Trauma Scoring Systems Research Articles

Case Series of Ocular Injury with Firecracker During Diwali in North India

Objectives:- The primary aim of this case series is to evaluate and report the patients presenting at a tertiary care hospital with an ocular injury sustained due to firecrackers during the occasion of the Diwali festival and to report the pattern and severity of firecrackers associated ocular injury and to what extent this affects the visual acuity of these patients.
 Methods:- This study is a tertiary care teaching hospital-based prospective study that includes 14 eyes of 12 patients who suffered firecracker-associated ocular injuries. All of them were presented to the hospital’s emergency department within one week after the Diwali festival. A detailed history of all the patients was taken and their ocular examination was done. Out of 12 patients, 7 were admitted for further surgical management, and one patient who sustained a superficial facial burn, including periorbital area, without any eye injury was admitted to the department of plastic surgery 4 patients were given conservative treatment. The injuries were classified according to the ocular trauma scoring system (OTSS).
 Results:- Out of the 12 patients presented, all were males, all of age group 6 years to 42 years (mean age group 18 years). Eight of them sustained injuries from explosive firecrackers and four sustained injuries from bottle rockets. Six of them were involved in igniting firecrackers, while 5 patients were either bystanders or passersby. Out of 11 patients, the right eye (RE) was involved in 6, the Left eye (LE) was involved in 4 and both eyes (BE) were engaged in 1 patient. Out of 12 eyes, six eyes had open globe perforating injuries involving cornea or cornea and sclera both, two eyes had mild conjunctival congestion and superficial burn over the periorbital region, one eye had conjunctival injury and one eye had a vitreous hemorrhage, one eye had traumatic retinal detachment, one eye had optic nerve avulsion. The maximum number of affected eyes falls under OTSS score II, indicating poor prognosis regarding visual acuity.
 Conclusion:- Firecrackers may cause injuries in one or both eyes which may be grievous in nature resulting in an irreversible loss of vision in either or both eyes. Hence, it is a matter of serious concern. Directives should be formulated to register the ocular injury presented to the hospitals. The public should be educated regarding the safe handling of firecrackers. Firecracker manufacturing companies should be instructed to manufacture less explosive and safer firecrackers.

Comparison of Injury Severity Score, Glasgow Coma Scale and Revised Trauma Score in Predicting the Outcome in Young Patients with Trauma Attending Emergency Department of Suez Canal University Hospitals

Background: Easy-to-use trauma scoring systems can be used for making good clinical decision before the patient reaches the hospital and at emergency department. These scoring systems can also be used for timely delivering medical support and preparing the patient for surgery in early stage. The objective of this study was to assess the ability of trauma scoring systems such as the Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) to predict outcomes in young children with traumatic injuries.
 Methods: This was a potential cross-sectional study that was conducted in the emergency department of Suez Canal University Hospitals. We included 86 children patients younger than 6 years of age who were presented to hospital via the emergency department with any traumatic injury and compared the trauma outcomes for GCS, ISS, and RTS on patient outcomes.
 Results: The main type of accident encountered in our study was fall from height (33.7%) followed by road traffic accidents (29.1%). Mortality rate in our study was 4.7%. The mean trauma scores of ISS, GCS, and RTS in our studied population were 11.47, 14.21, and 7.79, respectively. All trauma scores differed with statistical significance (p<0.001, <0.001, <0.030, respectively) between the survivors and mortality groups. We found a mean ISS of 10.30 ± 5.84 in survived children and 35.25 ± 25.97 in those who died. Mean GCS was 14.62 ± 1.10in survivors and 5.75 ± 1.50 in non-survivors. RTS means were7.96 ± 0.33in survived children and 4.25 ± 0.50 in those who died, respectively. ROC curve analysis of the three scores regarding mortality prediction revealed close results; all showed a modest ability to predict mortality. The highest AUC was for RTS and GCS; 0.998 and 0.997, respectively. ISS had a slightly lower AUC of 0.0816. In the current study, RTS and GCS showed the best sensitivity and specificity to predict mortality of 100% and 98.78%, respectively. A slight lower ability was found for ISS with a sensitivity of75%. The desired cut-offs to predict mortality were ≤7 for the GCS, ≤5 for the RTS and ≥17 for the ISS with the previously mentioned sensitivity and specificity. Regarding the need for surgery, among survived patients, those who had surgery had statistically significant higher ISS compared to those who did not have surgery (14.69 ± 9.98 Vs 7.39 ± 6.04) (p<0.001). On the other hand, there was no statistically significant difference between the two groups in regard to GCS (p=0.053) and RTS (p=0.251). Conclusion: In conclusion, we found that worse trauma scores of ISS, GCS, and RTS were associated with increased mortality and prolonged hospital stays among young children’s injuries. Among these three trauma scores, we found RTS and GCS to have the best predictive value. The cutoff values of ISS, GCS, and RTS for predicting mortality were >17, ≤7, and ≤5, respectively.

Efficacy of blunt abdominal trauma scoring system in management of blunt abdominal trauma

Background: Although there are many scores to evaluate a patient having trauma, BATSS is a newer score specifically designed for blunt abdominal trauma which is not adequately studied. The objective was to study the efficacy of BATSS by comparing it with conventional experience-based management of Blunt abdominal trauma.Methods: 100 patients presenting with blunt abdominal trauma between March 2019 to May 2020 were randomly selected. Patients were treated by conventional experience-based management and it was compared with management guided by BATSS by prospective observation. Analysis was done by assessing need for CT scan of abdomen and laparotomy to check efficacy of BATSS.Results:100 patients were included in study. CT Abdomen is rarely required in low-risk category (BATSS<8, p <0.0001). In Moderate and High-risk category (BATSS>8), CT Abdomen is required to accurately identify Intra-abdominal injury (p=0.0006 and 0.0965 respectively). Laparotomy may be necessary in any risk category patient for hollow viscous perforation. BATSS does not have a variable like X-ray-Chest standing to diagnose hollow viscous perforation. So, some patients in Low-risk category may also need Laparotomy (p 0.06892) which is not indicated by BATSS. Not all patients in high-risk category needs laparotomy (p=0.00009).Conclusions: Variables used to score the severity of trauma are inadequate and some patients would be improperly categorised in blunt abdominal trauma scoring system. So, we conclude that BATSS is not useful in our setup and requires modifications.

Evaluation of intentional and unintentional injuries in children and adolescents with trauma scoring systems

Evaluation of intentional and unintentional injuries in children and adolescents with trauma scoring systems

Elderly trauma patients and the effect of trauma scores on hospitalization decision.

Hospitalization, mortality and trauma scores are important in trauma patients aged ≥65 years. The present study aimed to investigate the use of trauma scores in the prediction of hospitalisation and mortality in trauma patients aged ≥65 years. Patients aged ≥65 years who presented to the emergency department with trauma over a one-year period were included in the study. Baseline data of the patients together with their Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Injury Severity Score (ISS), hospitalisation and mortality were analysed. A total of 2264 patients were included in the study, of whom 1434 (63.3%) were women. The most common mechanism of trauma was simple falls. Mean GCS scores, RTSs and ISSs of the inpatients were 14.87 ± 0.99, 6.97 ± 0.343 and 7.22 ± 5.826, respectively. Furthermore, a significant negative correlation was found between the duration of hospitalisation and GCS scores (r= -0.158, p <0.001) and RTSs (r= -0.133, p <0.001), whereas a positive significant correlation with ISSs (r= 0.306, p <0.001) was observed. The ISSs (p <0.001) of the deceased individuals were significantly elevated, whereas their GCS scores (p <0.001) and RTSs (p <0.001) were significantly decreased. All trauma scoring systems can be used to predict hospitalisation, but the results of the present study suggest that the use of ISS and GCS in making the decision regarding mortality is more appropriate.

APACHE II Scoring System and its Probability Impact in Poly Trauma Patients at a Tertiary Care Center

Background: Trauma is one of the most significant causes for in hospital mortality. Different predictors are available to predict the patient outcome like revised trauma scoring system (physiological), Injury severity scoring system (Anatomical scoring system), APACHE II, AIS etc. Aim: To assess pobability of APACHE II score in evaluating mortality for poly trauma patients within first 24 hr of hospitalization. Method: Cross sectional study was conducted at surgical unit in Lahore General Hospital, Lahore from Jan, 2019 to Dec, 2020. APACHE II for each patient was calculated with devised software APACHE II Score- MDCalc. After fulfilling the inclusion and exclusion criteria, 300 patients were included in the study from emergency department of a tertiary care hospital. All the data was entered in proforma and was analyzed in SPSS 23. Results: Mean age was 32.53 ± 11.67 years with 205 (68.33%) male and 95(31.67%) were female patients. Out of 300, in hospital mortality occurred in 88(29.33%) while other 212(70.66%) were alive within 24 hours after admission. 88(29.33%) patients out of 300 had probability APACHE II score ≥ 12 and rest 212(70.66%) had ≤ 12. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of APACHE II was 90.16%, 94.2%, 88%, 92.84% and 90.74%. Conclusion: By using APACHE II scoring system for poly trauma patients we can devise an efficient treatment and resuscitation plan to reduce the probability of hospital mortality. Keywords: Trauma, prediction, mortality, APACHE II.

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

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

The Usefulness of Trauma Scoring Systems to differentiate Severity of Life-Threatening İnjuries İn Forensic Reports

The Usefulness of Trauma Scoring Systems to differentiate Severity of Life-Threatening İnjuries İn Forensic Reports

A retrospective study on evaluating GAP, MGAP, RTS and ISS trauma scoring system for the prediction of mortality among multiple trauma patients

ObjectivesPredicting the outcome of trauma helps clinician to prioritize patients and provide timely and effective treatment. Several scoring systems are implemented to predict prognosis and mortality among these patients. Our study aims to use four scoring systems to predict mortality among multiple trauma patients. MethodsIn retrospective descriptive study, the data was collected from records of (XXX) of multiple trauma patients referred to the hospital from June 2019–January 2020. The patients were scored using four scoring systems: MGAP (mechanism, Glasgow coma scale, age, and arterial pressure), GAP (Glasgow coma scale, age, and arterial pressure), ISS (injury severity score) and RTS (revised trauma score). ResultsThe mean age of the patients was 37.4 ± 4.2 years and of 112 patients, 92 patients (82.1%) were males. Sensitivity of GAP, RTS and ISS was 100% in predicting mortality where MGAP had highest specificity, 97.2%. All four scoring systems significantly predicted mortality, p < 0.001, respectively and the highest area under the curve was for RTS criteria, 0.969. ConclusionMGAP, GAP, RTS and ISS were all effective in predicting mortality among multiple trauma patients whereas MGAP had both, highest sensitivity and specificity. Scoring trauma for mortality can be achieved by using any of the systems, provided the information required for score can be obtained.

In Search of Perfect Embalmment Scoring Tool

Background: Scoring systems for tissue preservation and embalmment can be likened to trauma scoring systems for their pivotal roles in healthcare institutions for evaluation and auditing purposes. Albeit, embalmment cannot always guarantee exact ante-mortem state, the present study was designed to validate the scoring tool that had been developed in appropriating medical and social needs of embalming practices. Methods: The study was one-year hospital-based using the standardized forms A, B and C of ‘Relative’s Perspective Scale of Embalmment’ for data collection. ‘Form A’ was self-explanatory and scored by the relatives of the dead. ‘Form B’ was handled by mortuary director, likewise ‘Form C’ for auditing. Reliability and descriptive statistics were applied to report the validation outcome data for the Likert-styled Form A. The hypotheses were tested at 0.05 level of significance. Results: Only 94 out of 129 bodies released within a year were deemed fit for the study (amounting to 73% of the bodies) due to exclusion criteria. Cronbach’s alpha reliability score of 0.710 (Acceptable) was recorded. Descriptive statistics further showed mode 33, median 33.5, range 19-45, mean 34.2±6.9 and response score of 76%. Assertion Q8 in Form A was the most reliable. Conclusion: Offensive odour from the embalming centre needed to be addressed. Final validatory judgement ‘RPSE-D’ interpreted ‘Improve on mortuary operation’ rightly projected this scoring tool for evidence based embalmment. Some modification exercises suggested because of commercial venture of the mortuary in order to encourage more patronage and consequential acquisition of cadavers for research and medical education.

Visual Outcomes and Prognostic Factors for Pediatric Open Globe Injuries.

Open globe injuries (OGIs) in children can be visually devastating traumas and are a common cause of unilateral blindness in children. Three commonly used ocular trauma scores (Ocular Trauma Score [OTS], Pediatric Penetrating Ocular Trauma Score [POTS], and Toddler/Infant Ocular Trauma Score [TOTS]) can be used to help predict visual outcomes in ocular injuries. Each has strengths and weaknesses, but these scores have not been studied extensively in the pediatric population. The medical records of all pediatric patients presenting at a single institution with OGIs from 2011 to 2016 were retrospectively reviewed. Initial clinical presentation and subsequent examinations were reviewed. The 3 trauma scoring systems were applied to patient data to determine the effectiveness at predicting final visual acuity (VA). A total of 15 patients met inclusion criteria. The mean age at presentation was 6.97 years. Seven of 15 (47%) of the patients had a final VA of 20/40 or better. The OTS was applied to 8 of 15 patients, as the OTS requires initial VA, which could not be obtained in 7 patients. The POTS and TOTS were applied to all 15 patients. The POTS, TOTS, and OTS were all significantly correlated to final VA. Incidence of relative afferent pupillary defect and more posterior zone of injury were correlated with poorer visual outcomes. All 3 available ocular trauma scores were effective at predicting final VA in our cohort of pediatric patients with OGIs even outside of the age ranges for which they have been created. Of all the factors included in the scores, relative afferent pupillary defect and zone of injury were most closely correlated with poor final VA.

Constructing a Trauma Scoring System from Databases of Road Crash Patients in Philippine Hospitals (2009–2019)

Introduction. Trauma scoring standardizes the severity of injuries of patients brought to trauma centers and is predictive of the outcome or prognosis among trauma victims. Hence, creating a trauma score allows for proper prioritization as well as proper management of patients in the emergency departments.&#x0D; Objectives. The objective of the study is to come up with a trauma scoring system that correlates to the probability of survival of a patient using the patient databases in major hospitals in the Philippines representing the three major island groups, Luzon, Visayas, and Mindanao. The study will also compare this proposed trauma scoring system with the gold standard (Revised Trauma Score) developed by Champion in 1989.&#x0D; Methods. The proposed Philippine Trauma Scoring System (PTSS) was based on data from the eight largest tertiary hospitals catering to trauma patients. A total of 40,286 patient charts were reviewed. The proposed trauma scoring system integrates concepts used in the Revised Trauma Score (RTS), with addition of age (from Kampala Trauma Scoring), as well as the Injury Score (based on the number of body parts injured). This proposed scoring system was weighted, using logistic regression to come up with coefficients for the components of the PTSS for a more accurate prediction of patient survival. The Receiver Operating Characteristic (ROC) was used to plot Sensitivity vs. 1-Specificity. In this analysis, ROC was used to evaluate and compare how good the models are in predicting patient recovery.&#x0D; Results. The components of GCS, RR, SBP, age, and body parts injured were significant predictors of patient outcomes for patients with trauma, specifically the road crash patients in this Philippine study. This study showed that both the PTSS and RTS have a significantly greater area under the curve than the diagonal reference line, which means that both the scoring system have a significant predictive value. The best predictive value, however, comes from the proposed scoring system that is developed from this study in the Philippines. Compared to the gold standard, PTSS Model 1 is a better predictor of outcomes than the gold standard RTS (ROC-AUC = 0.659 vs. 0.633) using only 22,214 valid subject population that contained all the variables needed for the PTSS analysis.&#x0D; Conclusion. In a developing country like the Philippines, there are limited resources especially in the healthcare setting. Therefore, it is important to lessen errors in triaging which may result in resource waste and a higher risk of adverse outcomes for the patients. Thus, the PTSS developed in this study can be used by Philippine hospitals as it is uniquely based on Filipino patients using a large database representative of the eight largest tertiary hospitals in the Philippines. The proposed PTSS is shown in this study as the best classifier for patient outcome compared to the gold standard – RTS of Champion.

Predictive value of quick sequential organ failure assessment (qSOFA) score in risk assessment and outcome prediction in blunt trauma patients: A prospective observational study

BackgroundThere is a plethora of trauma scoring systems currently in place. A lot of these scoring systems, however, are complex and thus have a limited utility in the emergency department. The present study was conducted to evaluate the relatively easy to calculate quick Sequential Organ Failure Assessment (qSOFA) Score in blunt trauma victims. We ought to study its utility in predicting outcomes in blunt trauma patients and its usefulness to guide resource allocation in the emergency department. MethodsA prospective observational study was performed on blunt trauma patients who had presented to the emergency department of our tertiary care center, over a period of 6 months. Their qSOFA scores were calculated and these patients were observed for their course in the hospital. The predictive validity of this score was then studied for the outcome prediction in these patients. ResultsA total of 246 patients were enrolled. Maximum 36.4% of patients had a qSOFA score of 0 and 10.1% were with a score of 3. Higher qSOFA scores were associated with higher in-hospital mortality, higher needs for an ICU admission, higher needs for mechanical ventilation. However, it did not reliably predict the need for an emergency surgery in these patients. ConclusionsqSOFA score serves as a reliable tool to predict adverse outcomes in blunt trauma victims. It helps with the quick allocation of resources in the emergency department.

The Relationship Between Trauma Scoring Systems and Outcomes in Patients With Severe Traumatic Brain Injury.

This study investigated the relationship between trauma scoring systems and outcomes in patients with severe traumatic brain injury (TBI). From January 2018 to June 2021, 1,122 patients with severe TBI were registered in the Korean Neuro-Trauma Data Bank System. Among them, 697 patients with data on trauma scoring systems were included in the study. According to the Glasgow Outcome Scale-Extended score, the patients were divided into unfavorable and favorable outcome groups. The abbreviated injury scale (AIS), injury severity score (ISS), revised trauma score (RTS), and trauma and injury severity score (TRISS) were evaluated. The AIS head score was higher in the unfavorable outcome group than in the favorable outcome group (4.39 vs. 4.06, p<0.001). ISS was also higher in the unfavorable outcome group (27.27 vs. 24.22, p=0.001). The RTS and TRISS were higher in the favorable outcome group (RTS, 4.74 vs. 5.45, p<0.001; TRISS, 48.05 vs. 71.02, p<0.001). In comparing the survival and death groups, the ISS was lower in the survival group (25.76 vs. 27.29, p=0.036). Furthermore, RTS was higher in the survival group (5.26 vs. 4.54, p<0.001), as was TRISS (62.11 vs. 44.91, p<0.001). Trauma scoring systems, including ISS, RTS, and TRISS, provide tools for quantifying posttraumatic risk and can be used to predict prognosis. Among these, TRISS is an indicator of the predicted survival rate and is considered a clinically useful tool for predicting unfavorable and favorable outcomes in patients with severe TBI.

Can ionized calcium levels and platelet counts used for estimating the prognosis of pediatric trauma patients admitted to the emergency surgery intensive care?

Injury is the leading cause of death for pediatric population older than 1 year of age and 95% of those deaths are from the low- and middle-income countries. Most of those injured pediatric patients are treated in general hospitals. In designated trauma centers, the outcomes of severely injured patients are better. Scoring systems used frequently in intensive care units (ICUs) to make triage easier and to estimate prognosis. However, some of the scores may require additional expensive and sometimes time consuming tests. The purpose of the present study was to compare the usefulness of several scoring systems with initial ionized calcium levels and platelet counts to predict prognosis of pediatric trauma patients admitted to the emergency surgery department. This retrospective study was performed at a tertiary university hospital. The patients' ages, genders, trauma etiologies, types of trauma, time of trauma, transport place (primary or secondary), duration of stay in the ICU and in the hospital, mortality rates, initial ionized calcium levels (Ca+2), initial platelet counts, and data of several trauma scores (GCS, RTS, ISS, TRISS, and PTS) were analyzed. One hundred and fourteen pediatric trauma patients were admitted to the ICU. The mean age was 77.8±54 months. Most of them were male, falls were the primary mechanism of injury, and head trauma was the most common pattern of injury. The mortality rate was 15.8%, and the admission values for Ca+2, platelet counts, GCS, RTS, TRISS, and PTS had been found higher for patients who survived, while ISS scores were higher for those who had died. It was found that pediatric patients admitted to the ICU were younger than 10 years, of whom most of them were male. Falls were the most common mechanism of injury, and head trauma was present in most of the pediatric patients admitted to the ICU. Initial Ca+2 levels and platelet counts can be used along with the trauma scoring systems in predicting mortality and overall survey regarding pediatric trauma patients.

Analysis of trauma scoring system for patients with abdominal trauma.

This study investigated the correlations between several trauma scoring systems, including the injury severity score (ISS), clinical abdominal scoring system (CASS), new injury severity score (NISS), and clinical outcomes, including laparotomy, in-hospital mortality (IHM), and long hospital stay (LS) in patients with abdominal trauma. Data of 749 patients with abdominal trauma between January 2009 and December 2019 were reviewed retrospectively. Data from medical records included age, sex, initial vital signs, type and mechanism of trauma, hospital stay, laparotomy, and IHM. Injured organs and grades were collected using computed tomography. Correlations between the scoring system and clinical outcomes were analyzed using the area under Curves (AUC) of the receiver operating characteristic (ROC) curve. The mean age of the patients was 40.14±19.47 years. Blunt trauma was the most common type of trauma in 704 patients (94.0%), and traffic accident was the most common mechanism in 475 (63.4%). Injured organs included liver (45.1%) and spleen (25.1%). A total of 179 patients (23.9%) underwent laparotomy and IHM was reported in 35 (4.6%). The AUC of ROC for ISS, NISS, and CASS was significantly associated with laparotomy (0.682; p=0.001, 0.713; p=0.001; 0.845; p=0.001). The AUCs showed significant for IHM (0.606; p=0.034, 0.626; p=0.012, 0.701; p=0.001). The AUCs for LS were 0.554 (p=0.041), 0.549 (p=0.062), and 0.581 (p=0.002). The CASS is excellent for predicting laparotomy, IHM, and LS in patients with abdominal trauma. The NISS is more appropriate than the ISS for predicting laparotomy and IHM.

Comparison of Blunt Abdominal Trauma Scoring System (BATSS) versus FAST in assessment of Blunt Trauma Abdomen

Trauma is the second largest cause of disease worldwide accounting for more than 16 % of global burden 1. By the next decade, the World Health Organization (WHO) estimates that trauma will be the leading cause of Years of Potential Life Lost (YPLL) amongst the world population. With advancement in infrastructure and economic prosperity, accidental trauma due to vehicular accidents has become more commonplace. A majority of victims of motor vehicular accidents present with Blunt abdominal trauma, which due to the complexity in diagnosis and management, presents with significant morbidity and mortality2. Introduced in the 1970s in Europe, point of care Ultrasonographic examination of the abdomen in trauma called as FAST (Focussed Assessment with Sonography for Trauma) has become a routine in emergency rooms worldwide 3. The Blunt Abdominal Trauma scoring system was developed to better diagnose intra-abdominal injury after blunt abdominal trauma 4. This study is aimed in comparing the findings of FAST and BATSS in predicting intra-abdominal injury accurately.

Shock Index and Modified Shock Index as Predictors of 24 Hour Mortality in Patients with Polytrauma

Abstract Context: The failure of the vital signs to predict the severity of shock and the drawbacks of the trauma scoring systems have led to extensive research on shock index in polytrauma patients. This prospective, observational study was conducted to study the efficacy of the Shock Index (SI) and Modified Shock Index (MSI) as predictors of 24 h mortality in polytrauma patients. Aim: To validate the Shock index and Modified Shock index as predictors of 24 h mortality in polytrauma patients. Method: All patients presenting with polytrauma meeting the inclusion criteria were evaluated using the following parameters: Heart rate, Systolic blood pressure, and Diastolic blood pressure, following which SI and MSI were calculated. Abbreviated Injury Score (AIS) &amp; Injury Severity Score (ISS) were formulated. The endpoint of the study was hospital stay, ICU stay, and 24 h mortality. Statistical Analysis: The sensitivity, specificity, positive predictive value, negative predictive value, odds ratio, positive likelihood ratio, and negative likelihood ratio of SI and MSI were evaluated using Graphpad software. ROC curves and scatter diagrams were also plotted. Results: SI &gt;0.9 has a sensitivity of 96% and a negative predictive value (NPV) of 93.75%. Similarly, MSI &gt;1.3 has a sensitivity of 96% and NPV of 94.12%. Statistically, a significant correlation was observed between SI &amp; MSI with ISS, ICU stay, and hospital stay. Conclusion: SI and MSI are effective predictors of 24 h mortality but less efficient in predicting mortality that does not occur before 24 h. Higher SI &amp; MSI values are related to higher ISS, and longer duration of ICU &amp; hospital stays.

Validity of vetrivel trauma score in predicting salvage of limb in gustilo anderson grade III B and grade III C open fractures

There have been many classification systems developed for open fractures like Gustilo Anderson grading system, Mangled extremity severity score, Ganga hospital open injury severity score. But the gray zone still exists in many open fractures whether the limb has to be salvaged or amputated. The above-mentioned scores have poor sensitivity and specificity in evaluating open fractures. This led to the development of a novel scoring system known as Vetrivel trauma score.This study aims to assess the validity of this novel scoring system in predicting the outcome of limbs in Gustilo Anderson Grade IIIB and Grade IIIC open fractures.One hundred and forty-four open fracture cases were taken for this study. 82 patients sustained Grade III injuries according to the Gustilo Anderson classification. Of these, 35 patients were of Grade IIIB and above. These 35 patients were scored using Vetrivel Trauma score, Ganga hospital open injury severity score, and Mangled extremity severity score.Vetrivel trauma score was compared with Ganga hospital open injury severity score, and Mangled extremity severity score. Analysis indicated Vetrivel trauma scoring system is more accurate than others. The area under the curve of the receiver operating characteristic curve for Vetrivel Trauma score (0.983) is found to be significantly higher than other scoring systems compared.Vetrivel trauma score is a better predictor of injury severity in Grade IIIB and Grade IIIC open fractures with the highest sensitivity and specificity in deciding amputation versus salvage. A score of 39 or more has the highest predictability for amputation.

Development and Validation of a Simplified Prehospital Triage Model Using Neural Network to Predict Mortality in Trauma Patients: The Ability to Follow Commands, Age, Pulse Rate, Systolic Blood Pressure and Peripheral Oxygen Saturation (CAPSO) Model.

Objective: Most trauma scoring systems with high accuracy are difficult to use quickly in field triage, especially in the case of mass casualty events. We aimed to develop a machine learning model for trauma mortality prediction using variables easy to obtain in the prehospital setting.Methods: This was a retrospective prognostic study using the National Trauma Data Bank (NTDB). Data from 2013 to 2016 were used for model training and internal testing, and data from 2017 were used for validation. A neural network model (NN-CAPSO) was developed using the ability to follow commands (whether GCS-motor was <6), age, pulse rate, systolic blood pressure (SBP) and peripheral oxygen saturation, and a new score (the CAPSO score) was developed based on logistic regression. To achieve further simplification, a neural network model with the SBP variable removed (NN-CAPO) was also developed. The discrimination ability of different models and scores was compared based on the area under the receiver operating characteristic curve (AUROC). Furthermore, a reclassification table with three defined risk groups was used to compare NN-CAPSO and other models or scores.Results: The NN-CAPSO had an AUROC of 0.911(95% confidence interval 0.909 to 0.913) in the validation set, which was higher than the other trauma scores available for prehospital settings (all p < 0.001). The NN-CAPO and CAPSO score both reached the AUROC of 0.904 (95% confidence interval 0.902 to 0.906), and were no worse than other prehospital trauma scores. Compared with the NN-CAPO, CAPSO score, and the other trauma scores in reclassification tables, NN-CAPSO was found to more accurately classify patients to the right risk groups.Conclusions: The newly developed CAPSO system simplifies the method of consciousness assessment and has the potential to accurately predict trauma patient mortality in the prehospital setting.