Trauma Injury Severity Score Research Articles

Long-term disability following childhood injury: an imperative to monitor and address the continuum of trauma care

Abstract Background While injuries remain a leading cause of childhood death, increasing proportions of children survive life-threatening injuries. However, robust epidemiological data on their risks of long-term disability are scant, undermining comprehensive injury control efforts. This population-based prospective cohort study investigated the functional status and health-related quality of life of seriously injured Australian children over a 5-year period. Methods Patients aged <18 years hospitalised for major trauma (Injury Severity Score >12) in the State of Victoria over a 12-month period were followed-up at 6, 12, 24, 36, 48 and 60-months post-injury. Primary outcomes were assessed using the PedsQL, King’s Outcome Scale for Childhood Head Injury and the Glasgow Outcome Scale-Extended. Multivariable regression models investigated factors associated with outcomes. Results Of the 186 participants, 71% were retained to 60 months post-injury. At five years post-injury, only 39% had fully recovered while 39% experienced moderate to severe disability. Despite gains in functional status across the five years, psychosocial recovery lagged improvements in physical health. Factors associated with adverse outcomes included older age at injury, female sex, socio-economic disadvantage, remote/regional (versus urban) residence, pre-existing comorbidities, and injuries deemed compensable, intentional, or involving head trauma. Implications The high risks of long-term disability following serious childhood injury highlight the need for robust injury control efforts that monitor and address the inequitable burden of childhood injury, including the social determinants influencing the occurrence as well as sequelae following injury.

Prognostic Value of ISS and TRISS Scores in Tunisian Terrorism Victims.

Injuries caused by terrorism attacks are one of the urgent problems of the society and the health system. In this work, we aimed to assess the injury severity score (ISS) and trauma injury severity score (TRISS) in Tunisian military combatants injured during terrorism attacks. A total of 153 victims of terrorism admitted to the Military Hospital of Tunis between January 2012 and January 2017 were included. Among them, 107 survived and 46 died (43 victims died at the terrorist attack scene and 3 died in the hospital). All dead patients were autopsied. Injury severity scores and TRISSs were then calculated by 2 professors in the anesthesia-resuscitation department, and the agreement level was assessed using the Bland and Altman curve. We obtained a strong agreement between the 2 experts when assessing the TRISS and ISS. Using the Bland and Altman curve, an agreement between the 2 experts was obtained between 0 to 40 and 60 to 75 for the ISS and between 0 to 25 and 75 to 100 for the TRISS. Moreover, we detected a high level of ISS and TRISS, especially in deceased victims compared to survivors (P <.001). To predict mortality, we revealed by the receiver operating characteristic curve high sensitivity and specificity (more than 90%) before day 28 of hospital stay as well as for ISS and TRISS. Regarding the mechanism of injury, patients injured by gunshot have higher ISSs and TRISSs than those injured by explosion (P < .001). Injury severity scores and TRISSs showed a high reliability to predict the mortality rate in Tunisian victims of terrorism.

Comparison of the epidemiology of elderly trauma between major trauma centres in Riyadh, Saudi Arabia and Melbourne, Australia.

To review the epidemiology of elderly trauma at the Kind Saud Medical City (KSMC), Riyadh, Saudi Arabia, and carry out risk-adjusted analyses to benchmark outcomes with the Alfred Hospital, Melbourne, Australia, the largest Australasian trauma service. This retrospective study included records of injured patients (≥65 years) from the hospital trauma registries during 2022. Demographic and injury data were extracted. Risk-adjusted endpoints were: inpatient mortality and length of stay, analysed using logistic and median regression. A total of 193 elderly patients were registered on the KSMC registry and 1233 elderly patients were registered on the Alfred Hospital registry. Kind Saud Medical City saw proportionally less major trauma (injury severity score of >12, 24.4% vs. 44.2%, p<0.001) and less females (31.1% vs 44.4%, p<0.001). The modal injury group was low level falls in both centres (≈60%). Discharge destination was different, particularly for patients discharged home (86.5% vs. 56%) or to a rehabilitation facility (0.5% vs. 28.2%). The risk-adjusted length of stay was 4.5 days less at the Alfred Hospital (95% CI: [3.25-5.77] days, p<0.001). The odds of in-hospital death were not significantly different (OR=0.72, 95% CI: [0.36-1.47], p=0.37). Despite the different settings, low level falls were the major cause of injury in older patients. A longer length of stay in the acute hospital was identified for KSMC, however, this may be partly explained by discharge destination practices in the 2 countries.

Prediction of mortality among severely injured trauma patients A comparison between TRISS and machine learning-based predictive models

BackgroundGiven the huge impact of trauma on hospital systems around the world, several attempts have been made to develop predictive models for the outcomes of trauma victims. The most used, and in many studies most accurate predictive model, is the “Trauma Score and Injury Severity Score” (TRISS). Although it has proven to be fairly accurate and is widely used, it has faced criticism for its inability to classify more complex cases. In this study, we aimed to develop machine learning models that better than TRISS could predict mortality among severely injured trauma patients, something that has not been studied using data from a nationwide register before. MethodsPatient data was collected from the national trauma register in Sweden, SweTrau. The studied period was from the 1st of January 2015 to 31st of December 2019. After feature selection and multiple imputation of missing data three machine learning (ML) methods (Random Forest, eXtreme Gradient Boosting, and a Generalized Linear Model) were used to create predictive models. The ML models and TRISS were then tested on predictive ability for 30-day mortality. ResultsThe ML models were well-calibrated and outperformed TRISS in all the tested measurements. Among the ML models, the eXtreme Gradient Boosting model performed best with an AUC of 0.91 (0.88–0.93). ConclusionThis study showed that all the developed ML-based prediction models were superior to TRISS for the prediction of trauma mortality.

On the Feasibility of Using REBOA Technology for the Treatment of Patients with Polytrauma

Introduction According to domestic and foreign authors, the leading cause of death in victims with polytrauma is blood loss. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is one of the new promising ways to manage bleeding in patients in a state of traumatic shock. There are a large number of publications in the world scientific literature indicating the high effectiveness of this technology in the treatment of bleeding. However, in the Russian Federation, this method has not yet entered into everyday practice, and scientific research on this matter is scarce. AIM Based on literature data and analysis of our own sample, to justify the need to use REBOA technology for the treatment of victims with polytrauma.Material and methods A retrospective analysis of the medical records of patients with polytrauma admitted to the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2021 was carried out. Data from medical records and the Results of forensic medical examinations were studied. The main sample included victims with polytrauma (Injury Severity Score, ISS, of more than 17 points) delivered from the scene of the incident in a state of traumatic shock (systolic blood pressure, SBP, of less than 90 mm Hg) and a verified source of bleeding. To assess the potential survival of victims, we used the Trauma Score and Injury Severity Score (TRISS) scale.Results Of the 92 patients with polytrauma, 19 patients (20.6%) had indications for REBOA. The most common sources of bleeding were injuries to the pelvic ring, 14 (73.7%), abdomen, 11 (57.9%), and chest, 7 (36.8%). In 6 victims (31.5%), there were combined abdomen and pelvic injuries as the area of blood loss. The mean age of the victims was 48.8±19.9 years, the mean ISS value was 39.4±20.1. On admission, the mean SBP was 62.4±31.5 mm Hg, and heart rate — 91.8±43.3 beats/min. In 8 victims (42.1%), norepinephrine was administered immediately upon hospitalization at an average dose of 837.5±537.0 ng/kg/min. As a result of their injuries, 15 patients (78.9%) died, and 4 were discharged from the hospital. According to the Conclusions of forensic experts, the leading cause of death was blood loss in 11 (61.1%), severe traumatic brain injury (TBI) in 4 (22.2%), and infectious complications in 3 cases (16.7%).The TRISS was calculated for each patient. In order to identify the most potentially viable patients with indications for REBOA, we excluded 5 patients with severe TBI (the mean TRISS was 20.9±11.1%), and 5 patients with the TRISS of less than 50% (the mean TRISS was 10.0±14.1%), the latter died from hemorrhagic shock. Among the remaining 9 patients with higher TRISS values, 5 (26.3%) who died had the mean TRISS of 80.5±15.8%, comparable to the mean TRISS of 83.3±2.4% in the 4 survivors.Conclusion 1. According to foreign and domestic publications, the technology of resuscitation endovascular balloon occlusion of the aorta (REBOA) is effective for stopping internal bleeding in patients with polytrauma. 2. When analyzing our own sample of patients, it was proven that 20.6% of patients with polytrauma had indications for the use of REBOA. Most of them (78.9%) died. The main cause of death was hemorrhagic shock. 3. About a quarter of patients (26.3%) with indications for REBOA had a potentially high chance of survival. In the future, the use of this technology may reduce the number of deaths.

364 Traumatic Dens Fracture Patients Comprise Distinct Subpopulations Distinguished by Differences in Age, Sex, and Injury Mechanism and Severity

INTRODUCTION: Dens fractures are an increasingly common cervical fractures, yet their epidemiology and its implications remain under-examined. METHODS: We retrospectively analyzed all traumatic dens fracture patients managed at our institution over a ten year period with respect to demographic, clinical, and outcomes data. Patient subsets were compared across these parameters. RESULTS: 303 traumatic dens fracture patients were identified, who showed a bimodal age distribution with strong goodness of fit centered at age 22.3 ± 5.7 (R = 0.8781) and at 77.7 ± 13.9 (R = 0.9686). A population pyramid demonstrated a bimodal distribution among male patients, but not among female patients, which was confirmed with a strong goodness of fit for two distinct male patient subpopulations age &lt;35 (R = 0.9791) and age =35 (R = 0.8843), but a weak fit for a second female subpopulation age &lt;35 (24.5 ± 14.2, R = 0.5957). Patients age &lt;35 were more likely to be male (82.4% vs. 46.9%, OR = 5.29 [1.54, 17.57], p = 0.0052). Moreover, patients age &lt;35 were more likely to have MVC as their mechanism of injury (64.7% vs. 14.1%, OR = 11.18 [3.77, 31.77], p &lt; 0.0001), were more likely to have a severe trauma injury severity score (17.6% vs. 2.9%, OR = 7.23 [1.88, 28.88], p = 0.0198). There was no difference with respect to underlying fracture morphology, likelihood of undergoing surgery, having concomitant atlas or subaxial fractures, or Nurick scores at presentation. Patients age &lt;35 were less likely to have fracture nonunion at follow (18.2% vs. 53.7%, OR = 0.19 [0.041, 0.76], p = 0.0288). CONCLUSIONS: The dens fracture patient population comprises two subpopulations, distinguished by differences in age, sex, and injury mechanism and severity, with male dens fracture patients demonstrating a bimodal age distribution. While young patients were more likely to high-energy injury mechanisms leading severe trauma, they were less likely to have fracture nonunion at follow up.

Optimizing Triage Practice in Pediatric Trauma: Lessons From Under-triage and Over-triage Rates and Risk Factors.

Triage accuracy is essential for delivering effective trauma care, especially in the pediatric population where unique challenges exist. The purpose of this study was to investigate risk factors contributing to under-triage and over-triage in an urban pediatric trauma center. This retrospective cohort study included all trauma activations at an urban level 1 trauma center between January 1, 2021, and July 31, 2023 (patients <18years old.) Patients who were under- or over-triaged were identified based on the level of trauma activation and injury severity score. There were 1094 trauma activations included in this study. The rate of under-triage was 3.8% (n = 42) and over-triage was 13.6% (n = 149). Infants aged 0-1 years had the highest rate of under-triage (10.9%, n = 19, P < .001), while those aged 11-17 had the highest rate of over-triage (17.0%, n = 82, P = .003). Non-accidental trauma was the strongest risk factor for under-triage (OR 30.2 [6.4-142.8] P < .001). Penetrating mechanism was the strongest risk factor for over-triage (OR 12.2 [5.6-26.2] P < .001). This study reveals the complexity of trauma triage in the pediatric population. We identified key predictive factors, such as age, comorbidities, and mechanism of injury, that can be used to refine triage practices and improve the care of pediatric trauma patients.

Evaluation of management of CT scan proved solid organ injury in blunt injury abdomen-a prospective study.

Trauma especially road traffic injury is one of the major health-related issues throughout the world, especially in developing countries like India (Mattox 2022). Solid organ injury is the most common cause of morbidity and mortality in patients with blunt abdominal trauma. The non-operative management (NOM) is being consistently followed for hemodynamically stable patients with respect to solid organ injuries. This study aims to provide an evidence base for management modalities of solid organ injuries in blunt abdominal trauma. The aim of this study is to evaluate the effectiveness of various treatment modalities for solid organ injury in blunt abdominal trauma. Evaluating the characteristics of blunt abdominal injury with respect to age and gender; distribution, mode of injury, most common organ injured, and severity of injury; effect of delay in getting treatment on the management outcome for patients with solid organ injury; evaluating the various modalities of treatment of CT-proven solid organ injury; incidence of complications in different modes of treatment. All patients aged more than 18years and suffering from CT-proven solid organ injury secondary to blunt abdominal trauma between February 2021 and September 2022 were included in this prospective observational study. Sixty-five patients were enrolled in the study after meeting the inclusion criteria. Details such as age, gender, mechanism of injury, the time between injury to first hospital contact, presenting complaints, organ and grade of injury, Revised Trauma Score (RTS), Trauma Score and Injury Severity Score (TRISS), management, and outcomes were collected using self-designed pro forma and analyzed. Different modalities of treatment were evaluated and patients undergoing operative and non-operative management were compared. Patients in whom non-operative management failed were compared with patients with successful non-operative management. The mean age of patients involved were 36.8years with a male:female ratio of 7.125:1 and the most common age group affected being between 21 and 30years. The most common mode of injury was noted to be road traffic accidents (72.3%). The most common presenting complaints were abdominal pain (64.6%) followed by chest pain (29.2%) and vomiting (13.8%). There was no significant relationship between latent period and type of intervention or failure of non-operative management. FAST positivity rate was noted to be 92.3%. Chronic alcoholism and bronchial asthma were significant predictors for patients undergoing upfront surgery (p = 0.003 and 0.006 respectively). The presence of pelvic and spine injury was statistically significant for predicting mortality in polytrauma patients (p = 0.003). Concurrent adrenal injury was found in 24.6% of patients but was not related to failure of non-operative management or mortality. RTS significantly predicts the multitude of organ involvement (p = 0.015). The liver was the most common organ injured (60%) followed by the spleen (52.3%) and the kidney (20%). The liver and the spleen (9.2%) were noted to be the most common organ combination involved. No specific organ or organ injury combination was noted to predict failure of non-operative management or mortality. But the multitude of organ involvement was statistically significant for predicting patients undergoing upfront surgery (p = 0.011). Out of 65 patients enrolled in the study, 7 patients (10.8%) underwent immediate surgery, and 58 patients (89.2%) underwent non-operative management. Among the 68 chosen for non-operative management, 6 patients (9.2%) failed non-operative management and 52 patients (80%) had success of non-operative management. A significant drop in hemoglobin (83.3%) on day 1 (66.6%) was seen to be the commonest reason for failure of non-operative management. The spleen was noted to be the most commonly involved organ intra-operatively (61.5%) followed by the liver (30.8%). Concordance between pre-operative and intra-operative grading of organ injuries was highest for liver and kidney injuries (100%) and lowest for pancreatic injuries (0%). Requirement of blood transfusion and liver injuries were significant factors for failure of non-operative management (p = 0.012 and 0.045 respectively). The presence of pancreatic leak was significant between the non-operated patients and patients operated upfront (p = 0.003). Mortality was noted to be 10.8% (7 patients) in our study. Solid organ injury in blunt abdominal trauma is an important cause of morbidity and mortality. RTS was noted to be a good predictor for solid organ injury in blunt abdominal trauma. Pancreatic injuries are notorious for being under-staged on CT findings; hence, the need arises for multimodality imaging for suspected pancreatic injuries. Non-operative management is a successful modality of treatment for majority of patients suffering from multiple solid organ injuries in blunt abdominal trauma provided serial close monitoring of patient's clinical signs and hemoglobin is instituted along with the presence of an emergency surgery team.

Burn or trauma scoring: experience of the burn unit of the Queen Astrid Military Hospital during the terror attacks on 22 March 2016.

On 22 March 2016, the burn unit (BU) of Queen Astrid Military Hospital assessed a surge in severely injured victims from terror attacks at the national airport and Maalbeek subway station according to the damage control resuscitation (DCR) and damage control surgery (DCS) principles. This study delves into its approach to identify a suitable triage scoring system and to determine if a BU can serve as buffer capacity for mass casualty incidents (MCIs). The study reviewed retrospectively the origin of explosion, demographic data, sustained injuries, performed surgery, and length of stay of all admitted patients. Trauma scores (Injury Severity Score (ISS) and New Injury Severity Score (NISS)) and triage scores (Revised Trauma Score (RTS), New Trauma Score (NTS), and Trauma Score Injury Severity Score (TRISS)), were compared to burn mortality scores (Osler updated Baux Score and Tobiasen's Abbreviated Burn Severity Index (ABSI)). Of the 23 casualties admitted to the BU, the scores calculated on average 3.5 indications for a level 1 trauma center (ISS 4, NISS 6, RTS 0, T-NTS 4). Nevertheless, no deaths occurred during admission or the 1-year follow-up. MCIs create chaos and a high demand for care. Avoiding bottlenecks and adhering to the DCR/DCS principles are necessary to deliver the best care to the largest number of people. This study indicates that a BU can serve as buffer capacity for MCIs. Nevertheless, its integration into the medical resilience plan depends on accurate scoring, comprehensive care availability, and understanding of the DCR/DCS concept. NTS for triage seems the best fit for scoring polytrauma referrals to a BU during MCIs.

Association between out-of-hospital cardiac arrest quality indicator and prehospital management and clinical outcomes for major trauma

IntroductionIt is unclear whether emergency medical service (EMS) agencies with good out-of-hospital cardiac arrest (OHCA) quality indicators also perform well in treating other emergency conditions. We aimed to evaluate the association of an EMS agency's non-traumatic OHCA quality indicators with prehospital management processes and clinical outcomes of major trauma. MethodsThis retrospective cross-sectional study analyzed data from registers of nationwide, population-based OHCA (adult EMS-treated non-traumatic OHCA patients from 2017 to 2018) and major trauma (adult, EMS-treated, and injury severity score ≥16 trauma patients in 2018) in South Korea. We developed a prehospital ROSC prediction model to categorize EMS agencies into quartiles (Q1-Q4) based on the observed-to-expected (O/E) ROSC ratio for each EMS agency. We evaluated the national EMS protocol compliance of on-scene management according to O/E ROSC ratio quartile. The association between O/E ROSC ratio quartiles and trauma-related early mortality was determined in a multi-level logistic regression model by adjusted odds ratios (OR) and 95 % confidence intervals (95 % CI). ResultsAmong 30,034 severe trauma patients, 4,836 were analyzed. Patients in Q4 showed the lowest early mortality rate (5.6 %, 5.5 %, 4.8 %, and 3.4 % in Q1, Q2, Q3, and Q4, respectively). In groups Q1 to Q4, increasing compliance with the national EMS on-scene management protocol (trauma center transport, basic airway management for patients with altered mentality, spinal motion restriction for patients with spinal injury, and intravenous access for patients with hypotension) was observed (p for trend <0.05). Multivariable multi-level logistic regression analysis showed significantly lower early mortality in Q4 than in Q1 (adjusted OR [95 % CI] 0.56 [0.35–0.91]). ConclusionMajor trauma patients managed by EMS agencies with high success rates in achieving prehospital ROSC in non-traumatic OHCA were more likely to receive protocol-based care and exhibited lower early mortality.

The role of public policy in reducing moped and scooter injuries in South Carolina

IntroductionMopeds and electric scooters have grown in popularity in recent years. A South Carolina (SC) law was passed on November 19, 2018, aimed to regulate mopeds and scooters. This study aims to evaluate whether this SC law was associated with a decrease in the moped injury rate in a Level 1 Trauma Center. MethodsA retrospective review of trauma registry data was used to identify a cohort of patients 14 years and older who came to a Level 1 trauma center for a moped/scooter accident between January 2014 - December 2022. The proportion of moped injuries before and after the passing of the law was calculated. The chi-square test and Wilcoxon Rank Sum test were used to compare differences in proportions for categorical factors and continuous factors, respectively. ResultsA total of 350 moped injury cases were identified. There was a significant decrease in the moped injury rate after the passing of the 2018 SC law (0.9 % vs 1.8 %, p<0.001). Additionally, those treated post-law implementation were significantly older (47.4 vs 43.2 years, p = 0.013) and more likely to be male (95.5 % vs 87.9 %, p = 0.025) than those treated pre-law. Patients treated post-law were significantly more likely to be uninsured (45.1 % vs 42.7 %, p = 0.009) and less likely to have commercial (16.2 % vs 20.1 %, p = 0.009), or government (29.7 % vs 35.6 %, p = 0.009) health insurance compared to those treated pre-law. There was no significant difference between the two groups in Glascow Coma Scale, Injury severity score, Trauma Injury Severity Score, or rate of fatalities. ConclusionAfter the implementation of a SC law, we found that the local proportion of injuries due to moped and scooter accidents was significantly lower than pre-law proportions. These findings suggest that public policies aimed at increasing regulations for mopeds may decrease the rate of injury, but not severity, from moped use.

Caregiver reported long-term outcomes in children with major trauma and traumatic brain injuries: A single-centre retrospective study.

We aim to investigate the functional outcomes and long-term health-related quality of life (HRQOL) in children with major trauma associated with traumatic brain injury (TBI). We performed a retrospective review of records among patients >2 and ≤16 years old in a tertiary paediatric hospital between January 2014 and October 2019 with major trauma (Injury Severity Score of ≥16) and TBI of all severities. We recorded each child's Glasgow Outcome Scale-Extended Pediatric Version (GOS-E Peds) at 12 months post-injury and Pediatric Quality of Life Inventory (PedsQL) scores at 6 and 12 months post-injury based on the parent proxy-report scales. We included 53 patients with a median age of 9.0 years old (interquartile range 2.3-15.5). Most injuries were due to falls (30, 56.6%) or road traffic collisions (15, 28.3%); 41 patients (77.3%) required intensive care while 30 patients (56.6%) underwent neurosurgical intervention. Most patients (43, 81.1%) had GOS-E Peds scores of ≤2 at 12 months post-injury. We reported a significant mean difference between the 6- and 12-month parent-reported scores for physical functioning (6.6, 95% confidence interval [CI] 0.3-12.8, P=0.041), psychosocial functioning (4.1, 95% CI 1.0-7.2, P=0.012) and overall scores (5.0, 95% CI 1.4-8.7, P=0.008). Compared with the validated PedsQL scores, our mean scores were higher across all domains at 12 months. With current standard of care, parents of children with major trauma and TBI reported gains in quality of life, physical, psychosocial and overall function between 6 and 12 months post-injury.

Severe traumatic brain injury and acute kidney injury patients: factors associated with in-hospital mortality and unfavorable outcomes

ABSTRACT Objective The purpose of this study was to identify the occurrence of AKI, and factors associated with in-hospital mortality and unfavorable outcomes in patients with severe traumatic brain injury (TBI) and acute kidney injury (AKI) severity. Method A retrospective cohort study which analyzed data with severe TBI between 2013 and 2017. We examined demographic and clinical information, and outcome by in-hospital mortality, and the Glasgow Outcome Scale six months after TBI. We associated factors to in-hospital mortality and unfavorable outcome in severe TBI and AKI with an association test. Results A total of 219 patients were selected, 39.3% had an AKI, and several factors associated with AKI occurrence after severe TBI. Stage 2 or 3 of AKI (OR 12.489; 95% CI = 4.45–37.94) were independent risk for both outcomes in multivariable models, severity injury by the New Trauma Injury Severity Score (OR 0.97; 95% CI = 0.96–0.99) for mortality, and the New Injury Severity Score (OR1.07; 95% CI = 1.04–1.10) and Trauma and Injury Severity Score (OR = 0.98; 95% CI = 0.965–0.997) for unfavorable outcome. Conclusion The findings of our study confirmed that AKI severity and severity of injury was also related to increased mortality and unfavorable outcome after severe TBI.

Modified physiologic criteria for the field triage scheme: Efficacy of major trauma recognition in different age groups in Asia

BackgroundMajor trauma is a leading cause of unexpected death globally, with increasing age-adjusted death rates for unintentional injuries. Field triage schemes (FTSs) assist emergency medical technicians in identifying appropriate medical care facilities for patients. While full FTSs may improve sensitivity, step-by-step field triage is time-consuming. A simplified FTS (sFTS) that uses only physiological and anatomical criteria may offer a more rapid decision-making process. However, evidence for this approach is limited, and its performance in identifying all age groups requiring trauma center resources in Asia remains unclear. MethodsWe conducted a multinational retrospective cohort study involving adult trauma patients admitted to emergency departments in the included countries from 2016 to 2020. Prehospital and hospital data were reviewed from the Pan-Asia Trauma Outcomes Study database. Patients aged ≥18 years transported by emergency medical services were included. Patients lacking data regarding age, sex, physiological criteria, or injury severity scores were excluded. We examined the performance of sFTS in all age groups and fine-tuned physiological criteria to improve sFTS performance in identifying high-risk trauma patients in different age groups. ResultsThe sensitivity and specificity of the physiological and anatomical criteria for identifying major trauma (injury severity score ≥ 16) were 80.6% and 58.8%, respectively. The modified sFTS showed increased sensitivity and decreased specificity, with more pronounced changes in the young age group. Adding the shock index further increased sensitivity in both age groups. ConclusionssFTS using only physiological and anatomical criteria is suboptimal for Asian adult patients with trauma of all age groups. Adjusting the physiological criteria and adding a shock index as a triage tool can improve the sensitivity of severely injured patients, particularly in young age groups. A swift field triage process can maintain acceptable sensitivity and specificity in severely injured patients.

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.

EVALUATION OF CYFRA 21-1, ANGIOPOETIN-2, PENTRAXIN-3, SRAGE, IL-6, AND IL-10 IN POLYTRAUMATIZED PATIENTS WITH CONCOMITANT THORACIC TRAUMA-HELPFUL MARKERS TO PREDICT PNEUMONIA?

Background: Pneumonia is a frequent complication after polytrauma. This study aims to evaluate the ability of different serum markers to identify patients at risk of developing pneumonia after polytrauma. Methods: A retrospective analysis of prospectively collected data in polytraumatized patients with concomitant thoracic trauma (Injury Severity Score ≥16, Abbreviated Injury Scale Thorax ≥ 3) was performed. The study cohort was divided into patients with and without pneumonia during the clinical course. Serum levels of lung epithelial (CYFRA 21-1), endothelial (Ang-2), and inflammatory (PTX-3, sRAGE, IL-6, IL-10) markers were measured upon arrival in the trauma room and on days 2 and 5. Results: A total of 73 patients and 16 healthy controls were included in this study. Of these, 20 patients (27.4%) developed pneumonia. Polytraumatized patients showed significantly increased CYFRA 21-1 levels with a distinct peak after admission compared with healthy controls. Serum PTX-3 significantly increased on day 2 in polytraumatized patients compared with healthy controls. Injury Severity Score and demographic parameters were comparable between both groups (pneumonia vs. no pneumonia). No statistically significant difference could be observed for serum levels of CYFRA 21-1, Ang-2, PTX-3, sRAGE, IL-6, and IL-10 between the groups (pneumonia vs. no pneumonia) on all days. Logistic regression revealed a combination of IL-6, IL-10, sRAGE, and PTX-3 to be eventually helpful to identify patients at risk of developing pneumonia and our newly developed score was significantly higher on day 0 in patients developing pneumonia ( P < 0.05). Conclusion: The investigated serum markers alone are not helpful to identify polytraumatized patients at risk of developing pneumonia, while a combination of IL-6, IL-10, PTX-3, and sRAGE might be.

Characteristics and Risk Factors for Pressure Ulcers in Severe Trauma Patients Admitted to the Trauma Intensive Care Unit

Purpose: A retrospective descriptive study was performed to develop strategies to manage or prevent pressure ulcers in patients with severe trauma being cared for in the trauma intensive care unit (TICU).Methods: Study data was compiled from 315 patients with severe trauma (injury severity score ≥ 15) who were admitted to a general hospital from January 1, 2020, to February 28, 2021 and were being cared for in the TICU. For patients with pressure ulcers, the characteristics and associated factors of pressure ulcers were examined.Results: There were 42 severe trauma patients (13.3%) with pressure ulcers, of which, 50.0% of cases occurred at the site of the coccyx. In 50% of patients, Stage 2 pressure ulcers were observed. The mean onset day of pressure ulcers was 9.74 days after admission. The occurrence of diabetes, critical care triage score, length of stay in intensive care, death, shock, dialysis, ventilator application, endotracheal intubation, peripheral insertion central catheter insertion, A-line insertion, body protector application, sedatives, blood pressure boosters, nasal cannula, high-flow oxygenators, oxygen tip application, drainage insertion, nasogastric tube nutrition, and ventilator application period were investigated. Logistic regression analysis revealed that the influencing factors for the development of pressure ulcers were endotracheal intubation, length of stay in the TICU, and age, in that order.Conclusion: By identifying the characteristics and risk factors associated with pressure ulcers in patients with severe trauma, strategies can be developed to better prevent or manage pressure ulcers in the future.

Traumatic Dens Fracture Patients Comprise Distinct Subpopulations Distinguished by Differences in Age, Sex, Injury Mechanism and Severity, and Outcome

Dens fractures are an increasingly common injury, yet their epidemiology and its implications remain underexamined. We retrospectively analyzed all traumatic dens fracture patients managed at our institution over a 10-year period, examining demographic, clinical, and outcomes data. Patient subsets were compared across these parameters. Among 303 traumatic dens fracture patients, we observed a bimodal age distribution with a strong goodness of fit centered at age 22.3 ± 5.7 (R= 0.8781) and at 77.7 ± 13.9 (R= 0.9686). A population pyramid demonstrated a bimodal distribution among male patients, but not female patients, which was confirmed with a strong goodness of fit for male patient subpopulations age <35 (R= 0.9791) and age ≥35 (R= 0.8843), but a weaker fit for a second female subpopulation age <35. Both age groups were equally likely to undergo surgery. Patients younger than age 35 were more likely to be male (82.4% vs. 46.9%, odds ratio [OR]= 5.29 [1.54, 17.57], P= 0.0052), have motor vehicle collision as their mechanism of injury (64.7% vs. 14.1%, OR= 11.18 [3.77, 31.77], P < 0.0001), and to have a severe trauma injury severity score (17.6% vs. 2.9%, OR= 7.23 [1.88, 28.88], P= 0.0198). Nevertheless, patients age <35 were less likely to have fracture nonunion at follow (18.2% vs. 53.7%, OR= 0.19 [0.041, 0.76], P= 0.0288). The dens fracture patient population comprises 2 subpopulations, distinguished by differences in age, sex, injury mechanism and severity, and outcome, with male dens fracture patients demonstrating a bimodal age distribution. Young, male patients were more likely to have high-energy injury mechanisms leading to severe trauma, yet were less likely to have fracture nonunion at follow-up.

Screening for alcohol and drug use in pediatric trauma.

Level 1 pediatric trauma centres should screen all trauma patients aged 12 years and older for alcohol use and provide substance use interventions as a means to minimize relapse. We aimed to approximate the rate of alcohol and drug use screening in Canadian pediatric patients admitted for trauma in our centre, determine the prevalence of intoxication on admission and compare the injury characteristics and morbidity of patients with and without concomitant substance use. We conducted a single-centre retrospective review of the Stollery Children's Hospital's medical records abstracted from the Alberta Trauma Registry database of patients aged 12-17 years who were admitted for trauma (Injury Severity Score ≥ 12) between Jan. 1, 2012, and Dec. 31, 2021. Of the 543 patients included in the analysis, 380 (70.0%) received screening for alcohol as a part of their trauma panel; meanwhile, only 5 (0.9%) patients were screened for drug use. Among the patients who were screened for alcohol, 47 (12.4%) had a positive blood alcohol level (BAC). Nine (7%) of 129 screened patients aged 12-14 years were found to have positive BACs compared with 38 (15.1%) of 251 screened patients aged 15-17 years. Patient age and mechanism of injury significantly affected rates of screening. Among patients with positive BACs on admission, the 3 most prevalent mechanisms of injury were motor vehicle accident (26 [55.3%]), assault (13 [27.7%]) and recreational vehicle accidents (4 [8.5%]). Patients with a positive BAC sustained significantly more severe injuries (p = 0.003). These results provide evidence of the importance of standardized screening to identify pediatric patients admitted for trauma who are in need of treatment for alcohol and drug use. The Screening, Brief Intervention and Referral to Treatment model is the primary approach used to fulfill substance use identification and intervention recommendations. The Alcohol Use Disorders Identification Test and the Car, Relax, Alone, Forget, Friends, Trouble questionnaire are most suitable for adolescent populations.

Incidence and outcomes of major trauma patients with thoracic injuries and rib fractures in Aotearoa New Zealand

IntroductionThoracic trauma represents a significant burden of disease in Aotearoa, New Zealand (AoNZ). To date, no study has examined the incidence or outcomes of patients suffering major thoracic trauma, or major trauma and rib fractures in AoNZ. MethodsA 6 year retrospective study of all major trauma (Injury Severity Score >12) patients in AoNZ was performed. The National Trauma Registry was searched to identify patients. The National Minimum Data Set was searched for all ICD-10 codes associated with surgical stabilisation of rib fractures (SSRF). Poisson regression was used to determine the change in incidence rate over the study period adjusted for age with the logarithm of population size as the offset variable. The incidence rate ratios (IRR) with 95% confidence intervals (CI) were reported. Results12,218 patients sustained major trauma. 7,059 (57.8%) of these patients sustained thoracic injuries. Of these patients, 5,585 (79.1%) sustained rib fractures, and 180 (3.2%) proceeded to SSRF. A flail segment was observed in 16% of patients with rib fractures. Transport was the mechanism of injury in 53% of patients. During the study the incidence (cases per 100,000 people per year) of major trauma increased from 39.5 to 49.3 (IRR 1.05, 95%CI 1.04 to 1.07, <0.001), the incidence of thoracic injuries from 21.3 to 28.7 (1.07, 95% CI 1.05 to 1.08, <0.001) and the incidence of rib fractures from 16.0 to 22.9 (1.08, 95% CI 1.06 to 1.09, <0.001). SSRF was performed in 3.2% of patients with rib fractures and increased from 0.2 to 0.8 cases per 100,000 people per year (1.27, 95% CI 1.15 to 1.41, <0.001) during the study. ConclusionThis study reports the incidence of major trauma patients with thoracic injury, major trauma patients with rib fractures and the incidence of SSRF in AoNZ. Transport related injuries are the predominant mechanism of injury. The incidence of SSRF was low across AoNZ. To improve the quality of care in AoNZ for major trauma patients with rib fractures, consideration should be made to create national guidelines and robust referral pathways to specialist centres that provide multidisciplinary care including performing SSRF.