EVALUATION THE PROGNOSIS OF POLYTRAUMATIC PATIENTS WITH INJURY SEVERITY SCORE (ISS)

2017 ◽  
pp. 16-19
Author(s):  
Dzuy Vu ◽  
Viet Trung Lam

Objectives:Surveying the relationship between Injury Severity Score features polytrauma patients.Survey correlation between Injury Severity Scorewith mortality in polytrauma patients. Subjects of study:75 patients aged 16 years, was diagnosed multiple injuries worse prognosis in the Emergency Department, Cho Ray Hospital from January 2015 to September 2015. Method: Cross-sectional descriptive. Results: Percentage of patients with polytrauma patients total points ISS > 40 points was 38.4%. Traffic accidents, patients with total points ISS > 40 points was 36.2%, labor accidents, the number of patients with total points ISS > 40 points was 54.5%. The difference was not statistically significant with p> 0.05. The percentage of patients with total points ISS > 40 points in the group with traumatic shock 48.2%, higher than the group without shock trauma. The differences are statistically significant at p <0.05. Patients with clotting disorders, who have a total point group ISS > 40 points accounted for 50%, higher than the group without coagulopathy. The differences are statistically significant at p <0.05. Patients with a total score ISS > 40 points, mortality or severe to very high, accounting for 53.6%, the differences are statistically significant with p <0.001. Key words: Polytrauma, ISS scale, Cho Ray Hospital

2020 ◽  
Vol 10 (32) ◽  
pp. 183-193
Author(s):  
Gisele Andrade Menolli ◽  
Eleine Aparecida Penha Martins

Identificar a influência da gravidade do trauma e do atendimento intra-hospitalar no óbito, em vítimas de acidentes motociclísticos. Estudo transversal, quantitativo com 31 vítimas encaminhadas para o Hospital no norte do Paraná, entre dezembro de 2016 e março de 2017. 80,6% das vítimas eram homens, 48,4% das ocorrências aconteceram durante o dia. As escalas de trauma, Injury Severity Score (TRISS), Revised Trauma Score (RTS) e Injury Severity Score (ISS) evidenciaram escores leves com baixo risco de morte.  Houve associação entre gravidade do trauma e óbito, chegaram ao hospital com imobilizações corporais 61,3%; o protocolo de atendimento ao trauma foi utilizado em 45,2% dos casos; a cirurgia ortopédica compreendeu 43,4%; houve associação das cirurgias com o desfecho óbito; 90,3% das vítimas não tiveram infecção. A gravidade do trauma e cirurgias tiveram associação com o desfecho óbito, todas as vítimas de trauma devem ser atendidas conforme protocolo.Descritores: Serviço Hospitalar de Admissão de Paciente, Acidentes de Trânsito, Índices de Gravidade do Trauma, Motocicletas. Influence of accidents and in-hospital procedures on deathAbstract: Identification of the influence of trauma severity and the in-hospital care at death, in victims of motorcycle accidents. Cross-sectional, quantitative study, considering 31 victims referred to the Hospital in northern Paraná, between December 2016 and March 2017. 80.6% of the victims were men and 48.4% of the occurrences took place during the daytime. The trauma scales, Injury Severity Score (TRISS), Revised Trauma Score (RTS) and Injury Severity Score (ISS) presented soft scores of low risks of death. There was evidence of association between trauma severity and death, 61.3% of the patients arrived at the hospital with bodily immobilizations; the trauma care protocol was used in 45.2% of cases; surgery comprised 43.4% of cases; there was an association of surgeries with the outcome of death and 90.3% of the victims had no infection. The severity of trauma and surgeries were associated with the outcome of death; all trauma victims should be treated according to the protocol.Descriptors: Hospital Service for patient Admission, Traffic-Accidents, Trauma Severity Indices, Motorcycles. Influencia de los accidentes y procedimientos intrahospitales en la muerteResumen: Identificar la influencia de la gravedad del trauma y del atendimiento intrahospitalario en la muerte, en víctimas de accidentes motociclísticos. Estudio transversal, cuantitativo con 31 víctimas encaminadas para el Hospital en el Norte del Paraná, entre diciembre de 2016 y marzo de 2017. El 80.6% de las víctimas eran hombres, un 48.4% de los casos ocurrieron durante el día. La puntuación de los traumas, Injury Severity Score (TRISS), RevisedTrauma Score (RTS) y Injury Severity Score (ISS) evidenciaron scores leves con bajo riesgo de muerte. Hubo asociación entre la gravedad del trauma y la muerte, llegaron al hospital con inmovilizaciones corporales el 61.3%; el protocolo de atendimiento al trauma fué utilizado el 45.2% de los casos; la cirugía ortopédica comprendió 43.4%; hubo asociación de las cirugías con la muerte; el 90.3% de las víctimas no tuvieron infección. La gravedad del trauma y cirugías tuvieron asociación con la muerte, todas las víctimas de trauma deben ser atendidas según el protocolo.Descriptores: Servicio Hospitalar de Admisión de Paciente, Accidentes de Transito, Indices de Gravedad del Trauma, Motocicletas.


Author(s):  
Abdullah Albakri ◽  
Ahmed Al-Hashmi ◽  
Abdulaziz Bakathir ◽  
Shikhan Al Hashmi ◽  
Said Al Rashdi ◽  
...  

Objectives: Road traffic accidents (RTAs) are the main cause of facial injuries in Oman. This study aimed to assess the effectiveness of the new traffic law enforcement regulations (TLERs) on the incidence and severity of maxillofacial injuries in Oman. Methods: A retrospective longitudinal analytic study was conducted at three tertiary care hospitals in Muscat, Oman. All patients with RTA-related maxillofacial injuries for a five-year period from January 2005 to December 2009 (before the new TLERs) and the five-year period from January 2015 to December 2019 (after the new TLERs) were included in the study. Results: A total of 1127 patients were included in the study. Of these, 646 (57.3%) patients sustained RTA-related maxillofacial injuries before the implementation of the new TLERs compared to 481 (42.7%) after the introduction of TLERs. There was no significant difference in gender sustained injuries between the two study periods. The incidence of injury before the implementation of the TLERs was 22.7 per 100,000 population, which then reduced significantly to 11 per 100,000 after the new TLERs. Overall, there was a significant reduction in the mean facial injury severity score from 3.2 to 2.3 before and after the implementation of the new TLERs, respectively. Conclusion: The findings of this study indicate that the newly introduced TLERs have resulted in a reduction in the incidence and severity of RTA-related maxillofacial injuries. Continuous improvement and reinforcement of TLERs will further help to reduce the burden of these injuries to the society in general and health services in particular. Keywords: Law Enforcement; Traffic Accidents; Maxillofacial Injuries; Injury Severity Score; Oman.


Author(s):  
Anant Singh ◽  
Raj K. Chejara ◽  
Ashok K. Sharma ◽  
Aditya Tolat

Background: Trauma is one of the major cause of mortality and morbidity in both developed and developing countries. Polytrauma patients present particular challenges as profile of the patient varies with different types and severity of injuries. Prediction of survival in trauma patients is an essential requirement of trauma care. Trauma and injury severity score (TRISS) have been considered as a standard of the quality of trauma care. Study was carried out to evaluate the performance of TRISS in predicting survival in patients of polytrauma.Methods: Prospective observational study was conducted in emergency department of a tertiary care centre. 100 patients were evaluated in the study for a period of 18 months between November 2019 and April 2021. Patient demographics, details of trauma, pattern of injuries and physiological status were recorded. Overall outcome were studied and data analysis was done on the basis of TRISS. Statistical analysis was performed using statistical package for the social sciences (SPSS) program for windows, version 25.0 (SPSS Chicago, Illinois).Results: Young patients with mean age of 34.54 were most commonly affected in polytrauma with male preponderance. Road traffic accidents were the most common mode of trauma followed by fall from height. Blunt trauma was the most common type of injury. TRISS strongly predicted survival in polytrauma patients (AUC 0.926 CI 95% 0.868-0.985). TRISS has high sensitivity 97.62% and specificity 62.50% at a cut off of 64.50%.Conclusions: TRISS is an effective method for predicting survival of polytrauma patients and thus can be utilized to evaluate and compare trauma care.


Author(s):  
Ting-Min Hsieh ◽  
Ching-Hua Tsai ◽  
Hang-Tsung Liu ◽  
Chun-Ying Huang ◽  
Sheng-En Chou ◽  
...  

Background: Accidental falls are a common cause of injury and deaths. Both ground-level falls (GLF) and non-GLF may lead to significant morbidity or mortality. This study aimed to explore the relationship between height of falls and mortality. Method: This is a retrospective study based on the data from a registered trauma database and included 8699 adult patients who were hospitalized between 1 January 2009 and 31 December 2017 for the treatment of fall-related injuries. Study subjects were divided into three groups of two categories based on the height of fall: GLF (group I: < 1 m) and non-GLF (group II: 1–6 m and group III: > 6 m). The primary outcome was in-hospital mortality. The adjusted odds ratio (AOR) of mortality adjusted for age, sex, and comorbidities with or without an injury severity score (ISS) was calculated using multiple logistic regression. Results: Among the 7001 patients in group I, 1588 in group II, and 110 in group III, patients in the GLF group were older, predominantly female, had less intentional injuries, and had more pre-existing comorbidities than those in the non-GLF group. The patients in the non-GLF group had a significantly lower Glasgow Coma Scale (GCS), a higher injury severity score (ISS), worse physiological responses, and required more procedures performed in the emergency department. The mortality rate for the patients in group I, II, and III were 2.5%, 3.5%, and 5.5%, respectively. After adjustment by age, sex, and comorbidities, group II and group III patients had significantly higher adjusted odds of mortality than group I patients (AOR 2.2, 95% CI 1.64–2.89, p < 0.001 and AOR 2.5, 95% CI 1.84–3.38, p < 0.001, respectively). With additional adjustment by ISS, group II did not have significantly higher adjusted odds of mortality than group I patients (AOR 1.4, 95% CI 0.95–2.22, p = 0.082), but group III patients still had significantly higher adjusted odds of mortality than group I patients (AOR 10.0, 95% CI 2.22–33.33, p = 0.002). Conclusion: This study suggested that patients who sustained GLF and non-GLF were distinct groups of patients, and the height of fall did have an impact on mortality in patients of fall accidents. A significantly higher adjusted odds of mortality was found in the GLF group than in the non-GLF group after adjusting for age, sex, and comorbidities.


2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
C Niggli ◽  
H -C Pape ◽  
L Mica

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.


Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1548
Author(s):  
Christopher Rugg ◽  
Mirjam Bachler ◽  
Robert Kammerlander ◽  
Daniel Niederbrunner ◽  
Johannes Bösch ◽  
...  

Hyperphosphataemia can originate from tissue ischaemia and damage and may be associated with injury severity in polytrauma patients. In this retrospective, single-centre study, 166 polytrauma patients (injury severity score (ISS) ≥ 16) primarily requiring intensive care unit (ICU) treatment were analysed within a five-year timeframe. ICU-admission phosphate levels defined a hyperphosphataemic (>1.45 mmol/L; n = 56) opposed to a non-hyperphosphataemic group (n = 110). In the hyperphosphataemic group, injury severity was increased (ISS median and IQR: 38 (30–44) vs. 26 (22–34); p < 0.001), as were signs of shock (lactate, resuscitation requirements), tissue damage (ASAT, ALAT, creatinine) and lastly in-hospital mortality (35.7% vs. 5.5%; p < 0.001). Hyperphosphataemia at ICU admission was shown to be a risk factor for mortality (1.46–2.10 mmol/L: odds ratio (OR) 3.96 (95% confidence interval (CI) 1.03–15.16); p = 0.045; >2.10 mmol/L: OR 12.81 (CI 3.45–47.48); p < 0.001) and admission phosphate levels alone performed as good as injury severity score (ISS) in predicting in-hospital mortality (area under the ROC curve: 0.811 vs. 0.770; p = 0.389). Hyperphosphataemia at ICU admission is related to tissue damage and shock and indicates injury severity and subsequent mortality in polytrauma patients. Admission phosphate levels represent an easily feasible yet strong predictor for in-hospital mortality.


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