scholarly journals Clinical Outcome and Management for Geriatric Traumatic Injury: Analysis of 2688 Cases in the Emergency Department of a Teaching Hospital in Taiwan

2018 ◽  
Vol 7 (9) ◽  
pp. 255 ◽  
Author(s):  
Meng-Yu Wu ◽  
Yu-Long Chen ◽  
Giou-Teng Yiang ◽  
Chia-Jung Li ◽  
Amy Lin
Keyword(s):  
Clinical Outcome ◽  
Injury Severity Score ◽  
Clinical Outcomes ◽  
Severity Score ◽  
Injury Severity ◽  
Strong Predictor ◽  
Traumatic Injury ◽  
Geriatric Trauma ◽  
Shock Index ◽  
New Injury Severity Score

Geriatric traumatic injuries in emergency departments are frequent and associated with higher mortality rates and catastrophic functional outcomes. Several prediction scores have been established to manage traumatic patients, including the shock index (SI), revised trauma score (RTS), injury severity score (ISS), trauma injury severity score (TRISS), and new injury severity score (NISS). However, it was necessary to investigate the effectiveness and efficiency of care for the geriatric traumatic population. In addition, image studies such as computed tomography and magnetic resonance imaging play an important role in early diagnosis and timely intervention. However, few studies focus on this aspect. The association between the benefit of carrying out more image studies and clinical outcomes remains unclear. In this study, we included a total of 2688 traumatic patients and analyzed the clinical outcomes and predicting factors in terms of geriatric trauma via pre-hospital and in-hospital analysis. Our evaluation revealed that a shock index ≥1 may be not a strong predictor of geriatric trauma due to the poor physical response in the aging population. This should be modified in geriatric patients. Other systems, like RTS, ISS, TRISS, and NISS, were significant in terms of predicting the clinical outcome.

scholarly journals Schockraum- und Schwerverletztenversorgung als „Verlustgeschäft“

2020 ◽  
Author(s):  
Thomas Gross ◽  
Felix Amsler
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Diagnosis Related Groups ◽  
Case Mix ◽  
Multivariate Analyse ◽  
New Injury Severity Score ◽  
Case Mix Index

Zusammenfassung Hintergrund Es galt herauszufinden, wie kostendeckend die Versorgung potenziell Schwerverletzter in einem Schweizer Traumazentrum ist, und inwieweit Spitalgewinne bzw. -verluste mit patientenbezogenen Unfall‑, Behandlungs- oder Outcome-Daten korrelieren. Methodik Analyse aller 2018 im Schockraum (SR) bzw. mit Verletzungsschwere New Injury Severity Score (NISS) ≥8 notfallmäßig stationär behandelter Patienten eines Schwerverletztenzentrums der Schweiz (uni- und multivariate Analyse; p < 0,05). Ergebnisse Für das Studienkollektiv (n = 513; Ø NISS = 18) resultierte gemäß Spitalkostenträgerrechnung ein Defizit von 1,8 Mio. CHF. Bei einem Gesamtdeckungsgrad von 86 % waren 66 % aller Fälle defizitär (71 % der Allgemein- vs. 42 % der Zusatzversicherten; p < 0,001). Im Mittel betrug das Defizit 3493.- pro Patient (allg. Versicherte, Verlust 4545.-, Zusatzversicherte, Gewinn 1318.-; p < 0,001). Auch „in“- und „underlier“ waren in 63 % defizitär. SR-Fälle machten häufiger Verlust als Nicht-SR-Fälle (73 vs. 58 %; p = 0,002) wie auch Traumatologie- vs. Neurochirurgiefälle (72 vs. 55 %; p < 0,001). In der multivariaten Analyse ließen sich 43 % der Varianz erhaltener Erlöse mit den untersuchten Variablen erklären. Hingegen war der ermittelte Deckungsgrad nur zu 11 % (korr. R2) durch die Variablen SR, chirurgisches Fachgebiet, Intensivaufenthalt, Thoraxverletzungsstärke und Spitalletalität zu beschreiben. Case-Mix-Index gemäß aktuellen Diagnosis Related Groups (DRG) und Versicherungsklasse addierten weitere 13 % zu insgesamt 24 % erklärter Varianz. Diskussion Die notfallmäßige Versorgung potenziell Schwerverletzter an einem Schweizer Traumazentrum erweist sich nur in einem Drittel der Fälle als zumindest kostendeckend, dies v. a. bei Zusatzversicherten, Patienten mit einem hohen Case-Mix-Index oder einer IPS- bzw. kombinierten Polytrauma- und Schädel-Hirn-Trauma-DRG-Abrechnungsmöglichkeit.

scholarly journals Ten years of new injury severity score (NISS): is it a possible change?

2008 ◽  
Vol 16 (2) ◽  
pp. 314-319 ◽  
Author(s):  
Lilia de Souza Nogueira ◽  
Cristiane de Alencar Domingues ◽  
Miriam de Araújo Campos ◽  
Regina Márcia Cardoso de Sousa
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Studies ◽  
New Injury Severity Score ◽  
Dependent Variables ◽  
Actual Range

The article is a bibliographic review which intends to present the actual range of researches comparing the Injury Severity Score (ISS) and the New Injury Severity Score (NISS). Databases were searched using the keyword NISS, with 42 articles, 23 of which didn't compare the two indexes. Most part of the 19 selected articles showed that NISS has been more accurate in predicting the outcomes (dependent variables) than ISS, moreover in severe and specific trauma. Studies with populations between 1,000 and 10,000 resulted in NISS-favorable results, whereas studies with populations larger than 10,000 or smaller than 1,000 showed either NISS-favorable results or no difference between the two groups. However, there were no studies showing ISS-favorable results. These results and the easier calculation of NISS lead to a future replacement of ISS by NISS.

scholarly journals Economical treatment-related burden assessment of maxillofacial trauma among Ukrainians patients

2020 ◽  
Vol 19 ◽  
pp. e209930
Author(s):  
Pavlo Brekhlichuk ◽  
Myroslav Goncharuk-Khomyn
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Treatment Cost ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Maxillofacial Trauma ◽  
Facial Injury ◽  
Maxillofacial Injury ◽  
Duration Of Hospitalization ◽  
Dental Rehabilitation

Aim: Quantitative evaluation of prognostic correspondence between initial maxillofacial traumatic injury assessed by facial injury severity score and maxillofacial injury severity score, treatment cost and duration of hospitalization among Ukrainian patients. Methods: Design of present study was retrospective and based on the medical data of patients hospitalized with signs of maxillofacial trauma. Quantitative assessment of maxillofacial trauma was held with the use of facial injury severity score (FISS) and maxillofacial injury severity score (MFISS). Average treatment cost and hospitalization duration were used as coordinative criteria for economical treatmentrelated burden verification. Results: Levels of correlation between FISS, treatment charges and hospitalization duration were r=0.69 (р<0.05) and r=0.67 (р<0.05) respectively, while analogical correlations for MFISS were 0.74 (р<0.05) and 0.69 respectively (р<0.05). Statistical correspondence between FISS and MFISS scores among study sample reached r=0.71 (р<0.05). Cases with milder maxillofacial trauma types, characterized with initial lower levels of FISS and MFISS scores, demonstrated greater degree of FISS-to-MFISS inter-relation compare to cases with severe maxillofacial trauma. Conclusion: Even though FISS and MFISS scores both demonstrated reliable levels of correlation with hospitalization duration and cost of dental rehabilitation after maxillofacial trauma injury, but MFISS approach characterized by prognostically greater level of statistical relationship with economically related treatment derivates. Moreover, differentiation capabilities of MFISS is relative greater than FISS, since independent grading of separate functional disabilities becomes possible.

Pretrauma Functional Independence Measure Score Predicts Survival in Geriatric Trauma

2017 ◽  
Vol 83 (6) ◽  
pp. 559-563 ◽  
Author(s):  
Brian Fletcher ◽  
Eric Bradburn ◽  
Christopher Baker ◽  
Bryan Collier ◽  
Mark Hamill ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Injury Severity Score ◽  
Trauma Patient ◽  
Severity Score ◽  
Injury Severity ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Geriatric Trauma ◽  
Revised Trauma Score ◽  
Trauma Score

The Functional Independence Measure (FIM) is used by rehabilitation professionals to access disability. The FIM score combines both motor and cognitive parameters to assess a patient's level of required assistance in performing activities of daily living (ADL). The geriatric trauma patient is becoming an increasingly important cohort for trauma services. FIM has been shown to predict discharge outcomes and those at high risk for falls. We hypothesized pretrauma FIM scores may predict survival in the geriatric trauma population. This was a retrospective study of patients 65 years and older that were admitted to our Level I trauma center from July 1, 2006 to July 1, 2012. A total 941 patients underwent stepwise regression to identify those factors predicting survival. Age, Injury Severity Score, revised trauma score, body mass index, and pretrauma FIM scores (12-point scale) were studied. The primary outcome was survival. Statistical significance reached at P value <0.05. Multiple logistic regression analysis was then performed. A total of 1315 patients were identified and complete data were available on 941 patients. Mean age was 78 (SD ± 8.2), mean Injury Severity Score was 13(SD ± 8.7), and mean body mass index was 26. Overall mortality was 11 per cent. The odds ratio of survival was 3.532 (95% confidence interval = 2.191–5.718) times greater for every 1-point increase in the preadmission FIM expression score. Glasgow Coma Scale, revised trauma score, gender, and pretrauma FIM expression scores were predictive of survival in the geriatric trauma patient. Pretrauma FIM expression can be used to predict survival in the elderly trauma victim. Further study is needed to establish the role of FIM as part of trauma scoring systems.

scholarly journals Measuring trauma severity using the 1998 and 2005 revisions of the Abbreviated Injury Scale

2014 ◽  
Vol 48 (4) ◽  
pp. 641-648 ◽  
Author(s):  
Maria Carolina Barbosa Teixeira Lopes ◽  
Iveth Yamaguchi Whitaker
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Sao Paulo ◽  
São Paulo ◽  
Abbreviated Injury Scale ◽  
New Injury Severity Score ◽  
Trauma Severity

Objetivo: Comparar a gravidade das lesões e do trauma mensurada pelas versões da Abbreviated Injury Scale 1998 e 2005 e verificar a mortalidade nos escores Injury Severity Score e New Injury Severity Score nas duas versões.Método: Estudo transversal e retrospectivo analisou lesões de pacientes de trauma, de três hospitais universitários do município de São Paulo, Brasil. Cada lesão foi codificada com Abbreviated Injury Scale 1998 e 2005. Os testes estatísticos aplicados foram Wilcoxon, McNemar-Bowker, Kappa e teste Z.Resultados: A comparação das duas versões resultou em discordância significante de escores em algumas regiões corpóreas. Com a versão 2005 os níveis de gravidade da lesão e do trauma foram significantemente reduzidos e a mortalidade foi mais elevada em escores mais baixos. Conclusão: Houve redução da gravidade da lesão e do trauma e alteração no percentual de mortalidade com o uso da Abbreviated Injury Scale 2005.





Epidemiology of Traumatic Esophageal Injury: An Analysis of the National Trauma Data Bank

2019 ◽  
Vol 85 (4) ◽  
pp. 342-349 ◽  
Author(s):  
Alexander A. Xu ◽  
Janis L. Breeze ◽  
Jessica K. Paulus ◽  
Nikolay Bugaev
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Data Bank ◽  
Esophageal Injury ◽  
Trauma Patients ◽  
Adult Age ◽  
National Trauma ◽  
National Trauma Data Bank

Existing literature on traumatic injury of the esophagus (TIE) is limited. We aimed to describe the clinical characteristics and outcomes of TIE. We reviewed the National Trauma Data Bank for the years 2010–2015. We described the demographics, characteristics, and outcomes of adult (age ≥16 years) TIE patients and also compared those factors in blunt versus penetrating TIE. The association between TIE and mortality was analyzed using multivariable logistic regression. Thousand four hundred eleven adult TIE patients were identified (37 per 100,000 trauma patients, 95% confidence intervals (CI): 35, 39). TIE patients were younger (38 vs 52 years), more likely to be male (81% vs 62%), and more severely injured (Injury Severity Score ≥ 25: 45% vs 7%) than patients without TIE (all P < 0.001). TIE was observed 16 times more frequently with penetrating injuries (257 per 100,000, 95% CI: 240, 270) than with blunt injuries (16 per 100,000, 95% CI: 15, 18). Inhospital TIE mortality was 19 per cent. TIE patients had greater risk of mortality than other trauma patients, after adjusting for age, gender, and Injury Severity Score (odds ratio = 1.4, 95% CI: 1.1, 1.7). Mortality in blunt and penetrating TIE did not differ. Although extremely rare, TIE is independently associated with a marked increase in mortality, even after adjusting for other risk factors.

scholarly journals Abdominal Trauma in Durban, South Africa: Factors Influencing Outcome

2012 ◽  
Vol 97 (2) ◽  
pp. 161-168 ◽  
Author(s):  
M.N. Mnguni ◽  
D.J.J. Muckart ◽  
T.E. Madiba
Keyword(s):  
Injury Severity Score ◽  
Abdominal Trauma ◽  
Severity Score ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
New Injury Severity Score ◽  
Transfusion Requirements ◽  
Surgical Ward ◽  
Severity Of Injury ◽  
A Prospective Study

Abstract Abdominal injury as a result of both blunt and penetrating trauma has an appreciable mortality rate from hemorrhage and sepsis. In this article, we present our experience with the management of abdominal trauma in Durban and investigate factors that influence outcome. We performed a prospective study of patients with abdominal trauma in one surgical ward at King Edward VIII Hospital in Durban over a period of 7 years, from 1998 through 2004. Demographic details, cause of injury, delay before surgery, clinical presentation, findings at surgery, management and outcome were documented. There were 488 patients with abdominal trauma with a mean age of 29.2 ± 10.7 years. There were 440 penetrating injuries (240 firearm wounds; 200 stab wounds) and 48 blunt injuries. The mean delay before surgery was 11.7 ± 16.4 hours, and 55 patients (11%) presented in shock. Four hundred and forty patients underwent laparotomy, and 48 were managed nonoperatively. The Injury Severity Score was 11.1 ± 6.7, and the New Injury Severity Score was 17.1 ± 11.1. One hundred and thirty-seven patients (28%) were admitted to the intensive care unit (ICU), with a mean ICU stay of 3.6 ± 5.5 days. One hundred and thirty-two patients developed complications (28%), and 52 (11%) died. Shock, acidosis, increased transfusion requirements, number of organs injured, and injury severity were all associated with higher mortality. Delay before surgery had no influence on outcome. Hospital stay was 9.2 ± 10.8 days. The majority of abdominal injuries in our environment are due to firearms. Physiological instability, mechanism of injury, severity of injury, and the number of organs injured influence outcome.

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