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BackgroundPediatric trauma is a major global health concern, accounting for a substantial proportion of deaths and disease burden from age 5 onwards. Effective triage and management are essential in pediatric trauma care, and prediction models such as the Trauma Injury Severity Score (TRISS) play a crucial role in estimating survival probability and guiding quality improvement. However, TRISS does not account for age-specific factors in pediatric populations, limiting its applicability to younger patients. This study aimed to modify TRISS to account for age for children (Peds-TRISS) and to evaluate its performance relative to the original TRISS. We also assessed survival outcomes to explore the model's potential utility across various clinical settings. These efforts align with quality improvement initiatives to reduce preventable mortality and supporting sustainable development goals.MethodsThis retrospective cohort study included patients under 18 years of age who were treated at a hospital in Colombia between 2011 and 2019. New coefficients for TRISS covariates were calculated using logistic regression, with age treated as a continuous variable. Model performance was evaluated based on discrimination (C statistic) and calibration, comparing Peds-TRISS with the original TRISS. Internal validation was conducted using bootstrap resampling. Survival outcomes were assessed using the M and Z statistics, which are commonly used for international trauma outcome comparisons.ResultsThe study included 1,013 pediatric patients with a median age of 12 years (IQR 5–15), of whom 73% were male. The leading causes of injury were traffic accidents (31.1%), falls (28.8%), and assaults (28.7%). The overall mortality rate was 5.7%. The Peds-TRISS model demonstrated good calibration (HL = 9.7, p = 0.3) and discrimination (C statistic = 0.98, 95% CI 0.97–0.99), with no statistically significant difference in the ROC curve comparison with the original TRISS. Internal validation demonstrated strong performance of Peds-TRISS. The M and Z statistics were 0.93 and 0, respectively, indicating no significant differences between expected and observed survival rates.ConclusionsMost fatalities occurred among adolescents and were due to intentional injuries. The Peds-TRISS model showed a partial improvement in performance compared to the original TRISS, with superior results in terms of calibration, although not in discrimination. These findings highlight the potential of model customization for specific populations. Prospective, multicenter studies are recommended to further validate the model's utility across diverse settings.

Objective: To compare the injury severity scales as predictors of mortality in trauma patients to search for the best scale.Methods: In a prospective cohort study and systematical random sampling conducted from March to September 2017, trauma patients over the age of 13 years were enrolled. The investigated variables were age, gender, systolic blood pressure, heart rate, respiratory rate, injured body region, Glasgow Coma Scale (GCS), injury severity score (ISS), revised trauma score (RTS), trauma injury severity score (TRISS) and the outcome.Results: Totally, 1410 trauma patients were followed up, out of which 68.5% were male. The participants’ mean age was 43.5±20.88 years. After adjusting the confounding effects, age over 60 years (OR=7.38, CI [3.91-13.93]), GCSthan 5.5.Conclusion: Our results showed that TRISS, RTS, GCS, and ISS were all very effective approaches for evaluating prognosis, mortality and probable complications in trauma patients; thus, these systems of injury evaluation and scoring are recommended to facilitate treatment. TRISS, RTS, and ISS had almost the same sensitivity that was higher than GCS, but GCS had the most specificity. Finally, TRISS was selected as the most efficient scale for predicting mortality.

The Trauma and Injury Severity Score (TRISS) is the current “gold” standard of screening patient’s condition for purposes of predicting survival probability. More than 40 years of TRISS practice revealed a number of problems, particularly, 1) unexplained fluctuation of predicted values caused by aggregation of screening tests, and 2) low accuracy of uncertainty intervals estimations. We developed a new method made it available for practitioners as a web calculator to reduce negative effect of factors given above. The method involves Bayesian methodology of statistical inference which, being computationally expensive, in theory provides most accurate predictions. We implemented and tested this approach on a data set including 571,148 patients registered in the US National Trauma Data Bank (NTDB) with 1–20 injuries. These patients were distributed over the following categories: (1) 174,647 with 1 injury, (2) 381,137 with 2–10 injuries, and (3) 15,364 with 11–20 injuries. Survival rates in each category were 0.977, 0.953, and 0.831, respectively. The proposed method has improved prediction accuracy by 0.04%, 0.36%, and 3.64% (p-value

Background: The aim of this study was to investigate and compare the injury pattern, mechanisms, severity, and mortality of adolescents and adults hospitalized for treatment of trauma following motorcycle accidents in a Level I trauma center. Methods: Detailed data regarding patients aged 13-19 years (adolescents) and aged 30-50 years (adults) who had sustained trauma due to a motorcycle accident were retrieved from the Trauma Registry System between January 1, 2009 and December 31, 2012. The Pearson's chi-squared test, Fisher's exact test, or the independent Student's t-test were performed to compare the adolescent and adult motorcyclists and to compare the motorcycle drivers and motorcycle pillion. Results: Analysis of Abbreviated Injury Scale (AIS) scores revealed that the adolescent patients had sustained higher rates of facial, abdominal, and hepatic injury and of cranial, mandibular, and femoral fracture but lower rates of thorax and extremity injury; hemothorax; and rib, scapular, clavicle, and humeral fracture compared to the adults. No significant differences were found between the adolescents and adults regarding Injury Severity Score (ISS), New Injury Severity Score (NISS), Trauma-Injury Severity Score (TRISS), mortality, length of hospital stay, or intensive care unit (ICU) admission rate. A significantly greater percentage of adolescents compared to adults were found not to have worn a helmet. Motorcycle riders who had not worn a helmet were found to have a significantly lower first Glasgow Coma Scale (GCS) score, and a significantly higher percentage was found to present with unconscious status, head and neck injury, and cranial fracture compared to those who had worn a helmet. Conclusion: Adolescent motorcycle riders comprise a major population of patients hospitalized for treatment of trauma. This population tends to present with a higher injury severity compared to other hospitalized trauma patients 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. [ABSTRACT FROM AUTHOR]

This study aims at evaluating trauma care at the American University of Beirut Medical Centre (AUB-MC) and comparing it to the norms established by the Major Trauma Outcome Study (MTOS). From January 2001 until January 2003, data necessary to calculate probability of survival using the Trauma Injury Severity Score methodology were collected. M, W, Z, Ws and Zs statistics were calculated to compare outcome at AUB-MC to the MTOS dataset. A total of 873 patients were included in the study. W statistics was calculated at 0.35 with Z score for the overall sample of 0.081 indicating that there was no statistically significant difference in survival between this group and the MTOS group. In a developing country a hospital achieves trauma outcomes similar to the MTOS dataset. Further studies looking at trauma care in Lebanon as a whole are needed. [ABSTRACT FROM AUTHOR]

Background: Secondary overtriage is a problematic phenomenon because it creates unnecessary expense and potentially results in the mismanagement of healthcare resources. The rates of secondary overtriage among patients with complicated mild traumatic brain injury (cmTBI) are unknown., Objective: To determine the rate of secondary overtriage among patients with cmTBI using the institutional trauma registry., Methods: An observational study using retrospective analysis of 1447 hospitalizations including all consecutive patients with cmTBI between 2004 and 2013. Data on age, sex, race/ethnicity, insurance status, GCS, Injury Severity Score (ISS), Trauma Injury Severity Score, transfer mode, overall length of stay (LOS), LOS within intensive care unit, and total charges were collected and analyzed., Results: Overall, the rate of secondary overtriage among patients with cmTBI was 17.2%. These patients tended to be younger (median: 41 vs 60.5 yr; P < .001), have a lower ISS (9 vs 16; P < .001), and were more likely to be discharged home or leave against medical advice., Conclusion: Our findings provide evidence to the growing body of literature suggesting that not all patients with cmTBI need to be transferred to a tertiary care center. In our study, these transfers ultimately incurred a total cost of $13 294 ($1337 transfer cost) per patient., (Copyright © 2019 by the Congress of Neurological Surgeons.)

Background: The Japan Advanced Trauma Evaluation and Care (JATEC) education program was introduced in 2002. To examine its effect on the survival of trauma patients, we investigated changes in trauma mortality in Japan in the years after JATEC was introduced., Study Design: We included patients registered in the Japan Trauma Databank (JTDB) from 2004 to 2011 with clear in-hospital mortality and sufficient data to estimate the Trauma Injury Severity Score (TRISS). Patients were grouped into the early (2004-2006), transition (2007-2008), and late (2009-2011) cohorts. We performed logistic regression analyses after adjusting for TRISS to estimate risk of death in the transition and late cohorts compared with the early cohort. Stratified logistic regression analyses showed which characteristics contributed to the changes in mortality., Results: Of 94,664 patients registered in the JTDB, 47,095 were selected. Adjusted mortality was significantly lower in the late cohort (odds ratio = 0.68; 95% CI, 0.61-0.76) than in the early cohort (reference). Stratification analyses demonstrated significant interactions in patients with or without any chest or abdominal surgery (odds ratio = 0.83 vs 0.68; p < 0.001 in the late cohort) and in patients with TRISS probability of survival <0.5 or ≥ 0.5 (odds ratio = 0.71 vs 0.67 for TRISS probability of survival ≥ 0.5; p < 0.001 in the late cohort)., Conclusions: Since 2007, mortality has decreased in patients with mild trauma injury; however, mortality was significantly worse for severely injured patients or patients requiring surgical procedures. These findings suggest that definitive trauma care in Japan should be strengthened., (Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)