scholarly journals A Comparison of the Predictive Value of the Glasgow Coma Scale and the Kampala Trauma Score for Mortality and Length of Hospital Stay in Head Injury Patients at a Tertiary Hospital in Uganda: A Diagnostic Prospective Study

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Herbert Ariaka ◽  
Joel Kiryabwire ◽  
Ssenyonjo Hussein ◽  
Alfred Ogwal ◽  
Emmanuel Nkonge ◽  
...  
Keyword(s):  
Head Injury ◽  
Glasgow Coma Scale ◽  
Prospective Study ◽  
Hospital Stay ◽  
Predictive Value ◽  
Length Of Hospital Stay ◽  
Tertiary Hospital ◽  
Operating Characteristics ◽  
Coma Scale ◽  
Trauma Score

Introduction. The prevalence rates of head injury have been shown to be as high as 25% among trauma patients with severe head injury contributing to about 31% of all trauma deaths. Triage utilizes numerical cutoff points along the scores continuum to predict the greatest number of people who would have a poor outcome, “severe” patients, when scoring below the threshold and a good outcome “non severe” patients, when scoring above the cutoff or numerical threshold. This study aimed to compare the predictive value of the Glasgow Coma Scale and the Kampala Trauma Score for mortality and length of hospital stay at a tertiary hospital in Uganda. Methods. A diagnostic prospective study was conducted from January 12, 2018 to March 16, 2018. We recruited patients with head injury admitted to the accidents and emergency department who met the inclusion criteria for the study. Data on patient’s demographic characteristics, mechanisms of injury, category of road use, and classification of injury according to the GCS and KTS at initial contact and at 24 hours were collected. The receiver operating characteristics (ROC) analysis and logistic regression analysis were used for comparison. Results. The GCS predicted mortality and length of hospital stay with the GCS at admission with AUC of 0.9048 and 0.7972, respectively (KTS at admission time, AUC 0.8178 and 0.7243). The GCS predicted mortality and length of hospital stay with the GCS at 24 hours with AUC of 0.9567 and 0.8203, respectively (KTS at 24 hours, AUC 0.8531 and 0.7276). At admission, the GCS at a cutoff of 11 had a sensitivity of 83.23% and specificity of 82.61% while the KTS had 88.02% and 73.91%, respectively, at a cutoff of 13 for predicting mortality. At admission, the GCS at a cutoff of 13 had sensitivity of 70.48% and specificity of 66.67% while the KTS had 68.07% and 62.50%, respectively, at a cutoff of 14 for predicting length of hospital stay. Conclusion. Comparatively, the GCS performed better than the KTS in predicting mortality and length of hospital stay. The GCS was also more accurate at labelling the head injury patients who died as severely injured as opposed to the KTS that categorized most of them as moderately injured. In general, the two scores were sensitive at detection of mortality and length of hospital stay among the study population.

scholarly journals Evaluation of care for traffic accidents victims made by on duty emergency physicians and surgeons in the emergency room

2016 ◽  
Vol 43 (6) ◽  
pp. 458-465 ◽  
Author(s):  
VLAUDIMIR DIAS MARQUES ◽  
MAURICIO MEDEIROS LEMOS ◽  
CESAR ORLANDO PERALTA BANDEIRA ◽  
AMÉLIA CRISTINA SEIDEL ◽  
SANDRA MARIA PELOSO ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Glasgow Coma Scale ◽  
Emergency Room ◽  
Hospital Stay ◽  
Traffic Accidents ◽  
Length Of Hospital Stay ◽  
Emergency Physicians ◽  
Surgical Specialty ◽  
Coma Scale ◽  
Minor Injuries

ABSTRACT Objective: to evaluate the care for victims of traffic accidents by on call emergency physicians and/or surgeons in the emergency room. Methods: we conducted a retrospective, descriptive and exploratory study on the care for traffic accidents victims in the urban area of Maringá-PR, between July 2013 and July 2014 in reference hospitals. We assessed demographics and vocational training through a questionnaire sent to the attending physicians. Results: of the 688 records evaluated, 99% of patients had a prehospital Revised Trauma Score of 12. Statistical analysis showed that in the cases conducted by the emergency physicians (n=187), the recording of the Glasgow Coma Scale and the performance of surgical procedures were less common, whereas the recording of blood pressure values was performed in greater numbers when compared with cases led by surgeons (n=501). There was a statistically significant relationship (p<0.01) between the length of hospital stay and surgical specialty, with a greater chance (crude OR=28) in the period from one to six hours for the group treated by emergency doctors. Most physicians participating in the study were young, with emergency room time of up to one to two years, and with ATLS training. Among those who had attended the ATLS course, 60% did so in the last four years. Surgeons performed 73% of hospital treatments. Conclusion: in the care of traffic victims with minor injuries, the Glasgow Coma Scale, the blood pressure levels, the type of treatment in the emergency room and hospital stay had different approaches between emergency physicians and surgeons.

Tracheostomy Timing in Adult Patients with Head Injury at King Abdulaziz Medical City Hospital, Riyadh, Saudi Arabia (Cross Sectional- Retrospective Study)

2020 ◽  
pp. 68-74
Author(s):  
Farhan Alenazi ◽  
Prachi Dilip Tambur ◽  
Noora Nabeel Mumenah ◽  
Haya Hendi Alqahtani ◽  
Rawan Abdulrazaq Alenazi ◽  
...  
Keyword(s):  
Head Injury ◽  
Glasgow Coma Scale ◽  
Hospital Stay ◽  
P Value ◽  
City Hospital ◽  
Early Tracheostomy ◽  
Coma Scale ◽  
Icu Stay ◽  
Medical City ◽  
Hospital Stays

Introduction: Tracheostomy is one of the most common procedures that done to critical patients such as head injury ones to improve their situation. It is done by creating an anterior stoma in the neck and inserting a short tube to maintain stoma open. Objective: The objective of this study was to determine if there were benefits of early tracheostomy and the following components: ICU stay, hospital stay, ventilation- associated-pneumonia, weaning from Mechanical Ventilator, Glasgow Coma Scale, and decannulation. Methods: This study was done retrospectively, and non-random sampling involved 56 head injury patients with a tracheostomy who were admitted to ICU in King Abdulaziz medical city (KAMC). Out of 56 head injury patients who underwent an early tracheostomy (≤12 days) were 25 patients and late tracheotomy (>12 days) were 31 patients. Using data collection form which contains demographic data, intubation duration, tracheostomy, decannulation, MV, Glasgow coma scale, VAP, ICU, and hospital stay. Results: Total of 56 head injury patients with tracheostomy; their age ranges from 18-80 years with the mean 41.77years, height 168.95cm, and weighs 69.07kg. Head injury patient in this paper was classified according to the day that was done the procedure on after the injury occurred. Which result in 25 patients had early tracheostomy ≤12 days with a mean of (9.8 days) and median (10), whereas 31 patients had late tracheostomy >12 with mean of (17.677 days) and median (16).Patients with early tracheostomy showed significant (P-value <0.05) less length stay in ICU (22.68 days), MV duration (15.16 days), decannulation (27.80 days) compared with late trach ICU stay (33.10 days), MV duration (28.10 days), decannulation (47.03 days). VAP incidence among patients with a late trach was 12.90% and there were no VAP with an early trach. The median in early tracheostomy patients did not show any improvement in GCS (6 before trach,7 after trach) while in the late trach (7 before thrach,8 after trach). The hospital stays showed an insignificant p-value which means there were no differences between the early and late tracheostomy.  Conclusion: Early tracheostomy for head injury patients associated with less MV time, less VAP, shorter ICU stay, and faster decannulation. However, there was no significant effect on hospital stays period and no improvements on GCS.

scholarly journals Robotically Assisted Hysterectomy versus Vaginal Hysterectomy for Benign Disease: A Prospective Study

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
M. Carbonnel ◽  
H. Abbou ◽  
H. T. N’Guyen ◽  
S. Roy ◽  
G. Hamdi ◽  
...  
Keyword(s):  
Blood Loss ◽  
Prospective Study ◽  
Hospital Stay ◽  
Vaginal Hysterectomy ◽  
Operative Time ◽  
Group Versus ◽  
Length Of Hospital Stay ◽  
Benign Disease ◽  
Post Surgery ◽  
A Prospective Study

Objectives. A prospective study was carried out to compare vaginal hysterectomy (VH) and robotically assisted hysterectomy (RH) for benign gynecological disease.Materials and Methods. All patients who underwent hysterectomy from March 2010 to March 2012 for a benign disease were included. Patients’ demographics per and post surgery results were collected from medical files. A questionnaire was also conducted 2 months after surgery.Results. Sixty patients were included in the RH group and thirty four in the VH one. Operative time was significantly longer in the RH group ( versus  min; ). Blood loss and length of hospital stay were significantly reduced: versus  ml; , and versus days; , respectively. Less pain was reported at D1 and D2 by RH patients, and levels of analgesia were lower compared to those observed in the VH group. No differences were found regarding the rate of conversion to laparotomy, intra- or postoperative complications.Conclusion. Robotically assisted hysterectomy appears to reduce blood loss, postoperative pain, and length of hospital stay, but it is associated with longer operative time and higher cost. Specific indications for RH remain to be defined.

scholarly journals Derivation and validation of an easy-to-compute trauma score that improves prognostication of mortality or the Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate and Systolic blood pressure (TRIAGES) score

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Atsushi Shiraishi ◽  
Yasuhiro Otomo ◽  
Shunsuke Yoshikawa ◽  
Koji Morishita ◽  
Ian Roberts ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Glasgow Coma Scale ◽  
Systolic Blood Pressure ◽  
Respiratory Rate ◽  
Validation Cohort ◽  
Hospital Death ◽  
The Novel ◽  
Coma Scale ◽  
Physiological Variables ◽  
Trauma Score

Abstract Background Multiple trauma scores have been developed and validated, including the Revised Trauma Score (RTS) and the Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP) score. However, these scores are complex to calculate or have low prognostic abilities for trauma mortality. Therefore, we aimed to develop and validate a trauma score that is easier to calculate and more accurate than the RTS and the MGAP score. Methods The study was a retrospective prognostic study. Data from patients registered in the Japan Trauma Databank (JTDB) were dichotomized into derivation and validation cohorts. Patients’ data from the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage-2 (CRASH-2) trial were assigned to another validation cohort. We obtained age and physiological variables at baseline, created ordinal variables from continuous variables, and defined integer weighting coefficients. Score performance to predict all-cause in-hospital death was assessed using the area under the curve in receiver operating characteristics (AUROC) analyses. Results Based on the JTDB derivation cohort (n = 99,867 with 12.5% mortality), the novel score ranged from 0 to 14 points, including 0–2 points for age, 0–6 points for the Glasgow Coma Scale, 0–4 points for systolic blood pressure, and 0–2 points for respiratory rate. The AUROC of the novel score was 0.932 for the JTDB validation cohort (n = 76,762 with 10.1% mortality) and 0.814 for the CRASH-2 cohort (n = 19,740 with 14.6% mortality), which was superior to RTS (0.907 and 0.808, respectively) and MGAP score (0.918 and 0.774, respectively) results. Conclusions We report an easy-to-use trauma score with better prognostication ability for in-hospital mortality compared to the RTS and MGAP score. Further studies to test clinical applicability of the novel score are warranted.

scholarly journals Profile of thoracic injury at College of Medical Sciences Teaching Hospital

2014 ◽  
Vol 9 (1) ◽  
pp. 30-39
Author(s):  
D Chapagain ◽  
D Jayapal Reddy ◽  
S Shah ◽  
KG Shrestha
Keyword(s):  
Prospective Study ◽  
Hospital Stay ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Flail Chest ◽  
Length Of Hospital Stay ◽  
Thoracic Injury ◽  
Road Traffic Accidents ◽  
Medical Sciences ◽  
Night Time

Objectives: Thoracic injury is a challenge to the thoracic surgeon practicing in developing countries. This prospective study was conducted to see the mode of injury, injury types and overall outcome of thoracic injury in our settings. Materials and methods: This prospective study was conducted in 100 thoracic injury patients between December 2011 to June 2012. The demographic features, type of the trauma, radiological assessment, associated organ injuries, management of the injury, surgical interventions, morbidity, mortality, length of hospital stay were analysed. Results: In this study the ages ranged from 7 to 84 years. There were 73 (73%) males and 27 (27%) females. The majority of patients (83%) were injured during the evening and night time. The majority of patients 92(92%) sustained blunt chest injuries. The mechanism of injury was not significantly associated with length of hospital stay (P > 0.05) and mortality (P > 0.05).Road traffic accident was the most common cause of injuries affecting 68(68%) of patients followed by fall injury of 19(19%). Rib fractures, haemothorax, pneumothorax and lung contusion were the most common type of injuries accounting for 83.0%, 57%,34% and 33% respectively. Associated extra-thoracic injuries were noted in 64.0% of patients. 45(45%) of the cases of haemothorax, pneumotharax and haemopneumothorax were treated by tube thoracotomy. Four patients (04%) had undergone thoracotomy. There were 09(09%) patients of flail chest and treated conservatively. Fourty six patients (46%) were admitted in the ICU. Eleven (11%) patients were treated with ventilator support. Seventeen (17%) patients had complication. The overall length of hospital stay ranged from 0 to 25 days. Conclusion: Road traffic accidents and fall from height are the major public health problems. Preventive measures at reducing road traffic accidents and timely management with closed tube thoracotomy are the main factors to be considered in the thoracic injury. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1, 30-39 DOI: http://dx.doi.org/10.3126/jcmsn.v9i1.9671

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