Trauma Severity Score Research Articles

Validation of age-specific survival prediction in pediatric patients with blunt trauma using trauma and injury severity score methodology: a ten-year Nationwide observational study

BackgroundIn-hospital mortality in trauma patients has decreased recently owing to improved trauma injury prevention systems. However, no study has evaluated the validity of the Trauma and Injury Severity Score (TRISS) in pediatric patients by a detailed classification of patients’ age and injury severity in Japan. This retrospective nationwide study evaluated the validity of TRISS in predicting survival in Japanese pediatric patients with blunt trauma by age and injury severity.MethodsData were obtained from the Japan Trauma Data Bank during 2009–2018. The outcomes were as follows: (1) patients’ characteristics and mortality by age groups (neonates/infants aged 0 years, preschool children aged 1–5 years, schoolchildren aged 6–11 years, and adolescents aged 12–18 years), (2) validity of survival probability (Ps) assessed using the TRISS methodology by the four age groups and six Ps-interval groups (0.00–0.25, 0.26–0.50, 0.51–0.75, 0.76–0.90, 0.91–0.95, and 0.96–1.00), and (3) the observed/expected survivor ratio by age- and Ps-interval groups. The validity of TRISS was evaluated by the predictive ability of the TRISS method using the receiver operating characteristic (ROC) curves that present the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, area under the receiver operator characteristic curve (AUC) of TRISS.ResultsIn all the age categories considered, the AUC for TRISS demonstrated high performance (0.935, 0.981, 0.979, and 0.977). The AUC for TRISS was 0.865, 0.585, 0.614, 0.585, 0.591, and 0.600 in Ps-interval groups (0.96–1.00), (0.91–0.95), (0.76. − 0.90), (0.51–0.75), (0.26–0.50), and (0.00–0.25), respectively. In all the age categories considered, the observed survivors among patients with Ps interval (0.00–0.25) were 1.5 times or more than the expected survivors calculated using the TRISS method.ConclusionsThe TRISS methodology appears to predict survival accurately in Japanese pediatric patients with blunt trauma; however, there were several problems in adopting the TRISS methodology for younger blunt trauma patients with higher injury severity. In the next step, it may be necessary to develop a simple, high-quality prediction model that is more suitable for pediatric trauma patients than the current TRISS model.

Can Pediatric Trauma Severity Scores Predict Outcomes?

Trauma is the leading cause of death in children aged 1 to 18 years old. Multiple different trauma severity scores exist including the shock index (SI), age adjusted shock index (SIPA), reverse shock index (rSI), age adjusted reverse shock index and reverse shock index multiplied by Glascow Coma Scale (rSIG). However, it is not known which one is the best predictor of clinical outcomes.

Association of trauma severity scores with limb amputation and death in acute leg compartment syndrome.

Limb amputation and death are devastating sequelae of acute compartment syndrome (ACS), and have been posited to result either from the initial injury burden or from pathophysiologic sequelae, such as rhabdomyolysis leading to acute renal failure. We aimed to test the hypothesis that severity of trauma is associated with limb amputation and death in patients with traumatic leg ACS. We retrospectively reviewed 302 patients with ACS of 302 legs treated with fasciotomies from 2000 to 2015 at two tertiary trauma centers. Our response variables were death and limb amputation during inpatient hospital admission. Three common trauma severity scores, injury severity score (ISS), revised trauma score (RTS), and Glasgow coma scale (GCS), were studied. Patient- and injury-related explanatory variables were studied. Bivariate analyses were used to identify factors associated with limb amputation and death. Of 302 patients, 13 (4%) underwent limb amputation and 10 (3%) died during the inpatient admission. Only one of 10 patients who expired died secondary to acute renal failure. ISS and GCS were significantly associated with limb amputation, and RTS was marginally associated. ISS, RTS, and GCS were significantly associated with death. Moreover, smoking and open fracture were significantly associated with limb amputation, and diabetes mellitus, presence of fracture, closed head injury, and chest or abdominal injury were associated with death. Trauma severity scores are associated with both limb amputation and death during inpatient admission for traumatic leg ACS. These adverse sequelae of leg ACS are likely driven by the initial injury burden.

Scoring Models For The Severity Of Combined Craniofacial Trauma (A Review)

Background. Severe combined trauma is a pressing issue in modern medicine. Victims with a severe combined trauma receive constant monitoring for the severity of their condition. There is no commonly adopted uniform model for assessing the severity of injuries.Objectives. To review existing scoring methods for assessing the severity of combined craniofacial trauma.Мethods. A search of Russian and foreign publications in the PubMed and Elibrary databases at the depth of 10 years was conducted. The query terms were: injury severity, trauma severity [тяжесть травм], trauma severity score [шкалы оценки тяжести травм], cranio-facial trauma severity [тяжесть черепно-лицевой травмы]. The record selection was based on its scientifi c value in this research topic.Results. This systematic review covered 49 scientifi c papers reporting methods for assessing the severity of combined craniofacial trauma. Depending on the main applied principle, the severity scoring methods were classifi ed into 3 groups: anatomical, physiological and combined. Along with the history of creation, main advantages and disadvantages of the methods in terms of scoring performance in combined craniofacial trauma were outlined. Severity scoring models in isolated maxillofacial trauma were described in detail.Conclusion. There is no generally accepted best clinical practice for trauma severity scoring, including craniofacial trauma. The majority of scoring models are developed for survival chance estimation. At the same time, dynamic monitoring in hospitals most commonly relies on non-specifi c methods for the general severity estimation in trauma victims.

Ten-Year in-Hospital Mortality Trends among Paediatric Injured Patients in Japan: A Nationwide Observational Study.

Injury is a major cause of worldwide child mortality. This retrospective nationwide study aimed to evaluate the characteristics of paediatric injured patients in Japan and their in-hospital mortality trends from 2009 to 2018. Injured patients aged <17 years were enrolled. Data were extracted from the Japan Trauma Data Bank. In the Cochran-Armitage test, in-hospital mortality significantly decreased during the study period (p < 0.001), except among patients <1 year old, and yearly reductions were observed among those with an Injury Severity Score ≥16 and survival rate ≥50% (p < 0.001). In regression analyses, patients who underwent urgent blood transfusion within 24 h after hospital admission (odds ratio (OR) = 3.24, 95% confidence interval (CI) = 2.38–4.41) had a higher in-hospital mortality risk. Higher survival probability as per the Trauma and Injury Severity Score was associated with lower in-hospital mortality (OR = 0.92, 95% CI = 0.91–0.92), a risk which decreased from 2009 to 2018 (OR = 6.16, 95% CI = 2.94–12.88). Based on our results, there is a need for improved injury surveillance systems for establishment of injury prevention strategies along with evaluation of the quality of injury care and outcome measures.

Toward a hemorrhagic trauma severity score: fusing five physiological biomarkers

BackgroundTo introduce the Hemorrhage Intensive Severity and Survivability (HISS) score, based on the fusion of multi-biomarker data; glucose, lactate, pH, potassium, and oxygen tension, to serve as a patient-specific attribute in hemorrhagic trauma.Materials and methodsOne hundred instances of Sensible Fictitious Rationalized Patient (SFRP) data were synthetically generated and the HISS score assigned by five clinically active physician experts (100 [5]). The HISS score stratifies the criticality of the trauma patient as; low(0), guarded(1), elevated(2), high(3) and severe(4). Standard classifier algorithms; linear support vector machine (SVM-L), multi-class ensemble bagged decision tree (EBDT), artificial neural network with bayesian regularization (ANN:BR) and possibility rule-based using function approximation (PRBF) were evaluated for their potential to similarly classify and predict a HISS score.ResultsSVM-L, EBDT, ANN:BR and PRBF generated score predictions with testing accuracies (majority vote) corresponding to 0.91 ± 0.06, 0.93 ± 0.04, 0.92 ± 0.07, and 0.92 ± 0.03, respectively, with no statistically significant difference (p > 0.05). Targeted accuracies of 0.99 and 0.999 could be achieved with SFRP data size and clinical expert scores of 147[7](0.99) and 154[9](0.999), respectively.ConclusionsThe predictions of the data-driven model in conjunction with an adjunct multi-analyte biosensor intended for point-of-care continual monitoring of trauma patients, can aid in patient stratification and triage decision-making.

High-flow nasal cannula therapy for acute respiratory failure in patients with chest trauma: A single-center retrospective study

PurposeThis retrospective study was performed to investigate the utility of high-flow nasal cannula (HFNC) therapy in patients with chest trauma and identify the risk factors associated with treatment failure. Materials and methodsWe identified 44 acute respiratory failure patients with chest trauma who received HFNC therapy between June 2016 and March 2019 at the Fourth Affiliated Hospital of Nantong University. According to their response to HFNC therapy, the patients were divided into success and failure groups. Their medical records were reviewed retrospectively to identify useful risk factors for HFNC treatment failure. ResultsOf the 44 patients, 25 and 19 patients were assigned to the HFNC success and failure groups, respectively. Compared with the success group, the failure group had a significantly higher rate of multiple rib fractures/flail chest (P = 0.035), higher Thoracic Trauma Severity Score (TTSS) (P = 0.001) and significantly longer ICU stay (P = 0.006) and hospital stay (P = 0.001). The mortality rate of the failure group was higher than that of the success group, but there was no significant difference (P = 0.414). High TTSS was a significant risk factor for treatment failure. The AUC of TTSS was 0.793. The cut-off value for TTSS was 14 points (sensitivity: 0.68, specificity: 0.84). ConclusionsHFNC therapy was safe and effective in patients with chest trauma, and more than 50% of the patients successfully recovered from acute respiratory failure without invasive ventilation. A high TTSS could be a significant risk factor for HFNC treatment failure and had a high predictive performance.

Patterns and outcomes of abdominal trauma patients Admitted to Trauma Intensive Care Unit..

Abdomen is the third most common area of the body that is damaged because of trauma. The nurse must be aware of specific assessment findings associated with abdominal trauma and immediate recognition of problems, so this study aimed to assess patterns and outcomes of abdominal trauma patients admitted to trauma intensive care unit.A descriptive research design was used. Setting: This study was carried out in trauma intensive care unit at Assuit University Hospital. Sample: 60 adult critically ill patients with abdominal trauma. Tools: Patient profile characteristic's sheet and abdominal trauma severity scores and outcomes assessment sheet were used. Main results: There were 65% males and 35% females. Mean Age was 36.62±10.8. Blunt trauma accounted for 86.67% while penetrating was 13.33%. Motor car accidents was the main cause of trauma with 51.67%, liver and spleen the most affected organs. Mortality rate was 10%. Gastrointestinal and respiratory complications are the most occurred. Conclusion: Abdominal trauma patients need frequent assessment as majority of the studied patients at a high risk for developing complications. Recommendations: Training the nurses about how to use abdominal trauma scoring systems for frequent assessment of patients' heath statue from first day of admission.

Prognosis of the Trauma Patients According to the Trauma and Injury Severity Score (TRISS); A Diagnostic Accuracy Study.

Objective:To investigate the prognosis and survival rates of a group of Iranian patients with traumatic injuries using the trauma and injury severity score (TRISS) model.Methods: In this prospective cohort study, all the patients with multi-trauma referring to the Yasuj Shahid Beheshti hospital during 2018 were included. The patients’ demographic information, trauma and history of previous illness were recorded. Vital symptoms including respiratory rate, heart rate, hypertension, pulse rate and Glasgow coma scale (GCS) score were assessed. The injury severity score (ISS) was calculated based on the type and location of the injuries and according to the abbreviated injury scale (AIS) classification. The survival probability of the patients was assessed according to the TRISS model. Results: Overall, 252 trauma patients were evaluated out of whom, 195 (77.4%) were men and 57 (22.6%) women. If we consider the TRISS score probability above 0.5 as the chance of being alive, the mortality rate was 6.75%, that was lower than our series (7.1%). The ISS score and GCS had a positive significant relationship with other variables except respiratory rate, body temperature and hospitalization. Revised trauma score (RTS) was significantly associated with other variables including age, GCS, hemoglobin, systolic blood pressure and respiratory rate. TRISS had an area under curve (AUC) of 0.988 indicating a high prognostic accuracy. Conclusion:The mortality rate was lower than that of being predicted by TRISS. This might be due to treatment effectiveness and care for traumatic patients leading to decreased mortality. TRISS had high prognostic accuracy in trauma patients. We also reported an association between hemoglobin and survival rate. Therefore, it seems that considering the laboratory parameters can be useful in patients with trauma.

Predicting Outcomes After Blunt Chest Trauma-Utility of Thoracic Trauma Severity Score, Cytokines (IL-1β, IL-6, IL-8, IL-10, and TNF-α), and Biomarkers (vWF and CC-16).

Thoracic trauma severity score (TTSS) has been used to assess severity and risk of pulmonary complications in patients with chest trauma. The role of cytokines and biomarkers in patients with chest trauma and its association with TTSS is not well elucidated. The aim of the study was to assess the cytokines (IL-1β, IL-6, IL-8, IL-10, and TNF-α) and biomarkers (vWF, CC-16) in patients of thoracic trauma and correlate it with TTSS and patient’s outcome. This was a prospective observational study. Serum and bronchoalveolar lavage fluid samples were collected from chest trauma patients. TTSS was calculated in all patients. Suitable controls for serum and bronchoalveolar lavage (BAL) sample were selected. The outcome parameters included patient discharge or death, duration of hospital, and intensive care unit (ICU) stay. Forty-three patients were included. There was no significant correlation between the measured cytokines and biomarkers and TTSS. The mean TTSS of patients who had a fatal outcome was significantly higher than the patients who recovered. Patients with a high TTSS score had a significant prolonged ICU stay. Patients with a prolonged hospital stay had lower values of CC-16. TTSS is a useful tool to predict severity of chest trauma and prolonged ICU stay. Lower levels of CC-16 in BAL fluid of chest trauma patients were associated with prolonged hospital stay suggestive of its protective role in the airway. Longer prospective studies are required to determine the role of cytokines and biomarkers in patients with thoracic trauma in predicting the patient’s outcome.

Outcomes of Damage Control Surgery for Abdominal Trauma Evaluated Using the Trauma and Injury Severity Score and Lethal Triad in a Single Institution

Outcomes of Damage Control Surgery for Abdominal Trauma Evaluated Using the Trauma and Injury Severity Score and Lethal Triad in a Single Institution

A study to validate thoracic trauma severity score in chest trauma patients

Background: Aim of this study was to validate thoracic trauma severity score (TTSS) in assessing the requirement of mechanical ventilation, mortality, and predicting prognosis in chest injury patients.Methods: This study was conducted in department of general surgery, Dr. S. N. Medical College, Jodhpur, Rajasthan, from December 2018 to September 2019. This was a single centred, prospective, observational study, conducted in 110 patients, aged &gt;18 years, of isolated chest injury, excluding polytrauma patients. Data was summarized in the form of proportions, histograms and tables to show relationships of parameters with results. Data was presented as mean±SD and proportions as appropriate. Chi square test, z test or t tests were used wherever necessary for association analysis between categorical variables. Diagnostic test characteristics for mortality and complications was calculated from the ROC curves. A two sided of p values of less than 0.05 was considered statistically significant.Results: Most common mode of chest injury was blunt trauma and most common age group affected was 42-54 years. Maximum mortality was seen in TTSS between 16-20, shows higher the TTSS more the mortality. Ventilator requirement was more in high TTSS. Patients with higher TTSS had longer hospital stay as compared to patients with lower TTSS.Conclusions: On application of TTSS on admission, TTSS had direct correlation with need for oxygenation, ventilator need, duration of hospital stay, mortality or outcome in chest trauma patients. Thus we recommend TTSS as a good useful score for evaluation of prognosis, outcome and mortality in chest trauma patients.

The search for a simple injury score to reliably discriminate the risk of in-hospital mortality in South Africa

BackgroundThe Injury Severity Score and Trauma and Injury Severity Score are used commonly to quantify the severity of injury, but they require comprehensive data collection that is impractical in many low- and middle-income countries . We sought to develop an injury score that is more feasible to implement in low- and middle-income countries with discrimination similar to the Injury Severity Score and the Trauma and Injury Severity Score. MethodsClinical data from KwaZulu-Natal, South Africa were used to compare the discrimination of the Injury Severity Score and the Trauma and Injury Severity Score with that of the 5, simple injury scores that rely primarily on physiologic data: Revised Trauma Score for Triage, “Mechanism, Glasgow Coma Scale, Age, Pressure” Score, Kampala Trauma Score, modified Kampala Trauma Score, and “Reversed Shock Index Multiplied by Glasgow Coma Scale” Score. ResultsData for 3,991 patients were analyzed. The Trauma and Injury Severity Score, the Injury Severity Score, and Kampala Trauma Score had similar discrimination (area under the receiver operating curve 0.85, 0.84, and 0.84, respectively). The simple injury scores demonstrated worse discrimination among patients presenting more than 6 hours postinjury, although Kampala Trauma Score maintained the best discrimination of the simple injury scores. ConclusionIn this patient population, Kampala Trauma Score demonstrated discrimination similar to the Injury Severity Score and the Trauma and Injury Severity Score and may be useful to quantify the severity of injury when calculation of the Injury Severity Score or the Trauma and Injury Severity Score is not feasible. Delay in presentation can degrade the discrimination of simple injury scores that rely primarily on physiologic data.

Predicting length of stay for trauma and emergency general surgery patients

BackgroundPredicting length of stay (LOS) is difficult for trauma and emergency general surgery (TEGS) patients. Our aim was to determine the accuracy of LOS predictions by TEGS team members and the NSQIP Risk Calculator and the patient factors associated with inaccurate predictions. MethodsLOS for 200 TEGS patients were predicted. Full-model univariate and multivariable linear regressions were used to determine associations between patient characteristics and inaccurate predictions. ResultsThere were 1,518 predictions of LOS. LOS predictions were rarely correct (TEGS team: 30.7% all patients, 35.6% surgical; NSQIP: 33.0% surgical). No individual group nor NSQIP was significantly better at predicting LOS. Inaccurate predictions were associated with female patients, longer LOS, trauma, frailty, higher comorbidity and injury severity scores, and lesser disposition. ConclusionBoth the TEGS team and NSQIP are poor at predicting LOS for TEGS patients. Further work helping to guide LOS predictions for TEGS patients is warranted.

Assessment of Isolated Blunt Chest Trauma Patients in Benha University Hospital According to Thoracic Trauma Severity Score

Background: Chest trauma, in the younger population, is considered a significant cause of morbidity and mortality. A scoring system that can give us a prediction of the thorax related complications in thoracic trauma patients is especially needed. So, the Thoracic Trauma Severity Score (TTSS) was described. The aim of this work: To assess the validity of the Thoracic Trauma Severity Score and its efficacy to predict outcome in blunt thoracic trauma patients. Methodology: Our study included 160 patients of isolated blunt chest trauma attending to emergency room at Benha University Hospital. Results: TTSS when larger than or equal 8 is a good test for prediction of outcome as sensitivity of it reaches 92.3% while specificity is 100% with 97.5% accuracy. Conclusion: This study shows how the usefulness of the TTSS for predicting outcome in thoracic trauma patients, as poor outcome was associated with higher scores. Keywords: Thorax trauma severity score; Blunt thoracic trauma; Trauma outcome

Prediction of Early TBI Mortality Using a Machine Learning Approach in a LMIC Population.

Background: In a time when the incidence of severe traumatic brain injury (TBI) is increasing in low- to middle-income countries (LMICs), it is important to understand the behavior of predictive variables in an LMIC's population. There are few previous attempts to generate prediction models for TBI outcomes from local data in LMICs. Our study aim is to design and compare a series of predictive models for mortality on a new cohort in TBI patients in Brazil using Machine Learning.Methods: A prospective registry was set in São Paulo, Brazil, enrolling all patients with a diagnosis of TBI that require admission to the intensive care unit. We evaluated the following predictors: gender, age, pupil reactivity at admission, Glasgow Coma Scale (GCS), presence of hypoxia and hypotension, computed tomography findings, trauma severity score, and laboratory results.Results: Overall mortality at 14 days was 22.8%. Models had a high prediction performance, with the best prediction for overall mortality achieved through Naive Bayes (area under the curve = 0.906). The most significant predictors were the GCS at admission and prehospital GCS, age, and pupil reaction. When predicting the length of stay at the intensive care unit, the Conditional Inference Tree model had the best performance (root mean square error = 1.011), with the most important variable across all models being the GCS at scene.Conclusions: Models for early mortality and hospital length of stay using Machine Learning can achieve high performance when based on registry data even in LMICs. These models have the potential to inform treatment decisions and counsel family members.Level of evidence: This observational study provides a level IV evidence on prognosis after TBI.

Evaluation of the predictive value of thorax trauma severity score (TTSS) in thoracic-traumatized patients

BackgroundThorax trauma severity score (TTSS) combines patient-related parameters with the anatomical and physiological parameters, and it can be easily calculated in the emergency room. The validity of this score in the Egyptian population has not been tested; therefore, the objective of this study was to evaluate the prognostic role of TTSS to predict the outcome of thoracic trauma in the Egyptian patients in two centers.ResultsThe study included 284 male patients (94.7%) with a mean age of 41 years. Fifty-six patients (18.7%) had conservative management, 216 had morbidity (72%), and 28 patients died (9.3%). One hundred forty-eight patients (49.3%) had a thoracostomy tube, and thoracotomy was required in 4 patients (1.3%). Respiratory rate above 20 cycles/min at admission was associated with mortality (n = 28 (9.3%); p < 0.001). One hundred thirty-six patients had TTSS between 0 and 5 points; 56 of them were discharged and 80 of them were admitted to the inpatient ward with a good prognosis. Twenty-four patients had TTSS between 21 and 25 points; all the 24 patients had a fatal prognosis. A cut-off value of 7 points or more of TTSS was 100% sensitive and 97.73% specific to poor and fatal prognosis, and it was significantly associated with acute respiratory distress syndrome and the need for mechanical ventilation (n = 64; p < 0.001; AUC = 0.998).ConclusionThe outcome of thoracic trauma patients could be predicted based on the thorax trauma severity score. A score of 7 points or above was associated with increased morbidity, and a score of 20 points or above predicted a fatal prognosis and prolonged mechanical ventilation.

Analysis of risk factors for preoperative mechanical ventilation in patients with acute traumatic cervical spinal cord injury

To analyze the risk factors associated with mechanical ventilation before surgery in patients with acute traumatic cervical spinal cord injury(TCSCI). According to whether preoperative mechanical ventilation, 59 patients with TCSCI admitted to our hospital from November 2016 to May 2018 were divided into mechanical ventilation(MV)group (37 cases) and non-mechanical ventilation(non-MV) group (22 cases). Falling from height was the most common causes of injury(30 cases, 50.8%), then was traffic accident(22 cases, 37.3%). The most common paraplegic plane was in C₁-C₄(36 cases, 61%). American Spinal Cord Injury Association(ASIA) injury degree and ASIA exercise score(AMS) were used to assess the extent of affected neurological plane and spinal cord injury. Trauma severity score(ISS) was used to evaluate the severity of the injury. Multivariate Logistic regression was used to analyze the risk factors for mechanical ventilation in TCSCI. ROC curves were used to assess the value of AMS and ISS in predicting mechanical ventilation. Univariate analysis showed that the percentage of male, complete injury and related injuries in the MV group were significantly higher than those in the non-MV group(P<0.05). The AMS score of the MV group was significantly lower than that of the non-MV group (16.4±10.7 vs 39.1±9.5, P<0.001), and the ISS score was significantly higher than that of the non-MV group(31.6±8.0 vs 26.5±6.7, P=0.015). Multivariate Logistic regression analysis showed that AMS[OR=3.340, 95% CI(1.321, 6.242), P<0.001] and ISS [OR=1.120, 95% CI(0.306, 3.786), P<0.001] were significant risk factors on predicting the need for mechanical ventilation.The ROC analysis showed that the area under the ROC curve(AUC) of AMS was significantly higher than that of ISS(0.899 vs 0.685, P<0.05). AMS and ISS at admission can be used as predictors of early mechanically assisted ventilation.

Ventilación mecánica no invasiva en pacientes con traumatismo de tórax

Mechanical ventilation in patients with chest injury becomes a challenge due to physiological changes. Currently, chest injuries account for 10-15% of all traumas, and are responsible for 17-25% of all deaths caused by trauma. However, there is no clinical evidence to make recommendations for the use of any of the ventilation modes. The objective of this study is to demonstrate that non-invasive mechanical ventilation (NIMV) corrects hypoxaemia in chest trauma patients. Materials and methodsProspective descriptive, observational and analytical study was conducted on 19 patients with chest trauma managed with NIMV in the continuous positive airway pressure (CPAP) mode. The age of the patients was between 18 and 67 years. For those patients with criteria for NIMV, the protocol implemented was 4hours of NIMV in CPAP mode with full mask. The parameters included: A pressure support variable plus a positive end-expiratory pressure of 10cm H2O, and FiO2 at 50% for 4h of venturi mask at 50%. Arterial blood samples were taken one hour after NIMV withdrawal. Failure was defined if continued with venturi, returned to NIMV, or went on to invasive mechanical ventilation. ResultsThe study included 89.5% males, and all (100%) of the patients had a mean Revised Trauma Score of less than 11 on admission to the emergency department, as well as a mean Injury Severity Score of 19, a mean Thorax Trauma Severity Score of 10, as well as a mean base excess −2.0. The mean time of NIMV was 3.2 days. An improvement of PO2 and PaO2/FiO2 index (PAFI) was observed in relation to the use of NIMV in CPAP mode, as well as a relationship with the classification of thoracic trauma (TTSS), and the time of NIMV. With this study, it can be concluded that NIMV in patients with chest trauma reduces intubation time and reduces mortality, as well as improving hypoxaemia in this group of patients.

Application of automated bronchial 3D-CT measurement in pulmonary contusion complicated with acute respiratory distress syndrome.

BACKGROUNDQuantitative measurement of bronchial morphological changes in pulmonary contusion with acute respiratory distress syndrome (ARDS) has important clinical implications.OBJECTIVETo investigate the morphological changes in bronchus before and after treatment in patients with pulmonary contusion combined with ARDS using an automated bronchial three-dimensional computed tomography (3D-CT) measurement method.METHODSThe study involves a dataset of CT images of 62 patients diagnosed with pulmonary contusion combined with ARDS. The volume of pulmonary contusion lesions was calculated as a percentage of the total lung volume using the automated 3D-CT method. The bronchial luminal cross-sectional area, wall cross-sectional area, the maximum and average wall thickness, the maximum and average luminal densities, intraluminal and extraluminal diameters, and circumferences of generations 2-4 bronchi before and after treatment were measured. Furthermore, the corresponding differences were analyzed statistically.RESULTSThe luminal cross-sectional area, wall cross-sectional area, intraluminal and extraluminal diameters, and circumferences of generations 2-4 bronchi were all significantly lower before treatment than after treatment (P < 0.05). However, the maximum and average wall thicknesses were both significantly higher before treatment than after treatment (P < 0.05). No significant difference was found in the maximum and average luminal densities before and after treatment (P > 0.05). The percentage of the pulmonary contusion lesion volume to the total lung volume correlated positively with the thoracic trauma severity score (r = 0.74, P < 0.01).CONCLUSIONSQuantitative bronchial CT image analysis enables to detect and assess bronchial morphological changes in patients diagnosed with pulmonary contusion combined with ARDS.