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PubMed1990

[Triage. Initial diagnosis of life-threatening injuries based on functional state and mechanism of injury].

Functional status expressed as Trauma Score (TS) and mechanism of injury were evaluated as criteria for diagnosing severe trauma in 253 traffic accident victims. An Injury Severity Score (ISS) of greater than or equal to 16 was considered a severe, potentially life-threatening injury. In 67 patients with ISS greater than or equal to 16, either TS was less than or equal to 13 or the history suggested risk of high energy trauma in 72%. When one or both of these criteria were met, ISS was greater than or equal to 16 in 54%. In addition, five patients (3%) with ISS less than 16 had potentially life-threatening injuries in the abdomen or in the thorax. Of these, two had a history indicating high energy trauma. Identifying severely injured patients by assessment of function and mechanism of injury gave an overtriage of 46%, which is acceptable, and an undertriage of 12%. Caution should be exercised in excluding severe trauma on these criteria. Considered together, decreased TS and a history indicating high energy injury, gave high sensitivity (72%) and specificity (78%) for diagnosing severe trauma, ISS greater than or equal to 16.

Accidents, Traffic↗
PubMed1995

A five-year experience with severe injuries in elderly patients.

Recent reports of injury in elderly patients document that aggressive care is justified. Our experience indicates that geriatric injury differs from that of other trauma patients. All patients entered into a large urban trauma center registry over a five-year period were analyzed. Variables reviewed included demographics, trauma indices, mechanism of injury, mean number of hospital days, and morbidity and mortality for patients under 60 years old and for geriatric patients defined as those aged 60 and above. There were 3,064 patients in the reviewed group, of whom 243 qualified for geriatric analysis. Blunt injuries in males were the most typical scenario. Failure to use safety belts and alcohol intoxication persist into the geriatric age group (83% and 13%, respectively). Trauma indices including Injury Severity Score (ISS) were slightly greater in the geriatric group (27 versus 23) as compared to younger patients; plus geriatric patients tolerated head injury less well (GCS in those who died 6.7 versus 4.6, respectively; p < 0.001). Mortality in the geriatric group was 31% while being 17.1% in the younger group (p < 0.005). Days in the hospital were 20 for the geriatric compared to 13 for the younger group (p < 0.025). Infections and chest complications were twice as common in the elderly and dysrhythmias were five times more frequent. Elderly patients constitute 8% of the trauma population and suffer a magnitude of injury at least comparable to the general population. Their mortality is approximately 50% above the population as a whole and morbidity twice as common, accounting for the prolonged hospital stay.

Accidents, Traffic↗
PubMed1993

Prophylactic vena cava filter insertion in severely injured trauma patients: indications and preliminary results.

Pulmonary embolism (PE) remains a significant problem in trauma patients. A 5-year review at this institution revealed 25 PEs (seven fatal) in 2525 admitted trauma patients (1% incidence). Three groups of high-risk patients were identified: (1) those with severe head injury and coma; (2) those with spinal cord injuries with neurologic deficit; and (3) those with pelvic and long bone fractures. The relative risk of PE in these high-risk patients was 21 to 54 times that of the general trauma population. Beginning in July 1991, as prophylaxis against PE, vena cava filters (VCF) were inserted in patients whose injuries placed them in a high-risk group. Thirty-four patients had VCFs inserted percutaneously in the radiology suite without complications. On follow-up examination, 17.6% developed documented lower extremity deep vein thrombosis. There were no PEs. Overall, the incidence of PE in the general trauma population was significantly decreased from 1% to 0.25% (p < 0.05; chi 2). We conclude that insertion of VCFs in high-risk trauma patients is safe and efficacious in decreasing the incidence of PE.

Adult↗
PubMed1992

[The type of coma as prognostic indicator in severe cranial trauma in childhood].

Various methods are used by neurologists to evaluate posttraumatic brain damage. The most important and reliable are the length of posttraumatic amnesia and coma. In previous papers we have already described the value of the type of coma in the prognosis of serious head injury in childhood (Baracchini-Muratorio et al. 1985; Pruneti et al. 1985). In this study, 30 children (aged 6-12 years) with serious closed head injury and subsequent coma were evaluated. The children were divided into two groups according to the type of coma, using the Plum and Posner coma classification (1966) modified by Pagni et al. (1974). The children were followed up for at least two years (9 for five years) after the trauma by means of neurological, physical, EEG, CT scan and neuropsychological examinations. The neuropsychological test results confirm the hypothesis of a different evolution of sequelae in relation to the type of coma, independently of length of coma and site of brain damage.

Adolescent↗
PubMed1990

Blunt renal trauma in childhood. Features indicating severe injury.

The clinical presentation of children with blunt renal trauma may differ from that of adults. The clinical features at presentation of 50 consecutive children (20 severe injuries, no pedicle injuries) admitted over a period of almost 8 years were reviewed to determine if there were clinical clues to major renal trauma in childhood. Gross haematuria and low haematocrit were the most helpful factors at the time of presentation and correlated well with severe renal injury. Hypotension was seen in 4 patients and only 1 had severe renal trauma. Suspicion of a major renal injury should be high when there is gross haematuria or a low haematocrit. In this study only 1 of 20 patients with major renal injury demonstrated clinical signs of shock. Unlike adults, hypotension does not appear to be a reliable indicator of the severity of renal injury in children and diagnostic evaluation should not be reserved only for those in shock.

Adolescent↗
PubMed1985

[The PMN elastase plasma level, a biochemical parameter of the severity of trauma].

Polytrauma patients with defined severity of trauma showed a significant release of lysosomal enzymes as measured by PMN leucocyte elastase-alpha 1 proteinase inhibitor complex in plasma. A positive correlation was found between the amount of liberated elastase and the severity of trauma (- indicated by means of extent of tissue trauma and blood loss). The concentration of elastase complexed with alpha 1 proteinase inhibitor may serve as an indicator for the severity of trauma and as an objective parameter supplementing the scales and scores used until now, which all are based upon subjective judgement.

Adolescent↗
PubMedDate not supplied

Injury severity and functional outcome following paediatric trauma in war conditions.

Trauma causes substantial morbidity and functional impairments among children. The aim of this study was to investigate injuries of children, type of injuries, injury severity, functional impairments and relation between functional impairments and mechanisms of severe injuries in children following trauma in war conditions. This study followed 193 children with trauma, aged 1-16 years, who were admitted and treated in a regional rehabilitation centre from 1992-1995. The degree of injury seriousness was determined according to Injury Severity Scores (ISS). Functional status was measured by means of the own functional assessment scale. Higher ISS was noted for severe injuries caused by firearms than by other means. There was significantly minor functional recovery in children with firearms severe trauma at discharge than with other types of severe injuries (t = 2.04, p < 0.05). The number of all paediatric trauma and firearms injuries decreased by length of war duration. ISS and functional status in children injured by fall at the discharge also decreased. These results show that there are direct and long-term consequences in children age, especially in children with severe traumas caused by firearms, and indicate assessment of psychosocial status of each injured child together with severity of injury.

Adolescent↗
PubMedDate not supplied

Is it possible to predict limb viability in complex Gustilo IIIB and IIIC tibial fractures? A comparison of two predictive indices.

The patient with severe lower limb trauma presents a management dilemma; whether to amputate primarily or to attempt limb salvage. In recent years, many predictive indices have been published which purport to identify limbs which are non-viable. We retrospectively applied two recently described indices, the Mangled Extremity Severity Score (MESS) and the Limb Salvage Index (LSI), to 54 limbs in 50 patients with either Gustilo IIIB or IIIC complex tibial fractures. There were 22 amputations (40.7 per cent) in the series. The mean MESS score in the limb salvage group was 3.8 (range 2-10), and the mean MESS score in the amputation group was 7.7 (range 4-13) (P < 0.0001). The mean LSI score in the limb salvage group was 3.6 (range 3-8), and the mean LSI score in the amputation group was 6.9 (P < 0.01). However, in the group with MESS scores > 7 (which recommends amputation), there were three limbs which were salvaged with acceptable functional outcome. Similarly, in those with LSI scores > 6 (which recommends amputation), there were seven limbs successfully salvaged. A MESS > 7 offered a greater relative risk of amputation (9.2) than a LSI score > 6 (5.3). We found both indices of use in predicting limb salvage and functional outcome. However, neither is sufficiently accurate to be considered absolutely reliable in clinical practice.

Adolescent↗
PubMed1990

Predictive value of the Glasgow Coma Scale for tracheotomy in head-injured patients.

Patients with severe head trauma often require prolonged intubation and subsequent tracheotomy. The Glasgow Coma Scale (GCS), an indicator of the severity of head injury, may help identify that subpopulation of trauma victims who will ultimately undergo tracheotomy. This retrospective study demonstrates through discriminant analysis that the likelihood of tracheotomy is significantly greater in patients with a GCS rating less than or equal to 7 than it is in patients with a GCS rating greater than 7 (p = .0001). Conversely, the presence of thoracoabdominal or maxillofacial injury is associated with but not predictive of eventual tracheotomy. In the hope of minimizing complications and enhancing the utilization of hospital resources, this study argues for early tracheotomy in patients with a GCS score less than or equal to 7 who do not undergo craniotomy and are otherwise stable.

Adolescent↗
PubMedDate not supplied

Injury Severity Score versus New Injury Severity Score for penetrating injuries.

INTRODUCTION: The New Injury Severity Score (NISS) was introduced in 1997 to improve outcome prediction based on anatomical severity scoring in trauma victims. Studies on populations of blunt trauma victims indicate that the NISS, predicts better than the Injury Severity Score (ISS) mortality post-injury, which is why the NISS has been recommended as the new "gold standard" for severity scoring. However, so far the accuracy of the NISS for penetrating injuries has not been validated against the ISS. METHODS: ISS and NISS scores were collected retrospectively for 1,787 war- and landmine victims in North Iraq. All victims only had penetrating injuries. The two tests were compared for prediction of short-term mortality and post-operative complications using Receiver Operating Characteristics (ROC) analysis. RESULTS: Both the ISS and the NISS predicted mortality with high accuracy (ROC area under curve 0.9). There were no significant differences between the two tests. The predictive accuracy for post-operative complications was moderate for both tests (ROC-AUC < 0.8), with the NISS performing significantly better than the ISS. CONCLUSION: The NISS does not perform better than the ISS in penetrating injuries. However, this study was done on a low-risk trauma population, thus the results should not be extrapolated to high severity trauma. Due to statistical shortcomings in studies previously published, studies on far larger cohorts are necessary before the NISS should be adopted as the new "gold standard" for severity scoring.

Explosions↗
PubMed2000

The effects of trauma among kidnap victims in Sardinia, Italy.

BACKGROUND: No study to date has investigated the effects of the trauma of being kidnapped for ransom. In the present study, we aimed to assess the general health status and the presence of post-traumatic stress disorder (PTSD) and major depression (MDD) in a sample of kidnap victims. We also focused attention on dissociative experiences and on the development of the Stockholm syndrome during captivity. METHODS: We investigated the traumatic experiences and reported general health status of 24 kidnap victims using a semistructured interview. The Structured Clinical Interview for DSM-IV was used to assess the presence of PTSD and MDD. The Dissociative Experiences Scale was also administered. RESULTS: The lifetime frequency of PTSD and MDD were 45.9% and 37.5% respectively. The Stockholm syndrome had been present in 50% of the sample during captivity. The presence of PTSD can be predicted by the number of violent experiences, whereas the number of humiliating or deprivation experiences predicts the development of the Stockholm syndrome. Subjects with both PTSD and the Stockholm syndrome reported a greater number of physical complaints at the interview. CONCLUSIONS: There is no significant connection between PTSD and the Stockholm syndrome. Both are indices of the severity of the trauma of being kidnapped, but they are associated with different aspects of the traumatic experience. The presence of both syndromes appears to have a detrimental effect on physical health.

Adult↗
PubMed1996

Maxillofacial injuries in multiply injured patients.

Experience in team management of multiply injured patients with maxillofacial injuries is reported. During 1992, out of 169 patients transferred to the Royal London Hospital, UK by the Helicopter Emergency medical Service 38 (22.4%) had injuries to the maxillofacial region, 17 of whom were scored on the Abbreviated Injury Scale (AIS) as having sustained facial AIS > 2. The median Injury Severity Score (ISS) was 22, while the ISS was 17.7 for survivors and 34.5 for those who died (chi 2 = 7.3, 0.05 < P > 0.02). Facial AIS (median 4) and facial AIS contribution to ISS were found to be poor indicators of severity of injury. Revised Trauma Score (RTS) and percentage probability of survival (Ps%) were found to be useful discriminators of severity of overall injuries. RTS compared between survivors and those who died was 0.05 < P > 0.02 (chi 2), while Ps% was 0.01 < P > 0.001 (chi 2). It was concluded that the severity of maxillofacial injuries, and hence their contribution to total injury assessments, tended to be underscored. We propose that refined facial injury assessment methods be tested.

Abbreviated Injury Scale↗
PubMed2006

Auditing 655 fatalities with pelvic fractures by autopsy as a basis to evaluate trauma care.

BACKGROUND: To determine the role of pelvic fractures in auditing mortality resulting from trauma. STUDY DESIGN: This retrospective case-control study based on autopsy-evaluated circumstances of the deaths of patients with pelvic fractures. RESULTS: Of 2,583 patients injured in motor-vehicle collisions, 655 (25.4%) constituted the pelvic fracture (PFx) group, and 1,928 (74.6%) constituted the control group. One-third of the PFx group's fatalities had an Injury Severity Score (ISS) of 75 and were not preventable. The PFx group had a substantially higher median ISS than the control group (50 versus 34; p < 0.0001). Four hundred fifty-four patients (69.3%) in the PFx group with ISS 16 to 74 had substantially higher rates of associated injuries. Nearly half of the PFx group patients with ISS <or= 74 had a potential cause of major hemorrhage other than pelvic fracture. Twenty-three (3.5%) deaths were directly attributable to pelvic fractures. Postinjury median survival time was 55 minutes for the PFx group and 100 minutes for the control group (p < 0.0001). The time limit for management of the patients with pelvic fractures was short, as 527 (81.5%) died in the first 6 hours. It was evident that the more severe the injuries were, the sooner the deaths occurred. Of 151 subjects who left the emergency department alive, 61.6% were subjected to operation and 48.3% to abdominal operation. CONCLUSIONS: Pelvic fracture is an indicator of severe multiple trauma, but a small proportion of deaths are directly attributable to pelvic fracture. A method based on autopsy audited patients with pelvic fractures as a paradigm of injury revealed that pelvic fracture is an important injury to consider in auditing trauma care and indicated several issues that should be considered to reduce mortality.

Accidents, Traffic↗
PubMed2000

Using Trauma and Injury Severity Score (TRISS)-based analysis in the development of regional risk adjustment tools to trend quality in a voluntary trauma system: the experience of the Trauma Foundation of Northeast Ohio.

BACKGROUND: Presently, no trauma system exists in Ohio. Since 1993, all hospitals in Cuyahoga County (CUY), northeast Ohio (n = 22) provide data to a trauma registry. In return, each received hospital-specific data, comparison data by trauma care level and a county-wide aggregate summary. This report describes the results of this approach in our region. METHODS: All cases were entered by paper abstract or electronic download. Interrater reliability audits and z score analysis was performed by using the Major Trauma Outcome Study and the CUY 1994 baseline groups. Risk adjustment of mortality data was performed using statistical modeling and logistic regression (Trauma and Injury Severity Score, Major Trauma Outcome Study, CUY). Trauma severity measures were defined. RESULTS: In 1995, 3,375 patients were entered. Two hundred ninety-one died (8.6%). Severity measures differed by level of trauma care, indicating differences in case mix. Probability of survival was lowest in the Level I centers, highest in the acute care hospitals. Outcomes z scores demonstrated survival differences for all levels. CONCLUSIONS: In a functioning trauma system, the most severely injured patients should be cared for at the trauma centers. A low volume at acute care hospitals is desirable. By using Trauma and Injury Severity Score with community-specific constants, NE Ohio is accomplishing these goals. The Level I performance data are an interesting finding compared with the data from the Level II centers in the region

Humans↗
PubMed2004

Lung contusion-lacerations after blunt thoracic trauma in children.

Chest trauma in children is an indicator of injury severity and is associated with a high mortality rate. The aim of this study was to investigate the impact of pulmonary contusion-laceration on short and long-term outcome of pediatric patients after blunt thoracic trauma. A retrospective analysis of records of 41 children aged 10 months to 17 years who were treated for pulmonary and associated injuries between 1986 and 2000 was done concerning mode of injury, types of injuries, management and outcome. In addition, a follow-up investigation was performed 4.5+/-1 years after injury. Of the patients 27 were involved in motor vehicle accidents (MVA group) and 14 patients suffered other types of accidents (others group). The mean injury severity score (ISS) was 30+/-2 (range 9-75) with no significant difference between the groups. Patients from the MVA group suffered more frequently bilateral pulmonary lesions and needed more often chest tube placement ( p<0.05), 5 patients died (12%) all from the MVA group. The follow-up investigation of 34 patients showed unremarkable chest x-rays and normal lung function in all but 1 patient with bronchial asthma. In conclusion, children who recover after a pulmonary contusion-laceration trauma do not suffer from significant late respiratory problems.

Accidents, Traffic↗
PubMed1990

Comparisons of the thoracic trauma index with other models.

The thoracic trauma index (TTI) provides an indication of the severity of injuries received by motor vehicle occupants in side-impact collision environments. The index was derived from results on two sets of cadaver tests. Using a variety of statistical and numerical methods, the authors reanalyzed the data from these 80+ cadaver tests to construct a better measure of injury than TTI. Indices generated by these analyses were compared with TTI using the following quantitative measures: monotonicity, overlap, percentage correct, and sensitivity. The values of these measures are broadly similar for all indices and none of the new indices consistently performs better than TTI. This suggests that TTI is as good a predictor of injury as any of the several alternative models created.

Accidents, Traffic↗