Search

• Applying XGBoost, identified key factors are injury location, race, age, safety compliance, and substance use. • Core clusters include older drivers, impaired young drivers, driver ethnicity, and motorcyclists. • Around 56% of injured roadway users tested positive for alcohol, THC, or other substances. • Young adults (21–34) with high BACs had higher severe injury rates. • Motorcyclists with inconsistent helmet use and substance involvement had high leg injuries. Alcohol and drugs, including Tetrahydrocannabinol (THC), significantly impact roadway safety by impairing cognitive functions, coordination, and reaction times, leading to increased crash risk and severity. This study examines the prevalence of alcohol and drugs among 4,586 injured roadway users (drivers, riders, and passengers) in the U.S. from 2019 to 2021, utilizing an XGBoost model to identify key variables associated with Injury Severity Score (ISS) in substance-related traffic crashes, and highlighting influential factors such as injury location, demographic characteristics (age, race), safety compliance, and alcohol and drug presence. These risk factors were further analyzed through Cluster Correspondence Analysis (CCA) to reveal patterns and trends affecting injury severity across different demographic and behavioral groups. The findings reveal that 55.8% of the injured tested positive for substances, with cannabinoids being the most common, followed by alcohol, stimulants, and opioids. This study identified six core crash clusters, each with distinct characteristics, including older drivers, impaired young drivers, specific driver ethnicities, and motorcyclists. Key findings from clusters indicate that older drivers, despite high safety compliance and negative substance tests, faced crash risks potentially due to age-related limitations. Impaired young adult crashes are characterized by risky behavior, including alcohol and THC use combined with low safety compliance, while motorcyclists with high substance involvement and inconsistent helmet use, are identified as a high-risk group, frequently experiencing severe leg injuries. These insights underscore the need for comprehensive traffic safety policies targeting substance use and promoting effective safety measures to mitigate crash risks and improve road safety. [ABSTRACT FROM AUTHOR]

Background: Trauma has a profound impact on mortality as well as short- and long-term health outcomes. For trauma patients to receive medical care in a timely manner, early identification and risk assessment are essential. The Geriatric Trauma Outcome Score (GTOS), which was created by combining age, the Injury Severity Score (ISS), and the requirement for packed red blood cell transfusion, has proven to be a valuable prognostic tool for elderly trauma patients, though its applicability to general trauma patients is still understudied. Methods: This retrospective study analyzed data from the Trauma Registry System at a Level I trauma center in southern Taiwan, covering the period from 1 January 2009 to 31 December 2021. This study included 40,068 trauma patients aged 20 years and older. Statistical analyses included chi-square tests, ANOVA, Mann–Whitney U tests, and multivariate analyses to identify independent risk factors for mortality. The predictive performance of the GTOS was assessed using the area under the curve (AUC) of the receiver operating characteristic curve. Results: The final study population included 40,068 patients, with 818 deaths and 39,250 survivors. Deceased patients had higher GTOS scores (mean 132.8 vs. 76.1, p < 0.001) and required more blood transfusions (mean 4.0 vs. 0.3 units, p < 0.001) compared to survivors. The optimal GTOS cut-off value for predicting mortality was 104.5, with a sensitivity of 82.6% and a specificity of 84.3% (AUC = 0.917). A high GTOS score was associated with increased mortality (9.6 vs. 0.4%, p < 0.001) compared with a low GTOS score, even after adjusting for confounding factors (adjusted mortality rate of 2.86, p < 0.001), and a longer hospital stay (14.0 vs. 7.7 days, p < 0.001). Conclusions: The GTOS is a valuable prognostic tool for predicting mortality in trauma patients, providing a simple and rapid assessment method. Its high predictive accuracy supports its use in broader trauma patient populations beyond the elderly. Further studies are recommended to refine and validate the GTOS in diverse trauma settings to enhance its clinical utility. [ABSTRACT FROM AUTHOR]

Soluble CD163 (sCD163) is a biomarker of macrophage activation, not previously investigated in the circulation of traumatized patients. A biobank of 398 adult trauma patients was analyzed. Patients with an Injury Severity Score (ISS) >8 served as trauma patients (n = 195) and those with ISS ≤ 8 as trauma controls (n = 203). Serum samples obtained upon admission, 15h and 72h after were analyzed for sCD163 using an in-house ELISA. Multiple linear regression was used to analyze the association between admission levels of sCD163 with, 1: overall trauma severity (ISS), and 2: severity of injury to specified organs using Abbreviated Injury Score (AIS) and Glasgow Coma Scale (GCS). The association between the peak level of sCD163 with 1-year all-cause mortality was analyzed by logistic regression analysis. Median admission levels of sCD163 were higher in trauma patients than trauma controls [2.32 (IQR 1.73 to 2.86) vs. 1.92 (IQR 1.41 to 2.51) mg/L, p < 0.01]. Worsening GCS score was associated with a 10.3% (95% CI: 17.0 to 3.1, p < 0.01) increase in sCD163. Increasing Head-AIS score was associated with a 5.1% (95% CI: −0.5 to 11.0, p = 0.07) increase in sCD163. The remaining AIS scores and ISS were not consistently associated with sCD163 admission levels. Each mg/L increase in sCD163 peak level had an odds ratio 1.34 (95%CI: 0.98 to 1.83), p = 0.06) after adjustment for age, sex, and GCS. Circulating sCD163 is increased in traumatized patients and associated with worsening GCS. Our findings suggest an association between circulating sCD163 levels with 1-year all-cause mortality. [ABSTRACT FROM AUTHOR]

BACKGROUND: Firearm injuries (FI) remain a significant cause of morbidity and mortality globally. Antibiotic use, supported by guideline recommendations for preventing post-injury infections in FI cases, encounters uncertainties regarding the selection of antimicrobial agents and associated outcomes. This study aimed to investigate the relationship between Injury Severity Scores (ISS) for FI cases presented to the emergency department. METHODS: We empirically revised antimicrobial treatment protocols based on culture results and mortality rates. In the study, 164 firearm injury cases, admitted to the emergency department in 2022 and subsequently hospitalized in clinics and intensive care units (ICU), were evaluated. Cases included in the study were categorized into four groups based on ISS: mild, moderate, severe, and profound injury severity. The study compared the timing of hospital presentation following the injury, hospital length of stay, tissue or blood culture positivity, empirical treatment administered, antimicrobial revision based on culture results, need for ICU admission, mortality status, and ISS among the cases. Data were analyzed using IBM SPSS Statistics 22.0 (SPSS Inc., Chicago, IL). Variables in trauma patients were compared among various groups using Pearson Chi-Square tests. Binary logistic regression tests were performed to identify independent risk factors. A significance level of p<0.05 was considered statistically significant. RESULTS: The study included 164 patients, all of whom were male. The mean age was calculated as 28.9±4.51 years. The average hospital length of stay was 25.54±21.81 days. Eighty-three patients (50.6%) required intensive care. Tissue cultures were obtained from 79 patients (48%). Bacterial growth was observed in 45 of these 79 patients (57%). The appropriate empirical antibiotic treatment rate, assessed among patients who received empirical treatment followed by culture-based antibiotic sensitivity testing, was 48.9%. It was observed that empirical antibiotic regimens were appropriate in 80% of cases in the mild group and 16.7% in the profound severe group (p=0.005). Our study compared the relationship between hospitalization duration and ISS groups. It was observed that hospitalization duration was significantly shorter in the mild group compared to the other groups (p=0.003, p=0.000, p=0.000). It was also observed that the need for ICU admission was higher in groups with higher ISS, indicating a correlation between higher ISS and increased ICU requirements (p=0.000). CONCLUSION: In conclusion, for cases of firearm injuries, we believe empirical antimicrobial therapy should be initiated with narrow-spectrum agents such as beta-lactam + beta-lactamase inhibitor or third-generation cephalosporin + nitroimidazole in the mild group, considering the lack of Pseudomonal activity. [ABSTRACT FROM AUTHOR]

Background: Major thoracic trauma represents a life-threatening condition, requiring a prompt multidisciplinary approach and appropriate pathways for effective recovery. While acute morbidity and mortality are well-known outcomes in thoracic-traumatized patients, long-term quality of life in patients surviving surgical treatment has not been widely investigated before. Methods: Between November 2016 and November 2023, thirty-two consecutive patients were operated on because of thoracic trauma. Age, sex, comorbidities, location and extent of thoracic trauma, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), Organ Injury Scale (OIS), intra and extrathoracic organ involvement, mechanism of injury, type of surgical procedure, postoperative complications, ICU and total length of stay, immediate clinical outcomes and long-term quality of life—by using the EQ-5D-3L scale and Numeric Rate Pain Score (NPRS)—were collected for each patient Results: Results indicated no significant difference in EQOL.5D3L among patients with thoracic trauma based on AIS (p = 0.55), but a significant difference was observed in relation to ISS (p = 0.000011). Conclusions: ISS is correlated with the EQOL.5D3L questionnaire on long-term quality of life, representing the best prognostic factor—in terms of long-term quality of life—in patients surviving major thoracic trauma surgical treatment. [ABSTRACT FROM AUTHOR]

BackgroundIn blunt chest trauma, patient management is challenging because clinical guidelines miss tools for risk assessment. No clinical scale reliably measures the severity of cases and the chance of complications.AimThe objective of the study was to optimize the management of patients with blunt chest trauma by creating models prognosticating the transfer to the intensive care unit and in-hospital length of stay (LOS).MethodsThe study cohort consisted of 212 cases. We retrieved information on the cases from the hospital’s trauma registry. After segmenting the lungs with Lung CT Analyzer, we performed volumetric feature extraction with data-characterization algorithms in PyRadiomics.ResultsTo predict whether the patient will require intensive care, we used the three groups of findings: ambulance, admission, and radiomics data. When trained on the ambulance data, the models exhibited a borderline performance. The metrics improved after we retrained the models on a combination of ambulance, laboratory, radiologic, and physical examination data (81.5% vs. 94.4% Sn). Radiomics data were the top-accurate predictors (96.3% Sn). Age, vital signs, anthropometrics, and first aid time were the best-performing features collected by the ambulance service. Laboratory findings, AIS scores for the lower extremity, abdomen, head, and thorax constituted the top-rank predictors received on admission to the hospital. The original first-order kurtosis had the highest predictive value among radiomics data. Top-informative radiomics features were derived from the right hemithorax because the right lung is larger. We constructed regression models that can adequately reflect the in-hospital LOS. When trained on different groups of data, the machine-learning regression models showed similar performance (MAE/ROV≈8%). Anatomic scores for the body parts other than thorax and laboratory markers of hemorrhage had the highest predictive value. Hence, the number of injured body parts correlated with the case severity.ConclusionThe study findings can be used to optimize the management of patients with a chest blunt injury as a specific case of monotrauma. The models we built may help physicians to stratify patients by risk of worsening and overcome the limitations of existing tools for risk assessment. High-quality AI models trained on radiomics data demonstrate superior performance.

Transportation databases have limited data regarding injury severity of pedestrian versus automobile patients. To identify opportunities to reduce injury severity, transportation and trauma databases were integrated to examine the differences in pedestrian injury severity at street crossings that were signalized crossings (SCs) versus nonsignalized crossings (NSCs). It was hypothesized that trauma database integration would enhance safety analysis and pedestrians struck at NSC would have greater injury severity. Single-center retrospective review of all pedestrian versus automobile patients treated at a level 1 trauma center from 2014 to 2018 was performed. Patients were matched to the transportation database by name, gender, and crash date. Google Earth Pro satellite imagery was used to identify SC versus NSC. Injury severity of pedestrians struck at SC was compared to NSC. A total of 512 patients were matched (median age = 41 y [Q1 = 26, Q3 = 55], 74% male). Pedestrians struck at SC (n = 206) had a lower injury severity score (ISS) (median = 9 [4, 14] versus 17 [9, 26], P < 0.001), hospital length of stay (median = 3 [0, 7] versus 6 [1, 15] days, P < 0.001), and mortality (21 [10%] versus 52 [17%], P = 0.04), as compared to those struck at NSC (n = 306). The transportation database had a sensitivity of 63.4% (55.8%-70.4%) and specificity of 63.4% (57.7%-68.9%) for classifying severe injuries (ISS >15). Pedestrians struck at SC were correlated with a lower ISS and mortality compared to those at NSC. Linkage with the trauma database could increase the transportation database's accuracy of injury severity assessment for nonfatal injuries. Database integration can be used for evidence-based action plans to reduce pedestrian morbidity, such as increasing the number of SC. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the hypothesis that identical abbreviated injury scale (AIS) scores may lead to varying risks of in-hospital mortality and admission to the intensive care unit (ICU) depending on the specific body region affected. Methods: This study focused on hospitalized trauma patients with moderate to serious injuries (AIS=2, 3). The final sample was stratified based on the injured body regions. To determine the impact of these injuries on mortality and ICU admission, we conducted binary logistic regression after adjusting for confounding factors. Results: Overall, 16,040 trauma patients with moderate injury (AIS=2) and 1,338 trauma patients with serious injury (AIS=3) were included in this study. When comparing outcomes of trauma patients in different body regions, there was no significant difference in the odds of two main outcomes in various injury sites, except for extremities (P values>0.05). When the AIS=2 patients were controlled for confounding factors, the adjusted odds of mortality were significantly higher for head, face, and neck injuries, as well as spine/back, thoracic, and abdominal injuries, compared to extremity injuries (adjusted odds ratio (aOR)s=9.81, 8.78, 8.11, and 3.96, respectively; P-values<0.05). Among those with AIS=3, the odds of mortality were significantly greater for abdominal (aOR=7.05, P-value=0.009) and head, face, and neck injuries (aOR=2.73, P-value=0.001) than for extremity injuries. Conclusion: Injuries with the same AIS (=2, 3) value almost indistinguishably confer the same mortality risk and ICU admission, except for extremities. The unique AIS value assigned to various body sites almost consistently indicates the same likelihood of negative outcomes. [ABSTRACT FROM AUTHOR]

Obesity is a chronic disease that adversely impacts patient outcomes and increasingly affecting the pediatric population. According to the CDC, in 2020 the prevalence of obesity among children and adolescents was estimated to be as high as 19.7%. The obesity paradox is the increased survival for overweight and obese adult trauma patients when compared to patients with healthy weights. The aim of this study was to analyze the impact of BMI and outcomes in the pediatric trauma population. Trauma patients in the 2–18 years age group and reported to the 2017–2019 National Trauma Data Bank were identified. CDC growth charts and z-scores were calculated to categorize patients into four subgroups: underweight (<5th percentile), healthy weight (5th-85th percentile), overweight (85th-95th percentile), and obesity (>95th percentile). Primary outcome studied was the mortality rate. Secondary outcomes included injury severity score (ISS), hospital length of stay (LOS), ICU LOS, and number of days on a ventilator. Continuous and categorical data were analyzed using ANOVA and Chi-squared test, respectively, using the healthy BMI category as reference group. P < 0.05 was considered significant. A total of 161,458 patients [Underweight: 9148 (6%), Healthy weight: 88,009 (55%), Overweight: 26,740 (17%), and Obese: 37,561 (23%)] were included. The mean age was 11 years (SD:5.1). Total mortality for the patient set was 1825 (1.13%). The lowest mortality rate was in the obese group. The ISS was lowest in the obese group, while ICU LOS and days on ventilator were no different than control patients. Hospital LOS and transfer to rehabilitation rates were higher in the obese population. Obesity appears to have a protective effect on mortality and significantly better secondary outcomes in the pediatric trauma population. Further study is necessary to evaluate the interplay between body weight and outcomes in pediatric trauma and disease states. III. • Obese and Overweight patients comprise of 40% of all pediatric trauma victims in the United States. • The obese patients had the lowest mortality on univariate analysis and were non-inferior to healthy weight controls on propensity matching. • Injury Severity Score was lowest in the Obese group. • Hospital Length of Stay and transfer to rehabilitation facility were higher in the Obese group. However, ICU LOS and Ventilator days were no different to healthy weight victims. [ABSTRACT FROM AUTHOR]

Objective: To identify the distinctive features of acutely injured patients who were presented to the emergency department (ED) and their association with mortality and surgical intervention outcomes.Methods: This cross-sectional study was conducted on all trauma patients resuscitated in the ED of ShahidRajaee (Emtiaz) Trauma Hospital (Shiraz, Iran) from May 2018 to June 2019. Demographic information, themechanism of trauma, trauma type, injured body regions, criteria of abbreviated injury scale (AIS) score,injury severity score (ISS), and surgical intervention was all taken into consideration. The items related to themortality and surgical performance outcomes among the patients were analyzed.Results: Of all 1281 cases, 82.9% were men, and the mean age of the patients was 37.9±19.1 years. The mostcommon mechanism of injury was a car accident, and the thorax was the most prevalent injured area of thebody. The majority of the patients had moderate blunt trauma. The mechanism of trauma, ISS, and the severityof head trauma were all significantly correlated with operation interventions. Moreover, age, the mechanismand type of trauma, ISS, and the necessity for the surgery were significantly associated with death occurrence.Additionally, head, thorax, and abdomen trauma were significantly related to a high mortality rate.Conclusion: Age, trauma mechanism and type, ISS, and the necessity for surgery were significantly associatedwith the mortality rate of injured patients. The severity of the trauma, particularly head injuries and themechanism of damage were important determinants in concern for surgery the necessity.

Objective:In our study, it was aimed to evaluate the effectiveness of the trauma scoring systems used in the reports, in which a situation that endangered the life of the person due to the trauma she/he was exposed to, on the situations that endanger the person’s life.Methods:The data of this study were obtained from retrospective file scans of general forensic and epicrisis reports of people who applied to the court as a result of intentional or negligent injury and who were referred by the judicial authorities to Aydın Adnan Menderes University Practice and Research Hospital between 01 January 2013 and 01 September 2019. In this study, forensic traumatological reports of 1684 cases were examined.Results:Sensitivity 75.6%, selectivity 99.1% for Abbreviated Injury Scale (AIS) optimal cut point 3, sensitivity 72.6% for Injury Severity Score (ISS) optimal cut point 9, selectivity 99%, sensitivity 14.6 for Revised Trauma Score (RTS) optimal cut point 7,0061, The selectivity was calculated as 99,7, the sensitivity for Circulation, Respiration, Abdominal/Thoracic, Motor and Speech Scale (CRAMS) optimal cut point 8 was 13.5%, the selectivity was 99.9%, for Trauma Revised Injury Severity Score (TRISS) the most suitable cut point was 93.610, the sensitivity was 23.4% and the selectivity was 99.7%. Patient groups between 0-17 years; sensitivity 76.1% for AIS optimal cut point 3, selectivity 99.2%, ISS 75% for selective cut point 9, selectivity 99.2%, sensitivity for RTS optimal cut point 7.4745 83.3% , selectivity 85.9%, CRAMS optimal cut point 9 for sensitivity 87.5%, selectivity 86.8%, TRISS optimal cut point 98.95 for sensitivity 95.7%, selectivity 93.7%, Pediatric Trauma Score (PTS) optimal The sensitivity for cut-off point 9 was 96.7%, and the selectivity was 97.3%.Conclusion:In the light of the data obtained from our study, it has been found that TRISS and PTS trauma scoring systems have benefits especially in terms of standardization, but should be approached carefully in terms of their limitations in order to determine the severity of the disease and the possibility of mortality in traumatized patients.

Introduction-Aim: Validated triage tools such as the Vittel criteria are essential to improve the care of trauma patients. The aim of this study was to evaluate the correlation between the Vittel triage criteria and the Injury Severity Score (ISS) to improve the accuracy of pre-hospital triage., Methods: We conducted a longitudinal study of all trauma patients transported by EMS over a two-year period (November 2021- November 2023). Vittel and (ISS) scores were calculated on admission. Predictive Vittel criteria were defined by independent risk factors for ISS>15 using a multiple logistic regression model with p-value < 0.05 and/or sensitivity (se)>50%, with positive Youden index (Yi)., Results: A total of 461 trauma patients were transported by EMS during the study period were included. The sex ratio was 5.3 and road traffic accidents accounted for 77.2%. An ISS>15 was found in 41% of participants, 25% required ICU admission and 23.9% died within 30 days. Using the above selection criteria, we identified seven key predictive criteria (OR CI 95%, se%, Yi) Glasgow coma scale<13(3.16 [1.91 5.24],44,0.25); fall>6 m(4.031[1.61-10.08],10,0.07); severe burn(23.89[10.21-55.93],6,0.02); Pelvic fracture (4.93 [1.19-20.32], 28, 0.25),suspected spinal cord injury(6.89 [2.79-16.96], 6, 0.05); Fluid resuscitation>1000 ml(-, 60.0. 11); Catecholamine (2.02 [1.09-3.75],51.0.27). Physiological variables (se 30%, Yi 0.16) and pre-hospital resuscitation(se 46%, Yi 0.18) were among the most relevant categories for predicting severity, similar to the full Vittel score., Conclusion: Seven criteria were associated with severe trauma (ISS score >15). Physiological variables and pre-hospital resuscitation were significant categories that may help to predict the severity of trauma and its impact on patients.

Background: Major trauma has been one of the leading causes of morbidity, mortality, and functional disability, resulting in substantial societal burden. The aim of this study was to estimate the trends in burden of adult major trauma in Taiwan during 2003–2015. Methods: Adult patients with initial encounter of major trauma (injury severity score ≥ 16) were abstracted from the claim data of National Health Insurance (NHI) in Taiwan from January 2003 to December 2015. We explored the trends of incidence and mortality rates over time stratified by age and sex, as well as life expectancy (LE), loss-of-LE, lifetime healthcare expenditure and total loss-of-LE compared with age, sex and calendar-year matched referents simulated from the vital statistics of Taiwan. Results: A total of 71,731 cases of adult major trauma, and an estimated loss of 979,676 life-years were found with an increasing trend in cumulative incidence rate (CIR18-84) during 2003–2015. The incidence rates were significantly higher in men than women. For both sexes, the incidence rates for those aged 65 and above were about 2–3 times higher than those of all other age groups. The one-year case fatality rates among the elderly were about 31–61%, higher than all other ages. The lifetime healthcare expenditures per person were 47,616 USD in men and 43,416 USD in women. Conclusion: There is a consistently increasing trend in incidence and mortality of major trauma in Taiwan, especially among elderly people. For Taiwan, an aged society beginning since 2018, the challenge should be tackled more effectively in the coming decades.

Objective: To determine correlation of important biochemical laboratory investigations in different trauma patients and their degree of injury severity and overall mortality association. Methods: In this hospital based retrospective observational study, 238 trauma patients were divided into two groups. Group I with injury severity score (ISS)16. Haemoglobin (Hb), international normalized ratio, serum creatinine, blood urea nitogen (BUN), serum electrolyte, serum uric acid and liver function parameters were recorded and statistically analyzed. Results: Group II had statistically significant (p 16). Conclusion: The study establishes the absolute need of doing three laboratory parameters (serum creatinine, serum blood urea nitrogen and serum potassium) instead of doing laboratory tests battery at the time of trauma victims admission and predicting survival among injured patients in trauma population from Indian settings.

Background. After trauma, the subtypes of white blood cells (WBCs) in circulation and the derived neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) may undergo relative changes and reflect the patients' immune-inflammatory status and outcome. This retrospective study was designed to investigate the relationship between these variables and the mortality outcomes in adult patients with polytrauma, which is defined as an abbreviated injury scale (AIS) score ≥ 3 in two or more different body regions. Methods. A comparison of the expression of subtypes of WBCs, NLR, MLR, and PLR upon arrival to the emergency department was performed in selected propensity score-matched patient cohorts created from 479 adult patients with polytrauma between 1 January 2015 and 31 December 2019. A multivariate logistic regression analysis was used to identify the independent risk factors for mortality. Results. There were no significant differences in monocyte, neutrophil, and platelet counts, as well as in MLR, NLR, and PLR, between deceased (n = 118) and surviving (n = 361) patients. In the propensity score-matched patient cohorts, which showed no significant differences in sex, age, comorbidities, and injury severity, deceased patients had significantly higher lymphocyte counts than survivors (2214 ± 1372 vs. 1807 ± 1162 [106/L], respectively, p = 0.036). In addition, the multivariate logistic regression analysis revealed that the lymphocyte count (OR, 1.0; 95% confidence interval [CI], 1.00–1.06; p = 0.043) was a significant independent risk factor for mortality in these patients. Conclusions. This study revealed that there was no significant difference in the counts of monocytes, neutrophils, and platelets, as well as in MLR, NLR, and PLR, between deceased and surviving patients with polytrauma. However, a significantly higher lymphocyte count may be associated with a worse mortality. [ABSTRACT FROM AUTHOR]

Abstract Background Trauma is a significant cause of death and impairment. The Abbreviated Injury Scale (AIS) differentiates the severity of trauma and is the basis for different trauma scores and prediction models. While the majority of patients do not survive injuries which are coded with an AIS 6, there are several patients with a severe high cervical spinal cord injury that could be discharged from hospital despite the prognosis of trauma scores. We estimate that the trauma scores and prediction models miscalculate these injuries. For this reason, we evaluated these findings in a larger control group. Methods In a retrospective, multi-centre study, we used the data recorded in the TraumaRegister DGU® (TR-DGU) to select patients with a severe cervical spinal cord injury and an AIS of 3 to 6 between 2002 to 2015. We compared the estimated mortality rate according to the Revised Injury Severity Classification II (RISC II) score against the actual mortality rate for this group. Results Six hundred and twelve patients (0.6%) sustained a severe cervical spinal cord injury with an AIS of 6. The mean age was 57.8 ± 21.8 years and 441 (72.3%) were male. 580 (98.6%) suffered a blunt trauma, 301 patients were injured in a car accident and 29 through attempted suicide. Out of the 612 patients, 391 (63.9%) died from their injury and 170 during the first 24 h. The group had a predicted mortality rate of 81.4%, but we observed an actual mortality rate of 63.9%. Conclusions An AIS of 6 with a complete cord syndrome above C3 as documented in the TR-DGU is survivable if patients get to the hospital alive, at which point they show a survival rate of more than 35%. Compared to the mortality prognosis based on the RISC II score, they survived much more often than expected.

Background In developing nations, the primary cause of death is trauma, and the prevalence of trauma is increasing as more vehicles are driven. Numerous trauma scoring systems have been created in order to predict the mortality rate and patients with trauma's prognosis. The purpose of the current study was to assess the prognostic ability of various trauma scoring systems for patients' mortality and morbidity in cases involving chest and abdominal injuries, as they are common in the surgery department. Methodology At Ranchi, Jharkhand's Rajendra Institute of Medical Sciences, a prospective observational study was conducted from June 2021 to September 2022. All patients who met the requirements for inclusion were older than 18 and reported chest and abdominal trauma totaling 204. Before any essential therapies, primary care and resuscitation, including airway maintenance, breathing, circulation, and hemorrhage control, were established. A comprehensive clinical evaluation was done based on each patient's needs. Radiological evaluation included chest X-ray and ultrasonography (USG) for chest trauma, whereas USG (FAST) and CT scans were for abdominal trauma. Trauma scores, such as the Revised Trauma Score (RTS), the Trauma Revised Injury Severity Score (TRISS), the New Injury Severity Score (NISS), and the Injury Severity Score (ISS), were computed and examined using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Results Of the 204 patients, 14.7% were female and 85.3% were male. The age range of 21-30 years old accounted for the largest percentage of cases (28%). 50 percent of injuries were caused by automobile accidents, while 25% were the result of assaults. At 83.8% versus 16.2%, blunt injuries were substantially more common than penetrating ones. In comparison to the chest, the abdomen was more frequently involved. The study's findings demonstrated that, while every trauma scoring was statistically significant in predicting mortality, the New Injury Severity Score (NISS), as well as the Trauma Revised Injury Severity Score (TRISS), became the most effective in predicting mortality (p < 0.0001). Conclusion According to the results, the most precise trauma grading method for chest and abdominal injuries is the Trauma Revised Injury Severity Score (TRISS), even though all other trauma scoring systems are useful in predicting patient outcomes. Surgeons using these metrics to predict outcomes and make well-informed treatment decisions can benefit greatly., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Rajendra Institute of Medical Sciences issued approval 230/IEC/RIMS. The conduct of the study was authorized ethically by the Institutional Ethics Committee of the Rajendra Institute of Medical Sciences, Ranchi (memorandum no. 230, dated 19/05/2021). The Declaration of Helsinki was fully followed in the conduct of the study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Besra et al.)

Background: Major trauma has been one of the leading causes of morbidity, mortality, and functional disability, resulting in substantial societal burden. The aim of this study was to estimate the trends in burden of adult major trauma in Taiwan during 2003-2015.Methods: Adult patients with initial encounter of major trauma (injury severity score ≥ 16) were abstracted from the claim data of National Health Insurance (NHI) in Taiwan from January 2003 to December 2015. We explored the trends of incidence and mortality rates over time stratified by age and sex, as well as life expectancy (LE), loss-of-LE, lifetime healthcare expenditure and total loss-of-LE compared with age, sex and calendar-year matched referents simulated from the vital statistics of Taiwan.Results: A total of 71,731 cases of adult major trauma, and an estimated loss of 979,676 life-years were found with an increasing trend in cumulative incidence rate (CIR18-84) during 2003-2015. The incidence rates were significantly higher in men than women. For both sexes, the incidence rates for those aged 65 and above were about 2-3 times higher than those of all other age groups. The one-year case fatality rates among the elderly were about 31-61%, higher than all other ages. The lifetime healthcare expenditures per person were 47,616 USD in men and 43,416 USD in women.Conclusion: There is a consistently increasing trend in incidence and mortality of major trauma in Taiwan, especially among elderly people. For Taiwan, an aged society beginning since 2018, the challenge should be tackled more effectively in the coming decades. [ABSTRACT FROM AUTHOR]

Copyright of Bulletin of Legal Medicine / Adli Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background The International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) Injury Severity Score (ICISS) is a risk adjustment model when injuries are recorded using ICD-9-CM coding. The trauma mortality prediction model (TMPM-ICD9) provides better calibration and discrimination compared with ICISS and injury severity score (ISS). Though TMPM-ICD9 is statistically rigorous, it is not precise enough mathematically and has the tendency to overestimate injury severity. The purpose of this study is to develop a new ICD-10-CM injury model which estimates injury severities for every injury in the ICD-10-CM lexicon by a combination of rigorous statistical probit models and mathematical properties and improves the prediction accuracy. Methods We developed an injury mortality prediction (IMP-ICDX) using data of 794,098 patients admitted to 738 hospitals in the National Trauma Data Bank from 2015 to 2016. Empiric measures of severity for each of the trauma ICD-10-CM codes were estimated using a weighted median death probability (WMDP) measurement and then used as the basis for IMP-ICDX. ISS (version 2005) and the single worst injury (SWI) model were re-estimated. The performance of each of these models was compared by using the area under the receiver operating characteristic (AUC), the Hosmer-Lemeshow (HL) statistic, and the Akaike information criterion statistic. Results IMP-ICDX exhibits significantly better discrimination (AUCIMP-ICDX, 0.893, and 95% confidence interval (CI), 0.887 to 0.898; AUCISS, 0.853, and 95% CI, 0.846 to 0.860; and AUCSWI, 0.886, and 95% CI, 0.881 to 0.892) and calibration (HLIMP-ICDX, 68, and 95% CI, 36 to 98; HLISS, 252, and 95% CI, 191 to 310; and HLSWI, 92, and 95% CI, 53 to 128) compared with ISS and SWI. All models were improved after the extension of age, gender, and injury mechanism, but the augmented IMP-ICDX still dominated ISS and SWI by every performance. Conclusions The IMP-ICDX has a better discrimination and calibration compared to ISS. Therefore, we believe that IMP-ICDX could be a new viable trauma research assessment method.

Background: Trauma is a significant cause of death and impairment. The Abbreviated Injury Scale (AIS) differentiates the severity of trauma and is the basis for different trauma scores and prediction models. While the majority of patients do not survive injuries which are coded with an AIS 6, there are several patients with a severe high cervical spinal cord injury that could be discharged from hospital despite the prognosis of trauma scores. We estimate that the trauma scores and prediction models miscalculate these injuries. For this reason, we evaluated these findings in a larger control group. Methods: In a retrospective, multi-centre study, we used the data recorded in the TraumaRegister DGU® (TR-DGU) to select patients with a severe cervical spinal cord injury and an AIS of 3 to 6 between 2002 to 2015. We compared the estimated mortality rate according to the Revised Injury Severity Classification II (RISC II) score against the actual mortality rate for this group. Results: Six hundred and twelve patients (0.6%) sustained a severe cervical spinal cord injury with an AIS of 6. The mean age was 57.8 ± 21.8 years and 441 (72.3%) were male. 580 (98.6%) suffered a blunt trauma, 301 patients were injured in a car accident and 29 through attempted suicide. Out of the 612 patients, 391 (63.9%) died from their injury and 170 during the first 24 h. The group had a predicted mortality rate of 81.4%, but we observed an actual mortality rate of 63.9%. Conclusions: An AIS of 6 with a complete cord syndrome above C3 as documented in the TR-DGU is survivable if patients get to the hospital alive, at which point they show a survival rate of more than 35%. Compared to the mortality prognosis based on the RISC II score, they survived much more often than expected. [ABSTRACT FROM AUTHOR]

The study was carried out in the department of forensic medicine at Government College and hospital, Nagpur over a period of one and half year on 200 dead bodies of victims of road traffic fatalities brought to mortuary for medico-legal post mortem examination. The aim of study was correlation between injury severity score (ISS) and survival time of victim of road traffic accidental deaths. The ISS was calculated from abbreviated injury scale (AIS). The cases were divided into four groups based on their ISS, where the group with less serious injuries (ISS<25) was considered survivable The second group (ISS 25-49) was considered as severe, third group (ISS 49-74) was critical and four group (ISS 75) was fatal . Survival time was more in victims of road traffic accidents who had injury severity score (ISS) less than 25. On the contrary to this, victims who had ISS more than 25 (25-74), survival time was low. Victims who had ISS 75 died on spot or within 1 hours of fatal road traffic accidents. The ISS score is negatively correlated with the survival time with pearson's correlation coefficient r=-.0.419 which is highly significant (p<0.0001). [ABSTRACT FROM AUTHOR]

Purpose: Identification of the group of patients meeting the criteria of a severe multiple trauma (polytrauma) among those admitted to the regional trauma centre and subjected to whole-body computed tomography (WBCT) due to injuries. Identification the patients for whom WBCT was the optimal choice. Material and methods: Retrospective analysis of the data of 303 patients undergoing WBCT in the period 2015-2017 with assessment of the injury severity based on the abbreviated injury scale (AIS) and injury severity score (ISS). Results: Among 303 patients undergoing WBCT due to trauma, multiple injuries with ISS > 15 were found in 74 individuals (24.4%). After excluding patients whose limb fractures increased ISS above 15, the group decreased to 63 patients (20.8%). For these patients, the WBCT may be described as the optimal imaging method at an early stage of management. Conclusions: Trauma patients are too often qualified for WBCT. Exposure to a high dose of ionising radiation associated with this modality requires critical analysis of the scope of indications and rules of conduct for trauma teams. [ABSTRACT FROM AUTHOR]

Background: To investigate the injury pattern, mechanisms, severity, and mortality of the elderly hospitalized for treatment of trauma following motorcycle accidents. Methods: Motorcycle-related hospitalization of 994 elderly and 5078 adult patients from the 16,548 hospitalized patients registered in the Trauma Registry System between January 1, 2009 and December 31, 2013. Results: The motorcycle-related elderly trauma patients had higher injury severity, less favorable outcomes, higher proportion of patients admitted to the intensive care unit (ICU), prolonged hospital and ICU stays and higher mortality than those adult motorcycle riders. It also revealed that a significant percentage of elderly motorcycle riders do not wear a helmet. Compared to patients who had worn a helmet, patients who had not worn a helmet had a lower first Glasgow Coma Scale (GCS) score, and a greater percentage presented with unconscious status (GCS score ≤8), had sustained subdural hematoma, subarachnoid hemorrhage, cerebral contusion, severe injury (injury severity score 16–24 and ≥25), had longer hospital stay and higher mortality, and had required admission to the ICU. Conclusions: Elderly motorcycle riders tend to present with a higher injury severity, worse outcome, and a bodily injury pattern differing from that of adult motorcycle riders, indicating the need to emphasize use of protective equipment, especially helmets, to reduce their rate and severity of injury.

Objective: Structured trauma care has proven to improve patient outcomes, and this is more relevant in the low- and middle-income countries (LMICs). The objective of this study was to determine the distribution, etiology, severity and outcomes of trauma patients at the Indus Hospital. Methods: All adult poly-trauma patients presenting to The Indus Hospital from July 2017 to June 2018 were included in this retrospective review. Data was extracted on etiology of trauma, severity of injury, investigations and final disposition of patients. Results: Of 972 trauma patients presenting to TIH Emergency Department, 663 (68.2%) were males with a mean age of 36 (17.4) years. Road traffic accidents (RTAs) led to trauma in 766 patients (78.8%), followed by 121 falls (12.7%). Injury Severity score (ISS) was calculated upon arrival and 528 (54.3%) were found to be critically injured. Median length of stay was 60 (24-720) minutes while none utilized pre-hospital Emergency Medical services. Conclusion: Most trauma patients were males suffering from RTA. Nearly half of the patients were critically injured on arrival. EMS is not utilized by trauma patients. There were gaps identified in the diagnosis and treatment of trauma. [ABSTRACT FROM AUTHOR]

Background: Identifying the severity of trauma to provide timely and adequate treatment and predict the prognosis are some of the significant challenges in trauma management. Increased red blood cell distribution width (RDW) is associated with several pathologies and associated mortality. This study aims to evaluate the RDW in predicting 24 h and 30-day mortality among multiple trauma patients., Methods: In this retrospective study, multiple trauma patients with ISS ≤16 were included. Blood samples of the patients were collected at 1 h and 24 h of the referral to determine RDW. Demographic data, 24 h and 30-day mortality, injury severity score (ISS), and RDW outcomes were evaluated for all the patients., Results: Of the 300 patients included in the study, 52 patients died in the first 24 h, and 85 patients within 30 days. One hour and 24 h RDW were not significantly different in 30-day mortality patients, P =0.104 and P =0.156, respectively. RDW in 30-day mortality patients was not significantly different at 1 h and 24 h, P -value=0.875. The means ISS in 24 h, 30-day mortality and survivors was significantly different, P <0.001., Conclusion: Our study does not report a significant increase in RDW among 24 h and 30-day mortality and survivor patients. ISS was significantly different among the two groups., Competing Interests: The authors deny any conflict of interest in any terms or by any means during the study.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background. Whole-body CT (WBCT) has become a modality of choice for early detection of injuries in polytraumatized patients. The decision to order WBCT should be based on defined criteria which can concern clinical state of a patient, mechanism of trauma or circumstances observed at the scene by doctors or paramedics and confirming a suspicion of severe trauma. Patients undergoing WBCT are exposed to a high dose of ionizing radiation so these criteria should be strictly obeyed. The aim of this study was to analyze the clinical and radiological data of the patients who underwent whole-body computed tomography for suspected polytrauma in regional trauma center over 1 year period. Material and methods. Retrospective analysis of 175 patients who were examined between July 2015 and June 2016 with whole-body CT. The mechanism of trauma, the number of body regions injured and type of injuries were recorded. The severity of each injury was assessed according Abbreviated Injury Scale rules (AIS 2005 update 2008) and Injury Severity Score (ISS) for each patient was calculated as well. Results. Only 20.6% of the patients fulfilled criteria of polytrauma (injuries in two or more body regions with ISS ≥ 16). Mean ISS value in the study group of the patients was 10.99. Severe pelvic injuries (AIS ≥ 3) were statistically more frequent in vulnerable road traffic accident victims and victims of fall from height. No statistical differences were observed between groups of the patients with different trauma mechanism as it comes to distribution of injuries to body regions and mean ISS value. [ABSTRACT FROM AUTHOR]

Objectives All Terrain Vehicles (ATVs) are increasing in popularity and becoming larger and faster at a production level. As a Level I Trauma Center, we perceived a disproportionately high volume of ATV-related admissions. Our goal was to study injury patterns and severity in adult and pediatric populations. Methods All ATV-related trauma admissions at a single Level I trauma center were retrospectively analyzed over a seven-year period. Results On-road incidents were more likely to result in a higher average Injury Severity Score (ISS) (p < 0.05). Higher ISS also occurred in children, un-helmeted, and impaired rider groups (p < 0.05). The pediatric population was more likely to have a major head injury (62.5% of children versus 31.8% of adults, p < 0.05) while thoracic injury was more common in adults (43.4% of adults versus 16.7% of children, p < 0.05). Death rates were similar in both adult and pediatric populations. Conclusion ATV-related injuries vary depending on incident characteristics and patient populations. On-road use incurs a significant increase in injury severity. The pediatric population is significantly more likely to incur a severe injury and the presenting injury pattern differs from the adult population. Knowledge of population and presentation trends can help direct trauma care providers in the care and management of injured ATV riders. [ABSTRACT FROM AUTHOR]

Background: Trauma systems currently rely on imperfect and subjective tools to prioritize responses and resources, thus there is a critical need to develop a more accurate trauma severity score. Our objective was to modify the Rapid Emergency Medicine (REMS) Score for the trauma population and test its accuracy as a predictor of in-hospital mortality when compared to other currently used scores, including the Revised Trauma Score (RTS), the Injury Severity Score (ISS), the "Mechanism, Glasgow Coma Scale, Age and Arterial Pressure" (MGAP) score, and the Shock Index (SI) score.Methods: The two-part study design involved both a modification step and a validation step. The first step incorporated a retrospective analysis of a local trauma database (3680 patients) where three components of REMS were modified to more accurately represent the trauma population. Using clinical judgment and goodness-of-fit tests, systolic blood pressure was substituted for mean arterial pressure, the weighting of age was reduced, and the weighting of Glasgow Coma Scale was increased. The second part comprised validating the new modified REMS (mREMS) score retrospectively on a U.S. National Trauma Databank (NTDB) that included 429,711 patients admitted with trauma in 2012. The discriminate power of mREMS was compared to other trauma scores using the area under the receiver operating characteristic (AUC) curve.Results: Overall the mREMS score with an AUC of 0.967 (95% CI: 0.963-0.971) was demonstrated to be higher than RTS (AUC 0.959 [95% CI: 0.955-0.964]), ISS (AUC 0.780 [95% CI 0.770-0.791]), MGAP (AUC 0.964 [95% CI: 0.959-0.968]), and SI (AUC 0.670 [95% CI: 0.650-0.690]) in predicting in-hospital mortality on the NTDB.Conclusion: In the trauma population, mREMS is an accurate predictor of in-hospital mortality, outperforming other used scores. Simple and objective, mREMS may hold value in the pre-hospital and emergency department setting in order to guide trauma team responses. [ABSTRACT FROM AUTHOR]

This single-center retrospective study included a total of 99 extracorporeal life support (ECLS) cannulated patients assigned to a traumatic extracorporeal life-support cohort (TECLS) or a non-traumatic extracorporeal life-support cohort (NTECLS). Forty-nine TECLS patients and 50 NTECLS patients were compared. The TECLS patients were significantly younger [49.9 years 16.6-86.2 vs. 57.1 (21.4-78.6); p = 0.007] and had lower body mass indices (BMIs) [27.7 kg/m (20-37) vs. 32.5 (19-88.5); p = 0.001] than the NTECLS patients. The intensive care unit (ICU) survival rate [ n = 34 (69.4%) vs. n = 13 (26%); p ≤ 0.001] and the hospital survival rate [ n = 32 (65.3%) vs. n = 13 (26%); p ≤ 0.001] were significantly higher for the TECLS cohort than for the NTECLS cohort. The lengths of stay (LOSs) in the ICU [24 days (4.8-71.1) vs. 11.3 (0-88.6); p = 0.001] and in the hospital [46.6 days (2.9-197.6) vs. 21 (0.1-213.8); p = 0.001] were significantly longer for the TECLS patients than for the NTECLS patients. [ABSTRACT FROM AUTHOR]

Objective: To record and classify mechanisms of injury and injury severity score (ISS) in trauma patients admitted to the largest trauma center in Southern Iran.Methods: This was a prospective cross-sectional study including all the patients who were admitted to Nemazee hospital from 2009 to 2010. We recorded the trauma injury information of 1217 patients who were admitted to of emergency room of the Nemazee hospital during a 13-months period by means of a standard questionnaire. ISS was then obtained for every single patient.Results: The mean age of patients was 26.6 ± 15.1 (range 1–95) years. The commonest type of trauma including 279 cases (22.9%) was car accident and the least resulted from shotgun injuries in 13 (1.1%) patients. The lowest ISS was due to assault multiple blunt traumas and the highest ISS resulted from shotgun injury. The mean ISS was about 6.3 ± 1.8 (range 1-66). Overall, 86 patients had scores above 17 (7.1%). A total of 69 male patients (7.5%) compared to 17 females (5.7%) had severe injury (ISS>17). Trauma injuries were significantly more severe in males compared to females (p=0.014). In the sunny and hot seasons total number of patient was higher. The mean ISS was highest in during spring (p

Objective(s): To determine epidemiological pattern of road traffic injuries in Tehran-Abali axis in 2008.Methods: In a prospective study road traffic injuries data in Tehran-Abali axis on event time until one month later and information of pre hospital and hospital care of injured subjects was collected by road traffic police, six emergency stations, twelve hospitals and three clinics during one year. Pre hospital information was included: age, gender, injured organ, Revised Trauma Score (RTS), Injury Severity Score (ISS) and hospital information was duration of hospitalization, status on dismissed time and post event one month later.Results: During one year 243 accidents occurred. In scene 23 subjects have been died. 345 injured subjects were followed. Mean age of subjects was 33.6±15.6. Overall, 71.1 percent of injured subjects were male and more than 60 percent of them were 20-39 years. The most common injuries were head and face damage. Mean of (RTS) and (ISS) was 7.23 and 9.38 respectively. Intensity of injury was higher among pedestrian than vehicles and motorcycle drivers, and occupants, (P

"nBackground: Trauma is a common problem in the world, predominately affecting young adults. Considering the high mortality rate in patients suffering from thoracic trauma, the condition is considered to be extremely important. The purpose of this study was to evaluate the prevalence and the epidemiology of chest trauma as well as the severity of the resulted injury in Tehran, Iran. "nMethods: This prospective, descriptive study was conducted on patients admitted to three medical centers in Tehran during June 1997 and 1998 due to chest trauma. The data on the demographic information of the patients, the mechanism of the trauma and the severity of the injury were collected and analyzed. "nResults: Three hundred forty two patients were admitted to hospital due to thoracic trauma; the majority of which were male adults. Blunt trauma especially secondary to motor vehicle accidents were the most frequent cause of chest injury in the studied patients. In 280(82%) of the cases, another form of trauma was also reported. Chest wall injury was the most common type of thoracic trauma in these patients. The trauma was reported to be mild in 181(53%) of the patients (ISS

Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Many prognostic models predicting mortality in patients with TBI were developed, which also include patients with mild or moderate TBI and patients who suffered major extracranial injuries. Methods: From a prospective database, we conducted a retrospective medical chart review covering the period between January 2000 and December 2012 of patients with isolated severe TBI (Abbreviated Injury Score for head, AIS ≥ 3) without extracranial injuries, who were intubated in the field using the rapid sequence intubation method and were of age 16 or more. Prehospital vital signs, Injury Severity Score (ISS) and laboratory tests were compared in two study groups: survivors ( n = 25) and non-survivors ( n = 27). Selected variables identified during univariate analysis ( p < 0.1) were then subjected to multivariate analysis logistic regression model. Results: Univariate analysis showed that in-hospital mortality was statistically significantly associated with male sex ( p = 0.040), ISS ( p = 0.005) and mydriasis ( p = 0.012). For predicting mortality, area under the curve (AUC) was calculated: for ISS 0.76 (95 % confidence interval, CI; 0.63-0.90; p < 0.001) and for initial Glasgow Coma Scale (GCS) 0.64 (95 % CI, 0.49-0.80, p = 0.079). In the multivariate analysis, ISS (odds ratio, OR; 1.19, 95 % CI, 1.06-1.35; p = 0.004) and mydriasis (OR, 5.73; 95 % CI, 1.06-30.88; p = 0.042) were identified as independent risk factors for in-hospital mortality. The AUC for the regression model was 0.83 (95 % CI, 0.71-0.94; p < 0.001). Conclusions: In prehospital intubated patients with isolated severe TBI only ISS and mydriasis were found to be independent predictors of in-hospital mortality. [ABSTRACT FROM AUTHOR]

Copyright of Notfall & Rettungsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of this paper is to analyse and compare injuries and injury sources in pedestrian and bicyclist non-fatal real-life frontal passengercar crashes, considering in what way pedestrian injury mitigation systems also might be adequate for bicyclists. Data from 203 non-fatal vehicle-to-pedestrian and vehicle-to-bicyclist crashes from 1997 through 2006 in a city in northern Sweden were analysed by use of the hospitals injury data base in addition to interviews with the injured. In vehicle-to-pedestrian crashes (n = 103) head and neck injuries were in general due to hitting the windscreen frame, while in vehicle-to-bicycle crashes (n = 100) head and neck injuries were typically sustained by ground impact. Abdominal, pelvic and thoracic injuries in pedestrians and thoracic injuries in bicyclists were in general caused by impacting the bonnet. In vehicle-to-pedestrian crashes, energy reducing airbags at critical impact points with low yielding ability on the car, as the bonnet and the windscreen frame, might reduce injuries. As vehicle-to-bicyclist crashes occurred mostly in good lighting conditions and visibility and the ground impact causing almost four times as many injuries as an impact to the different regions of the car, crash avoidance systems as well as separating bicyclists from motor traffic, may contribute to mitigate these injuries. [ABSTRACT FROM AUTHOR]

Objective: Since the civilian war in Syria began, thousands of seriously injured trauma patients from Syria were brought to Turkey for emergency operations and/or postoperative intensive care. The aim of this study was to present the demographics and clinical features of the wounded patients in Syrian civil war admitted to the surgical intensive care units in a tertiary care centre. Methods: The records of 80 trauma patients admitted to the Anaesthesia, General Surgery and Neurosurgery ICUs between June 1, 2012 and July 15, 2014 were included in the study. The data were reviewed regarding the demographics, time of presentation, place of reference, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Injury Severity Score (ISS), surgical procedures, complications, length of stay and mortality. Results: A total of 80 wounded patients (70 males and 10 females) with a mean age of 28.7 years were admitted to surgical ICUs. The most frequent cause of injury was gunshot injury. The mean time interval between the occurrence of injury and time of admission was 2.87 days. Mean ISS score on admission was 21, and mean APACHE II score was 15.7. APACHE II scores of non-survivors were significantly increased compared with those of survivors (P=0.001). No significant differences was found in the age, ISS, time interval before admission, length of stay in ICU, rate of surgery before or after admission. Conclusion: The most important factor affecting mortality in this particular trauma-ICU patient population from Syrian civil war was the physiological condition of patients on admission. Rapid transport and effective initial and on-road resuscitation are critical in decreasing the mortality rate in civil wars and military conflicts. [ABSTRACT FROM AUTHOR]

Background A myriad of trauma indices has been validated to predict probability of trauma survival. We aimed to compare the performance of commonly used indices for the development of the acute respiratory distress syndrome (ARDS). Materials and methods Historic, observational cohort study of 27,385 consecutive patients admitted to a statewide referral trauma center between July 11, 2003 and October 31, 2011. A validated algorithm was adapted to identify patients with ARDS. Each trauma index was evaluated in logistic regression using the area under the receiver operating characteristic curve. Results The case rate for ARDS development was 5.8% (1594). The receiver operating characteristics for injury severity score (ISS) had the best discrimination and had an area under the curve of 0.88 (95% confidence interval [CI] = 0.87–0.89). Glasgow coma score (0.71, 95% CI = 0.70–0.73), A Severity Characterization of Trauma (0.86, 95% CI = 0.85–0.87), Revised Trauma Score (0.71, 95% CI = 0.70–0.72) and thorax Abbreviated Injury Score (0.73, 95% CI = 0.72–0.74) performed worse ( P < 0.001) and Trauma and Injury Severity Score (0.88, 95% CI = 0.87–0.88) performed equivocally ( P = 0.51) in comparison to ISS. Using a cutoff point ISS ≥16, sensitivity and specificity were 84.9% (95% CI = 83.0%–86.6%) and 75.6% (95% CI = 75.1%–76.2%), respectively. Conclusions Among commonly used trauma indices, ISS has superior or equivocal discriminative ability for development of ARDS. A cutoff point of ISS ≥16 provided good sensitivity and specificity. The use of ISS ≥16 is a simple method to evaluate ARDS in trauma epidemiology and outcomes research. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To identify the distinctive features of acutely injured patients who were presented to the emergency department (ED) and their association with mortality and surgical intervention outcomes., Methods: This cross-sectional study was conducted on all trauma patients resuscitated in the ED of Shahid Rajaee (Emtiaz) Trauma Hospital (Shiraz, Iran) from May 2018 to June 2019. Demographic information, the mechanism of trauma, trauma type, injured body regions, criteria of abbreviated injury scale (AIS) score, injury severity score (ISS), and surgical intervention were all taken into consideration. The items related to the mortality and surgical performance outcomes among the patients were analyzed., Results: Of all 1281 cases, 82.9% were men, and the mean age of the patients was 37.9±19.1 years. The most common mechanism of injury was a car accident, and the thorax was the most prevalent injured area of the body. The majority of the patients had moderate blunt trauma. The mechanism of trauma, ISS, and the severity of head trauma were all significantly correlated with operation interventions. Moreover, age, the mechanism and type of trauma, ISS, and the necessity for the surgery were significantly associated with death occurrence. Additionally, head, thorax, and abdomen trauma were significantly related to a high mortality rate., Conclusion: Age, trauma mechanism and type, ISS, and the necessity for surgery were significantly associated with the mortality rate of injured patients. The severity of the trauma, particularly head injuries and the mechanism of damage were important determinants in concern for surgery the necessity., Competing Interests: The authors declare no conflict of interests.

Objective To provide an overview of the demographic characteristics of adult motorcycle riders with alcohol-related hospitalizations. Methods Data obtained from the Trauma Registry System were retrospectively reviewed for trauma admissions at a level I trauma center between January 1, 2009 and December 31, 2013. Out of 16,548 registered patients, detailed information was retrieved regarding 1,430 (8.64%) adult motorcycle riders who underwent a blood alcohol concentration (BAC) test. A BAC level of 50 mg/dL was defined as the cut-off value for alcohol intoxication. Results In this study, alcohol consumption was more frequently noted among male motorcycle riders, those aged 30-49 years, those who had arrived at the hospital in the evening or during the night, and those who did not wear a helmet. Alcohol consumption was associated with a lower percentage of sustained severe injury (injury severity score ≥25) and lower frequencies of specific body injuries, including cerebral contusion (0.6; 95% confidence interval [CI] = 0.42-0.80), lung contusion (0.5; 95% CI = 0.24-0.90), lumbar vertebral fracture (0.1; 95% CI = 0.01-0.80), humeral fracture (0.5; 95% CI = 0.27-0.90), and radial fracture (0.6; 95% CI = 0.40-0.89). In addition, alcohol-intoxicated motorcycle riders who wore helmets had significantly lower frequencies of cranial fracture (0.4; 95% CI = 0.29-0.67), epidural hematoma (0.5; 95% CI = 0.29-0.79), subdural hematoma (0.4; 95% CI = 0.28-0.64), subarachnoid hemorrhage (0.5; 95% CI = 0.32-0.72), and cerebral contusion (0.4; 95% CI = 0.25-0.78). Conclusions Motorcycle riders who consumed alcohol presented different characteristics and bodily injury patterns relative to sober patients, suggesting the importance of helmet use to decrease head injuries in alcohol-intoxicated riders. [ABSTRACT FROM AUTHOR]

Objective: Traumatic rupture of the thoracic aorta is a life-threatening injury requiring urgent surgical intervention. Despite recent improvements in resuscitation and emergency operative techniques, the outcomes of patients with multiple injuries are still associated with a high mortality rate. We retrospectively examined the preoperative demographic data, associated complications and mortality rate of these patients. Materials and methods: We analyzed the data (1991-2009) of 18 patients with acute traumatic rupture of the thoracic aorta. Most patients had rupture limited to the aortic isthmus and severe associated injuries in other organs. The aorta was repaired by direct suturing, patch plasty ( n = 5; 27.7 %) or graft interposition ( n = 9; 50 %). Results: The overall mortality rate was 33.3 %. All six patients who underwent emergency surgery within 2 h died, four intra-operatively and two postoperatively. The causes of the intra-operative mortality were uncontrollable hemorrhage and irreversible cardiac arrest due to penetrating injury of the thoracic aorta and intercostal arteries in three patients, and uncontrollable hemorrhage due to severe liver laceration in one. The surgical complications (42.8 %) were acute lung injury ( n = 2), liver insufficiency ( n = 2), acute renal failure ( n = 1) and cerebral infarction ( n = 1). No patients had postsurgical paraplegia. The mean period between arrival and treatment and the mean Injury Severity Score were significantly higher in group D than in group A. Conclusion: To improve the outcome of traumatic thoracic aortic injury, the degree of multi-organ damage, the priority of treatment be evaluated accurately is important. [ABSTRACT FROM AUTHOR]