scholarly journals Validation of a Visual-Based Analytics Tool for Outcome Prediction in Polytrauma Patients (WATSON Trauma Pathway Explorer) and Comparison with the Predictive Values of TRISS

2021 ◽  
Vol 10 (10) ◽  
pp. 2115
Author(s):  
Cédric Niggli ◽  
Hans-Christoph Pape ◽  
Philipp Niggli ◽  
Ladislav Mica
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Goodness Of Fit ◽  
Injury Severity ◽  
Early Death ◽  
Trauma Centre ◽  
Brier Score ◽  
Individual Risk ◽  
Predictive Values ◽  
Overall Performance

Introduction: Big data-based artificial intelligence (AI) has become increasingly important in medicine and may be helpful in the future to predict diseases and outcomes. For severely injured patients, a new analytics tool has recently been developed (WATSON Trauma Pathway Explorer) to assess individual risk profiles early after trauma. We performed a validation of this tool and a comparison with the Trauma and Injury Severity Score (TRISS), an established trauma survival estimation score. Methods: Prospective data collection, level I trauma centre, 1 January 2018–31 December 2019. Inclusion criteria: Primary admission for trauma, injury severity score (ISS) ≥ 16, age ≥ 16. Parameters: Age, ISS, temperature, presence of head injury by the Glasgow Coma Scale (GCS). Outcomes: SIRS and sepsis within 21 days and early death within 72 h after hospitalisation. Statistics: Area under the receiver operating characteristic (ROC) curve for predictive quality, calibration plots for graphical goodness of fit, Brier score for overall performance of WATSON and TRISS. Results: Between 2018 and 2019, 107 patients were included (33 female, 74 male; mean age 48.3 ± 19.7; mean temperature 35.9 ± 1.3; median ISS 30, IQR 23–36). The area under the curve (AUC) is 0.77 (95% CI 0.68–0.85) for SIRS and 0.71 (95% CI 0.58–0.83) for sepsis. WATSON and TRISS showed similar AUCs to predict early death (AUC 0.90, 95% CI 0.79–0.99 vs. AUC 0.88, 95% CI 0.77–0.97; p = 0.75). The goodness of fit of WATSON (X2 = 8.19, Hosmer–Lemeshow p = 0.42) was superior to that of TRISS (X2 = 31.93, Hosmer–Lemeshow p < 0.05), as was the overall performance based on Brier score (0.06 vs. 0.11 points). Discussion: The validation supports previous reports in terms of feasibility of the WATSON Trauma Pathway Explorer and emphasises its relevance to predict SIRS, sepsis, and early death when compared with the TRISS method.

scholarly journals IBM WATSON Trauma Pathway Explorer outperforms the TRISS score to predict early death after polytrauma

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
C Niggli ◽  
H -C Pape ◽  
L Mica
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Visual Analytics ◽  
Injury Severity ◽  
Characteristic Curve ◽  
Early Death ◽  
Brier Score ◽  
Chi Squared ◽  
Polytrauma Patients ◽  
Ibm Watson

Abstract Objective In recent years, several big data-based artificial intelligence (AI) systems have found its way in health care, one of which we present here: The IBM WATSON Trauma Pathway Explorer, a visual analytics tool to predict early death in polytrauma patients. The aim of this study was to compare the predictive performance of the Trauma Pathway Explorer for early in-hospital mortality with an established trauma scoring system, the Trauma Revised Injury Severity Score (TRISS). Methods A retrospective comparative accuracy study in a level I trauma center including patients with an Injury Severity Score (ISS) ≥16 and age ≥16 was performed. The compared outcome was early death within 72 hours since admission of the patient. The area under the receiver operating characteristic curve (AUC) was used to measure discrimination. Hosmer-Lemeshow statistics was calculated to analyse calibration of the two predictive models. The Brier score assessed the overall performance of the two models. Results The cohort included 107 polytrauma patients with a death rate of 10.3% at 72 hours since patient admission. The Trauma Pathway Explorer and TRISS showed similar AUCs to predict early death (AUC 0.90, 95% CI 0.79-0.99 vs. AUC 0.88, 95% 0.77-0.97; p = 0.75). The calibration of the Trauma Pathway Explorer was superior to that of TRISS (chi-squared 8.19, Hosmer-Lemeshow p = 0.42 vs. chi-squared 31.93, Hosmer-Lemeshow p &lt; 0.05). The Trauma Pathway Explorer had a lower Brier score than TRISS (0.06 vs. 0.11). Conclusion The IBM WATSON Trauma Pathway Explorer showed equal results in discrimination as TRISS but outperformed in calibration. In addition to being able to provide a prediction of early death, this visual analytics tool for polytrauma patients can also show the quantitative flow of patient sub-cohorts through different events, such as coagulopathy, hemorrhagic shock class, surgical strategy and the above-mentioned outcome. Here, we can present an accurate and valid alternative to TRISS for predicting early death in polytrauma patients.

scholarly journals Injury Severity Score (ISS) vs. ICD-derived Injury Severity Score (ICISS) in a patient population treated in a designated Hong Kong trauma centre

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Sydney S.N. Wong ◽  
Gilberto K.K. Leung
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Roc Curves ◽  
Trauma Centre ◽  
Trauma Centers ◽  
Chi Square ◽  
Chi Square Test ◽  
New Type ◽  
Trauma And Injury

Trauma and Injury Severity Score (TRISS) has been the benchmark of mortality riskin trauma centers for over 30 years. TRISS utilizes the Injury Severity Score (ISS) as an index ofanatomical injury. This study investigated the efficacy of a new type of index of anatomical injury called the ICD-derived Injury Severity Score (ICISS) compared to the ISS using a logisticregression analysis and a global chi-square test of the areas under the Receiver OperatorCharacteristic (ROC) curves. We found that the empirically derived ICISS performed as well as the consensus derived ISS with no statistical differences between their respective area under the ROC curves.

scholarly journals Mechanisms, patterns and outcomes of paediatric polytrauma in a UK major trauma centre

2017 ◽  
Vol 99 (1) ◽  
pp. 39-45 ◽  
Author(s):  
G Naqvi ◽  
G Johansson ◽  
G Yip ◽  
A Rehm ◽  
A Carrothers ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Major Trauma ◽  
Injury Severity ◽  
Age Groups ◽  
Trauma Centre ◽  
Team Approach ◽  
Paediatric Trauma ◽  
Major Trauma Centre ◽  
The Uk

IntroductionPaediatric trauma is a significant burden to healthcare worldwide and accounts for a large proportion of deaths in the UK.MethodsThis retrospective study examined the epidemiological data from a major trauma centre in the UK between January 2012 and December 2014, reviewing all cases of moderate to severe trauma in children. Patients were included if aged ≤16 years and if they had an abbreviated injury scale score of ≥2 in one or more body region.ResultsA total of 213 patients were included in the study, with a mean age of 7.8 years (standard deviation [SD]: 5.2 years). The most common cause of injury was vehicle related incidents (46%). The median length of hospital stay was 5 days (interquartile range [IQR]: 4–10 days). Approximately half (52%) of the patients had to stay in the intensive care unit, for a median of 1 day (IQR: 0–2 days). The mortality rate was 6.6%. The mean injury severity score was 19 (SD: 10). Pearson’s correlation coefficient showed a positive correlation for injury severity score with length of stay in hospital (p<0.001).ConclusionsThere is significant variation in mechanism of injury, severity and pattern of paediatric trauma across age groups. A multidisciplinary team approach is imperative, and patients should be managed in specialist centres to optimise their care and eventual functional recovery. Head injury remained the most common, with significant mortality in all age groups. Rib fractures and pelvic fractures should be considered a marker for the severity of injury, and should alert doctors to look for other associated injuries.

Evaluating the effect of driving distance to the nearest higher level trauma centre on undertriage: a cohort study

2021 ◽  
pp. emermed-2021-211635
Author(s):  
Job F Waalwijk ◽  
Robin D Lokerman ◽  
Rogier van der Sluijs ◽  
Audrey A A Fiddelers ◽  
Luke P H Leenen ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Emergency Medical Services ◽  
Resource Use ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Centre ◽  
Medical Services ◽  
Trauma Patients ◽  
Emergency Medical ◽  
Critical Resource

BackgroundIt is of great importance that emergency medical services professionals transport trauma patients in need of specialised care to higher level trauma centres to achieve optimal patient outcomes. Possibly, undertriage is more likely to occur in patients with a longer distance to the nearest higher level trauma centre. This study aims to determine the association between driving distance and undertriage.MethodThis prospective cohort study was conducted from January 2015 to December 2017. All trauma patients in need of specialised care that were transported to a trauma centre by emergency medical services professionals from eight ambulance regions in the Netherlands were included. Patients with critical resource use or an Injury Severity Score ≥16 were defined as in need of specialised care. Driving distance was calculated between the scene of injury and the nearest higher level trauma centre. Undertriage was defined as transporting a patient in need of specialised care to a lower level trauma centre. Generalised linear models adjusting for confounders were constructed to determine the association between driving distance to the nearest higher level trauma centre per 1 and 10 km and undertriage. A sensitivity analysis was conducted with a generalised linear model including inverse probability weights.Results6101 patients, of which 4404 patients with critical resource use and 3760 patients with an Injury Severity Score ≥16, were included. The adjusted generalised linear model demonstrated a significant association between a 1 km (OR 1.04; 95% CI 1.04 to 1.05) and 10 kilometre (OR 1.50; 95% CI 1.42 to 1.58) increase in driving distance and undertriage in patients with critical resource use. Also in patients with an Injury Severity Score ≥16, a significant association between driving distance (1 km (OR 1.06; 95% CI 1.06 to 1.07), 10 km (OR 1.83; 95% CI 1.71 to 1.95)) and undertriage was observed.ConclusionPatients in need of specialised care are less likely to be transported to the appropriate trauma centre with increasing driving distance. Our results suggest that emergency medical services professionals incorporate driving distance into their decision making regarding transport destinations, although distance is not included in the triage protocol.

scholarly journals Validation of a visual-based analytics tool to predict outcomes of polytrauma patients: The IBM WATSON trauma pathway explorer

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
C Niggli ◽  
H -C Pape ◽  
L Mica
Keyword(s):  
Visual Analytics ◽  
Goodness Of Fit ◽  
Injury Severity ◽  
Trauma Surgery ◽  
Area Under The Curve ◽  
Early Death ◽  
Predictive Performance ◽  
Brier Score ◽  
Polytrauma Patients ◽  
Ibm Watson

Abstract Objective Big data-based artificial intelligence (AI) is on the way to develop into a part of daily clinical life and its reasonable application could help to improve disease or injury outcomes. A visual polytrauma analytics tool based on IBM WATSON was developed and described in a previous publication. The present article relates to the validation of the IBM WATSON Trauma Pathway Explorer. Methods A retrospective prediction model validation in a level I trauma center including 107 patients with an Injury Severity Score (ISS) ≥16 and age ≥16 was performed. Age, ISS, temperature and the presence of head injury were the predictors used to validate the following three outcomes: SIRS and sepsis within 21 days since admission of the patient, as well as early death within 72 hours since admission. The area under the receiver operating characteristic (ROC) curve was used to determine predictive quality. Calibration plots showed the graphical goodness of fit. The Brier score assessed the overall performance of the two models. Results The area under the curve (AUC) is 0.77 (95% CI: 0.679-0.851) for SIRS, 0.71 (95% CI: 0.578-0.831) for sepsis and 0.90 (95% CI: 0.786-987) for early death. The Brier scores are as follows: early death 0.06, sepsis 0.12 and SIRS 0.15. Conclusion The validation has shown that the predictive performance of WATSON for SIRS and early death corresponds to the clinical outcome in nearly 80% of cases and 90% of cases, respectively. The concordance for sepsis was modest with over 70% of cases. This visual analytics tool for polytrauma patients can be used to obtain valid predictions for SIRS, sepsis and early death. Here, we can present a possible working variant of AI in trauma surgery.

Disseminierte intravasale Gerinnung und Fibrinolyse in der Frühphase nach Polytrauma

1995 ◽  
Vol 15 (02) ◽  
pp. 79-86
Author(s):  
L. Lampl ◽  
M. Helm ◽  
M. Tisch ◽  
K. H. Bock ◽  
E. Seifried
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Tissue Type ◽  
Disseminierte Intravasale Gerinnung

ZusammenfassungGerinnungsstörungen nach einem Polytrauma werden eine große Bedeutung für die weitere Prognose der Patienten beigemessen. In einer prospektiv angelegten Studie wurden bei 20 polytraumatisierten Patienten Gerinnungsund Fibrinolyseparameter analysiert, um deren Veränderungen während der präklinischen Phase zu definieren. Die Blutentnahmen wurden zum frühestmöglichen Zeitpunkt am Unfallort und bei Klinikübergabe durchgeführt. Die gewonnenen Proben wurden mit Hilfe eines speziell konzipierten »Kleinlabors« noch vor Ort verarbeitet, um möglichst native Meßwerte zu erhalten. Die Patienten wurden dem Schweregrad der Verletzung entsprechend kategorisiert und hatten einen Verletzungsschweregrad nach NACA > IV und einen Injury Severity Score (ISS) > 20. Die Ergebnisse zeigen, daß bereits in der sehr frühen Phase nach Eintritt des Traumas schwerwiegende Veränderungen des Gerinnungsund Fibrinolysesystems eintreten. Die frühzeitige Thrombingenerierung führt zu einer Verbrauchskoagulopathie und reaktiven Hyperfibrinolyse. Zusätzlich erzeugt die Freisetzung von endothelständigem Tissue-type-Plasminogenaktivator eine primäre Hyperfibrinolyse. Die Veränderungen des Gerinnungsund Fibrinolysesystems in der frühen präklinischen Phase nach Polytrauma können zu schwerwiegenden klinischen Komplikationen wie Blutungen, thromboembolischen Komplikationen und zur Ausbildung von Schockorganen führen.

Non-Selective Thoracic Computed Tomography in Trauma Patients Results in Injury Severity Score Inflation

2021 ◽  
pp. 000313482110249
Author(s):  
Leonardo Alaniz ◽  
Omaer Muttalib ◽  
Juan Hoyos ◽  
Cesar Figueroa ◽  
Cristobal Barrios
Keyword(s):  
Computed Tomography ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Treatment Plan ◽  
Mortality Prediction ◽  
Trauma Patients ◽  
Mortality Benefit ◽  
Severity Scores ◽  
Score Inflation

Introduction Extensive research relying on Injury Severity Scores (ISS) reports a mortality benefit from routine non-selective thoracic CTs (an integral part of pan-computed tomography (pan-CT)s). Recent research suggests this mortality benefit may be artifact. We hypothesized that the use of pan-CTs inflates ISS categorization in patients, artificially affecting admission rates and apparent mortality benefit. Methods Eight hundred and eleven patients were identified with an ISS >15 with significant findings in the chest area. Patient charts were reviewed and scores were adjusted to exclude only occult injuries that did not affect treatment plan. Pearson chi-square tests and multivariable logistic regression were used to compare adjusted cases vs non-adjusted cases. Results After adjusting for inflation, 388 (47.8%) patients remained in the same ISS category, 378 (46.6%) were reclassified into 1 lower ISS category, and 45 (5.6%) patients were reclassified into 2 lower ISS categories. Patients reclassified by 1 category had a lower rate of mortality ( P < 0.001), lower median total hospital LOS ( P < .001), ICU days ( P < .001), and ventilator days ( P = 0.008), compared to those that remained in the same ISS category. Conclusion Injury Severity Score inflation artificially increases survival rate, perpetuating the increased use of pan-CTs. This artifact has been propagated by outdated mortality prediction calculation methods. Thus, prospective evaluations of algorithms for more selective CT scanning are warranted.

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