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BACKGROUND: The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. METHODS: Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. RESULTS: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patients directives, family feelings and representatives desires, and all decisions should be shared. CONCLUSIONS: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes.

Objective: There is limited evidence for the early and rapid assessment of earthquake-related soft tissue injuries. This research examined parameters that can be utilized to identify the prognosis of patients with these injuries. Materials and Methods: This retrospective study was conducted at Erciyes University. Patients injured in the Kahramanmaraş-centered earthquake in Türkiye in 2023 were enrolled. The effect of injury types, trauma, and injury severity scores (TRISS), and specific laboratory values of the patients at the time of application on the success of soft tissue reconstruction was investigated. Results: A total of 61 patients were enrolled in the study. The median TRISS scores were 98.35 in Group 1, 88.20 in Group 2, and 57.35 in Group 3. The TRISS scores exhibited statistically significant differences between the groups. The TRISS score of Group 3 was found to be significantly lower than those of Groups 1 and 2 (p<0.001, p<0.011, respectively). Prolongation of the time spent under the wreckage and elevated TRISS scores were correlated with an increase in the number of injury debridements, a decrease in injury closure success, an increase in the frequency of Acinetobacter baumanii reproduction, an increase in the need for amputation, an increase in mortality, and hospitalization costs (p<0.05). Conclusion: In the early and rapid assessment of earthquake-related soft tissue injuries, the time spent under the wreckage and the TRISS score were crucial parameters in determining the prognosis. The parameters mentioned above may guide the management of patients with earthquake-related soft tissue injuries. [ABSTRACT FROM AUTHOR]

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.

Abstract Background The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. Methods Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. Results The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patient’s directives, family feelings and representatives' desires, and all decisions should be shared. Conclusions The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes. Graphical abstract

Background: The base deficit, international normalized ratio, and Glasgow Coma Scale (BIG) score was previously developed to predict the outcomes of pediatric trauma patients. We designed this study to explore and improve the prognostic value of the BIG score in adult patients with traumatic brain injury (TBI). Methods: Adult patients diagnosed with TBI in a public critical care database were included in this observational study. The BIG score was calculated based on the Glasgow Coma Scale (GCS), the international normalized ratio (INR), and the base deficit. Logistic regression analysis was performed to confirmthe association between the BIG score and the outcome of included patients. Receiver operating characteristic (ROC) curves were drawn to evaluate the prognostic value of the BIG score and novel constructed models. Results: In total, 1,034 TBI patients were included in this study with a mortality of 22.8%. Non-survivors had higher BIG scores than survivors (p < 0.001). The results of multivariable logistic regression analysis showed that age (p < 0.001), pulse oxygen saturation (SpO2) (p = 0.032), glucose (p = 0.015), hemoglobin (p = 0.047), BIG score (p < 0.001), subarachnoid hemorrhage (p = 0.013), and intracerebral hematoma (p = 0.001) were associated with in-hospital mortality of included patients. The AUC (area under the ROC curves) of the BIG score was 0.669, which was not as high as in previous pediatric trauma cohorts. However, combining the BIG score with age increased the AUC to 0.764. The prognostic model composed of significant factors including BIG had the highest AUC of 0.786. Conclusion: The age-adjusted BIG score is superior to the original BIG score in predicting mortality of adult TBI patients. The prognostic model incorporating the BIG score is beneficial for clinicians, aiding them in making early triage and treatment decisions in adult TBI patients. [ABSTRACT FROM AUTHOR]

BackgroundPersistent Inflammation, Immunosuppression, and Catabolism Syndrome (PIICS) is a significant contributor to adverse long-term outcomes in severe trauma patients.ObjectiveThe objective of this study was to establish and validate a PIICS predictive model in severe trauma patients, providing a practical tool for early clinical prediction.Patients and methodsAdult severe trauma patients with an Injury Severity Score (ISS) of ≥16, admitted between October 2020 and December 2022, were randomly divided into a training set and a validation set in a 7:3 ratio. Patients were classified into PIICS and non-PIICS groups based on diagnostic criteria. LASSO regression was used to select appropriate variables for constructing the prognostic model. A logistic regression model was developed and presented in the form of a nomogram. The performance of the model was evaluated using calibration and ROC curves.ResultsA total of 215 patients were included, consisting of 155 males (72.1%) and 60 females (27.9%), with a median age of 51 years (range: 38–59). NRS2002, ISS, APACHE II, and SOFA scores were selected using LASSO regression to construct the prognostic model. The AUC of the ROC analysis for the predictive model in the validation set was 0.84 (95% CI 0.72–0.95). The Hosmer-Lemeshow test in the validation set yielded a χ2 value of 14.74, with a value of p of 0.098.ConclusionAn accurate and easily implementable PIICS risk prediction model was established. It can enhance risk stratification during hospitalization for severe trauma patients, providing a novel approach for prognostic prediction.

As the older population increases, the number of elderly accessing the emergency department following a trauma increases accordingly. High-level trauma enters together with the identification of predictive parameters for poor outcome and mortality, may result in a death rate improvement of up to 30% in this group of patients. This study analyzes the epidemiology of major trauma admissions at Niguarda Trauma Center in Milan, Italy, focusing on the geriatric population and aiming to discriminate the trauma outcomes in the range of population between 65 and 75 years old (Senior Adult) and to compare it with the outcomes among people over 75 years old (Elderly). The variables analyzed included mortality, mechanism of injury, body district injured, Injury Severity Score (ISS), Trauma Injury Severity Score (TRISS), Geriatric Trauma Score (GTO), and outcome. Head trauma remains the main cause of mortality with falls and road accidents being the most common mechanism of injury. Frailty and associated use of anticoagulant and antiplatelet therapy increased the risk of death by 42%. The subdivision of the elder patients into two groups (65–75 and > 75) showed a difference in the probability of death and effective mortality rate. [ABSTRACT FROM AUTHOR]

Background and Objectives: We developed a machine learning algorithm to analyze trauma-related data and predict the mortality and chronic care needs of patients with trauma. Materials and Methods: We recruited admitted patients with trauma during 2015 and 2016 and collected their clinical data. Then, we subjected this database to different machine learning techniques and chose the one with the highest accuracy by using cross-validation. The primary endpoint was mortality, and the secondary endpoint was requirement for chronic care. Results: Data of 5871 patients were collected. We then used the eXtreme Gradient Boosting (xGBT) machine learning model to create two algorithms: a complete model and a short-term model. The complete model exhibited an 86% recall for recovery, 30% for chronic care, 67% for mortality, and 80% for complications; the short-term model fitted for ED displayed an 89% recall for recovery, 25% for chronic care, and 41% for mortality. Conclusions: We developed a machine learning algorithm that displayed good recall for the healthy recovery group but unsatisfactory results for those requiring chronic care or having a risk of mortality. The prediction power of this algorithm may be improved by implementing features such as age group classification, severity selection, and score calibration of trauma-related variables. [ABSTRACT FROM AUTHOR]

Objective: The recent increased use of electric scooters (E-scooter) in daily life has generated a great deal of discussion involving various areas, such as infrastructure problems, legal issues, and rider safety. This study aimed to manage the analysis of the clinical and demographic characteristics of patients who were admitted to emergency departments due to e-scooter accidents, especially during post-legal regulations in Turkey. Methods: The study is conducted as cross-sectional and descriptive research. The notice, data, and documents of the patients included in the study were scanned retrospectively, after which certain measurements were performed, such as the Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), Trauma and Injury Severity Score (TRISS), and Pediatric Trauma Score (PTS) for children aged 15 years or under. Results: The age of the patients included in this study varies from 5 to 76 years, with a mean age of 27.20±11.90 years. When the injury regions of the patients were examined, the results were revealed as follows: 49.6% (n=58) to the upper extremities, 45.3% (n=53) to the lower extremities, 35.0% (n=41) to the head/face, 8.5% 9% (n=10) to the thorax, 0.9% (n=1) to the cervical vertebra, and 0.9% (n=1) to the thoracic vertebra. Considering the correlation between age, hospital admission time, and accident rates in the accidents with trauma scores, no statistically significant association was found between age and AIS (p>0.05) or ISS (p>0.05), and a statistically significant negative correlation of 45.2% was found between age and TRISS (p=0.001; p<0.01). Conclusion: Although it is revealed that E-scooter accidents lead to minor injuries to patients, the use is outside the target audience, causing injury due to mechanical deficiencies and noncompliance with legal rules. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to evaluate the correlation between the trauma score of individuals wounded in the Lushan earthquake and emergency workload for treatment. We further created a trauma score-emergency workload calculation model. Methods: We included data from patients wounded in the Lushan earthquake and treated at West China Hospital, Sichuan University. We calculated scores per the following models separately: Revised Trauma Score (RTS), Prehospital Index (PHI), Circulation Respiration Abdominal Movement Speech (CRAMS), Therapeutic Intervention Scoring System (TISS-28), and Nursing Activities Score (NAS). We assessed the association between values for CRAMS, PHI, and RTS and those for TISS-28 and NAS. Subsequently, we built a trauma score-emergency workload calculation model to quantitative workload estimation. Results: Significant correlations were observed for all pairs of trauma scoring models with emergency workload scoring models. TISS-28 score was significantly associated with PHI score and RTS; however, no significant correlation was observed between the TISS-28 score and CRAMS score. Conclusions: CRAMS, PHI, and RTS were consistent in evaluating the injury condition of wounded individuals; TISS-28 and NAS scores were consistent in evaluating the required treatment workload. Dynamic changes in emergency workload in unit time were closely associated with wounded patient visits. [ABSTRACT FROM AUTHOR]

Abstract Background Multiple trauma scores have been developed and validated, including the Revised Trauma Score (RTS) and the Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP) score. However, these scores are complex to calculate or have low prognostic abilities for trauma mortality. Therefore, we aimed to develop and validate a trauma score that is easier to calculate and more accurate than the RTS and the MGAP score. Methods The study was a retrospective prognostic study. Data from patients registered in the Japan Trauma Databank (JTDB) were dichotomized into derivation and validation cohorts. Patients’ data from the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage-2 (CRASH-2) trial were assigned to another validation cohort. We obtained age and physiological variables at baseline, created ordinal variables from continuous variables, and defined integer weighting coefficients. Score performance to predict all-cause in-hospital death was assessed using the area under the curve in receiver operating characteristics (AUROC) analyses. Results Based on the JTDB derivation cohort (n = 99,867 with 12.5% mortality), the novel score ranged from 0 to 14 points, including 0–2 points for age, 0–6 points for the Glasgow Coma Scale, 0–4 points for systolic blood pressure, and 0–2 points for respiratory rate. The AUROC of the novel score was 0.932 for the JTDB validation cohort (n = 76,762 with 10.1% mortality) and 0.814 for the CRASH-2 cohort (n = 19,740 with 14.6% mortality), which was superior to RTS (0.907 and 0.808, respectively) and MGAP score (0.918 and 0.774, respectively) results. Conclusions We report an easy-to-use trauma score with better prognostication ability for in-hospital mortality compared to the RTS and MGAP score. Further studies to test clinical applicability of the novel score are warranted.

Background and Objectives: We developed a machine learning algorithm to analyze trauma-related data and predict the mortality and chronic care needs of patients with trauma. Materials and Methods: We recruited admitted patients with trauma during 2015 and 2016 and collected their clinical data. Then, we subjected this database to different machine learning techniques and chose the one with the highest accuracy by using cross-validation. The primary endpoint was mortality, and the secondary endpoint was requirement for chronic care. Results: Data of 5871 patients were collected. We then used the eXtreme Gradient Boosting (xGBT) machine learning model to create two algorithms: a complete model and a short-term model. The complete model exhibited an 86% recall for recovery, 30% for chronic care, 67% for mortality, and 80% for complications; the short-term model fitted for ED displayed an 89% recall for recovery, 25% for chronic care, and 41% for mortality. Conclusions: We developed a machine learning algorithm that displayed good recall for the healthy recovery group but unsatisfactory results for those requiring chronic care or having a risk of mortality. The prediction power of this algorithm may be improved by implementing features such as age group classification, severity selection, and score calibration of trauma-related variables.

Introduction; The University Hospital of Trauma, Tirana, Albania, is the only National referent center for trauma in Albania. As the primary care center for trauma, often operating over capacity of trauma patient, limiting access to Emergency surgical care for non-trauma patients. For non-traumatic surgical emergencies are instructions to inform the patient selection for transfer to another institution such as a University Hospital Center “Mother Theresa” in Tirana, Albania. Such decisions can be particularly difficult for severely ill patients when transferring benefits are uncertain. Material and Methods: To point out the role of surgeons in different hospital levels, for transfer, we took a qualitative analysis of cases that are transferred from a regional or municipal hospital to the University Hospital of Trauma... Results: Surgeons in the regional or municipal hospitals require transfer when the ability to care for the traumatized patient is limited by the lack of necessary staff or equipment, and when the needs of surgical treatment of patients or comorbid conditions are not available at the level local. Surgeons (non-primary centers) sometimes transfer patients who can be selected at home (second or third level hospitals ...) or with fatal safety progress, in order to try all treatment options or to satisfy families by thus reducing the possibility of benefiting from the treatment of other patients. Conclusion: Decisions on the transfer of surgical patients are complex and require good recognition of traumatized patient assessment protocols, knowledge and capacity coordination both local and central as well as in logistics, personnel, and scientific and professional levels.

Objective:This study was conducted to determine the effectiveness of current trauma scoring systems in childhood traumas and to compare these scoring systems with each other.Methods:In our study, files of 208 patients (age 7.5±3.7 years) with chest trauma who have been followed in our clinic and data regarding their sex, age, body weight, cause of trauma, type of trauma, other system injuries, length of stay in hospital, death rate and its reasons were collected, and for each patient Pediatric trauma score (PTS), Injury severity score (ISS), New injury severity score (NISS), Revised trauma score (RTS), Trauma and injury severity score were calculated and relations between the scores were evaluated.Results:174 (83.7%) cases had blunt trauma, 34 (16.3%) cases had penetrant chest trauma. The most commonly observed pathologies were lung contusion (44.2%), hemopneumothorax (20.2%), pneumothorax (18.3%), diaphragm rupture (6.2%) and flail chest (4.8%). ISS and NISS were found to be the best scoring systems to determine mortality (p=0.0002), while RTS was found to be more reliable than PTS in triage.Conclusion:None of the scoring systems are perfect in thorax traumas. However, we believe that popularization of the use of trauma scoring systems will bring significant advantages to diagnosis and treatment.

Prospective predictors of trauma-related outcomes have been validated to guide management in low-resource settings. The primary objective of this study was to determine the optimal prospective prediction method for mortality within combat and humanitarian trauma. Retrospective review of the Department of Defense Trauma Registry from 2008 to 2016 was performed for adult patients. Areas under receiver operating characteristic curves (AUROCs) were calculated to assess the predictability of shock index (SI), reverse SI × Glasgow Coma Scale (rSIG), SI × Glasgow Coma Scale (SIG), Revised Trauma Score, and Trauma and Injury Severity Score (TRISS) on mortality at point of injury, arrival in emergency department (ED), and the difference in vital signs between those time points. A total of 22,218 patients were included. Overall, 97.1% were male, median age range 25-29 y, Injury Severity Score 9.4 ± 0.07, with predominantly penetrating injuries (58.1%), and mortality of 3.4%. ED vitals yielded higher predictability of mortality for all tests based on higher AUROCs. TRISS and rSIG demonstrated the highest AUROCs (0.955 and 0.923, respectively). The optimal cutoff value for rSIG was 14.1 (sensitivity 89% and specificity 87%). rSIG values <14.1 were significantly associated with mortality (P < 0.01; odds ratio = 5.901). Initial ED vital signs represented a better predictor of early mortality compared with point of injury vital signs for all predictive tools assessed. TRISS and rSIG proved to be most predictive of mortality. However, of the prospective tools assessed, rSIG may be optimal scoring tool because of its ease of calculation and its increased ability to predict mortality. [ABSTRACT FROM AUTHOR]

Background: Trauma is the leading cause of morbidity and mortality in pediatric age. Abdominal trauma is the third most frequent cause of trauma injuries in children. The purpose of our study is to discuss BATp epidemiology and its relationship with polytrauma, , to recognize and describe the mechanisms of blunt abdominal trauma in pediatric age and to identify the signs and symptoms that associate it. Material and methods: In this retrospective study we reviewed all patients with blunt abdominal trauma in pediatric age who presented in Emergency Department at the University Hospital of Trauma in Tirana, Albania in the period between December 1-st 2017 and June 24-th 2018. The sample in the study was taken randomly. The Injury Severity Score, Revised Trauma Score were used as important points to evaluate gravity of injuries, and method of treatment. The data was introduced in absolute and percentage values and Kendal's tau b correlation coefficient and the regression analysis was used to analyze and to find out any association among the dependent versus independent variable. The type of study is case control with two components; descriptive and analytical. Results: In the time period that we studied, about 25200 patients were presented in Emergency department and 6.68% of these cases were hospitalized. Most frequent causes were motor vehicle accidents (35.4%) and abdominal trauma comprised 25.8% of cases, whereas in children it comprised 13.7% of total pediatric trauma. We have found correlation between the injury severity score and complications rate (r = 0.254, n = 49, p

Timur Kouliev Beijing United Family Hospital, Beijing, People's Republic of China Abstract: The study of disaster triage is made difficult by the complex emotional response of potentially lifesaving intervention that a triage officer must make basing decisions on a succinct and efficient algorithm. A survey of triage professionals in international settings was designed to identify possible emotionally led bias that affects objective decision making in identifying victims most likely to benefit from immediate life support intervention. This survey suggests a lack of correlation between triage priority and predictable clinical outcomes as predicted by the Revised Trauma Score tool. Among the subjects, it was observed that a pediatric victim is uniformly overtriaged when compared to less injured victims. Keywords: triage, disaster triage, emotional bias, pediatric trauma, obstetric trauma, People's Republic of China

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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: Trauma scores are prone to misreading. Therefore, a readily available, objective way to estimate the mortality of the trauma patients is needed. We aimed to evaluate the prognostic utility of lactate levels, and clearance for 30-days mortality, and compare with the physiological trauma scores. Methods: All adult trauma patients (two hundred) admitted to ED were enrolled. Initial and 2-hour serum lactate levels were measured and components of GAP, MGAP, RTS, VIEWS and VIEWS-L trauma scores were calculated. Results: Final study population was 200 patients with a median age of 33 years. Mortality was 7/200 (3.5%) in 30-days. Both initial (2.3 vs. 7.7 mmol/L) and 2h-lactate (1.7 vs. 8.4 mmol/L) levels were significantly lower, and lactate clearance was significantly higher (23.8% vs. -12.0%) in survivors. Also, the change in the lactate level from 0h to 2h (2.3 vs. 1.7mmol/L) was significant in survivors, contrary to non-survivors (7.7 vs. 8.4mmol/L). VIEWS-L, VIEWS, two hour-lactate level and EMTRAS showed high specificity at the 100% sensitivity cut-offs, therefore, were the most valuable prognostic parameters in this study. Conclusion: Calculation of 2h-lactate clearance and evaluation of a 2h-lactate level may not be needed to predict long-term mortality if the initial lactate level is below 2.8mmol/L. [ABSTRACT FROM AUTHOR]

Traumatic asphyxia is a rare clinical syndrome usually caused by sudden and severe thoracic and/or thoracoabdominal compression. It presents with craniofacial cyanosis, petechiae, and subconjunctival haemorrhages. The present study employed a postmortem retrospective methodology to analyse autopsy findings and accompanying injuries in cases of death due to traumatic asphyxia. Four years of case files from a morgue department at a forensic medicine institute were searched and 53 cases of lethal traumatic asphyxia were found. These cases were then classified into groups and compared using the Injury Severity Score (ISS) and New Injury Severity Score (NISS) indices to measure trauma.Results: The individuals had died due to occupational (n = 28; 52.8%), farm (n = 10; 18.9%), traffic (n = 9; 17.0%) or household (n = 6; 11.3%) accidents. At the external examination, conjunctival petechiae (60.4%) and petechiae on the face/neck (52.8%); at the autopsy, subpleural petechiae (58.5%) and petrous ridge hemorrgahe (without skull base fracture) (56.6%) were the most common findings. A finding of petrous ridge hemorrgahe was very common in the cases without any accompanying injuries (Group A in which mean Injury Severity Score was 0.83 ± 0.98). Traumatic asphyxia is usually suspected from the given circumstances before an autosopy is performed. In cases without hospitalisation, any of the following signs may lead the physician to diagnose traumatic asphyxia as the cause of death: petechiae on the upper parts of the body and conjunctiva, petechiae on serous membranes (including subpleural regions), signs of petrous ridge haemorrhage without skull base fracture. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between the trauma severity and the usage of antibacterial drugs and to provide reference for standard protocol of proper antibiotic use in wound care. Methods ICD-10 and AIS were used to set up the relationship and to analyze the use of antibiotics in patients with different trauma score. Results 25 035 trauma patients were enrolled in this study. Those patients were divided into five groups according to the AIS score with least severe as group 1 to most severe as group 5. The patient percentage in group 1 to 5 was 21.92%, 67.73%, 8.86%, 0.97% and 0.52% respectively. The five most frequently used antibiotic classes are second generation cephalosporins,third generation cephalosporins, first generation cephalosporins, fluoroquinolones and penicillin/beta lactamase inhibitor combination, accounted for 29.69%,22.57%,20.33%,4.66% and 4.47% of total DDDs of antibacterial drugs. Individually, the top 10 antibiotics are cefuroxime (12.21%), cefazolin (8.31%), ceftriaxone (7.74%), cefathiamidine (7.34%), cefotiam (4.87%), ceftazidime (3.68%), amoxicillin/clavulanic acid (3.63%), levofloxacin (3.59%), cefoxitin (3.56%), flucloxacillin (3.52%); gentamicin (2.27%), ornidazole (2.00%) and cefoperazone/tazobactam (1.44%) were used most in their categories respectively. The variety and quantity of antibacterial drugs used for different trauma patients were different. Conclusion The trauma score based on ICD-AIS can reflect the severity of trauma. The use of antibiotics in patients with different trauma score can provide reference for the clinical applications of antibiotics in wound care. [ABSTRACT FROM AUTHOR]

Introduction: Although a plethora of pediatric injury severity scoring systems is available, many of them present important challenges and limitations in the low resource setting. Our aim is to generate consensus among a group of experts regarding the optimal parameters, outcomes, and methods of estimating injury severity for pediatric trauma patients in low resource settings.Materials and Methods: A systematic review of the literature was conducted to identify and compare existing injury scores used in pediatric patients. Qualitative data was extracted from the systematic review, including scoring parameters, settings and outcomes. In order to establish consensus regarding which of these elements are most adapted to pediatric patients in low-resource settings, they were subjected to a modified Delphi survey for external validation. The Delphi process is a structured communication technique that relies on a panel of experts to develop a systematic, interactive consensus method. We invited a group of 38 experts, including adult and pediatric surgeons, emergency physicians and anesthesiologists trauma team leaders from a level 1 trauma center in Montreal, Canada, and a pediatric referral trauma hospital in Santiago, Chile to participate in two successive rounds of our survey.Results: Consensus was reached regarding various features of an ideal pediatric trauma score. Specifically, our experts agreed pediatric trauma scoring tool should differ from its adult counterpart, that it can be derived from point of care data available at first assessment, that blood pressure is an important variable to include in a predictive model for pediatric trauma outcomes, that blood pressure is a late but specific marker of shock in pediatric patients, that pulse rate is a more sensitive marker of hemodynamic instability than blood pressure, that an assessment of airway status should be included as a predictive variable for pediatric trauma outcomes, that the AVPU classification of neurologic status is simple and reliable in the acute setting, and more so than GCS at all ages.Conclusion: Therefore, we conclude that an opportunity exists to develop a new pediatric trauma score, combining the above consensus-generating ideas, that would be best adapted for use in low-resource settings. [ABSTRACT FROM AUTHOR]

Introduction: Trauma is a leading cause of mortality and disability in children worldwide. The World Health Organization reports that 95% of all childhood injury deaths occur in Low-Middle-Income Countries (LMIC). Injury scores have been developed to facilitate risk stratification, clinical decision making, and research. Trauma registries in LMIC depend on adapted trauma scores that do not rely on investigations that require unavailable material or human resources. We sought to review and assess the existing trauma scores used in pediatric patients. Our objective is to determine their wideness of use, validity, setting of use, outcome measures, and criticisms. We believe that there is a need for an adapted trauma score developed specifically for pediatric patients in low-resource settings.Materials and Methods: A systematic review of the literature was conducted to identify and compare existing injury scores used in pediatric patients. We constructed a search strategy in collaboration with a senior hospital librarian. Multiple databases were searched, including Embase, Medline, and the Cochrane Central Register of Controlled Trials. Articles were selected based on predefined inclusion criteria by two reviewers and underwent qualitative analysis.Results: The scores identified are suboptimal for use in pediatric patients in low-resource settings due to various factors, including reliance on precise anatomic diagnosis, physiologic parameters maladapted to pediatric patients, or laboratory data with inconsistent accessibility in LMIC.Conclusion: An important gap exists in our ability to simply and reliably estimate injury severity in pediatric patients and predict their associated probability of outcomes in settings, where resources are limited. An ideal score should be easy to calculate using point-of-care data that are readily available in LMIC, and can be easily adapted to the specific physiologic variations of different age groups. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims The aim of the study was to develop a simplified emergency trauma score ( SETS) for rating injury severity as well as triaging and predicting mortality in Hong Kong. Background Many existing trauma scoring systems require measurements that are not generally available in emergency settings in Hong Kong. As many of these important measures in the scoring systems are not available before the patients are admitted in the hospitals, it may delay treatment because of the extent of a patient's injury is often not clear at the site of accident or in the emergency settings. Design A retrospective cohort analysis of trauma patients' records from Trauma Registry in Hong Kong was performed. Method Potential significant parameters in predicting mortality were identified by univariate analysis. Binary logistic regression then was used to develop an equation for SETS. Four parameters including age, Glasgow coma scale, respiratory rate and American College of Surgeons ( ACS) mechanism of injury were identified, and the reliability and validity of SETS was assessed. Results At cut-off point of a SETS score of 60, the sensitivity and specificity of SETS were 64% and 98% respectively. The area under receiver operating characteristic curve was 0·939 which was comparable with other commonly used trauma scores. Conclusions SETS should be considered a relevant trauma scoring system in Hong Kong emergency settings. It is suggested that similar scoring systems should be developed in other countries based upon obtainable measures in their corresponding emergency settings. Relevance to clinical practice As a trauma scoring system is closely related to the context of its application, a system that can facilitate accurate sorting of patients into treatment hierarchies should be adopted in the congested emergency settings. [ABSTRACT FROM AUTHOR]

Objective: To evaluate outcomes after treatment of rape-induced urogenital and lower gastrointestinal lesions among young girls.Methods: In a retrospective study, data were assessed from girls aged 5 years or younger who were treated for sexual-assault-related injuries at the General Referral Hospital, Panzi, Bukavu, Democratic Republic of Congo, between 2004 and 2014. Data were obtained from review of charts, records of the mother's impressions and physical examinations, and photographic evidence. Elective surgery had been reserved for patients experiencing fecal and/or urinary incontinence.Results: Overall, 205 girls aged 5 years or younger presented with rape injuries: 162 (79.1%) had only mucocutaneous lesions, 22 (10.7%) had musculocutaneous lesions, and 21 (10.2%) had musculocutaneous lesions complicated by fecal and/or urinary incontinence. Among the 21 girls who underwent perineal surgery, two with fecal and urinary incontinence and perforation of the peritoneum of Douglas pouch were additionally treated by laparoscopy. Among 16 patients with fecal incontinence, the continence score had improved significantly at 10.4 months after surgery (P<0.001). Concomitant urinary incontinence subsided for four of five patients but persisted for one who had a gunshot wound to the vagina. Cosmetic outcome was normal in 19 cases.Conclusion: For rape survivors aged 5 years or younger, a treatment strategy by which surgery is reserved for incontinent patients provided good cosmetic and functional outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Report 20 years experience of bladder injuries after external trauma. Methods: Gender, age, mechanism/location of damage, associated injuries, systolic blood pressure (SBP), Revised Trauma Score (RTS), Injury Severity Score (ISS), Trauma Injury Severity Score (TRISS), complications, and length of stay (LOS) were analyzed in a prospective collected bladder injuries AAST-OIS grade ≥II database (American Association for the Surgery of Trauma Organ Injury Scaling) from 1990 to 2009 in a trauma reference center. Results: Among 2,575 patients experiencing laparotomy for trauma, 111 (4.3 %) presented bladder ruptures grade ≥II, being 83.8 % ( n = 93) males, mean age 31.5 years old (±11.2). Blunt mechanism accounted for 50.5 % ( n = 56)-motor vehicle crashes 47.3 % ( n = 26), pedestrians hit by a car (29.1 %). Gunshot wounds represented 87.3 % of penetrating mechanism. The most frequent injury was grade IV (51 patients, 46 %). The mean ISS was 23.8 (±11.2), TRISS 0.90 (±0.24), and RTS 7.26 (±1.48). Severity (AAST-OIS), mechanism (blunt/penetrating), localization of the bladder injury (intra/extraperitoneal, associated), and neither concomitant rectum lesion were related to complications, LOS, or death. Mortality rate was 10.8 %. ISS > 25 ( p = 0.0001), SBP <90 mmHg ( p = 0.0001), RTS <7.84 ( p = 0.0001), and pelvic fracture ( p = 0.0011) were highly associated with grim prognosis and death with hazard ratios of 5.46, 2.70, 2.22, and 2.06, respectively. Conclusions: Trauma scores and pelvic fractures impact survival in bladder trauma. The mortality rate has remained stable for the last two decades. [ABSTRACT FROM AUTHOR]

Purpose: Severe lower extremity trauma presents challenges in decision-making in terms of reconstruction or amputation. While injury severity scores have been developed to aid decision-making in adults, evaluation of their use in children is limited. Methods: Children presenting with severe lower limb trauma from 2000 to 2010 in a major trauma centre were identified from a trauma registry. Records were reviewed for details of the injury, surgical intervention, amputation and scores for the Mangled Extremity Severity Score, Limb Salvage Index, Predictive Salvage Index, Nerve injury, Ischaemia, Soft tissue injury, Skeletal injury, Shock, Age System and the Hanover Fracture Scale 1998. Results: Twenty children (average age 8.7 years) were eligible for inclusion. There were three primary amputations and no secondary amputations. All of the scoring systems had poor specificity and would have recommended amputation in several limbs that were successfully reconstructed. Conclusions: Currently available injury severity scores behave differently in children and adults. In their current format, these scores should not be used as an absolute indication for early amputation in children. [ABSTRACT FROM AUTHOR]

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Summary: In Brazil, trauma occupies third place among the various causes of death and is the first cause of death among young people. Among the various approaches to the study of trauma, analysis of the organisation and quality of care has been frequently reported in the literature. The objective of the present study was to assess the quality of care for victims of trauma due to traffic accidents provided at the Emergency Unit of the University Hospital, Faculty of Medicine of Ribeirão Preto, SP, Brazil. The quality of care was compared between two different periods, i.e., before and after the introduction of modifications in prehospital care, and was also compared to the North American standards of the Major Trauma Outcome Study (MTOS). The Trauma Score and Injury Severity Score (TRISS) was used to calculate the probability of survival and the Z statistic was used for comparison with the MTOS. During both periods studied, the results were inferior to those obtained by the MTOS, although positive signs were detected at the Emergency Unit regarding the organisation of the system of trauma care during the study period. [Copyright &y& Elsevier]