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Background: Using three patient characteristics, including age, Injury Severity Score (ISS) and transfusion within 24 h of admission (yes vs. no), the Geriatric Trauma Outcome Score (GTOS) and Geriatric Trauma Outcome Score II (GTOS II) have been developed to predict mortality and unfavourable discharge (to a nursing home or hospice facility), of those who were ≥65 years old, respectively. Objectives: This study aimed to validate the GTOS and GTOS II models. For the nested-cohort requiring intensive care, we compared the GTOS scores with two ICU prognostic scores – the Acute Physiology and Chronic Health Evaluation (APACHE) III and Australian and New Zealand Risk of Death (ANZROD). Methods: All elderly trauma patients admitted to the State Trauma Unit between 2009 and 2019 were included. The discrimination ability and calibration of the GTOS and GTOS II scores were assessed by the area under the receiver-operating-characteristic (AUROC) curve and a calibration plot, respectively. Results: Of the 57,473 trauma admissions during the study period, 15,034 (26.2%) were ≥65 years-old. The median age and ISS of the cohort were 80 (interquartile range [IQR] 72–87) and 6 (IQR 2–9), respectively; and the average observed mortality was 4.3%. The ability of the GTOS to predict mortality was good (AUROC 0.838, 95% confidence interval [CI] 0.821–0.855), and better than either age (AUROC 0.603, 95%CI 0.581–0.624) or ISS (AUROC 0.799, 95%CI 0.779–0.819) alone. The GTOS II's ability to predict unfavourable discharge was satisfactory (AUROC 0.707, 95%CI 0.696–0.719) but no better than age alone. Both GTOS and GTOS II scores over-estimated risks of the adverse outcome when the predicted risks were high. The GTOS score (AUROC 0.683, 95%CI 0.591–0.775) was also inferior to the APACHE III (AUROC 0.783, 95%CI 0.699–0.867) or ANZROD (AUROC 0.788, 95%CI 0.705–0.870) in predicting mortality for those requiring intensive care. Conclusions: The GTOS scores had a good ability to discriminate be

Introduction and hypothesis: Postpartum anal incontinence is common and distressing for women. We sought to look at the prevalence of anal incontinence in women who sustained obstetric anal sphincter injuries (OASI) compared with women who did not, and factors leading to these symptoms during the postpartum period. Methods: A total of 129 primiparous women sustaining OASI were compared with 131 women who did not (controls). They were contacted at approximately 6–10 weeks postpartum to obtain information on their symptoms of anal incontinence (AI). The data underwent univariate and multivariate analysis. Results: There was no difference in the prevalence of AI symptoms, occurring in 30% of women with OASI, and 23% of women without at 6–10 weeks postpartum; however, in women with high-grade tears the prevalence was 59%. Severe OASI (grade 3c and 4) was associated with an increased prevalence of both AI and severe AI, whereas forceps delivery and increasing maternal age were associated with an increased prevalence of severe AI only. Conclusion: Women with less severe (grade 3a and 3b) OASI do not experience a higher prevalence of AI than women without OASI in the postpartum period. Higher grade (3c and 4) tears, forceps delivery and increasing maternal age are associated with higher rates of AI. These factors should be avoided where possible to reduce postpartum AI. All women should be warned of the 23–30% chance of experiencing some mild AI in this period. Whether these symptoms are transient or long-lasting requires further investigation.

Background The ideal thromboprophylaxis in patients at risk of bleeding is uncertain. This retrospective cohort study assessed the risk factors for complications after using retrievable inferior vena cava (IVC) filters for primary or secondary thromboembolism prophylaxis in patients after major trauma. Methods Using data from radiology, trauma and death registries, the incidence of and risk factors for subsequent deep venous thrombosis (DVT), venous thromboembolism (VTE), and mechanical complications related to retrievable IVC filters in patients, admitted between 2007 and 2012, were assessed in a single trauma centre. Results Of the 2940 major trauma patients admitted during the study period, a retrievable IVC filter was used in 223 patients (7.6%). Thirty-six patients (16%) developed DVT or VTE subsequent to placement of IVC filters (median 20 days, interquartile range 9-33), including 27 with lower limb (DVT), 8 upper limb DVT, and 4 pulmonary embolism. A high Injury Severity Score, tibial/fibular fractures, and a delay in initiating pharmacological thromboprophylaxis after insertion of the filters (14 vs 7 days, P=0.001) were significant risk factors. Thirty patients were lost to follow-up (13%) and their filters were not retrieved. Mechanical complications - including filters adherent to the wall of IVC (4.9%), IVC thrombus (4.0%), and displaced or tilted filters (2.2%) - were common when the filters were left in situ for >50 days. Conclusions A delay in initiating pharmacological thromboprophylaxis or filter removal were associated with an increased risk of subsequent DVT, VTE, and mechanical complications of retrievable IVC filters in patients after major trauma.

Background Road trauma is a leading cause of death and injury in young people. Traffic offences are common, but their importance as a risk indicator for subsequent road trauma is unknown. This cohort study assessed whether severe road trauma could be predicted by a history of prior traffic offences. Methodology and Principal Findings Clinical data of all adult road trauma patients admitted to the Western Australia (WA) State Trauma Centre between 1998 and 2013 were linked to traffic offences records at the WA Department of Transport. The primary outcomes were alcohol exposure prior to road trauma, severe trauma (defined by Injury Severity Score > 15), and intensive care admission (ICU) or death, analyzed by logistic regression. Traffic offences directly leading to the road trauma admissions were excluded. Of the 10,330 patients included (median age 34 years-old, 78% male), 1955 (18.9%) had alcohol-exposure before road trauma, 2415 (23.4%) had severe trauma, 1360 (13.2%) required ICU admission, and 267 (2.6%) died. Prior traffic offences were recorded in 6269 (60.7%) patients. The number of prior traffic offences was significantly associated with alcohol-related road trauma (odds ratio [OR] per offence 1.03, 95% confidence interval [CI] 1.02-1.05), severe trauma (OR 1.13, 95% CI 1.14-1.15), and ICU admission or death (OR 1.10, 95% CI 1.08-1.11). Drink-drinking, seat-belt, and use of handheld electronic device offences were specific offences strongly associated with road trauma leading to ICU admission or death-all in a 'dose-related' fashion. For those who recovered from road trauma after an ICU admission, there was a significant reduction in subsequent traffic offences (mean difference 1.8, 95% CI 1.5 to 2.0) and demerit points (mean difference 7.0, 95% CI 6.5 to 7.6) compared to before the trauma event. Significance Previous traffic offences were a significant risk factor for alcohol-related road trauma and severe road trauma leading to ICU admission or death.