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Objective: To understand the situation and epidemic characteristics of injury deaths among children aged 5 to 24 years in Jiangsu Province from 2012 to 2021 and the trend of annual changes. Methods: The main injury mortality data of children and adolescents was collected, and the crude and standardized mortality rates of road traffic accidents, drowning, suicide, and accidental falls among children and adolescents over a decade and the annual average percentage of change (AAPC) were calculated. The main injury mortality characteristics and trends of children and adolescents of different age groups and genders were analyzed. Results: The total number of injury deaths among 5 to 24 adolescents in Jiangsu Province was 16 052, with a standardized mortality rate of 9.58/100 000. There was no significant trend in the overall standardized mortality rate of injuries (AAPC=-3.450%, P =0.055). The standardized mortality rate of road traffic injuries among children and adolescents showed a decreasing trend over the past decade, with statistical significance (AAPC=-9.406%, P <0.001). The standardized suicide mortality rate showed an upward trend over the past decade, with statistical significance (AAPC=9.000%, P =0.001). The overall injury mortality rate showed an upward trend with age. Suicide rates in males and females were on the rise and both have statistical significance (AAPC=9.420% and AAPC=9.607%, both P <0.05). The standardized mortality rates of female traffic accidents, drowning, and male traffic accidents showed a decreasing trend and were statistically significant (AAPC for female traffic accidents=-7.364%, AAPC for female drowning=-5.352%, and AAPC for male traffic accidents=-10.242%, all P <0.05). The standardized mortality rate of urban and rural traffic accidents showed a decreasing trend and was statistically significant(AAPC=-7.899% and AAPC=-9.421%, both P <0.001). The standardized suicide mortality rate showed an upward trend and statistical significance (AAPC=11.009% and AAPC=7.528%, both P <0.05). Conclusions: The overall injury situation of children and adolescents in Jiangsu Province improved in the past decade from 2012 to 2021, but the suicide mortality rate was on the rise. It is necessary to focus on the mental health issues of this age group and to strengthen the prevention and control of suicide among children and adolescents, in Jiangsu.

Objective: To describe the trends and potential reasons responsible for injury mortality among children under 18 years old in different stages of the China Children's Development Outlines (CCDO) for children from 1990 to 2017, in China. Methods: Data derived from the Global Burden of Disease 2017 (GBD2017) were used to analyze the change of injury mortality, among children under 18 years old, by sex and provinces. Results: Since 1990, the Chinese government had formulated and implemented three CCDOs on Children. Each CCDO proposed corresponding main targets and strategic measures based on the development of children under current situation, in each area, accordingly. The first two CCDOs failed to set clear targets for child injury prevention and control, but the third one did propose a quantifiable target. The injury mortality rate of children under 18 years old showed a declining trend in all periods of the three CCDOs, by 26.07 % , 40.68 % and 26.48 % , respectively. Both boys and girls showed significant downward trend in these three stages. Mortality rate on child injury differed in these three stages in all the 31 provinces. Conclusion: Thanks to the contribution of CCDO in different stages that providing important policies and impetus for the prevention and control of child injury, the number of deaths caused by child injury kept reducing, from 1990 to 2017, in China.

Objective: To evaluate the efficacy of high (≥1:2) and low (<1:2) plasma: red blood cell (RBC) ratio resuscitation in patients with severe trauma requiring massive blood transfusion., Methods: The databases including the Cochrane Library, Pubmed, Web of Science, and EMBASE were systemically searched for relevant studies published between January, 2009 and April, 2016. The selection of studies, assessment of methodological quality and data extraction were performed by two researchers independently according to the inclusion and exclusion criteria. The main endpoint was 24-h mortality, 30-day mortality and 24-h survival rate., Results: Five observational studies reporting outcomes of 1024 patients were included in this meta-analysis. Four studies documented civilian cases and one study had a military setting. No significant differences were found in the Injury Severity Score (ISS) between patient groups receiving high and low plasma: RBC ratio resuscitation. Compared with the low-ratio group, the patients with high-ratio resuscitation showed a significant reduction in the 24-h mortality rate (OR=0.35, 95%CI [0.25, 0.48], P<0.000 01) and the 30-day mortality rate (OR=0.55, 95%CI [0.41, 0.75], P=0.0001). An increased survival rate was observed in patients receiving high plasma: RBC ratio resuscitation within the initial 24 h following the trauma (HR=2.34, 95%CI [1.46, 3.73], P=0.00001)., Conclusion: Raising the plasma: RBC ratio to 0.5 or higher may decrease the mortality rate of the patients with severe trauma who need massive blood transfusion.

Objective: To quantitatively evaluate the treatment quality of trauma integration treatment system in the patients with severe trauma., Methods: Records of patients with severe trauma hospitalized in our department from January 2010 to December 2012 were extracted from trauma database and analyzed, including gender, age, basic situation after admission [including systolic pressure, diastolic pressure, axillary temperature, heart rate, Injury Severity Score (ISS), Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, Glasgow Coma Score, and urine volume on the first day], the first time determination values of physiological and biochemical indexes after admission (including pH value, base excess, PaCO(2), PaO(2), standard bicarbonate ion, leucocyte count, neutrophile granulocyte, hemoglobin, platelet count, albumin, urea nitrogen, lactic acid, blood glucose, and blood sodium), surgical situation, length of ICU stay, occurrence of major complications [including infection, acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS)/multiple organ failure (MOF)], and death. Single factor analysis was used to screen death-associated exposure factors, then the exposure factors were brought into multivariate Logistic regression to establish adjustment mortality models to calculate observation/expectation (O/E) ratio of adjustment mortality of patients in these three years, and Poisson distribution was used to calculate the 95% confidence interval (CI) of O/E ratio. Data were processed with Student t test, Wilcox test, chi-square test and or Fisher's exact test., Results: A total of 536 patients with severe trauma were enrolled in these three years, with 438 male (81.72%) and 98 female (18.28%). There were no statistically significant differences in gender, age, and basic situation of patients after admission among these three years (χ(2)=0.16, with t values from 0.05 to 104.50, W values from 0.008 to 104.500, P values above 0.05). There were no statistically significant differences in the first time determination values of physiological and biochemical indexes after admission including pH value, base excess, PaCO(2), PaO(2), hemoglobin, platelet count, and blood sodium of patients among these three years (with t values from 0.80 to 29.10, W values respectively 0.110 and 5.450, P values above 0.05), while there were statistically significant differences in standard bicarbonate ion, leucocyte count, neutrophile granulocyte, albumin, urea nitrogen, lactic acid, and blood glucose of patients among these three years (with t values from 1 542.00 to 500 000.00, W values from 637.000 to 500 000.000, P<0.05 or P<0.01). There were no statistically significant differences in surgical situation, length of ICU stay, and occurrence of major complications including infection, ARDS, and MODS/MOF in patients among these three years (with χ(2) values from 0.48 to 2.43, W =2.100, P values above 0.05). The mortality of patients in 2010, 2011, and 2012 were 11.9% (19/159), 11.2% (21/187), and 7.4% (14/190), respectively, showing a trend of decline, but there was no statistically significant difference (χ(2)=2.43, P>0.05). Death-associated exposure factors were age, ISS, APACHE Ⅱ score, urea volume on the first day, platelet count, albumin, and blood sodium. The O/E ratio of adjustment mortality (95%CI) in 2010, 2011, and 2012 were 0.727 (0.460-1.180), 0.718 (0.460-1.230), and 0.460 (0.270-0.840), respectively, showing a trend of decline each year., Conclusions: The trauma integration treatment system can improve the treatment quality of patients with severe trauma.

Objective: To analyze the changing pattern of injury mortality from 1990 to 2010 in China., Methods: Data related to injury mortality between 1990 and 2010 from the estimates of the Global Burden of Disease 2010 were analyzed by sex, age, causes and risk factors, under the linear regression model., Results: The rates on mortality of injuries showed a significant decline between 1990 and 2010, especially in women and in children aged 0-4 years. In 2010, there were around 796 thousand people died from all kinds of injuries, with an age-standardized mortality as 57/100 000 population. Rates on injury mortality were higher in men and in people aged 70 years or over, than in women or in younger age groups. In contrast to the substantial increase on mortality rate caused by road injury, all the other causes induced mortalities showed distinct decrease. In 2010, injuries accounted for 9.6 percent of the total number of deaths in China, which exceeded the number of deaths caused by communicable, maternal, neonatal diseases or nutritional disorders. The leading causes of injury mortality were road traffic injury, self-hurt, drowning and falls in 2010. In addition, major risk factors that causing injury mortality reduced during the study period, and the top three risk factors showed as occupational-related, alcohol use, and low bone mineral density (osteoporosis)., Conclusion: Despite the fact that rates on injury-related mortality were decreasing, injury remained a critical public health problem in China.

Objective: To summarize the causes of death and to analyze the risk factors in a surgical intensive care unit (SICU)., Methods: The relevant information of patients died in the SICU of Xijing Hospital of Fourth Military Medical University in past 15 years (from December 1999 to February 2015) was retrospectively analyzed. The gender, age, reason and date of hospitalization, date of transfer SICU, past medical history, whether or not admitted directly from emergency department or transferred from other department, operated or not, date of death, the main cause of death, acute physiology and chronic health evaluation II (APACHE II) score, the history of undergoing mechanical ventilation, continuous renal replacement therapy (CRRT), or antifungal therapy, as well as the ratio of the patients with body temperature higher than 39 °C, white blood cell (WBC) count higher than 10 x 10⁹/L, platelet (PLT) count below 100 x 10⁹/L, albumin (Alb) below 35 g/L of two periods, namely from December 1999 to July 2007 (the first period), and from August 2007 to February 2015 (the second period) were compared. The above parameters were compared with those of 201 survivors in SICU, and the risk factors leading to death were analyzed by logistic regression., Results: From December 1999 to February 2015, 4 317 patients were taken care of in the SICU. Among them, the number of death was 186, and the mortality rate was 4.3%. In the first time period (from December 1999 to July 2007), the total number of patients was 1 356, and the number of death were 109 (the mortality rate was 8.0%). In the second period, i.e. from August 2007 to February 2015, the number of SICU patients was 2,961, and 77 died (the mortality rate was 2.6%). The difference of mortality rate between the two periods was statistically significant (χ² = 66.707, P = 0.001 ). The death rate of patients transferred directly from emergency department in the first period was 79.8% (87/109), and it was lower in the second period (51.9%, 40/77, χ² = 16.181, P = 0.001 ). The death rate of the patients with blood A1b below 35 g/L in the second period (59.7%, 46/77) was higher than that of the first period (41.3%, 45/109, χ² = 6.151, P = 0.017). The top three causes of death from December 1999 to February 2015 were sepsis (38.2%), trauma (16.7%), and operation for cancer (14.0%). In the first period, the top three causes of death were sepsis (35.8%), trauma (22.0%), and operation for cancer (13.8%). In the second period, the top three causes of death were sepsis (41.6%), damage of the central nervous system (16.9%), and operation for cancer (14.3%). Top three reasons for SICU admission were trauma (29.03%), abdominal pain (20.97%) and other reasons (18.82%). Top three departments from which the patients were transferred were the emergency department (19.35%), orthopedics department (17.20%), and hepatobiliary department (16.13%). Logistic regression analysis showed that age [odds ratio (OR) = 2.025, 95% confidence interval (95% CI) = 1.500-2.734, P = 0.000], mechanical ventilation (OR = 3.514, 95% CI = 1.701-7.259, P = 0.001), CRR T (OR = 5.604, 95% CI = 3.003-10.459, P = 0.000 ), body temperature higher than 39 °C (OR = 1.992, 95%CI = 1.052-3.771, P = 0.034) were the risk factors of death in SICU patients., Conclusion: Sepsis and severe trauma are the leading causes of death in severe SICU patients, to whom with risk factors of death enough attention should be given.

Objective: To discuss a best predictive score index in predicting death in patients with severe trauma, death warning score, and to provide a simple score for clinical use., Methods: The clinical data of 394 traumatic patients admitted to Department of Critical Care Medicine of Xi'nan Hospital of the Third Military Medical University, Daping Hospital of the Third Military Medical University, and Affiliated Hospital of Zunyi Medical College from January 2014 to December 2014 were retrospectively analyzed. The patients were divided into survival group (n = 330) and non-survival group (n = 64). The clinical data in two groups were recorded as following: gender, age; respiratory rate, heart rate, and systolic blood pressure at admission; the lowest values of serum creatinine (SCr), white blood cell count (WBC), platelet count (PLT), hematocrit (Hct), respectively, within 24 hours after admission; acute physiology and chronic health evaluation II (APACHE II) score, Glasgow coma scale (GCS) score, sequential organ failure assessment (SOFA), systemic inflammatory response syndrome (SIRS) score, injury severity score (ISS) within 24 hours of final diagnosis; the performance of emergency operation or intubation within 24 hours; incidence of sepsis, and clinical outcomes. Each observed indicator was analyzed by univariate analysis, and factors leading to death were further analyzed by logistic regression. Risk factors of severe trauma patients were sorted, from which the meaningful indicators were included to calculate the warning score of death. Receiver operating characteristic curve (ROC) was plotted to evaluate the predictive value of the warning score of death in severe trauma patients., Results: Compared with the survival group, the age in non-survival group was older (years old: 51.50 ± 18.31 vs. 45.54 ± 14.70, t = -2.456, P = 0.016); SCr was increased (µmol/L: 94.18 ± 65.51 vs. 72.42 ± 28.22, t = -2.611, P = 0.011); APACHE II score (24.30 ± 6.23 vs. 16.38 ± 6.19, t = -9.353, P < 0.001) and SOFA score were higher (7.84 ± 3.68 vs. 4.43 ± 2.75, t = -7.049, P < 0.001); and the incidence of emergency intubation [79.7% (51/64) vs. 42.7% (141/330), χ² = 29.309, P < 0.001] and sepsis was also higher [48.4% (31/64) vs. 30.3% (100/330), χ² = 18.512, P < 0.001], but PLT count (X 10⁹/L: 112.75 ± 59.85 vs. 144.12 ± 68.28, t = 3.428, P = 0.001) and GCS score (6.44 ± 4.20 vs. 11.02 ± 3.93, t = 8.449, P < 0.001) were significantly lower. There was no significant difference in gender, respiratory rate, heart rate, systolic blood pressure, WBC, Hct, SIRS score, ISS, or emergency operation between two groups. The indicators with statistically significant difference from the univariate analysis were further analyzed by multivariate logistic regression, and the indices included in the regression model were age ≥ 65 years [95% confidence interval (95%CI) = 0.176-1.974, P = 0.019], APACHE II score ≥ 21 (95% CI = 0.121-2.725, P = 0.032), GCS < 6 (95% CI = 0.201-3.221, P = 0.026), severe sepsis (95%CI = 0.421-2.735, P = 0.008) or septic shock (95%CI = 0.430-3.636, P = 0.013), with assigning scores of 1.0, 1.5, 1.5, 1.5, 2.0, respectively. Finally these five indicators were included into the warning score of death. It was shown by ROC curve analysis that the area under ROC curve (AUC) of warning score of death in predicting mortality in critically ill trauma patients was 0.867, which was significantly higher than that of the APACHE II score (AUC = 0.812, P = 0.022) and GCS score (AUC = 0.783, P = 0.001). When the cut-off value of warning score of death was 1.5, the sensitivity, specificity, positive predict value (+PV), negative predict value (-PV), positive likelihood ratio (+LR), negative likelihood ratio (-LR), and Youden index was 75.00%, 85.40%, 50.0%, 94.6%, 5.16, 0.29, and 0.605, respectively., Conclusions: Age ≥ 65 years, APACHE II score ≥ 21, GCS < 6, severe sepsis or septic shock were the risk factors of death in patients with severe trauma, and they can be considered as warning score of death in patients with severe trauma. With the score mortality can be better predicted than any other kind of score for patients with severe trauma.

Objective: To study the characteristics and trend of illegal driving behavior in China to provide evidence for related policy enforcement., Methods: Using indices as death rate of ten thousand vehicle, death rate per 100 000 population, thousands of road mileage, degree of motorization and death ratio etc. to analyze the current situation, characteristics of illegal vehicle driving behavior related to road traffic injuries, in China., Results: From 2006 to 2010, death ratio on vehicle road traffic injuries related to the top five illegal driving behaviors were as follows: speeding (from 0.33 down to 0.17), on refuse to give way to others (from 0.26 to 0.14), on driving without license (from 0.21 to 0.08), on illegal driving encroachment (from 0.17 to 0.04) and on reverse driving (from 0.11 to 0.07). Death rates related to vehicle road traffic injuries on drunk driving or fatigue driving were 0.04 in 2010 and 0.02 in 2010, respectively., Conclusion: Despite the fact that the number of vehicle road traffic injuries appeared a declining trend, the severity was increasing. Illegal driving behavior was still prevalent in China.

Objective: To explore the relation between the behavior psychology analysis of partial mechanical injuries and the nature of death in high-falling cases, and provide reference, for such cases., Methods: Of 311 death victims of high-falling injuries collected from 2008 to 2013, 205 cases were associated with partial mechanical injuries. The characteristics of injury formation, preliminary crime scene traces, fatal injury of high-falling, and text messages were all retrospectively analyzed., Results: According to the investigation of preliminary crime scene traces, fatal injury of high-falling and text message, there were 86 suicide, 24 accident and 95 uncertainty in the 205 cases. According to the behavior psychology analysis of partial mechanical injuries, there were 80 suicide, 11 accident, and 4 homicide in the 95 uncertainty cases., Conclusion: The partial mechanical injuries uncertainly caused by high-falling correlate with the manner of high-falling death. According to the behavior psychology analysis of the partial mechanical injuries in high-falling death cases, the presumption of high-falling death is usually accurate

Objective: To explore the application value of multi-slice spiral computed tomography (MSCT) in traffic accidents through observing and analyzing the injury features of the accidents., Methods: Two fatal cases caused by traffic accidents were fully examined using MSCT, 3D imaging reconstruction and angiography through cardiac puncture. The features of traffic injury mechanism were analyzed through combination of MSCT and postmortem external examination., Results: In case 1, right cardiac rupture was found by MSCT and angiography through cardiac puncture. The cause of death was cardiac tamponade and right ventricular rupture due to the crush injury of chest in the traffic accident. In case 2, splenic rupture and intra-abdominal hemorrhage was found and caused by injury of left trunk by MSCT. The cause of death was hemorrhage and traumatic shock., Conclusion: MSCT could observe skeletal injury, soft tissue injury, and hematologic disorder well. The combination use of MSCT and angiography through cardiac puncture provided assistance to the diagnosis of cardiovascular system injury.

Objective: To estimate the indirect economic burden of disease-related premature deaths in China, 2012., Methods: Both human capital approach and friction cost methods were used to compute the indirect economic burden of premature deaths from the following sources: mortality from the national disease surveillance system in 2012, average annual income per capita from the China Statistic Yearbook in 2012, population size from the 2010 China census, and life expectancy in China from the World Health Organization life table., Results: Data from the Human Capital Approach Estimates showed that the indirect economic burden of premature deaths in China was 425.1 billion in 2012, accounting for 8‰ of the GDP. The indirect economic burden of chronic non-communicable diseases associated premature deaths was accounted for the highest proportion(67.1%, 295.4 billion), followed by those of injuries related premature deaths (25.6% , 108.9 billion), infectious diseases, maternal and infants diseases, and malnutrition related deaths (6.4% , 26.9 billion). The top five premature deaths that cause the indirect economic burden were malignancy, cardiovascular diseases, unintentional injuries, intentional injuries, and diseases of the respiratory system. The indirect economic burden of premature deaths mainly occurred in the population of 20-59 year-olds. Under the Friction Cost method, the estimates appeared to be 0.11%-3.49% of the total human capital approach estimates., Conclusion: Premature death caused heavy indirect economic burden in China. Chronic non-communicable diseases and injuries seemed to incur the major disease burden. The indirect economic burden of premature deaths mainly occurred in the working age group.

Objective: To explore the relationship between pedestrian traffic accidents and the type of vehicles and summarize the characteristics., Methods: Ninety cases of pedestrian traffic accidents were reviewed, and the relationship between the types of vehicles and the injuries (site, feature and severity) were analyzed., Results: Different impact injuries were caused by different types of vehicles. The primary sites of the impact injuries depended on the body posture and the height of protruding parts of the front when the accident happened. The injury characteristics were related to the size, direction of acting force and contact surface., Conclusion: The analysis of position, feature, and severity of pedestrian injury can determine the type of injury vehicle.

Objective: To explore the forensic identification points of deaths caused by secondary damages of road traffic accidents., Methods: Seventeen deaths caused by secondary damages of road traffic accidents were collected. Through scene investigation and necropsy, the basic information of the accidents, distribution and property of the injuries, and other information were collected. According to the collected data, the scene was reconstructed in order to confirm the injury process, analyze the way, mechanism and severity of injury, distinguish antemortem injury from postmortem injury, and determine the cause of deaths., Results: Certain features such as serious injuries, multiple traumas, combined injuries, co-existence of antemortem and postmortem injuries, multiple causes of wounds, complex injury mechanism, as well as the mutual damaging and overlapping injuries were quite characteristically noted in these secondary traffic accident cases., Conclusion: Forensic assessment of deaths caused by secondary damages of road traffic accidents should be synthetically analyzed and judged through scene investigation and necropsy.

Objective: To explore the characteristics of the dismembered homicide cases in Shanghai and to provide the valuable guidance for forensic pathological practices., Methods: Twenty-four cases of dismembered homicides were selected from 2005 to 2012 in Institute of Forensic Science, Shanghai Public Security Bureau. The general information of the victims and suspects, cause of death, criminal motive, postmortem body parts, tools and information of discarding body parts were retrospectively analyzed., Results: Among the 24 dismembered homicide cases, victims were female in 16 cases, and suspects were male in 23 cases and were acquaintances in 22 cases. The main causes of death were mechanical asphyxia and traumatic brain injury. Most of the criminal motives were emotional disputes. The number of postmortem body parts was commonly from 20 to 30. The tools were mainly sharp instruments, including kitchen knives used in 20 cases. The postmortem body parts were discarded to different transregional areas, mainly using vehicles., Conclusion: The dismembered homicide cases in Shanghai show the following characteristics: the number of postmortem body parts is in large quantity; the methods of dismembered corpse are complex and different; the job characteristics of suspects are difficult to determine; the distance from homicide scene is far and the vehicles are commonly used.

Objective: To summarize the solved homicide cases taking place in Suzhou city and to find out the characteristics and commonness of them in order to analyze the key points of investigation at the scene., Methods: The data of 483 solved homicide cases occurring from January 2006 to March 2010 in the city were analyzed., Results: Most cases involved 1 victim and 1 suspect, with young male adults dominated. Most of them were non-local residents. The majority of suspects were intentional by passion due to quarrel and dispute. The most common weapons were sharp instruments generally carried by the suspects. Mechanical asphyxia and mechanical injury were the two most common causes of death in these cases., Conclusion: The social characteristics of suspects, criminal motivation, injury instruments, distribution of injuries, cause of death, and manner of death in Suzhou showed similar general characteristics as the experience for detecting homicide cases in the future.

Objective: To explore the main problems and ideas in the death cases of medical tangles after trauma., Methods: Twelve death cases of medical tangles after trauma were selected from a forensic science institute during recent six years. Traumatic conditions, medical malpractices and contribute degree of malpractice were estimated and analyzed., Results: The reasons of trauma included accidents and intentional injury. Among these cases, there were 10 involved in malpractice, of which 7 cases played secondary role., Conclusion: Diagnosis, symptom observation and emergency therapy are the important keys for determining the responsibility in death cases of medical tangles after trauma.

Objective: To explore the unidentified corpses in Shaoxing city in recent years to provide the experience for these types of corpse examination and forensic identification., Methods: One hundred and twenty-seven unidentified corpses were collected and analyzed in the period from January 2009 to June 2011. The scene investigation, clothing examination and information of forensic investigation were collected and analyzed., Results: Most of the unidentified corpses are the young male. Of them, there are 3 homicide cases. There are 92 cases (72.44%) of the corpses was found with all clothes and 72 cases (56.69%) with the belongings. There are 63 cases (49.61%) of the cases was died from downing and 15 cases (11.81%) was died from hypothermia and starvation. Cause of death in 25 cases (19.69%) was undetermined., Conclusion: The most of unidentified corpses in Shaoxing are found in water and died from accidents. The degree of corpse putrefaction is the principal factor to analyze the cause of death.

Objective: To study the long-term trend of injury related deaths, the distribution of causes of injuries as well as disease burden in Macheng city, Hubei province, in 1974 - 2008., Methods: Data was gathered from vital statistics and registration system of Macheng city which was established in 1974. Data related to Cause Eliminated Life Expectancy (CELE), years of potential life lost (YPLL) and proportion of YPLL on total deaths were calculated., Results: The injury death rates varied between 62.64/100 000 and 154.97/100 000 during that 35 years. In males and females, injury death rates varied between 69.16/100 000 - 163.86/100 000 and 55.34/100 000 - 157.35/100 000, respectively. Death rates on injury in males exceeded those of females. The average infant injury mortality was 770.13/100 000, stayed the highest in all of the age groups. In terms of geographic region, death rate showed the highest in the hilly area (37.03/100 000), followed by mountainous area (33.66/100 000) and the rate was lowest in the plain area (31.43/100 000). In terms of causes of deaths, suicide, drowning, suffocation, traffic accident and fall were the five top causes of injury, accounting for 84.26% of all the injury mortality. The mortality of suicide showed highest in the injury mortality accounting for 48.14% of all the injury mortality. Injury was the main causes of death among children and youths. The mortality of injury was the highest in people aged from 15 to 29 years, with 59.38% in males and 62.26% in females. Injury eliminated life expectancy increased while the YPLL due to injury decreased, annually., Conclusion: Although the trends of mortality rates on injuries were declining over the past 10 years, it remained high in figures. The main causes of injury shifted around, but suicide had always been the main cause over the years, in different age groups, sex or terrains. The death rate of traffic accident was increasing. Effective control strategies should be formulated based on the caused of death related to injuries and among the high-risk populations.

Objective: To establish a database of high-fall death cases for future forensic study and practice, based on the scene investigation, injury characteristics and other informations., Methods: Five hundred and four cases of high-fall death from 5 provinces and cities were included in the study. Data including personal information of the deceased, scene investigation, autopsy findings, history of mental illness and the results of toxicology were collected and analyzed., Results: The male accidental death rate was significantly higher than that of female. No case of suicide was found in the 0-10 age group, while the suicide rate was apparently higher in the 60 years or over age group than that of accident. Most of the accident cases occurred at workplace, with head landing first and foot or lower-extremity landing first observed from height below 10 m and between 10-25 m, respectively., Conclusion: The majority of cases have obvious conclusions. A substantial set of the cases, however, is still difficult to determine the mechanism of injury and the manner of death. So further study should be performed.

Objective: To analyze the features of death cases in the urban rail traffic accidents in order to prevent the similar accidents in the future and to provide reference for forensic expertise., Methods: Eighteen death cases in urban rail traffic accidents between 2005 to 2008 in Shanghai were collected. The forensic characteristics were summarized in aspects of the nature of cases, the injury mechanism and characteristics, etc., Results: There were total 18 cases with 14 suicide and 4 accidental incidents, aged from 21 to 55 years. Of those dead, 14 died of craniocerebral injury and 4 died of traumatic shock. The injury mechanism included hit, fall and rolling., Conclusion: The injury in urban rail traffic accidents have their own characteristics, mainly due to suicide, and partly due to accidental incident, and most of these cases are probably preventable.

Objective: To explore the causes of death and risk factors in patients of war wound and trauma of extremities., Methods: This retrospective study involved 352 patients of war wound and trauma of extremities admitted to 303rd Hospital of People's Liberation Army during the period between 1968 to 2002. All the data were reviewed and the causes of death of 15 patients were analyzed by autopsy, and a computer's logistic regression model analysis was performed to approach the risk factors of death., Results: Fifteen of the three hundred and fifty-two patients were died (4.3 %). The causes of death included acute renal failure (ARF) (46.7%, 7/15), lung embolism (20.0%, 3/15), clostridial myonecrosis (20.0%, 3/15) and multiple organ system failure (MOSF) (13.3%, 2/15). In the univariate analysis, the risk of death increased by shock, time admitted to hospital, amputation, time of tourniquet, associated injury of head, thoracic region, abdomen or blood vessel (P < 0. 05). In the logistic regression model analysis, shock and amputation were the two factors most strongly associated with the death of patients of war wound and trauma. (P < 0. 05)., Conclusion: Acute renal failure (ARF) was the main cause of death of patients of war wound and trauma of extremities. Its should be helpful for minimize the mortality of patients of war wound and trauma to manage the shock in time and have a correct choice of amputation promptly.

Objective: To investigate and analyze the traumatic conditions of Longnan area of Gansu in Wenchuan earthquake, and to explore the measures coping with unexpected disasters., Methods: A sample survey including questionnaire survey, interviews and other methods was adopted to investigate the conditions of affected population of Longnan area in earthquake, especially on the traumatic conditions, the injured causes, treatment methods., Results: In the sample survey of a total of 1652 earthquake casualties, the dead were 16 and the patients with extremities fractures were 750 (45.4%). Organized and timely rescue of the wounded could reduce the complications and the mortality ., Conclusion: Strengthening the prevention and treatment of earthquake trauma can effectively decrease the death rate and disabled rate.

This study analyzed injuries of motorcycle occupants and the trace evidence of motor vehicles in 3 cases of motorcycle accidents. Due to differences in positions, postures, and responses, the driver and passenger showed their unique injury patterns and characteristics, which could be verified by analysis of trace evidence of the vehicles. It provided some common features from these cases and could be useful to determine the responsible parties and to determine who was the driver.

Objective: To analyze and summarize the secular trend and influencing factors of road traffic injuries(RTI) in China, so as to provide evidence for the management of traffic safety., Methods: Indexes as fatalities per 10,000 vehicles, fatalities per 100,000 population, fatalities per 10,000 kilometers, motorization(number of vehicles per 1000 population) and mortal coefficient were used. Clustering analysis and ranking correlation were used to analyze the relative factors., Results: The number of casualties of RTI had doubled every decade before the year of 2000. One hundred thousand people were killed in RTI every year since 2000. Facts as: Gross National Product(GNP) of China exceeded 1000 USD in 2002, number of motor vehicles reached 1.3 million in 2005, had both influenced the rates of road traffic fatality, mileage fatality and mortal coefficient which causing them to drop since 2002. In China, RTI happened in the underdeveloped districts in the western part of the country including Tibet, Ningxia, Xinjiang, Qinghai, and in some coastal areas as Zhejiang and Guangdong provinces. Men seemed to be more at risk than women in RTI, and accounted for three-quarters of the victims. Majority of fatalities happened in 21-50 year olds and the fatalities among those over 65 year olds had risen every year. The vulnerable populations in road-user category were pedestrians, passengers, motorcyclists and bicyclists. Under most situations, drivers were responsible for RTI and over half of them were professionals. Bad behaviors were the major causes of RTI, including exceeding the speed limit, handle misfeasance, breaking traffic rules and regulation, having taken alcohol or driving with fatigue etc. Exceeding the speed limit was the most risky factor which causing 75% of the RTI and the traffic deaths increased between 2002 to 2004. A positive correlation was discovered between population fatality rate and the factors as the number of vehicles, volume of road haulage, volume of passengers and the degree of highway etc. with correlation coefficients as r1 = 0.986, r2 = 0.986, r3 = 0.987, r4 = 0.985, P = 0.001, respectively., Conclusion: Since 1951, the population fatality rate of RTI had been going up continuously until it began to fall in 2003.

147 homicidal cases were studied through case status, scene investigation, and postmortem examination. Its characters were then concluded for reference of detection in homicidal scene.

Objective: To determine the risk factors involved in the typhoon episodes and to put forward and evaluate the intervention measures., Methods: We defined a confirmed injury case as: 'a person with fall,scalpel and stab, collision, drowning, injuries and trauma due to flying debris and building collapse, asphyxiation due to entrapment in collapsed buildings by typhoon from 0 am,August 12 to 6 pm, August 14 2004' and a death case as: 'a person with fall, scalpel and stab, collision, drowning, injuries and trauma due to flying debris and building collapse, asphyxiation due to entrapment in collapsed buildings by typhoon from 0 am, August 12 to 12 am, August 18 2004'. We investigated all hospitalized injured cases in ten hospitals and telephoned to those who were not hospitalized and the cases of death. We did case-control study with 1 pair versus 2 cases. 74 cases were selected in ten hospitals. The controls were neighbors of the controls matched by occupation, sex, village, and within 5 years of age without injury in this typhoon. We asked the cases and the controls on their alertness regarding typhoon and what actions taken when typhoon arrived., Results: There were 392 injury cases in all ten hospitals and 50 death cases. The attack rate of injury was 27.3 per 100 000. The fatal rate was 11.3% with the death rate 3.1 per 100 000. We investigated 209 injury cases and 31 death cases. The number of cases who were injured from 1 to 6 hours before typhoon landing accounted for 64.6% (155) of all cases. The peak of epidemic curve was 4 hours before the landing of typhoon. Data on the analysis of 74 cases and 148 controls revealed that 42% (31) of the cases were outside their homes before and during typhoon compared to 15% (22) of the controls (OR = 3.9, 95% CI: 1.9-7.7). Compared with 20% (30) control persons (OR = 17,95% CI: 4.2-68). 28% (21) cases did not receive the alert of typhoon before it arrived compared with 18% (27) control persons (OR = 3.3, 95% CI:1.3-8.6). 53% (39) of the cases did not pay attention to the alert of typhoon before typhoon arrived., Conclusion: Staying outdoor, not receiving or did not take seriously about the alert of typhoon seemed to be the risk factors of injury by the typhoon episode, suggesting that the government should increase the emergency preparedness and to raise the awareness on risks associated with typhoon.

Objective: To explore the pattern of road traffic injuries (RTI) in China and to furnish evidence to formulate strategy and measures to improve RTI., Methods: Using the data from the National Statistical Office, Ministry of Communications and the Traffic Administration bureau, factors as the time trends, features and risk factors of RTI were analysed for all provinces in China., Results: Over the past 51 years, RTI have increased more than 100-fold. The fatality rate of RTI was up to 8.51 per 100 000 population in 2001, almost doubled for the past ten years. In the past decade, the deaths of RTI always held in the front fifth rank in Guangdong, Shandong and Zhejiang. Calculating mortal coefficient (MC) to evaluate the severity of RTI, Tibet, Xinjiang, Qinghai, Ningxia and Gansu stood the worst. The 26 - 45 years age-group represented the majority of all fatalities and overall casualties, and the age-group over 65-year olds having an increased trend in China. The main risk factors of RTI were road quality, motorization, volume of traffic transportation, maldriving and the behaviors of pedestrians., Conclusions: The main means to reduce RTI would include: improving road traffic environment, setting road safety rules and securing compliance, changing perception, understanding and practice traffic safety.

Objective: To analyze the characteristics of injuries between two types of Emergency Department (ED) in China., Methods: We selected 25 hospital EDs in the whole country as spots for investigation, and designed one special questionnaire to collect information, from 1st July, 2001 to 30th June, 2002., Results: In city hospitals (CIH), the proportion of injury to all diseases were 19.65%, and in country hospital (COH) it was 29.88%. The fatality rate of injuries was 1.29% in COH, which was higher than that of CIH's (P < 0.001). In COH, ambulance was more frequently used to treat injury patients than in CIH, but the average rescue time was not different. In cities, machinery was the leading cause (about 32.88%), but in country it was due to transpert (35.34%). Traffic accidents, suicide/homicide and unintentional drowning were the main causes of death. In CIH, the number of unintentional poisoning was almost twice as intentional, but in COH the patients due to poisoning suicide act were more than unintentional poisoning, with 2/3 of the poisoning causes were women. Patients due to chemical, drug and food poisoning accounted for 86.13% in CIH, while in COH the main causes were pesticidal, chemical and druggery (89.80%). In all poisons, pesticide was the leading cause for death., Conclusion: It's suggested that patients with injury be treated timely since the acute injury patients accounted for important part of ED's patients. The differences between CIH and COH were obvious, with better ability of treatment in CIH than in COH. More relevant measures were needed to improve the ability of acute treatment for injuries.

Objective: The mortality and trend of injury in 1991 - 2000, the distribution of causes of injuries by areas as well as disease burden in Chinese population were discussed., Methods: Data on mortality level and causes of injuries provided by National Disease Surveillance Program in 1991 - 2000, adjusted by under-reporting rate together with years of potential life lost (YPLL) and WPYLL of injuries and proportion of YPLL and WPYLL of total death, were calculated., Results: The mortality of injury was kept at a stable level from 1991 to 2000. The adjusted average death rates were 66.56/100,000 with 81.41/100,000 in males, 51.17/100,000 in females, and 38.68/100,000, 74.63/100,000 in urban and rural populations respectively. Death rates of injury in the east, central and west rural areas were 1:1.14:1.21 respectively. Injury was the main cause of death among children and youths. Traffic accident, suicide, drowning, poisoning and fall were main causes of injury accounting for 70 percent of all the injury mortality. Since 1990's, the death rate of traffic accident had been obviously increasing, YPLL and WPYLL in injury 2132 years/10,000 and 1587 years/10,000, respectively. The YPLL and WPYLL were 24.56% and 26.51% of total deaths., Conclusion: The disease burden of injury was heavy and the death of injury caused more social and economic losses owing to premature death. The increasing death rate of traffic accident called for more attention. Different effective control strategies should be formulated based on different death causes of injury and different target populations.

Objective: To understand the incidence and prevalence by causes of injury, and the proportion of different causes of deaths, as well as occurrence of disability due to injuries., Methods: 200,000 families were randomly sampled in 4 rural communities. Questionnaire on occurrence, disability, death of injury and related risk factors for all family members living at home from Feb. 12, 2002 to Aug. 12, 2002 were studied., Results: The incidence rate and prevalence rate in the observed population were 65.1/1000 and 69.2/1000, respectively. In every 100 cases of injury there were one death and 6 disabled. Fall, animal bites, striking or crushing, cutting and piercing, road accidents, fire and poisoning were the common causes in injury. Animal bites was the leading cause while drawing appeared the highest in children aged 0 - 14. Rate of road accident was the highest in adults aged 15 - 34, while falls causing higher proportion of disability in population aged over 60., Conclusions: Based on the report of National Disease Surveillance Points System, there were 592,000 death cases of injury in Chinese rural areas every year, meaning 59.2 million cases of injury and 3,490,000 disabled cases every year. Since injury causes serious social and economic loss with different orders of incidence and mortality, it is necessary to develop different preventive strategies on different target populations and different causes accordingly.

Objective: To study the trends in the distribution and change of total injuries were explored during 1997 - 2001. To provide scientific bases in setting up priorities and improving safety standards., Methods: To collect and analyze the data about all inpatients of injuries attending hospital and hospitalization at 322 hospitals between 1997 and 2001 in Guangdong, China. The main outcome measures included external causes, medical consequences, mortality, length of hospital stay, and costs., Results: Rate of all-injury hospitalization increased yearly, from 1997 to 2001. The ratio of inpatient case-fatality declined over a 5-year period, with the total case-fatality rate of 1.64%. The inpatients were mainly caused by motor vehicle accident, unintentional falls, punctured and cut by machine, hurt by others and homicide. The constituent ratio of deaths among patients caused by motor vehicle accident was accounted for 56.13% among the total deaths, which occupied the first place. Despite the fact that the mean length of stay declined by 3.58% for the hospitalized patients over a 5 year period, and by 2.20% for the healed patients, costs increased by 3.89% for the hospitalized patients and by 4.71% for the healed patients with an average costs per patient per day increased by 7.33%., Conclusion: The all-injury hospitalization rate had a trend of increase from 1997 to 2001, but the ratio of inpatient case-fatality declined over the 5-year period, and the direct medical cost also had a trend of increase.

Objective: To study the incidence of injuries among residents living in the communities in Zhejiang., Methods: A household questionnaire survey was conducted to 16 899 residents in four communities., Results: The incidence of injuries was 16.11% in total, higher in urban area than in rural area and higher in men than in women. The leading causes of injuries were falls (4.80%), knife-cutting or by sharp articles (3.86%), traffic accident (2.07%), collision (1.99%), scalds (1.13%) and animal bites (1.06%). Peak incidence of age group was different in different injuries, such as traffic accident was high in 45 - 60 age group and falls was high in 5 and 60 age group. Direct economic loss for each case with injury would cost 324.21 RMB yuan., Conclusion: Injury was common and frequently occurred among residents at the community level which seriously on danger their health and families.

Objective: To understand socio-economic losses of inpatients and deaths caused by injuries in 2000 in Ningxia and to estimate their extent of harmfulness., Methods: Eight of 35 local hospitals totaling 5 876 inpatients were recruited with two-stage sampling in Ningxia in 2000. All medical cost incurred during their hospitalizations for injuries, cardiovascular and cerebrovascular diseases, respiratory disease, cancer and communicable diseases, losses in labor time were analyzed, and years of potential life lost (YPLL), working years of potential lost (WYPLL), valued years of potential life lost (VYPLL) due to these diseases were estimated for the residents in Ningxia with corrected human capital method., Results: The study showed that indirect economic losses due to hospitalization for injuries accounted for 24 million yuan, higher than those for other diseases. YPLL, WYPLL and VYPLL due to injuries were also higher than those in other diseases., Conclusions: Injury has caused serious threat to their health of the residents in Ningxia and brought heavy burden for the society and economy. It has become an important public health problem and its prevention and control should be strengthened as soon as possible.

Objective: To study the epidemiological transition of injuries in Ningxia., Methods: Demographic and mortality data during 1990s in Ningxia were collected and analyzed for temporal trend with linear regression model., Results: During the past decade, mortality of injury raised by 28.22% among the residents in Ningxia and ranked the 3rd place in the causes of deaths. In 1999, the top four leading causes of injury deaths were traffic accident, suicide, drowning and poisoning. Overall injury mortality and mortalities of traffic accident and suicide increased, but mortality of drowning decreased during the past decade. As predicted, suicide will rank the 1st place in the causes of deaths among the residents in Ningxia by 2005., Conclusions: Injury was one of major risk factors influencing health and death among the residents in Ningxia, with a temporal trend in its incidence. Effective research, prevention and control of traffic accident, suicide, drowning and poisoning should be focused.

Objective: To understand of characteristics and burden of injuries in people living in Shenzhen., Methods: A cluster sample on the condition was conducted through house hold questionnaire administration among 11,576 inhabitant during the period of December 1999 to 2000 in Shenzhen city, Guangdong province., Results: The overall incidence of injuries was 7.07%. Accident, fallings, collision wounds were the first three injures. The standard mortality of injuries was 54.13/10(5). The burden of person family and society were hospital fee-for-service induce unemployment, and so on. Mind burden gave priority to be down in spirits, it occupied to 31.62%., Conclusions: The incidence of injury were higher in Shenzhen inhabitant, and its burden be weighter, and the incidence of inhabitant with temporary cards was higher than inhabitants with resident cards. Therefore it is very important that prevention and control of injury would be enhancing.

Objective: To describe the characteristics and trend of injuries among urban and rural Chinese population., Methods: Data from annual Chinese national health statistics (1990 - 1997) were analyzed., Results: The overall mortality of injury in China increased from 36.8/10(6) to 76.7/10(6) from 1990 to 1997. Injury was the forth leading causes of death in urban areas and the fifth in rural areas. The death rate of injury declined in the urban while increasing in the rural areas. The rural death rate of injury was about two times of that in urban and the difference was increasing over time. The death rate of men was higher than that of women and the ratio was 1.3 - 1.9. Children below 4 years old and people above 60 years old showed the highest rates. The first three leading causes of death of injuries in urban areas were traffic accident, suicide and fall, while in rural areas were suicide, traffic accident and drowning. The death rate caused by suicide was 6.5/10(6) - 27.1/10(6) and the rate in rural areas was 2.7 to 4.0 times of that in urban areas. The mortality of suicide declined in urban while increased in rural areas. The mortality of traffic accidents had a tendency of increase in both urban and rural areas., Conclusion: Injury has been one of the leading cause of death but without effectively control programs for population in Urban and Rural areas in China, special in rural areas.

Objectives: To describe time trend of mortality and proportional mortality of injury and to determine the characteristics of distribution of injury deaths in children aged 0 - 14 in Macheng city during 1969 to 1998., Methods: Data were collected from Notification System for Deaths of Macheng City during 1969 to 1998. Injury claimed 14,510 deaths caused by injury in children in total during these years. Changes in mortality and proportional mortality for injury were fitted with log-linear and simple linear regression models to compare their difference in children with different gender and ages., Results: Both injury mortality and proportional mortality in infants declined during the past 30 years, and injury mortality dropped but proportional mortality due to injury increased gradually in children aged 1 - 14 years old. From 1984 to 1998, the average injury mortality was 81.36 per 100,000 children of 0 - 14 of age, with a potential years of life lost rate was 57.92 per 1,000 children. Boys had higher injury mortality than girls. Injury mortality in infants reached 560.15 per 100,000, and mechanical suffocation was the leading cause of injury deaths in infants. Injury mortality was 95.48 per 100,000 in children aged 1 - 4 years. Injury deaths in children aged 0 - 4 accounted for 73.2 percent of total injury deaths. And, drowning was the leading cause of injury deaths in children aged 1 - 14 years., Conclusion: Children under five years old were the vulnerable population for injury death needed for special care and strategy and measures should be taken to control injury in children in the rural areas.

Objective: To discuss the relative factor, development tendency and prevention of the fatal complications in traffic accident injury., Method: We observed injury severity scale (AIS-ISS), clinical response time, and occurrence in traffic accident injury with fatal complications. Ridit mathematical statistics and Q test were used., Result: There were high ISS and long clinical response time in traffic accident injury with fatal complications. A significant relation was found between complications and the progress of time after trauma, thereby the clinical course could be divided into phases of cerebral hernia and shock (or acute), transition, infection and multiple organ dysfunction syndrome (MODS). There was higher head AIS in the cerebral hernia. ISS of shock patients was significantly higher than that of the others. Massive infections occurred in the patients with extremity trauma. There was a significant relation between the occurrence of MODS and infection., Conclusion: The occurrence of fatal complications is related to the location and severity of injury in traffic accident injury. A regularity is present in the occurrence of fatal complications with time progress.

Information on road injury with analyses on the epidemiological features and determinants of fatality rate with prevention and control of road injury was presented in this paper. From 1951 to 1994, road injury and motor vehicle deaths had a continuous increase by 43 and 78 times respectively. Since 1987 about 250,000 cases, 5000 deaths and 15,000 trauma cases caused by road crashes year after year. The fatality rate increased by an average of 12.9% increase per year from 1984 to 1994 (from 2.43 to 5.56 per 100,000 pop). Zhejiang, Guangdong, Liaoning, Sichuan and Jiangsu occupied the first five places in 30 provinces, accounted for over 45% of total road injuries and one thirds of road fatalities. Both incidence and death rate were lowest in Beijing City and highest in Zhejiang Province. Three-quarters of the fatality on road injury were occurred on smooth and straight pavement in sunny days. Over 60% of the motor vehicle deaths were young males (age 20-50 yrs). Classified by occupation, majority of the victims were peasants (55%) and workers (19%). Two thirds of the road fatalities were pedestrians, bicycle riders and passengers. Human factors including driver's irresponsibility, non-licensing, bicycle rider and pedestrian carelessness, etc. were notified that accounted for over 90% of the causes for road injury. Primary causes from the drivers were rules and regulations violation, absent-mindedness, driving after drinking alcohol. The risk factors of road injuries were the increase of motor vehicles and traffic congestion. It is also necessary to improve the traffic safety knowledge among residents.

We have analyzed the report on data of all deaths among 60 year-olds and above in Hai Dian District from 1987 to 1994. The results showed that the mortality of injuries in aging group had a decreasing trend in the last 8 years. The main reasons of death of injuries in this area are fall, traffic accident, poisoning and suicide. Thus the prevention of injury in elderly population should be considered very important.

In this study, we compare the Trauma and Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOT) models by using NCKUH trauma registry to assess the performance of correct prediction in terms of sensitivity, specificity and misclassification rate. The database has accumulated to 5,672 cases, NCKUH 2,490; Chi-Mei 3,182 respectively. Blunt trauma mechanism was composed of 4, 892 (86.2%) while 552 (9.7%) were pertinent to penetrating. The male/female ratio is 2.4:1. Traffic accident is the major cause of injury (3, 472-(61.2%)), followed by work injury (723-(12.7%)); fall (702-(12.4%)) and burn injuries (160-(2.8%)). The category of traffic accident is comprised of motorcycle-related, (1,257-(69.14%)), followed by automobile-related was (301-(16.56%)) and bicycle injuries (123-(6.8%)). The category of working injury comprised by machine crushed cases (332-(45.92%)) followed by cutting (148-(20.47%)) and impacts (69-(9.5%)). The overall mortality rate in our registry was 8.3%. ASCOT and TRISS were compared using sensitivity, specificity and misclassification rates. Each method had disadvantages in predicting outcomes of particular subgroups of patients. ASCOT tends to underestimate the probability of survival among patients with head/spinal injuries; while TRISS had a similar effect on multiple trauma victims. In conclusion, ASCOT is superior to TRISS in correctly predicting severe head trauma cases. However, both methods have their limitations in terms of accurate prediction. It is our hope to develop a mixed, revised model to better predict patients survival probability. Therefore, it is feasible to adopt ASCOT methodology in prediction of trauma patients in Taiwan. Expanded database and better methodology need to be developed in further study.

It is important to evaluate trauma patients with a properly graded severity system in the emergency management of these patients. In this study the Trauma and the Injury Severity Scores based on the evaluation of trauma patients at the emergency services of Mackay Memorial Hospital and Taipei Medical College Hospital, and the mortality rate of these patients is analyzed. There was not a single mortality in patients with a Trauma Score of 15 or 16 and no survival in the patients with Trauma Scores under 11. Eighty-three of 1000 patients (8.3%) had a Trauma Score under 16, and hospitalization was necessary for most of them. All the 22 fatal cases had an Injury Severity Score greater than 24. The mortality rate was 70.6% for the patients with an Injury Severity Score greater than 30. This was the first trial in Taiwan to evaluate patients with the Trauma Score in the hope of aiding medical and paramedical staffs in the selection hospitals to which to transfer patients. All patients having a Trauma Score under 14 should be transferred to well-equipped trauma centers and those with a better score to other hospitals. The Injury Severity Score is nowadays used widely in the world to evaluate the severity and to predict the outcome of the patients. By comparing and utilizing these two grading systems, a more accurate evaluation of the trauma patients can be expected.