on patients younger than 50 years and older than 50 years. The significance level was defined as P < 0.05. Results: The 1,189 patients included in this registry were divided into adjusted groups of 226 male and female patients each. In the main analysis, 28-day survival rates in females were significantly higher than those in males ( P = 0.046). In the subgroup analyses, there was no statistically significant prognostic effect of gender. Secondary outcomes, including transfusion volume, showed no significant gender-based variations. Logistic regression analyses consistently demonstrated that female sex was a significant favorable prognostic factor in all ages. This was true for the over-50 group on subgroup analysis, but no significant gender-prognosis relationship was identified in the under-50 age group. High ISSs were associated with poorer outcomes across all age groups. Conclusion: In severe trauma, survival at 28 days was significantly lower in males. However, this trend was not observed in patients aged <50 years. Factors other than sex hormones may be responsible for differences in posttraumatic outcomes by gender.

Eastern Association for the Surgery of Trauma (EAST) vs Western Trauma Association (WTA): How a Level 1 Trauma Center Splits the Difference in Resuscitative Thoracotomy.

Background Resuscitative thoracotomy (RT) is performed in severe trauma cases as a final lifesaving effort. Prominent, yet differing, practice management guidelines exist from Eastern Association for the Surgery of Trauma (EAST) and Western Trauma Association (WTA). This study evaluates all RTs performed from 2012 to 2019 at an urban Level 1 trauma center for management guideline indication and subsequent outcomes. Methods Our trauma registry was queried to identify RT cases from 2012 to 2019. Data was collected on patient demographics, prehospital presentation, cardiopulmonary resuscitation (CPR) requirements, and resuscitation provided. Survival to the operating room, intensive care unit, and overall were recorded. Information was compared with regard to EAST and WTA criteria. Results Eighty-seven patients who underwent RTs were included. WTA guidelines were met in 78/87 (89.7%) of cases, comparatively EAST guidelines were met in every case. Within the EAST criteria, conditional and strong recommendations were met in 70/87 (80.4%) and 17/87 (19.5%) of cases, respectively. In nine cases (10.3%) indications were discordant, each meeting conditional indication by EAST and no indication by WTA. All patients that survived to the operating room (OR), ICU admission, and overall met EAST criteria. Conclusion All RTs performed at our Level 1 trauma center met indications provided by EAST criteria. WTA guidelines were not applicable in nine salvaging encounters due to the protracted duration of CPR before proceeding to RT. Furthermore, more patients that survived to OR and ICU admission met EAST guidelines suggesting an improved potential for patient survivability. As increased data is derived, management guidelines will likely be re-established for optimized patient outcomes.

A meta-analysis of cognitive and functional outcomes in severe brain trauma cases.

Severe traumatic brain injuries (TBIs) are an important health issue worldwide, which are associated with harmful side effects. This meta-analysis investigates the cognitive and functional outcomes in severe brain trauma cases. It assesses the impact on memory, verbal and visual abilities, attention, learning, and the presence of depression. The study provides a comprehensive overview of the consequences of severe brain trauma injury on cognitive and functional domains. The main objective of the current comprehensive meta-analysis study is to assess and analyze the impact of severe TBI on functional and cognitive outcomes, including verbal, visual, attention, learning, memory, and emotional stability. We collected data from three online databases, including PubMed, Cochrane Library, and Embase. Case-control trials related to severe TBI association with cognitive and functional outcomes were included. Verbal strength, visual functions, learning abilities, attention, memory, and depression were considered primary outcomes. We have included 13 case-control studies with 1,442 subjects in this meta-analysis, which provide adequate data to determine the pooled effect size for targeted outcomes. The effect of severe TBI on the inducement of depression and impairment of memory, verbal, visual, attention, and learning abilities compared to the control group showed statistically significant outcomes (p < 0.05). Severe TBI is strongly associated with impaired cognitive and functional abilities, including visual and verbal disabilities, impaired memory, depression inducement, attention deficits, and learning disabilities.

Accuracy of rapid blood coagulation testing device FibCare® in a tertiary emergency department.

FibCare® is a novel point-of-care testing device enabling prompt evaluation of fibrinogen levels. This study aimed to investigate the accuracy of FibCare® at a tertiary emergency department. Blood specimens obtained at a tertiary emergency medical center between October 1, 2021, and April 30, 2023, were evaluated. The correlation between the fibrinogen levels assessed via FibCare® and those via the Clauss method was evaluated using the Spearman's test. The discrepancy between the two measurement methods was assessed according to fibrinogen level and diagnosis. A total of 177 specimens from 147 patients were eligible for the analysis. The median age of the patients was 49 years, and 109 (61.6%) were men. The two measurements had statistically significant but moderate correlation (p < 0.001, ρ = 0.76). FibCare® missed 14 out of 35 cases from patients with hypofibrinogenemia (fibrinogen ≤150 mg/dL assessed by the Clauss method). The discrepancy between the two measurements was significantly greater in specimens with lower fibrinogen levels and those obtained from patients following trauma. FibCare®, a novel point-of-care testing device, can be compatible with the Clauss method. However, clinicians should be aware of the risk that FibCare® may underestimate fibrinogen reduction, especially in severe cases and trauma cases.

Innovation in surgical trauma care education: assessment of a Panamerican Trauma Society online surgical skills course hosted by the Spanish Surgical Association.

Incorporating surgical skills education in trauma care is essential for young surgeons and surgical trainees. This study describes an innovative e-learning course for teaching trauma care surgical skills in an international cooperative setting. Furthermore, it aims to offer valuable insights on enhancing e-learning practices. The Panamerican Trauma Society and the Spanish Surgical Association have joined forces to launch an online course focusing on advanced trauma care surgical skills. This report provides an in-depth examination of the project and scrutinizes participant feedback through a post-course survey. The survey thoroughly evaluates their satisfaction level, the usefulness of the course content, and their view on its clinical relevance. Three hundred eighty-two surgeons from 16 countries completed an online course. Three hundred seventy-nine of them responded to the post-course survey. The mean age was 36, with 64% females and 36% males. The course consisted of 9.9h of academic content, including 5h of video lectures and 4.9h of live discussions. Ninety-seven percent of the participants were practicing general and acute care surgeons, and only 2% were exclusively dedicated to trauma surgery. Sixty-one percent of participants highly valued real-time interaction with faculty, and 95% believed their trauma surgical skills would improve. Additionally, 93% of the participants were satisfied or very satisfied with the e-learning experience. The use of video-based instructional materials has revolutionized surgical education. With online courses in trauma surgery, surgeons can now improve their skills and better prepare themselves to handle severe trauma cases. This innovative approach to surgical education has proven to be very effective and can potentially enhance patients' quality of care.

Peculiarities of treatment of maxillofacial polytrauma during wartime.

Aim: Analyzing of the last-time papers in this subject in organizing, diagnostic and surgery tactic is the aim of this work. Materials and Methods: The study analyzed the experience of treating patients with maxillofacial polytrauma before and after February 24, 2022. Research methods: bibliographic, systematic, comparative, general clinical, radiological and retrospective analysis. Conclusions: Tactic of the multidisciplinal team should based on the principles of damage control, which involves the initial performance of manipulations and surgical interventions that ensure the patient's survival. Modern strategies for infusion-transfusion therapy play a significant role in severe trauma cases. Choosing the rational management of this therapy for severe trauma remains an important issue. Reconstructive surgeries are recommended to be performer deferred, after surgical wound management, neurosurgical interventions and stabilization of the patient common status. Patients with maxillofacial polytrauma needs in specialized medical care at all the levels. Active wound management aimed at creating favorable conditions for healing, comprehensive medical treatment, prevention, early detection and timely treatment of complications.

Specificities of pediatric ocular emergencies before and during the COVID-19 era: A retrospective comparative study in an eye-related emergency department in Paris

IntroductionEpidemiological data on the use of eye-related emergency services by children are limited. The objective of this study was to determine how COVID-19 affected the epidemiological trends of pediatric ocular emergencies. MethodsWe performed a retrospective chart review of children under the age of 18 years who visited our eye-related emergency department between March 17 and June 7, 2020 and between March 18 and June 9, 2019. This was a descriptive and comparative analysis of the two study periods based on the demographic characteristics of patients and the diagnosis reported by the ophthalmologist in the digital medical charts. One of the investigators performed a second reading of the files to homogenize the diagnosis classification based on the most frequently found items. ResultsIn total, 754 children were seen in our eye-related emergency department during the 2020 study period versus 1399 in 2019, representing a 46% decrease. In 2019, the four main diagnoses were traumatic injury (30%), allergic conjunctivitis (15%), infectious conjunctivitis (12%), and chalazion/blepharitis (12%). In the 2020 study period there was a significant decrease in the proportion of patients presenting with traumatic injuries (p < 0.001), infectious conjunctivitis (p = 0.03), and chalazion/blepharitis (p < 0.001). Consultations for chalazion/blepharitis were the most affected by the pandemic, followed by traumatic injuries (−72% and −64%, respectively). The proportion of patients who required surgery after trauma was higher in 2020 than in 2019 (p < 0.01), but the absolute number of severe trauma cases remained stable. ConclusionsThe COVID-19 pandemic was accompanied by a decrease in the overall use of a pediatric eye-related emergency services in Paris. Visits due to benign causes and ocular trauma also decreased, but visits for more severe pathologies were not affected. Longer-term epidemiological studies may confirm or refute a change in eye emergency department use habits.

Surgical Management of Severe Abdominal Trauma Patients in the Surgical Department of the Toamasina CHU, Madagascar

Severe abdominal trauma represents an absolute surgical emergency. The objective of our study is to report the surgical management of severe abdominal trauma in a low-resource center. This was a 31-month observational study from January 2018 to August 2020. We have 44 cases of severe abdominal trauma. The sex ratio was 4.5. The mean age of patients with severe abdominal trauma was 31.43182 years. A penetrating wound to the abdomen was seen in 68.18%. The circumstance of the trauma was a liability accident in 70.45%. A shortened laparotomy was performed. The mean duration of the operation was 45.63636 minutes. No perioperative death was reported during the performance of the shortened laparotomy. Controlling emergency surgery improves the vital prognosis of polytrauma patients.

Twenty-minute harvesting of flow-through type vastus lateralis muscle flap significantly reduces the need for a temporary intravascular shunt in the treatment of severe upper extremity trauma in civilian patients.

For the reconstruction of severe upper extremity trauma involving arterial injury in civilian patients, it is generally recommended that the revascularization time be shortened using a temporary intravascular shunt (TIVS). However, if a flow-through type vastus lateralis muscle (VLm) flap can be harvested in 20 minutes and bypassed at the obstructed ischemic zone within 30 minutes, blood flow can be restored as quickly or more quickly than when using a TIVS, eliminating the need for a TIVS. This procedure was applied in the reconstruction of 3 cases of severe extremity trauma with vascular injury. The mean age was 69.7 years. Surgery was started an average of 2.93 hours from the onset. The average flap harvest time was 0.33 hours. The average time to revascularization from flap harvest was 1.33 hours, the average total operation time was 6.43 hours, and all upper extremities were salvaged. No cases showed ischemia-reperfusion injury or severe muscle contracture. The flow-through-type VLm flap can be applicable as a bypass graft for a 20 cm defect at any region distal to the elbow. In addition, harvesting the flap attached to blood-rich muscle not only controls the infection of contaminated wounds through the filling of dead space, but also has the potential to replace damaged muscle or tendon tissue. Even though TIVS placement is currently used extensively in this field of treatment, its role could be significantly reduced if a flow-through-type VLm flap can be harvested within 20 minutes.

The impact of procalcitonin in assessing outcomes in pediatrics severe trauma cases: A three-year experience from a tertiary hospital.

Although procalcitonin levels are raised in patients with systemic inflammation, its usage in pediatric patients, particularly those in the intensive care unit who are most susceptible to sepsis. It is a retrospective research study that included pediatric patients aged more than two weeks who were brought to the King Fahd Hospital of the University's PICU owing to serious trauma or post-acute postoperative occurrences from January 2017 to December 2019. At 24 h after admission, data such as age, gender, comorbidities, trauma severity as measured by the Injury Severity Score, and PRISM III score were collected. Following a surgery abscess, there were a total of 39 (15.9%) deaths. Patients who died during their hospital stay had significantly higher mean levels of biomarkers such as PRISM III, PCT at 24 h, PCT 48-72 h, and PCT at day 5 (p = 0.001). The area under the ROC curve for PCT level 48/72 h was 0.89 (% CI: 0.85-0.93), p = 0.001, indicating that PCT had highly significant predictive validity in predicting in-hospital mortality at the best cutoff point of >1.35 with a high level of accuracy and precision of 82.1% and 82.0%, respectively. The serum procalcitonin level (PTCL) can help predict the in-hospital prognosis of pediatrics that has had surgery. A combined control system is designed based on PTC expression for the examination of a patient receiving medication over a longer length of time.

Accuracy of a Prehospital Triage Protocol in Predicting In-Hospital Mortality and Severe Trauma Cases among Older Adults.

Background: Prehospital trauma triage tools are not tailored to identify severely injured older adults. Our trauma triage protocol based on a three-tier trauma severity grading system (A, B, and C) has never been studied in this population. The objective was to assess its accuracy in predicting in-hospital mortality among older adults (≥65 years) and to compare it to younger patients. Methods: A retrospective multicenter cohort study, from 2011 to 2021. Consecutive adult trauma patients managed by a mobile medical team were prospectively graded A, B, or C according to the initial seriousness of their injuries. Accuracy was evaluated using sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. Results: 8888 patients were included (14.1% were ≥65 years). Overall, 10.1% were labeled Grade A (15.2% vs. 9.3% among older and younger adults, respectively), 21.9% Grade B (27.9% vs. 20.9%), and 68.0% Grade C (56.9% vs. 69.8%). In-hospital mortality was 7.1% and was significantly higher among older adults regardless of severity grade. Grade A showed lower sensitivity (50.5 (43.7; 57.2) vs. 74.6 (69.8; 79.1), p < 0.0001) for predicting mortality among older adults compared to their younger counterparts. Similarly, Grade B was associated with lower sensitivity (89.5 (84.7; 93.3) vs. 97.2 (94.8; 98.60), p = 0.0003) and specificity (69.4 (66.3; 72.4) vs. 74.6 (73.6; 75.7], p = 0.001) among older adults. Conclusions: Our prehospital trauma triage protocol offers high sensitivity for predicting in-hospital mortality including older adults.

Association Between Neutrophil Density and Survival in Trauma Patients Admitted to the Intensive Care Unit; a Retrospective Cohort Study.

Altered immune responses, in particular neutrophil changes, are perceived to play a key role in immune responses to trauma. This study aimed to evaluate the association of neutrophil changes with patients' survival in severe multiple trauma cases. The current retrospective cohort study was conducted using data from patients admitted in the intensive care unit (ICU) of a trauma center in Shiraz, Iran, between 2016 and 2021. Patients were divided into three groups (i.e., normal, neutropenia, and neutrophilia) based on neutrophil count at the time of ICU admission, and the association of neutrophil count with in-hospital mortality was analyzed. 2176 patients with the mean age of 37.90 ± 18.57 years were evaluated (84.04% male). The median trauma severity based on injury severity score (ISS) in this series was 9 (4 -17). Patients were divided in to three groups of neutrophilia (n = 1805), normal (n = 357), and neutropenia (n = 14). There were not any significant differences between groups regarding age distribution (p = 0.634), gender (p = 0.544), and trauma severity (p = 0.197). The median survival times for the normal, neutropenia, and neutrophilia groups were 49 (IQR: 33 -47) days, 51 (IQR: 8- 51) days, and 38 (IQR: 26 - 52) days, respectively (p = 0.346). The log-rank test showed a statistically significant difference between the three groups adjustment for ISS (p ≤ 0.001). For each unit increase in ISS, the hazard ratio increased by 2%. In ISS 9-17, the hazard ratio increased by 11% compared to ISS<4. Also, in ISS>17, the hazard ratio increased by 76% compared to ISS<4 in ICU-hospitalized patients. In general, the findings of the present study showed that the survival rate of patients in the normal group after ISS adjustment was higher than the other two groups. Also, the Cox model showed that the mortality risk ratio in the neutropenia group was 15 times higher than the normal group.

Predictive Accuracy of Paediatric Trauma Score, our experience at Children Hospital, Lahore

Aim: To find predictive accuracy of pediatric trauma score (PTS) in terms of mortality in the Children’s hospital and institute of child health Lahore. Study design: Cross sectional study. Setting: Paediatric Surgery department, CH &amp; ICH, Lahore. Duration of study: 1st January 2019 to 30th June 2019. Methods: All patients presented with trauma, aged 1-15 years were included in study. All patients with major burn, associated cardiac injuries (e.g., stab heart), victims who required monitoring and hospitalization less than 24 hours, and those referred to other hospitals were excluded from the study. Initial assessment of all patients was done and paediatric trauma score was evaluated in the emergency room. Patients were managed and 24 hours follow-up was done to predict the mortality. Results: From 290 children, 207(71.38%) were males and 83 (28.6%) were females. Mean age of the children was 7.53 years. The most common mode of trauma was Car accident in children 67(23.1%), followed by Auto rickshaw vs. motorcycle n= 50 (17.24%), and auto rickshaw vs. pedestrian 40(13.79%). Mean Hospital Arrival Time in Minutes was 100.31 minutes. Mean paediatric trauma score amongst all children was 7.22. Overall mortality was reported in 27(9.3%) children. PTS &lt; 8 turned out to be statistically significantly related to mortality (P value &lt; 0.001). Patients with diagnostic test characteristics of PTS &lt; 8 to predict mortality were having sensitivity 91.0%, specificity 56.1%, positive predictive value 38.4%, negative predictive value 95.4% and the diagnostic accuracy of 64.1%. Conclusion: By Paediatric trauma score we can predict about the necessity of critical interventions in patients and also, we can predict percentage of mortality in paediatric trauma patients. However, accuracy of paediatric trauma score seems to be moderate in detecting most severe paediatric trauma cases. Keywords: PTS, mortality, hospital arrival time, morbidity, major burn predictor.

Clinical characteristics of patients with snow sports trauma transported to a trauma care center: A retrospective observational study

BackgroundSnow sports are a popular recreational activity; however, the incidence of injury of snow sports can be high for skiers and snowboarders. Our hospital receives severe trauma cases from snow resorts and hospitals throughout the region. This study aimed to determine whether the risk of snow sports-related major trauma that requires emergency surgery under general anesthesia varies by the equipment and injury mechanism. MethodsThis retrospective cohort study included patients with snow sports trauma referred to Gifu University Hospital, Japan between November 2010 and March 2020. We analyzed the need for emergency operation under general anesthesia within 24 h using Fisher's exact test. We identified 106 patients: (1) 90 in the snowboarders’ group and 16 in the skiers’ group or (2) 46 in the fall after jumping group (jumping group), 27 in the collide with other people and obstacle group (collision group), and 33 in the fall during gliding group (gliding group). ResultsSnowboarders were nearly twice as likely as skiers to require emergency surgery under general anesthesia (44% vs. 25%; p = 0.236]. No significant associations were found between emergency surgery under general anesthesia and injury mechanism, but half of the patients in the jumping group required emergency surgery. ConclusionsSnowboard as equipment and falls after jumping as a mechanism of injury tended to be associated with emergency surgery under general anesthesia, with no significant differences. In order to provide adequate resources for snow sports trauma, the cause of the patient's injury is strongly related to the urgency of the condition, and transport to a trauma center should be actively considered. Further studies are warranted with respect to the effects of personal protective equipment and skill level.

Development of a Modular Tissue Phantom for Evaluating Vascular Access Devices.

Central vascular access (CVA) may be critical for trauma care and stabilizing the casualty. However, it requires skilled personnel, often unavailable during remote medical situations and combat casualty care scenarios. Automated CVA medical devices have the potential to make life-saving therapeutics available in these resource-limited scenarios, but they must be properly designed. Unfortunately, currently available tissue phantoms are inadequate for this use, resulting in delayed product development. Here, we present a tissue phantom that is modular in design, allowing for adjustable flow rate, circulating fluid pressure, vessel diameter, and vessel positions. The phantom consists of a gelatin cast using a 3D-printed mold with inserts representing vessels and bone locations. These removable inserts allow for tubing insertion which can mimic normal and hypovolemic flow, as well as pressure and vessel diameters. Trauma to the vessel wall is assessed using quantification of leak rates from the tubing after removal from the model. Lastly, the phantom can be adjusted to swine or human anatomy, including modeling the entire neurovascular bundle. Overall, this model can better recreate severe hypovolemic trauma cases and subject variability than commercial CVA trainers and may potentially accelerate automated CVA device development.