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Introduction The optimal management strategy for patients with head injury admitted to a non-specialist hospital is uncertain. The aim of this study was to evaluate the outcomes of victims of head injury requiring hospitalisation but initially admitted to a rural level II trauma centre without a neurosurgical facility but with a system for neurosurgical consultation via teleradiology. Methods Patients admitted for head injury during 2006–2011 were included. Late transfer of patients initially hospitalised in the level II trauma centre was evaluated for treatment failure, defined as clinical or radiological deterioration. Results Five hundred and sixty-two patients were initially hospitalised in the level II trauma centre. Evaluation of late transfers showed that only 23 (4.1%) represented real treatment failures due to clinical or radiological deterioration. The clinical course was altered by primary intent to hospitalise patients in the level II trauma centre in only one patient. Conclusions Selected patients with head trauma who have a pathological CT scan may be safely managed in level II trauma centres following neurosurgical consultation using teleradiology. Review of treatment failures is necessary to ensure proper ongoing management of a system in which neurosurgical patients are selectively transferred to trauma centres with neurosurgical capacity.

Background Despite ISS being a widely accepted tool for measuring injury severity, many researchers and practitioners use different partition of ISS into severity groups. The lack of uniformity in ISS use inhibits proper comparisons between different studies. Creation of ISS group boundaries based on single AIS value squares and their sums was proposed in 1988 during Major Trauma Study (MTOS) in the USA, but was not validated by analysis of large databases. Methods A validation study analysing 316 944 patients in the Israeli National Trauma registry (INTR) and 249 150 patients in the American National Trauma Data Bases (NTDB). A binary algorithm (Classification and Regression Trees (CART)) was used to detect the most significantly different ISS groups and was also applied to original MTOS data. Results The division of ISS into groups by the CART algorithm was identical in both Trauma Registries and very similar to original division in the MTOS. For most samples, the recommended groups are 1–8, 9–14, 16–24 and 25–75, while in very large samples or in studies specifically targeting critical patients there is a possibility to divide the last group into 25–48 and 50–75 groups, with an option for further division into 50–66 and 75 groups. Conclusions Using a statistical analysis of two very large databases of trauma patients, we have found that partitioning of ISS into groups based on their association with patient mortality enables us to establish clear cut-off points for these groups. We propose that the suggested partition of ISS into severity groups would be adopted as a standard in order to have a common language when discussing injury severity.

To demonstrate the benefit of using multiple injury profiles (MIP) as an alternative to "primary diagnosis," for the presentation and analysis of multiple injuries in populations.Retrospective analysis of national trauma registry data in Israel between 1 January 1998 and 31 December 2002. Multiple diagnoses per patient were recorded. A primary diagnosis was selected for each patient and data were presented twice: first by selecting a primary diagnosis and then using multiple injury profiles.23 909 transport casualties were included. Findings show that MIP enable the identification of all patients with a specific injury, even where secondary. The proportion of additional injuries recorded when using MIP ranged from 12% in head injuries to 270% for facial injuries. Based on the primary diagnosis patients with head, chest, and abdominal injuries had a 5-6% inpatient death rate each. Multiple injury profiles of the same population reveal that an isolated head injury has a 3% inpatient death rate, isolated chest and isolated abdomen have a 1% inpatient death rate, while combined head and chest casualties have a 21% inpatient death rate.Multiple injury profiles are a new approach that enables presenting an improved picture of injury in a population.

Background Breathalyzers have become an indispensable tool for monitoring alcohol levels among drivers for evidential purposes. Israels traffic police, like many other countries worldwide, uses the Drager 7110 MKIII, which is correlated with blood alcohol levels at a 2100:1 partition ratio. Recent uncertainty with this association resulted in a legal standstill in the conviction of drunk drivers. Objective To assess the correlation between breath alcohol, measured using the Drager 7110 MKIII-IL breathalyzer, and blood alcohol concentrations (BAC). Methods Sixty-one healthy volunteers, ages 21–37 years, participated in a blinded study. Participants were administered between 0.89 and1.16 g 95% alcohol/kg body weight according to gender mixed with juice. Breath and blood samples were taken simultaneously before and at 30-, 60- and 90-min after alcohol ingestion. Breath alcohol concentrations were measured by police officers trained in the use of the breathalyzer and under field conditions. Blood alcohol levels were determined by head-space gas chromatography technique in an accredited laboratory. Results A total of 242 valid blood/breath tests were performed on 61 participants. The correlation coefficient between breath and blood alcohol levels was high (r=0.983). The regression equation for the prediction of breath alcohol was equal to 10.224+4.292*blood alcohol. The sensitivity and the specificity of the breathalyzer instrument were 97% and 93%, respectively. Blood to breath alcohol ratio was 1:2231242. Conclusions The Drager 7110 MKIII IL breathalyzer was highly correlated with BAC. The results of this study were used in the Israeli courts as evidence for the reliability of the Drager 7110 MKIII breathalyzer measurement.

Background Over the past decade the consumption of alcohol in Israel has been on the rise and the role of alcohol in driver-related injuries in Israel is unknown. Monitoring blood alcohol concentrations (BACs) among drivers is not routine and confounded by numerous methodological issues. Methods A prospective study was conducted to examine the BAC of drivers admitted as trauma patients due to motor vehicle crashes. Data were collected for 22 months over a 3-year period (2006–2008). Non-identifiable patient numbers were assigned to each driver. Questionnaires regarding injury characteristics were completed by trauma room staff. Excess blood samples according to the assigned patient numbers were used to identify BAC. Results Approximately 15% of injured drivers had a BAC≥0.05 g/dl (positive BAC). The majority of drivers were males under 30 years old. Drivers with a positive BAC had a higher prevalence of self accidents, rolling over, crashes at an intersection and disregard of seatbelt use. Conclusions This is the first study to systematically quantify BAC among drivers in Israel by using untraceable results. We found a substantially high prevalence of positive BAC among hospitalised drivers. At-risk groups for alcohol-related driver crashes were identified. We recommend that this study be used as a basis for preventive and enforcement strategies for reducing alcohol-related driver crashes.

Introduction The rise in the incidence of burns among victims of terror was proportionate to the rise in the incidence of burns among all trauma victims. The aim was to compare the severity of injuries and outcome in terror victims with and without burns injuries. Methods Data were obtained from the Israeli Trauma Registry for all patients admitted to 8–10 hospitals in Israel between 1997 and 2003. We analyzed and compared demographic and clinical characteristics of 219 terror-related burn patients (Terror/Burn), 2228 terror patients with no associated burns (Terror/no-Burns) and 6546 non terror related burn patients (Burn/no-Terror). Severity of injuries was measured using the Injury Severity Score, total Bode Surface Percentage, admission rates to Intensive Care Units and in-hospital mortalities. Results Of burn/terror patients, 87.2% suffered other accompanying injuries, compared with 10.4% of burn/no-terror patients. Of burn/terror patients, 49.8% were admitted to ICU compared with only 11.9% of burn/no-terror patients and 23.8% of no-burn/terror patients. Mean length of hospital stay was 18.5 days for the terror/burn group compared with 11.1 days for the burn/no-terror group and 9.5 days for the terror/no-burn group. Burn/terror patients had a significantly higher injury severity score compared with the other groups. In-hospital mortality rate for the burn/no-terror group was 3.4%. The burn/terror group had a mortality of 6.4% which was similar to the no-burn/terror group (6.6%). Conclusions Terror-attack injuries with accompanying burns have a more complex presentation, are of higher severity, and are associated with increased length of stay and a higher ICU admissions rate, compared with terror-attack injuries without burns and non terror-attack related burns. However, mortalities in terror-attack injuries are not affected by burns.

Firearms, cuts and falls from heights are the major causes of injury among hospitalised of aggressive attempted suicide (AAS) and victims of violence (VV). Aim To compare the outcomes of similar mechanisms of injury for patients of AAS and VV. Method A retrospective study using data from the Israel National Trauma Registry including 10 hospitals during the years 2003–2007. ICD9 definitions of AAS and VV were utilised. Results During the study period, 825 AAS patients and 7912 VV patients were hospitalised. The most common mechanism of injury for VV was stab wounds (40%) and non-firearm fighting (28%). The outcome was different, among AAS, 45% jumped from height and 32% from stab wounds. For both groups, approximately 10% were injured from firearms. AAS patients were more severe, 39% had an ISS of 16+, 45% were hospitalised for 7+ days and 31% were admitted to the ICU, compared to 16%, 16% and 9% respectively among VV. In general, VV were younger than AAS. In-hospital mortality was 8.1 times greater among AAS victims, and similarly, rehabilitation referrals were 10 times greater among AAS patients. Conclusions and Recommendations (1) Hospitalised AAS patients are severely injured, and require increased use of hospital resources. Further research should check if this group receives the necessary support during hospitalisation and follow up treatment after discharge. (2) Methods for reducing use of aggressive mechanisms of violence should begin with the local municipality taking responsibility and working together with other forces.