A multivariate approach for modeling driver injury severity by body region

Background: In hospital-based studies, hypotension (HT, SBP <90) is more likely to occur in multisystem traumatic brain injury (MTBI) than isolated (ITBI). However, there are few EMS studies on this issue. Hypothesis: Prehospital HT is associated with differential effects in MTBI and ITBI and these effects are influenced by the severity of primary brain injury. Methods: Inclusion: TBI cases in the EPIC Study (NIH 1R01NS071049) before TBI guideline implementation (1/07-3/14). ITBI: Major TBI cases (CDC Barell Matrix Type 1) that had no injury with ICD9-based Regional Severity Score [RSS (AIS equivalent)] ≥3 in any other body region. MTBI: Type 1 TBI plus at least one non-head region injury with RSS ≥3. Results: Included were 13,435 cases [Excl: age <10 (5.9%), missing data (6.2%)]. 10,374 (77.2%) were ITBI, 3061 (22.8%) MTBI. Mortality: ITBI: 7.7% (797/10,374), MTBI: 19.2% (587/3061, p<0.0001). Prehospital HT occurred 3.5 times more often in MTBI (14.8%, 453/3061 vs 4.2%, 437/10,374; p<0.0001). Among HT cases, 40.8% (185/453) with MTBI died vs 30.9% with ITBI (135/437; p<0.0001). In the hypotensive moderate/severe TBI cohort (RSS-Head 3/4), MTBI mortality was 2.4 times higher (17.2%, 40/232) than ITBI (7.1%, 17/240, p = 0.001). However, in the hypotensive very/extremely severe TBI group (RSS-Head 5/6), mortality was almost identical in MTBI (73.4%, 141/192) and ITBI (72.1%, 116/161, p = 0.864). Conclusion: Among major TBI patients with prehospital HT, those with MTBI were much more likely to die than those with ITBI. However, this association varied dramatically with TBI severity. In mod/severe TBI cases with HT, MTBI mortality was 2.4 times higher than in ITBI. In contrast, in very/extremely severe TBI with HT, there was no identifiable mortality difference. Thus, in cases with substantial potential to survive the primary brain injury (mod/severe), outcome is markedly worse in patients with multisystem injuries. However, in very/extremely severe TBI, non-head region injuries have no apparent association with mortality. This may be because the TBI is the primary factor leading to death in these cases. The main EPIC study is evaluating whether this severity-based difference in “effect” has implications for TBI guideline treatment effectiveness.

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An Analysis of Ketamine Doses Administrated to Nonintubated Casualties Prehospital

Military Medicine ◽

10.1093/milmed/usab511 ◽

2021 ◽

Author(s):

Grace E Bebarta ◽

Vikhyat S Bebarta ◽

Andrew D Fisher ◽

Michael D April ◽

Andrew J Atkinson ◽

...

Keyword(s):

Injury Severity ◽

Significant Proportion ◽

Secondary Analysis ◽

Body Region ◽

Intravenous Route ◽

Delivery Methods ◽

Pain Medications ◽

Combat Casualty ◽

Care Guidelines ◽

Battle Injuries

ABSTRACT Introduction Previous studies demonstrate that a significant proportion of casualties do not receive pain medication prehospital after traumatic injuries. To address possible reasons, the U.S. Military has sought to develop novel delivery methods to aid in administration of pain medications prehospital. We sought to describe the dose and route of ketamine administered prehospital to help inform materiel solutions. Materials and Methods This is a secondary analysis of a previously described dataset focused on prehospital data within the Department of Defense Trauma Registry from 2007 to 2020. We isolated encounters in which ketamine was administered along with the amount dosed and the route of administration in nonintubated patients. Results Within our dataset, 862 casualties met inclusion for this analysis. The median age was 28 and nearly all (98%) were male. Most were battle injuries (88%) caused by explosives (54%). The median injury severity score was 10 with the extremities accounting to the most frequent seriously injured body region (38%). The mean dose via intravenous route was 50.4 mg (n = 743, 95% CI 46.5-54.3), intramuscular was 66.7 mg (n = 234, 95% CI 60.3-73.1), intranasal was 56.5 mg (n = 10, 39.1-73.8), and intraosseous was 83.3 mg (n = 34, 66.3-100.4). Most had a medic or CLS in their chain of care (87%) with air evacuation as the primary mechanism of evacuation (86%). Conclusions The average doses administered were generally larger than the doses recommended by Tactical Combat Casualty Care guidelines. Currently, guidelines may underdose analgesia. Our data will help inform materiel solutions based on end-user requirements.

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Transforming the German ICD-10 (ICD-10-GM) into Injury Severity Score (ISS)—Introducing a new method for automated re-coding

PLoS ONE ◽

10.1371/journal.pone.0257183 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257183

Author(s):

Marcel Niemann ◽

Sven Märdian ◽

Pascal Niemann ◽

Liv Tetteh ◽

Serafeim Tsitsilonis ◽

...

Keyword(s):

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Group Analysis ◽

Medical Documentation ◽

Body Region ◽

Radiology Reports ◽

Diagnosis Codes ◽

Java Program ◽

Icd 10

Background While potentially timesaving, there is no program to automatically transform diagnosis codes of the ICD-10 German modification (ICD-10-GM) into the injury severity score (ISS). Objective To develop a mapping method from ICD-10-GM into ICD-10 clinical modification (ICD-10-CM) to calculate the abbreviated injury scale (AIS) and ISS of each patient using the ICDPIC-R and to compare the manually and automatically calculated scores. Methods Between January 2019 and June 2021, the most severe AIS of each body region and the ISS were manually calculated using medical documentation and radiology reports of all major trauma patients of a German level I trauma centre. The ICD-10-GM codes of these patients were exported from the electronic medical data system SAP, and a Java program was written to transform these into ICD-10-CM codes. Afterwards, the ICDPIC-R was used to automatically generate the most severe AIS of each body region and the ISS. The automatically and manually determined ISS and AIS scores were then tested for equivalence. Results Statistical analysis revealed that the manually and automatically calculated ISS were significantly equivalent over the entire patient cohort. Further sub-group analysis, however, showed that equivalence could only be demonstrated for patients with an ISS between 16 and 24. Likewise, the highest AIS scores of each body region were not equal in the manually and automatically calculated group. Conclusion Though achieving mapping results highly comparable to previous mapping methods of ICD-10-CM diagnosis codes, it is not unrestrictedly possible to automatically calculate the AIS and ISS using ICD-10-GM codes.

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A Turbo Pascal Program to Convert Icd-9Cm Coded Injury Diagnoses into Injury Severity Scores: Icdtoais

Perceptual and Motor Skills ◽

10.1177/003151259407800346 ◽

1994 ◽

Vol 78 (3) ◽

pp. 915-930 ◽

Cited By ~ 6

Author(s):

Johannes Kingma ◽

Elisabeth Tenvergert ◽

Hinke Anja Werkman ◽

Henk Jan Ten Duis ◽

Henk J. Klasen

Keyword(s):

Injury Severity ◽

Data File ◽

International Classification Of Diseases ◽

Body Region ◽

Pascal Program ◽

Body Regions ◽

Severity Scores ◽

Severity Of Injury ◽

Classification Of Diseases

Diagnoses of injuries as a result of trauma are commonly coded by means of the International Classification of Diseases (9th rev.) Clinical Modification (ICD-9CM). The Abbreviated Injury Scale (AIS) is frequently employed to assess the severity of injury per body region. The Injury Severity Score (ISS) is an over-all index or summary of the severity of injury. To compute one of these two types of scores the entire medical record of each patient must be examined. The program ICDTOAIS replaces the manual coding or translation between the two scores. The program converts the ICD-9CM coded diagnoses into AIS and ISS scores. The program also computes the maximum AIS (MAXAIS) per body region, enabling the researcher to assess the relative impact of the severity of trauma of different body regions in both morbidity and mortality studies. The program locates invalid ICD-9CM rubrics in the data file. ICDTOAIS may be employed as a program alone or as a procedure in database management systems (e.g., DBase III plus, DBase IV, or the different versions of FOXPRO). The program is written in Turbo Pascal, Version 6.

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Equestrian Trauma: Injury Patterns Vary among Age Groups

The American Surgeon ◽

10.1177/000313481408000424 ◽

2014 ◽

Vol 80 (4) ◽

pp. 396-402 ◽

Cited By ~ 11

Author(s):

Jaroslaw W. Bilaniuk ◽

John M. Adams ◽

Louis T. DiFazio ◽

Brian K. Siegel ◽

John R. Allegra ◽

...

Keyword(s):

Injury Severity ◽

Head Injuries ◽

A Priori ◽

Age Groups ◽

Rib Fractures ◽

Body Region ◽

Injury Patterns ◽

Closed Head Injuries ◽

Closed Head ◽

Trauma Injury

Patients with equestrian injuries were identified in the trauma registry from 2004 to 2007. We a priori divided patients into three groups: 0 to 18 years, 19 to 49 years, and 50 years old or older. There were 284 patients identified with equestrian-related trauma. Injury Severity Score for the three major age categories 0 to 18 years, 19 to 49 years, and 50 years or older, were 3.47, 5.09, and 6.27, respectively. The most common body region injured among all patients was the head (26.1%). The most common injuries by age group were: 0 to 18 years, upper extremity fractures; 19 to 49 year olds, concussions; and 50 years or older, rib fractures. Significant differences were observed among the three age groups in terms of percent of patients with rib fractures: percent of patients with rib fractures was 2, 8, and 22 per cent in age groups 0 to 18, 19 to 49, and 50 years or older, respectively. We found different patterns of injuries associated with equestrian accidents by age. Head injuries were commonly seen among participants in equestrian activities and helmet use should be promoted to minimize the severity of closed head injuries. Injury patterns also seem to vary among the various age groups that ride horses. This information could be used to better target injury prevention efforts among these patients.

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A Focus on Non-Amputation Combat Extremity Injury: 2001-2018

Military Medicine ◽

10.1093/milmed/usab143 ◽

2021 ◽

Author(s):

Katheryne G Perez ◽

Susan L Eskridge ◽

Mary C Clouser ◽

Cameron T McCabe ◽

Michael R Galarneau

Keyword(s):

World War Ii ◽

Injury Severity ◽

Health Care Systems ◽

Full Range ◽

Lower Extremity Injury ◽

Body Region ◽

Extremity Injury ◽

Full Spectrum ◽

Military Health ◽

Extremity Injuries

ABSTRACT Introduction Extremity injuries have comprised the majority of battlefield injuries in modern U.S. conflicts since World War II. Most reports have focused on serious injuries only and, to date, no reports have described the full extent of combat extremity injuries, from mild to severe, resulting from post-9/11 conflicts. This study aims to identify and characterize the full spectrum of non-amputation combat-related extremity injury and extend the findings of previous reports. Methods The Expeditionary Medical Encounter Database was queried for all extremity injured service members (SMs) deployed in support of post-9/11 conflicts through July 2018. Only injuries incurred during combat operations were included in this report. Major amputations were excluded as well as SMs killed in action or who died of wounds. Extremity injuries were categorized by body region, nature of injury, and severity. Demographics and injury event characteristics are also presented. Results A total of 17,629 SMs sustained 42,740 extremity injuries during 18,004 separate injury events. The highest number of SMs were injured in 2004 (n = 3,553), 2007 (n = 2,244), and 2011 (n = 2,023). Injured SMs were mostly young (78% under 30 years), male (97%), junior- to mid-level enlisted (89%), in the Army (69%) or Marine Corps (28%), active duty (84%), serving as infantry and gun crew (59%), and injured in support of Operation Iraqi Freedom (60%). Blast weaponry was responsible for 75% of extremity injuries. Injuries were similarly distributed between the lower (52%) and upper (48%) extremities. The most common sites of lower extremity injury were the lower leg/ankle complex (40%) and thigh (26%). The most common upper extremities sites were the shoulder and upper arms (37%), and the hand, wrist, and fingers (33%). Nearly half (48%) of all extremity injuries were open wounds (48%), followed by fractures (20%) and contusions/superficial injuries (16%). SMs sustained an average of 2.4 extremity injuries per event and 56% of injuries were considered mild, with a median Injury Severity Score (ISS) of 3. Conclusion This study is the first publication to capture, review, and characterize the full range, from mild to severe, of non-amputation combat-related extremity injuries resulting from post-9/11 conflicts. The high prevalence of extremity injury, particularly in such a young population, and associated short- and long-term health outcomes, will impact military health care systems for decades to come.

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Epidemiology of injuries in Olympic-style karate competitions: systematic review and meta-analysis

British Journal of Sports Medicine ◽

10.1136/bjsports-2020-101990 ◽

2020 ◽

Vol 54 (16) ◽

pp. 976-983

Author(s):

Reidar P Lystad ◽

Dusana Augustovičová ◽

Gail Harris ◽

Kirran Beskin ◽

Rafael Arriaza

Keyword(s):

Systematic Review ◽

Injury Severity ◽

Meta Analysis ◽

Incidence Rates ◽

Body Region ◽

Injury Incidence ◽

Eligibility Criteria ◽

Random Effects Models ◽

Significant Difference ◽

Karate Athletes

ObjectiveTo report the epidemiology of injuries in Olympic-style karate competitions.DesignSystematic review and meta-analysis. Pooled estimates of injury incidence rates per 1000 athlete-exposures (IIRAE) and per 1000 min of exposure (IIRME) were obtained by fitting random-effects models.Data sourcesMEDLINE, Embase, AMED, SPORTDiscus and AusportMed databases were searched from inception to 21 August 2019.Eligibility criteriaProspective cohort studies published in peer-reviewed journals and reporting injury data (ie, incidence, severity, location, type, mechanism or risk factors) among athletes participating in Olympic-style karate competition.ResultsTwenty-eight studies were included. The estimated IIRAE and IIRME were 88.3 (95%CI 66.6 to 117.2) and 39.2 (95%CI 30.6 to 50.2), respectively. The most commonly injured body region was the head and neck (median: 57.9%; range: 33.3% to 96.8%), while contusion (median: 68.3%; range: 54.9% to 95.1%) and laceration (median: 18.6%; range: 0.0% to 29.3%) were the most frequently reported types of injury. Despite inconsistency in classifying injury severity, included studies reported that most injuries were in the least severe category. There was no significant difference in IIRME between male and female karate athletes (rate ratio 1.09; 95%CI 0.88 to 1.36).ConclusionKarate athletes sustain, on average, 1 injury every 11 exposures (bouts) or approximately 25 min of competition. The large majority of these injuries were minor or mild in severity.

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Validation of an ICD-9-CM and ICD-10-CM map to AIS 2005 Update 2008

Injury Prevention ◽

10.1136/injuryprev-2017-042519 ◽

2017 ◽

Vol 25 (2) ◽

pp. 90-92 ◽

Cited By ~ 5

Author(s):

Kimberly M Glerum ◽

Mark R Zonfrillo

Keyword(s):

Chart Review ◽

Injury Severity ◽

International Classification Of Diseases ◽

Body Region ◽

Traumatic Injuries ◽

Severity Scores ◽

Classification Of Diseases ◽

Icd 10 ◽

Conversion Tool

Although the Abbreviated Injury Scale (AIS) is the most widely used severity scoring system for traumatic injuries, hospitals are required to document and bill based on the International Classification of Diseases (ICD). An expert panel recently developed a map between ICD-9-CM and ICD-10-CM to AIS 2005 Update 2008. This study aimed to validate the recently developed map using a large trauma registry. The map demonstrated moderate to substantial agreement for maximum AIS (MAIS) scores per body region based on expert chart review versus map-derived values (range: 44%–86%). Injury Severity Scores (ISSs) calculated from expert coders versus map-derived values were also compared and demonstrated moderate agreement (ICD-9-CM: 48%, ICD-10-CM: 54%). Although not a perfect conversion tool, the new ICD-AIS map provides a systematic method to assign injury severity for datasets with only ICD-9-CM and ICD-10-CM codes available and can be used for future injury-related research and data analysis.

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Forensic expertise of the injury severity in fatally injured car-occupants

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0702074n ◽

2007 ◽

Vol 135 (1-2) ◽

pp. 74-79

Author(s):

Slobodan Nikolic ◽

Tatjana Atanasijevic ◽

Vesna Popovic ◽

Dragan Babic

Keyword(s):

Injury Severity ◽

Body Region ◽

Autopsy Study ◽

Chi Square ◽

Severe Injuries ◽

Forensic Expertise ◽

Body Regions ◽

The Face ◽

Chi Square Test ◽

Thoracic And Abdominal

Introduction: There is no specific injury among fatally injured frontal car-occupants in frontal car collisions, used in forensic expertise. We tried to point out the usefulness of the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) for the expertise in such cases. Objective Analyzing the severity of body region injuries and total injury severity of deceased car occupants, to point out their importance in forensic expertise. Method Retrospective autopsy study was performed. Autopsy records of all deceased car-occupants in frontal car collisions were analyzed in order to establish the severity of injuries in body regions (AIS) and total severity of injuries (ISS). Statistical analysis was performed using the chi-square test, t-test, and logistic regression, with significance set at p<0.05. Results A total of 500 cases were analyzed: 282 car-drivers and 218 front car-passengers, average age of 41.48?15.31 and 39.78?16.93. There were 401 males and 99 females. The most injured body region was head with neck: AIS=3.50?2.48, for car-drivers, and AIS=3.54?2.50, for front car-passengers, as well as thorax: AIS=3.63?2.16 car-drivers, and AIS=3.37?2.14, for front car-passengers. More severe injuries of head (AIS?4) suggested that deceased was a front car-passenger (Wald =13.27; p=0.04). More severe injuries of thorax and abdomen (AIS?5) indicated that deceased was a car-driver (Wald=5.72; p=0.02, and Wald=8.23; p=0.01, respectively). The injury severity of the face and limbs were useless in such expertise (Wald=1.72; p=0.19, and Wald=0.89; p=0.34, respectively). An average ISS was 57.31?20.16 for car-drivers, and 54.54?21.01 for front car passengers. The ISS value was useless in expertise (t=1.50; p=0.13, and Wald=2.24; p=0.13). Conclusion As the injury of the head is more severe, the deceased is more likely to be the front car-passenger. Severe thoracic and abdominal injuries are more characteristic for cardrivers. A total injury severity is useless for forensic expertise in cases of fatally injured in car collisions.

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P.3.10 Causes and consequences of work accidents in estonian agriculture

Occupational and Environmental Medicine ◽

10.1136/oem-2019-epi.271 ◽

2019 ◽

Vol 76 (Suppl 1) ◽

pp. A99.1-A99

Author(s):

Anni Enn ◽

Eda Merisalu

Keyword(s):

Injury Severity ◽

Bone Fractures ◽

Injury Rate ◽

Lower Limbs ◽

Body Region ◽

Body Regions ◽

Work Accidents ◽

Minor Injuries ◽

Main Activity ◽

Type Of Injury

IntroductionWork accidents (WA) in agriculture are a problem all over the world. There are over 1,3 billion agricultural workers, that counts more than 50% of all the worlds’ workforce. Even if the most of work tasks become more automated, farmers, family members and farm workers are facing risks at work that are higher than in most other occupations. Many accidents involve the handling of machinery or animals. The costs of WAs are increasing, exhausting national economy as a whole. The aim of this study is to analyse the main causes and consequences of WAs in Estonian agriculture.MethodThe database of accidents in agriculture (2008–2017) has obtained from the Estonian Labour Inspectorate. WAs statistics is based on official reports of employers. Causes and consequences including injury severity, type and body region are described in the present study.ResultsThe main cause of WAs in agriculture is disregarding of safety requirements (28,9%), whereas more than half of cases remain unclear. Loss of control over animals or machinery (33,4%), falling and slipping (21,5%) and an attack or an assault by cattle (15,8%) are the main activity-based reasons of WAs. During the last decade the most were minor injuries (72,8%). By the type of injury most often wounds and superficial injuries (40,4%), bone fractures (25,6%) and concussion or internal injuries (16,2%) have been registered. Upper and lower limbs (35,7% and 33,6%) were the most often injured body regions.ConclusionsAgriculture is a sector with high accident risks, where injury rate shows steady tendency to increase. It is important to pay more attention on improvement of safety culture and prevention of work accidents in agriculture.

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