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Fiona Lecky

Publications and source records attributed to Fiona Lecky.

10 recordsLinked to original sources
PubMed2006

Outcome prediction in trauma.

BACKGROUND: In the Trauma Audit and Research Network (TARN), currently the largest trauma network in Europe, outcome prediction is performed using the TRISS methodology since 1989. Its database contains 200,000 hospital admissions from 110 hospitals over the country, but a large amount of data is lost for the modelling because of missing data. To improve some of the shortcomings of TRISS a new model was developed. METHODS: The data for modelling consisted of 100,399 hospital trauma admissions over the period 1996 to 2001. Using the Glasgow Coma Score (GCS) instead of RTS has dramatically reduced the number of missing cases. Gender and its interaction with age have also been included in the model. The model was tested on different subsets of cases traditionally excluded, such as children, those with penetrating injuries, and ventilated and transferred patients. The new model included all those subsets using age, a transformation of ISS, GCS, gender and gender by age interaction as predictors. RESULTS: The model has shown a good discriminant ability tested by the area under the receiver operating characteristic (AROC) curve. The values of the AROC for the new model were 0.947 (95% CI: 0.943-0.951) on the prediction set and 0.952 (95% CI: 0.946-0.957) on the validation set compared respectively with 0.937 (95% CI: 0.932-0.943) and 0.941 (95% CI: 0.936-0.952) for TRISS. CONCLUSION: The new model has enabled us to include most of the cases that were excluded under the TRISS's inclusion criteria, less missing data are incurred and the predictive performance was significantly better than that of the TRISS model as shown by the AROC curves.

Adolescent↗
PubMed2006

Rapid elimination of protein S-100B from serum after minor head trauma.

Protein S-100B is released into the circulation after traumatic brain injury, and its serum concentration relates to measures of injury severity and outcome. These properties have led to interest in its development as a marker for clinical use, particularly in the prediction of adverse outcome for those with apparently trivial injuries. Before it can be used in populations of patients with head injuries, however, more needs to be understood about its release and elimination. This study was designed to estimate the elimination half-life of S-100B from the circulation after minor head trauma. We studied 14 patients with minor head injuries and measured serum S-100B serially after initial assessment in the Emergency Department of an inner city teaching hospital. We used curve-fit analysis to estimate the elimination constant that best fitted our data, and from this estimated the elimination half-life of protein S-100B. We estimated the mean half-life in this setting to be 97 min (95% confidence interval [CI] of 75-136 min). S-100B is cleared rapidly, relative to the time elapsed between injury and initial assessment in the Emergency Department. Variation in the time elapsed between injury and sampling is likely to influence the accuracy of head injury outcome prediction based on S-100B concentrations in serum, and should be considered when designing future studies.

Adult↗
PubMed2006

A new approach to outcome prediction in trauma: A comparison with the TRISS model.

BACKGROUND: The Trauma Audit & Research Network (TARN) has been using the TRISS methodology since 1989. Its database contains 200,000 hospital admissions from 110 hospitals over the country. To improve outcome prediction, a revision of the current model became necessary. Our model tried to overcome some of the concerns of the trauma community, namely missing data, functional form of the predictors, inclusion criteria and patient's death within 30 days. METHODS: The data for modeling consisted of 100,399 anonymized hospital trauma admissions during the period 1996 to 2001. Cross validation was performed on this data set, and a multiple logistic regression model was derived using the prediction set and then its prediction ability was tested on the validation set. Fractional polynomials modeling showed that the linear functional form of the Injury Severity Score (ISS) in the model was not satisfactory. Using the Glasgow Coma Score (GCS) instead of the revised trauma score (RTS) has dramatically reduced the number of missing cases. Sex and its interaction with age have also been included in the model. The model was tested on different subsets of cases, traditionally excluded, such as children, those with penetrating injuries, and ventilated and transferred patients. The new model included all those subsets using age, a transformation of ISS, GCS, sex, and sex by age interaction as predictors. RESULTS: The model has shown a good discriminant ability tested by the Area under the Receiver Operating Characteristic (AROC) curve. The values of the AROC for the new model were 0.947 (95% confidence interval [CI]: 0.943-0.951) on the prediction set and 0.952 (95% CI: 0.946-0.957) on the validation set compared, respectively, with 0.937 (95% CI: 0.932-0.943) and 0.941 (95% CI: 0.936-0.952) for TRISS. CONCLUSION: The new model has enabled us to include most of the cases that were excluded under the TRISSs inclusion criteria, less missing data are incurred and the predictive performance was significantly better than that of the TRISS model as shown by the AROC curves.

Adolescent↗
PubMed2006

The effect of pre-existing medical conditions and age on mortality after injury.

BACKGROUND: Pre-existing medical conditions (PMCs) have been shown to increase mortality after trauma even after adjustment for the effect of chronological aging. It has been suggested that there is an interaction between injury severity and physiologic reserve, such that diminished physiologic reserve will have an adverse effect on survival at lower injury severity, but that at higher levels of injury severity, physiologic reserve will have much less of an impact. METHODS: Records of 65,743 patients, admitted after trauma, were extracted from the database of the United Kingdom Trauma Network to explore the impacts of age, gender and PMCs on mortality, and modification of these effects by severity of injury. RESULTS: PMCs were categorized as absent (23%), present (23%), or unrecorded (54%). There was an increase in mortality with increasing age at all levels of injury severity. Presence of a PMC was associated with a marked increase in mortality of patients with minor injuries (odds ratio [OR] = 5.9, 95% confidence interval [CI] 4.4, 8.0) or moderate injuries (OR = 2.0, 95% CI 1.4, 2.9), but not in those with more severe injuries (OR = 1.1, 95% CI 0.9, 1.4). The impact of age and male gender were also somewhat more pronounced for patients with less severe injuries. CONCLUSION: These findings support the hypothesis of an interaction between physiologic reserve and injury severity, where PMCs are associated with increased mortality when combined with low to moderate severity injuries, but not when combined with more severe injuries.

Adolescent↗
PubMed2005

The utilisation of intraosseous infusion in the resuscitation of paediatric major trauma patients.

Intraosseous lines are a reliable and rapid tool for obtaining vascular access in emergency situations, particularly in children. Their use is recommended when intravenous access cannot be easily secured and there is a need for fluid or pharmacological resuscitation. Training in this technique is included in the Advanced Trauma Life Support (ATLS) and Advanced Paediatric Life Support course (APLS) provider courses. The objective of this study is to analyse the national use of intraosseous lines in paediatric trauma in England and Wales. Data has been collected from the Trauma Audit and Research Network (TARN) group longitudinally over 14 years from 1988 to 2002. From 23,489 paediatric trauma cases, intraosseous lines were used in only 129 patients. Compared with the remainder of the paediatric data, we found that these were the younger (1-6 years), more severely injured patients (higher ISS, lower GCS, higher head, thorax, and abdominal AIS). The mortality of these patients was high at 64% compared with 4% overall. IO line use was greater in general than in Paediatric hospitals, perhaps due to good intravenous access skills in paediatric centres. We recommend that intraosseous line use should be a skill available to everybody involved in paediatric trauma resuscitation, particularly those who may not have refined paediatric intravenous cannulation skills.

Age Distribution↗
PubMed2005

Best evidence topic report. Do non-steroidal anti-inflammatory drugs cause a delay in fracture healing?

A short cut review was carried out to establish whether there is any evidence that non-steroidal anti-inflammatory drugs (NSAIDs) might delay fracture healing. A total of 514 papers were found using the reported search, of which three represent the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. At present, although there are theoretical concerns about the adverse effects of NSAIDs on fracture healing, there is not enough clinical evidence to deny patients with simple fractures their analgesic benefits.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2004

A meta-analysis of clinical correlates that predict significant intracranial injury in adults with minor head trauma.

Previous studies have resulted in conflicting results regarding the predictive effect of various clinical symptoms, signs, and plain imaging for intracranial pathology in adults with minor head injury. We sought to perform a meta-analysis of the literature to assess the significance of these factors for the prediction of intracranial hemorrhage (ICH). The literature was searched using Medline, Embase, Experts, and the Grey literature. Reference lists of major guidelines were crosschecked. Included were control or nested case control studies of patients attending hospital with head injury that recorded clinical correlates relating to the outcome variable of presence or absence of ICH. The common relative risk ratio was calculated using the Mantel-Haenszel test with a pooled estimate. Thirty-five papers containing 83,636 patients were included in the meta-analysis after systematic review of the literature. Relative risk ratios were calculated for 23 clinical correlates from the history, the mechanism of injury, and the examination. In addition, adjusted relative risks were presented for those variables that showed significant heterogeneity across studies. Reasons for the heterogeneity are discussed. This study has determined the relative risks of 23 clinical variables that may predict the presence of an ICH in patients after minor head injury. These risks should prove invaluable to clinicians for the assessment of individual patients as well as the assessment of guidelines presented for the management of minor head injuries.

Adult↗
PubMed2004

Courtesy calls.

Explore the source record for details and available documents.

Adult↗
PubMed2002

Systolic hypertension and the response to blunt trauma in infants and children.

OBJECTIVES: To describe age-related systolic blood pressures and pulse rates in children following blunt injury. To compare these variables with standard reference values for uninjured children at rest and with reference ranges from the Advanced Paediatric Life Support (APLS) guidelines. DESIGN: Secondary analysis of a prospective cohort. SETTING: Emergency departments throughout England and Wales. PARTICIPANTS: 12906 children presenting with acute blunt traumatic injury from August 1989 to September 1998. MAIN OUTCOME MEASURES: Systolic blood pressure and pulse rate on arrival. RESULTS: Injured children had higher systolic blood pressures than the standard quoted 'norms'. Standard reference values of systolic blood pressure for children at rest always appeared below the 50th percentile for our cohort of injured children (range 7th-27th percentiles). Pulse rates for children at rest were always towards the mid-range for injured children (range 41st-54th percentiles). These results appeared unrelated to injury severity. Age related APLS reference ranges for systolic blood pressure and pulse rate resembled the standard reference values for uninjured children at rest. CONCLUSIONS: Injured children have a relative systolic hypertension compared with children at rest. Pulse rates in the two groups are comparable. Following injury, children with apparently 'normal' age-specific systolic blood pressures on arrival in the Emergency Department are relatively hypotensive and should be carefully assessed.

Adolescent↗