Injury Severity Score Inflation Resulting From Pan–Computed Tomography in Patients With Blunt Trauma

2016 ◽  
Vol 67 (1) ◽  
pp. 71-75.e3 ◽  
Author(s):  
Malkeet Gupta ◽  
Michael Gertz ◽  
David L. Schriger
Keyword(s):  
Computed Tomography ◽  
Injury Severity Score ◽  
Blunt Trauma ◽  
Severity Score ◽  
Injury Severity ◽  
Score Inflation

Non-Selective Thoracic Computed Tomography in Trauma Patients Results in Injury Severity Score Inflation

2021 ◽  
pp. 000313482110249
Author(s):  
Leonardo Alaniz ◽  
Omaer Muttalib ◽  
Juan Hoyos ◽  
Cesar Figueroa ◽  
Cristobal Barrios
Keyword(s):  
Computed Tomography ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Treatment Plan ◽  
Mortality Prediction ◽  
Trauma Patients ◽  
Mortality Benefit ◽  
Severity Scores ◽  
Score Inflation

Introduction Extensive research relying on Injury Severity Scores (ISS) reports a mortality benefit from routine non-selective thoracic CTs (an integral part of pan-computed tomography (pan-CT)s). Recent research suggests this mortality benefit may be artifact. We hypothesized that the use of pan-CTs inflates ISS categorization in patients, artificially affecting admission rates and apparent mortality benefit. Methods Eight hundred and eleven patients were identified with an ISS >15 with significant findings in the chest area. Patient charts were reviewed and scores were adjusted to exclude only occult injuries that did not affect treatment plan. Pearson chi-square tests and multivariable logistic regression were used to compare adjusted cases vs non-adjusted cases. Results After adjusting for inflation, 388 (47.8%) patients remained in the same ISS category, 378 (46.6%) were reclassified into 1 lower ISS category, and 45 (5.6%) patients were reclassified into 2 lower ISS categories. Patients reclassified by 1 category had a lower rate of mortality ( P < 0.001), lower median total hospital LOS ( P < .001), ICU days ( P < .001), and ventilator days ( P = 0.008), compared to those that remained in the same ISS category. Conclusion Injury Severity Score inflation artificially increases survival rate, perpetuating the increased use of pan-CTs. This artifact has been propagated by outdated mortality prediction calculation methods. Thus, prospective evaluations of algorithms for more selective CT scanning are warranted.

scholarly journals The Applicability of Trauma and Injury Severity Score for a Blunt Trauma Population in Korea and a Proposal of New Models Using Score Predictors

2016 ◽  
Vol 57 (3) ◽  
pp. 728 ◽  
Author(s):  
Kyoungwon Jung ◽  
Yo Huh ◽  
John Cook-Jong Lee ◽  
Younghwan Kim ◽  
Jonghwan Moon ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Blunt Trauma ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Population ◽  
New Models ◽  
Trauma And Injury

scholarly journals Validation of Age-specific Survival Prediction in Pediatric Patients With Blunt Trauma Using Trauma and Injury Severity Score Methodology: A Ten-year Nationwide Observational Study

2020 ◽  
Author(s):  
Chiaki Toida ◽  
Takashi Muguruma ◽  
Masayasu Gakumazawa ◽  
Mafumi Shinohara ◽  
Takeru Abe ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Blunt Trauma ◽  
Severity Score ◽  
Pediatric Patients ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Survival Prediction ◽  
Trauma Patients ◽  
Interval Group ◽  
Trauma And Injury

Abstract Background: In-hospital mortality in trauma patients decreased recently owing to improved trauma injury prevention systems. However, no study which evaluated the validity of Trauma and Injury Severity Score (TRISS) in pediatrics by detailed classification of patients’ age and injury severity in Japan. This retrospective nationwide study evaluated the validity of TRISS in predicting survival in Japanese pediatric patients with blunt trauma by age and injury severity.Methods: Data were obtained from the Japan Trauma Data Bank during 2009−2018.Results: In all age categories, the area under the curve (AUC) for TRISS demonstrated high performance (0.935, 0.981, 0.979, and 0.977). The Accuracy of TRISS was 99.9%, 98.2%, 92.1%, 76.7%, 55.3%, and 72.1% in survival probability (Ps) interval groups (0.96−1.00), (0.91−0.95), (0.76.−0.90), (0.51−0.75), (0.26−0.50), and (0.00−0.25), respectively. The AUC for TRISS demonstrated moderate performance in the Ps interval group (0.96−1.00) and low performance in other Ps interval groups.Conclusions: The TRISS methodology appears to predict survival accurately in Japanese pediatric patients with blunt trauma; however, there were several problems in adopting the TRISS methodology for younger blunt trauma patients with higher injury severity. In the future, we should consider to conducting a simple, high-quality prediction model that is more suitable for pediatric trauma patients than the current TRISS model.

Assessing Incidence and Risk Factors of Cervical Spine Injury in Blunt Trauma Patients Using the National Trauma Data Bank

2015 ◽  
Vol 81 (9) ◽  
pp. 879-883 ◽  
Author(s):  
Andrew J. Young ◽  
Luke Wolfe ◽  
Glenn Tinkoff ◽  
Therese M. Duane
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Injury Severity Score ◽  
Blunt Trauma ◽  
Severity Score ◽  
Injury Severity ◽  
Alcohol Intoxication ◽  
Spine Injury ◽  
Ligamentous Injury ◽  
National Trauma

Despite the potentially devastating impact of missed cervical spine injuries (CI), there continues to be a large disparity in how institutions attempt to make the diagnosis. To better streamline the approach among institutions, understanding incidence and risk factors across the country is paramount. We evaluated the incidence and risk factors of CI using the National Trauma Databank for 2008 and 2009. We performed a retrospective review of the National Trauma Databank for 2008 and 2009 comparing patients with and without CI. We then performed subset analysis separating injury by patients with and without fracture and ligamentous injury. There were a total of 591,138 patients included with a 6.2 per cent incidence of CI. Regression found that age, Injury Severity Score, alcohol intoxication, and specific mechanisms of motor vehicle crash (MVC), motorcycle crash (MCC), fall, pedestrian stuck, and bicycle were independent risk factors for overall injury ( P < 0.0001). Patients with CI had longer intensive care unit (8.5 12.5 vs 5.1 7.7) and hospital lengths of stay (days) (9.6 14.2 vs 5.3 8.1) and higher mortality (1.2 per cent vs 0.3%), compared with those without injury ( P < 0.0001). There were 33,276 patient with only fractures for an incidence of 5.6 per cent and 1875 patients with ligamentous injury. Just over 6 per cent of patients suffer some form of CI after blunt trauma with the majority being fractures. Higher Injury Severity Score and MVC were consistent risk factors in both groups. This information will assist in devising an algorithm for clearance that can be used nationally allowing for more consistency among trauma providers.

Lactate in Trauma: A Poor Predictor of Mortality in the Setting of Alcohol Ingestion

2011 ◽  
Vol 77 (12) ◽  
pp. 1576-1579 ◽  
Author(s):  
Hadley K. Herbert ◽  
Tracey A. Dechert ◽  
Luke Wolfe ◽  
Michel B. Aboutanos ◽  
Ajai K. Malhotra ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Blunt Trauma ◽  
Severity Score ◽  
Injury Severity ◽  
Alcohol Ingestion ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
End Point ◽  
Blood Alcohol Levels ◽  
Level I

Resuscitation end point markers such as lactate and base deficit (BD) are used in trauma to identify and treat a state of compensated shock. Lactate and BD levels are also elevated by alcohol. In blunt trauma patients with positive blood alcohol levels, lactate may be a poor indicator of injury. Retrospective data were collected on 1083 blunt trauma patients with positive blood alcohol levels admitted a Level I trauma center between 2003 and 2006. Patients were stratified by Injury Severity Score, age, gender, and Glasgow Coma Score. Logistic regression analyses were used to assess lactate and BD as independent risk factors for mortality. Seventy-four per cent of patients had an abnormal lactate level compared with 28 per cent with abnormal BD levels. In patients with mild injury, lactate levels were abnormal in more than 70 per cent of patients compared with less than 20 per cent of patients with abnormal BD levels. Linear regression showed lactate is not a significant predictor of mortality. Regardless of Injury Severity Score, lactate appeared to be more often abnormal than BD in the setting of alcohol ingestion. Additionally, because BD, and not lactate, was shown to be an independent predictor of mortality, lactate may not be a reliable marker of end point resuscitation in this patient population.

scholarly journals Validation of age-specific survival prediction in pediatric patients with blunt trauma using trauma and injury severity score methodology: a ten-year Nationwide observational study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chiaki Toida ◽  
Takashi Muguruma ◽  
Masayasu Gakumazawa ◽  
Mafumi Shinohara ◽  
Takeru Abe ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Blunt Trauma ◽  
Predictive Value ◽  
Severity Score ◽  
Pediatric Patients ◽  
Injury Severity ◽  
Age Groups ◽  
Survival Prediction ◽  
Trauma Patients ◽  
Trauma And Injury

Abstract Background In-hospital mortality in trauma patients has decreased recently owing to improved trauma injury prevention systems. However, no study has evaluated the validity of the Trauma and Injury Severity Score (TRISS) in pediatric patients by a detailed classification of patients’ age and injury severity in Japan. This retrospective nationwide study evaluated the validity of TRISS in predicting survival in Japanese pediatric patients with blunt trauma by age and injury severity. Methods Data were obtained from the Japan Trauma Data Bank during 2009–2018. The outcomes were as follows: (1) patients’ characteristics and mortality by age groups (neonates/infants aged 0 years, preschool children aged 1–5 years, schoolchildren aged 6–11 years, and adolescents aged 12–18 years), (2) validity of survival probability (Ps) assessed using the TRISS methodology by the four age groups and six Ps-interval groups (0.00–0.25, 0.26–0.50, 0.51–0.75, 0.76–0.90, 0.91–0.95, and 0.96–1.00), and (3) the observed/expected survivor ratio by age- and Ps-interval groups. The validity of TRISS was evaluated by the predictive ability of the TRISS method using the receiver operating characteristic (ROC) curves that present the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, area under the receiver operator characteristic curve (AUC) of TRISS. Results In all the age categories considered, the AUC for TRISS demonstrated high performance (0.935, 0.981, 0.979, and 0.977). The AUC for TRISS was 0.865, 0.585, 0.614, 0.585, 0.591, and 0.600 in Ps-interval groups (0.96–1.00), (0.91–0.95), (0.76. − 0.90), (0.51–0.75), (0.26–0.50), and (0.00–0.25), respectively. In all the age categories considered, the observed survivors among patients with Ps interval (0.00–0.25) were 1.5 times or more than the expected survivors calculated using the TRISS method. Conclusions The TRISS methodology appears to predict survival accurately in Japanese pediatric patients with blunt trauma; however, there were several problems in adopting the TRISS methodology for younger blunt trauma patients with higher injury severity. In the next step, it may be necessary to develop a simple, high-quality prediction model that is more suitable for pediatric trauma patients than the current TRISS model.

Morbid Obesity Impacts Mortality in Blunt Trauma

2007 ◽  
Vol 73 (11) ◽  
pp. 1122-1125 ◽  
Author(s):  
A. Britton Christmas ◽  
Jennifer Reynolds ◽  
Ashley K. Wilson ◽  
Glen A. Franklin ◽  
Frank B. Miller ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Morbid Obesity ◽  
Injury Severity Score ◽  
Blunt Trauma ◽  
Body Mass ◽  
Severity Score ◽  
Injury Severity ◽  
Morbidly Obese ◽  
Normal Body Mass Index ◽  
Obese Patients

Twenty-six per cent of adults in the Unites States are obese and trauma remains a major cause of death. We assessed the impact of morbid obesity on mortality in patients with blunt trauma. We reviewed the records of patients with a body mass index 40 kg/m2 or greater injured by blunt trauma from 1993 to 2003 and compared them with a 4:1 control population with a normal body mass index and matched for sex and constellation of injuries. For comparison, patients were categorized by Injury Severity Score 9 or less or Injury Severity Score 10 or greater. Student t test and χ2 were used for statistical analysis. P < 0.05 was considered significant. One hundred seven morbidly obese patients were identified and compared with 458 control subjects with a normal body mass index and matched for sex and constellation of injuries. Although the morbidly obese patients were found to be significantly younger, those who incurred multiorgan injury experienced a significantly longer hospital length of stay and displayed a greater than fourfold increase in mortality when compared with the control subjects. Furthermore, the number of morbidly obese patients admitted over the 10-year period significantly increased by fourfold (0.4% to 1.5%). Over the last decade, there has been a significant increase in morbidly obese patients cared for in our trauma center. Although these patients were significantly younger with a similar Glasgow Coma Score as that of the control population, morbid obesity significantly increased mortality when the injury from blunt trauma transitioned from a single to a multiorgan injury.

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