Prehospital Severity Scoring at Major Rock Concert Events

1997 ◽  
Vol 12 (3) ◽  
pp. 22-26 ◽  
Author(s):  
Timothy B. Erickson ◽  
Max Koenigsberg ◽  
E. Bradshaw Bunney ◽  
Brian Schurgin ◽  
Paul Levy ◽  
...  
Keyword(s):  
Severity Score ◽  
Recurrent Events ◽  
Injury Severity ◽  
First Aid ◽  
Utilization Rate ◽  
Minor Trauma ◽  
Chi Square ◽  
Study Objective ◽  
Severity Scores ◽  
Common Diagnosis

AbstractIntroduction:Rock and contemporary music concerts are popular, recurrent events requiring on-site medical staffing.Study objective:To describe a novel severity score used to stratify the level of acuity of patients presenting to first-aid stations at these events.Methods:Retrospective review of charts generated at the first-aid stations of five major rock concerts within a 60,000 spectator capacity, outdoor, professional sports stadium. Participants included all concert patrons presenting to the stadiums first-aid stations as patients. Data were collected on patient demographics, history of drug or ethanol usage while at the concert event, first-aid station time, treatment rendered, diagnosis, and disposition. All patients evaluated were retrospectively assigned a “DRUG-ROCK” Injury Severity Score (DRISS) to stratify their level of acuity. Individual concert events and patient dispositions were compared statistically using chi-square, Fisher's exact, and the ANOVA Mean tests.Results:Approximately 250,000 spectators attended the five concert events. First-aid stations evaluated 308 patients (utilization rate of 1.2 per 1,000 patrons). The most common diagnosis was minor trauma (130; 42%), followed in frequency by ethanol/illicit drug intoxication (98; 32%). The average time in the first-aid station was 23.5±22.5 minutes (± standard deviation; range: 5–150 minutes). Disposition of patients included 100 (32.5%) who were treated and released; 98 (32%) were transported by paramedics to emergency departments (EDs); and 110 (35.5%) signed-out against medical advise (AMA), refusing transport. The mean DRISS was 4.1 (±2.65). Two-thirds (67%) of the study population were ranked as mild by DRISS criteria (score = 1–4), with 27% rated as moderate (score = 5–9), and 6% severe (score >10). The average of severity scores was highest (6.5) for patients transported to hospitals, and statistically different from the scores of the average of the treated and released and AMA groups (p <0.005).Conclusion:The DRISS was useful in stratifying the acuity level of this patient population. This severity score may serve as a potential triage mechanism for future mass gatherings such as rock concerts.

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 A Comparative Study Between Two Combat Injury Severity Scores

2021 ◽  
Author(s):  
Rafael García Cañas ◽  
Ricardo Navarro Suay ◽  
Carlos Rodríguez Moro ◽  
Diana M Crego Vita ◽  
Javier Arias Díaz ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Scoring Systems ◽  
Combat Injury ◽  
New Injury Severity Score ◽  
Severity Scores ◽  
Trauma Scoring ◽  
Combat Casualties ◽  
The Military

ABSTRACT Introduction In recent years, specific trauma scoring systems have been developed for military casualties. The objective of this study was to examine the discrepancies in severity scores of combat casualties between the Abbreviated Injury Scale 2005-Military (mAIS) and the Military Combat Injury Scale (MCIS) and a review of the current literature on the application of trauma scoring systems in the military setting. Methods A cross-sectional, descriptive, and retrospective study was conducted between May 1, 2005, and December 31, 2014. The study population consisted of all combat casualties attended in the Spanish Role 2 deployed in Herat (Afghanistan). We used the New Injury Severity Score (NISS) as reference score. Severity of each injury was calculated according to mAIS and MCIS, respectively. The severity of each casualty was calculated according to the NISS based on the mAIS (Military New Injury Severity Score—mNISS) and MCIS (Military Combat Injury Scale-New Injury Severity Score—MCIS-NISS). Casualty severity were grouped by severity levels (mild—scores: 1-8, moderate—scores: 9-15, severe—scores: 16-24, and critical—scores: 25-75). Results Nine hundred and eleven casualties were analyzed. Most were male (96.37%) with a median age of 27 years. Afghan patients comprised 71.13%. Air medevac was the main casualty transportation method (80.13). Explosion (64.76%) and gunshot wound (34.68%) mechanisms predominated. Overall mortality was 3.51%. Median mNISS and MCIS-NISS were similar in nonsurvivors (36 [IQR, 25-49] vs. [IQR, 25-48], respectively) but different in survivors, 9 (IQR, 4-17) vs. 5 (IQR, 2-13), respectively (P &lt; .0001). The mNISS and MCIS-NISS were discordant in 34.35% (n = 313). Among cases with discordant severity scores, the median difference between mNISS and MCIS-NISS was 9 (IQR, 4-16); range, 1 to 57. Conclusion Our study findings suggest that discrepancies in injury severity levels may be observed in one in three of the casualties when using mNISS and MCIS-NISS.

scholarly journals Epidemiological and risk predictors of severity of school injuries

1999 ◽  
Vol 5 (4) ◽  
pp. 676-683
Author(s):  
M. I. Kamel ◽  
N. M. Kamel ◽  
N. Foda ◽  
S. Khashab
Keyword(s):  
Health Services ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Significant Risk ◽  
First Aid ◽  
Acute Disease ◽  
Morbidity And Mortality ◽  
Mechanism Of Injury ◽  
Risk Predictors

Accidents are the leading cause of morbidity and mortality among schoolchildren. Epidemiological and risk predictors of injury severity were investigated among all school injuries presenting at the Students’ Hospital in Alexandria during the scholastic year 1996-97. In all, 3422 injured pupils were surveyed. Age, nature of injury, place and mechanism of school injury and referral method were significant risk predictors for hospitalization. Age, referral method and nature of injury were significant predictors of referral to specialized health services. Injury severity score was significantly predicted by the presence of acute disease during time of injury, place and mechanism of injury as well as by provision of first aid and referral method and time

scholarly journals Injury Severity Score (ISS) vs. ICD-derived Injury Severity Score (ICISS) in a patient population treated in a designated Hong Kong trauma centre

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Sydney S.N. Wong ◽  
Gilberto K.K. Leung
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Roc Curves ◽  
Trauma Centre ◽  
Trauma Centers ◽  
Chi Square ◽  
Chi Square Test ◽  
New Type ◽  
Trauma And Injury

Trauma and Injury Severity Score (TRISS) has been the benchmark of mortality riskin trauma centers for over 30 years. TRISS utilizes the Injury Severity Score (ISS) as an index ofanatomical injury. This study investigated the efficacy of a new type of index of anatomical injury called the ICD-derived Injury Severity Score (ICISS) compared to the ISS using a logisticregression analysis and a global chi-square test of the areas under the Receiver OperatorCharacteristic (ROC) curves. We found that the empirically derived ICISS performed as well as the consensus derived ISS with no statistical differences between their respective area under the ROC curves.

scholarly journals Hubungan antara Nilai Fibrinogen Inisial dengan Kejadian Koagulopati dan Mortalitas pada Pasien Trauma Multipel di Rumah Sakit Hasan Sadikin Bandung

2020 ◽  
Vol 45 (1) ◽  
pp. 71-79
Author(s):  
Raden Lyana Sulistyanti ◽  
Reno Rudiman ◽  
Nurhayat Usman
Keyword(s):  
Injury Severity Score ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Severity Score ◽  
Injury Severity ◽  
Chi Square ◽  
Trauma Induced Coagulopathy

Latar Belakang: Dari data suatu penelitian dikatakan 1 dari 7 kematian disebabkan oleh trauma dan 30% dari trauma tersebut datang dalam kondisi koagulopati. Koagulopati pada trauma disebut sebagai Trauma Induced Coagulopathy (TIC). Pada TIC, nilai fibrinogen yang rendah sering ditemui dan nilai fibrinogen plasma mencapai nilai terendah lebih awal dibandingkan parameter factor koagulasi lainnya. Nilai fibrinogen inisial berhubungan kuat dengan nilai Injury Severity Score  (ISS) dan menjadi nilai prediktor independen untuk mortalitas. Penelitian ini bertujuan melihat hubungan antara fibrinogen inisial dengan kejadian koagulopati dan mortalitas. Metode: Penelitian ini merupakan studi prospektif. Seluruh pemeriksaan didapatkan dari 25 pasien trauma multipel. Kadar fibrinogen inisial diambil dari pemeriksaan laboratorium darah bersamaan dengan pemeriksaan rutin lainnya ketika pasien datang ke Instalasi Gawat Darurat Rumah Sakit Hasan Sadikin (IGD RSHS). Koagulopati ditentukan berdasarkan nilai laboratorium Prothrombin Time (PT) atau Partial Thromboplastin Time (aPTT) yang abnormal. Trauma multipel ditentukan dengan nilai ISS ≥ 15 dan dihitung berdasarkan diagnosis pasti setelah tegak berdasarkan pemeriksaan klinis dan penunjang sesuai dengan prosedur tetap di IGD RSHS. Analisis menggunakan SPSS 19.0 dengan metoea analisis chi square untuk melihat kemaknaan hubungan. Hasil: Dari 25 pasien trauma multipel didapatkan mayoritas 80% adalah pasien laki – laki dengan mekanisme kejadian terbanyak adalah trauma kepala sebanyak 16 orang (64%). Terdapat  8 pasien (32%) terjadi koagulopati dan mortalitas terjadi pada  7 pasien (28%). Dari metode analisis chi square didapatkan hubungan yang bermakna antara fibrinogen dengan kejadian koagulopati (p=0,043) sedangkan hubungan antara fibrinogen inisial dengan terjadinya mortalitas didapatkan tidak bermakna (p=0.341). Kesimpulan: Terdapat hubungan bermakna antara fibrinogen inisial dengan kejadian koagulopati tetapi tidak didapatkan hubungan bermakna antara fibrinogen inisial dengan terjadinya mortalitas pada pasien dengan trauma multipel di RSHS.

scholarly journals 35. Emergency Medical Services Use of Trauma Triage Criteria to Stratify Patients by Injury Severity and Need for Emergent Intervention

1996 ◽  
Vol 11 (S2) ◽  
pp. S32-S32
Author(s):  
Robert E. O'Connor ◽  
Glen H. Tinkoff ◽  
Susan Mascioli ◽  
Ross E. Megargel
Keyword(s):  
Injury Severity ◽  
Vital Signs ◽  
Penetrating Trauma ◽  
Trauma Patients ◽  
Chi Square ◽  
Probability Of Survival ◽  
Trauma Service ◽  
Severity Scores ◽  
Serious Injury ◽  
Level I

Purpose: Prehospital triage criteria (PTC) have been used to classify patients according to risk of serious injury. This study was conducted determine whether PTC could be used to identify serious injury, the need for intensive care (ICU), or immediate operative intervention (IOI).Methods: Data for this observational study were gathered prospectively, at a level-I trauma center, from a patient cohort admitted to the trauma service from 01 February to 31 July 1995. Specific triage criteria, based on information given by EMS prior to arrival were used to categorize patients by severity. Patients classified as most serious (codes) had the following: shock, major anatomic injury or proximal penetrating trauma. Patients classified as more serious (alerts) had one of the following: abnormal vital signs, Glasgow Coma Scale <13, moderate anatomic injury, high-risk mechanism of injury, or co-morbid factors. Patients not meeting either set of criteria, but were admitted, served as controls (consults). Injury severity scores (ISS) and probability of survival (Probsurvival) were calculated for each patient. The percentage admitted to the ICU, operating room (OR), or requiring IOI, were tabulated. Statistical analysis was performed using ANOVA, Mest and chi-square.

scholarly journals Intentional Fallers with Complex Pelvic and Acetabular Fractures Do Not Have worse Radiological and Functional Outcomes than Accidental Fallers

2022 ◽  
Vol 2022 ◽  
pp. 1-6
Author(s):  
Yi-Hsun Yu ◽  
Ying-Chao Chou ◽  
Bo-Yan Yeh ◽  
Yung-Heng Hsu ◽  
I-Jung Chen ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Injury Severity ◽  
Adjustment Disorder ◽  
Acetabular Fractures ◽  
Rehabilitation Programs ◽  
Severity Scores ◽  
Common Diagnosis ◽  
Hospital Stays ◽  
Combined Injuries

Individuals who fall from heights of ≥6 m can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. Therefore, we aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and compare the radiological and functional outcomes between intentional and accidental fallers. We retrospectively reviewed 49 fallers who fell from heights of ≥6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatment between 2014 and 2017. Fallers were divided into intentional and accidental fallers. Sixteen patients were intentional fallers, whereas the rest of the patients were accidental fallers. Psychiatric counseling was provided to each of the intentional fallers during follow-up. All intentional fallers had preexisting mental disorders, and the most common diagnosis was adjustment disorder. The group of intentional fallers predominantly comprised females that had a higher injury and new injury severity scores and longer hospital stays. However, early loss of fixation (<3 months) and functional outcomes (Merle d’Aubigné and Majeed hip scores at 6- and 12-month follow-ups) did not significantly differ between intentional and accidental fallers. We found that intentional fallers with pelvic and acetabular fractures may have more severe combined injuries compared to accidental fallers. However, the radiological and functional outcomes of the intentional fallers after osteosynthesis were not inferior to those of the accidental fallers with the implementation of well-designed surgical protocols and individualized physical and mental rehabilitation programs.

Comparison of manual and computer assigned injury severity scores

2019 ◽  
Vol 26 (4) ◽  
pp. 330-333
Author(s):  
Lauren Otto ◽  
Angela Wang ◽  
Krista Wheeler ◽  
Junxin Shi ◽  
Jonathan I Groner ◽  
...  
Keyword(s):  
Regression Models ◽  
Predictive Power ◽  
Injury Severity ◽  
Roc Curves ◽  
Data Bank ◽  
Trauma Centre ◽  
Linear Regression Models ◽  
Study Objective ◽  
Logistic Regression Models ◽  
Severity Scores

BackgroundThe study objective was to compare the ISS manually assigned by hospital personnel and those generated by the ICDPIC software for value agreement and predictive power of length of stay (LOS) and mortality.MethodsWe used data from the 2010–2016 trauma registry of a paediatric trauma centre (PTC) and 2014 National Trauma Data Bank (NTDB) hospitals that reported manually coded ISS. Agreement analysis was performed between manually and computer assigned ISS with severity groupings of 1–8, 9–15, 16–25 and 25–75. The prediction of LOS was compared using coefficients of determination (R2) from linear regression models. Mortality predictive power was compared using receiver operating characteristic (ROC) curves from logistic regression models.ResultsThe proportion of agreement between manually and computer assigned ISS in PTC data was 0.84 and for NTDB was 0.75. Analysing predictive power for LOS in the PTC sample, the R2=0.19 for manually assigned scores, and the R2=0.15 for computer assigned scores (p=0.0009). The areas under the ROC curve indicated a mortality predictive power of 0.95 for manually assigned scores and 0.86 for computer assigned scores in the PTC data (p=0.0011).ConclusionsManually and computer assigned ISS had strong comparative agreement for minor injuries but did not correlate well for critical injuries (ISS=25–75). The LOS and mortality predictive power were significantly higher for manually assigned ISS when compared with computer assigned ISS in both PTC and NTDB data sets. Thus, hospitals should be cautious about transitioning to computer assigned ISS, specifically for patients who are critically injured.

scholarly journals The Factors Related to Death of Trauma Preventable Death Patients in Rajavithi Hospital

2021 ◽  
pp. 39-44
Author(s):  
T. Nopmanee ◽  
C. Sukrom ◽  
U. Teerachai ◽  
D. Jirapong ◽  
K. Nirutchara
Keyword(s):  
Injury Severity Score ◽  
Pulse Rate ◽  
Severity Score ◽  
Injury Severity ◽  
Underlying Disease ◽  
Preventable Death ◽  
Chi Square ◽  
Probability Of Survival ◽  
Survival Score ◽  
Chi Square Test

Aims: To study the factors related to death of traumatic preventable death patients with probability of survival score more than 0.75 Methodology: A 1:4 case-control study was conducted on traumatic preventable death patients with probability of survival score more than 0.75 who received treatment at the Emergency Department and was admitted in Rajavithi Hospital between 2015 and 2018. Data were retrieved from Rajavithi trauma registry. Statistical analysis using Chi-square test, student t-test, and Multiple logistic regression was employed for factors associated with death of trauma. Results: There were 36 cases (death) and 150 controls (survivors). In cases group, 21 (61.1%) were male with mean age of 61.36±20.23 years. 26 (72.2%) had underlying diseases. 22 (61.10%) of these injuries occurred at home. The cause of accidents are categorized to fall injury occurring 21 (58.3%), and blunt mechanism of injury 35 (97.20%). The mean Injury Severity Score was 17.81±9.66. Factors significantly associated with increased death are age (Adjust OR: 1.05 (1.01-1.08), P = .02), pulse rate (Adjusted OR): 1.05 (1.01-1.08), P = .01), underlying disease (Adjusted OR): 12.0 (2.29-62.88), and Injury Severity Score (Adjusted OR): 1.29 (1.16-1.43), P < .001) Conclusion: The factors related to death of traumatic preventable death patients with probability of survival score more than 0.75 were age, pulse rate, underlying disease, and Injury Severity Score.

Showicd: A Computer Program to Display Icd-9Cm Coded Injury Diagnoses and Their Corresponding Injury Severity Scores for a Particular Patient

1994 ◽  
Vol 78 (3) ◽  
pp. 939-946
Author(s):  
Johannes Kingma ◽  
Elisabeth Tenvergert ◽  
Henk J. Klasen
Keyword(s):  
Injury Severity Score ◽  
Computer Program ◽  
Severity Score ◽  
Injury Severity ◽  
Summary Score ◽  
Whole Body ◽  
Body Region ◽  
Severity Scores ◽  
Severity Of Injury ◽  
Different Types

SHOWICD is an interactive computer program designed to document severity of injury from the ICD-9CM coded injury diagnoses of a particular patient. Two severity-of-injury scores [the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS)] are used. By employing the AIS scores, the severity of injury may be assessed per body region. The ISS provides an over-all index or summary score for severity of injury of the whole body. SHOWICD allows the user to analyze the effects of different types of injuries on the Injury Severity Score. SHOWICD may be employed either alone as a program or as a procedure in database management systems. The program is written in Turbo Pascal.

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