scholarly journals (A215) Delayed Diagnosis of Injury in Survivors of the February 2009 Crash of Flight TK 1951

2011 ◽  
Vol 26 (S1) ◽  
pp. s59-s60
Author(s):  
I.L.E. Postma ◽  
J. Winkelhagen ◽  
T. Bijlsma ◽  
F. Bloemers ◽  
M. Heetveld ◽  
...  
Keyword(s):  
Injury Severity ◽  
Life Support ◽  
Delayed Diagnosis ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Emergency Intervention ◽  
Plane Crash ◽  
Tertiary Survey ◽  
Clinically Significant ◽  
The Uk

IntroductionIn 2009, a Boeing 737 crashed near Amsterdam, traumatically injuring 126 people. In trauma patients, some injuries initially escape detection. The aim of this study is to evaluate the incidence of Delayed Diagnosis of Injury (DDI) and the effects of tertiary survey on the victims of a plane crash.MethodsData collected included documentations of DDI, tertiary surveys, Injury Severity Scale (ISS) score, Glasgow Coma Scale score, number and type of injuries, and emergency intervention. Clinically significant injuries were separated from non-clinically significant injuries. Comparison was made to a crash in the UK (1989), before advanced trauma life support became practiced widely.ResultsAll 126 victims were evaluated in a hospital emergency department; 66 were admitted with a total of 171 clinically significant injuries. Twelve clinically significant DDIs were found in eight patients (12%). In 65%, a tertiary survey was documented. The DDI incidences differed for several risk factors. Eighty-one survivors of the UK crash had a total of 332 injuries. Of those with > 5 injuries, 5% had a DDI, versus 8% of those with ≤ 5 injuries.ConclusionsThe DDI incidence in this study was 7% of the injuries in 12% of the population. A tertiary survey was documented in 65%; ideally this should be 100%. In this study, a high ISS score, head injury, > 5 injuries, and emergency intervention were associated with DDI. The DDI incidence in the current study was lower than in the UK crash.

Prehospital Care and In-hospital Mortality of Trauma Patients in Iran

2014 ◽  
Vol 29 (5) ◽  
pp. 473-477 ◽  
Author(s):  
Mohammad Paravar ◽  
Mehrdad Hosseinpour ◽  
Mahdi Mohammadzadeh ◽  
Azade Sadat Mirzadeh
Keyword(s):  
Hospital Mortality ◽  
Trauma Center ◽  
Injury Severity ◽  
Life Support ◽  
Prehospital Care ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Publication Type ◽  
Transport Time ◽  
Severe Injuries

AbstractIntroductionThe aim of this study was to determine the effect of prehospital time and advanced trauma life support interventions for trauma patients transported to an Iranian Trauma Center.MethodsThis study was a retrospective study of trauma victims presenting to a trauma center in central Iran by Emergency Medical Services (EMS) and hospitalized more than 24 hours. Demographic and injury characteristics were obtained, including accident location, damaged organs, injury mechanism, injury severity score, prehospital times (response, scene, and transport), interventions and in-hospital outcome.ResultsTwo thousand patients were studied with an average age of 36.3 (SD = 20.8) years; 83.1% were male. One hundred twenty patients (6.1%) died during hospitalization. The mean response time, at scene time and transport time were 6.6 (SD = 3), 11.1 (SD = 5.2) and 12.8 (SD = 9.4), respectively. There was a significant association of longer transport time to worse outcome (P = .02). There was a trend for patients with transport times >10 minutes to die (OR: 0.8; 95% CI, 0.1-6.59). Advanced Life Support (ALS) interventions were applied for patients with severe injuries (Revised Trauma Score ⩽7) and ALS intervention was associated with more time on scene. There was a positive association of survival with ALS interventions applied in suburban areas (P = .001).ConclusionIn-hospital trauma mortality was more common for patients with severe injuries and long prehospital transport times. While more severely injured patients received ALS interventions and died, these interventions were associated with positive survival trends when conducted in suburban and out-of-city road locations with long transport times.HosseinpourM, ParavarM, MohammadzadehM, MirzadehAS. Prehospital care and in-hospital mortality of trauma patients in Iran. Prehosp Disaster Med. 2014;29(5):1-5.

Relationship between the Injury Severity Score and the need for life-saving interventions in trauma patients in the UK

2020 ◽  
pp. emermed-2019-209092
Author(s):  
James Vassallo ◽  
Gordon Fuller ◽  
Jason E Smith
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Major Trauma ◽  
Injury Severity ◽  
Research Network ◽  
Trauma Patients ◽  
Traditional Definition ◽  
Life Saving ◽  
Clinically Significant ◽  
The Uk

IntroductionMajor trauma is the third leading cause of avoidable mortality in the UK. Defining which patients require care in a major trauma centre is a critical component of developing, evaluating and enhancing regional major trauma systems. Traditionally, trauma patients have been classified using the Injury Severity Score (ISS), but resource-based criteria have been proposed as an alternative. The aim of this study was to investigate the relationship between ISS and the use of life-saving interventions (LSI).MethodsRetrospective cohort study using the Trauma Audit Research Network database for all adult patients (aged ≥18 years) between 2006 and 2014. Patients were categorised as needing an LSI if they received one or more interventions from a previously defined list determined by expert consensus.Results193 290 patients met study inclusion criteria: 56.9% male, median age 60.0 years (IQR 41.2–78.8) and median ISS 9 (IQR 9–16). The most common mechanism of injury was falls <2 m (52.1%), followed by road traffic collisions (22.2%). 15.1% received one or more LSIs. The probability of a receiving an LSI increased with increasing ISS, but only a low to moderate correlation was evident (0.334, p<0.001). A clinically significant number of cases (5.3% and 7.6%) received an LSI despite having an ISS ≤8 or <15, respectively.ConclusionsA clinically significant number of adult trauma patients requiring LSIs have an ISS below the traditional definition of major trauma. The traditional definition should be reconsidered and either lowered, or an alternative metric should be used.

Case Report: FAST Ultrasound Interpretation in Trauma Resuscitation

POCUS Journal ◽  
2016 ◽  
Vol 1 (3) ◽  
pp. 13-14
Author(s):  
Stuart Douglas, PGY4 ◽  
Joseph Newbigging, MD ◽  
David Robertson, MD
Keyword(s):  
Case Report ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Life Support ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Ultrasound Probe ◽  
Trauma Resuscitation ◽  
Highly Sensitive ◽  
Pouch Of Douglas

FAST Background: Focused Assessment with Sonography for Trauma (FAST) is an integral adjunct to primary survey in trauma patients (1-4) and is incorporated into Advanced Trauma Life Support (ATLS) algorithms (4). A collection of four discrete ultrasound probe examinations (pericardial sac, hepatorenal fossa (Morison’s pouch), splenorenal fossa, and pelvis/pouch of Douglas), it has been shown to be highly sensitive for detection of as little as 100cm3 of intraabdominal fluid (4,5), with a sensitivity quoted between 60-98%, specificity of 84-98%, and negative predictive value of 97-99% (3).

scholarly journals Validation of the BATT score for prehospital risk stratification of traumatic haemorrhagic death: usefulness for tranexamic acid treatment criteria

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Francois-Xavier Ageron ◽  
Timothy J. Coats ◽  
Vincent Darioli ◽  
Ian Roberts
Keyword(s):  
Tranexamic Acid ◽  
Acid Treatment ◽  
Injury Severity ◽  
External Validation ◽  
Research Network ◽  
Brier Score ◽  
Trauma Patients ◽  
Using Data ◽  
The Uk ◽  
The Impact

Abstract Background Tranexamic acid reduces surgical blood loss and reduces deaths from bleeding in trauma patients. Tranexamic acid must be given urgently, preferably by paramedics at the scene of the injury or in the ambulance. We developed a simple score (Bleeding Audit Triage Trauma score) to predict death from bleeding. Methods We conducted an external validation of the BATT score using data from the UK Trauma Audit Research Network (TARN) from 1st January 2017 to 31st December 2018. We evaluated the impact of tranexamic acid treatment thresholds in trauma patients. Results We included 104,862 trauma patients with an injury severity score of 9 or above. Tranexamic acid was administered to 9915 (9%) patients. Of these 5185 (52%) received prehospital tranexamic acid. The BATT score had good accuracy (Brier score = 6%) and good discrimination (C-statistic 0.90; 95% CI 0.89–0.91). Calibration in the large showed no substantial difference between predicted and observed death due to bleeding (1.15% versus 1.16%, P = 0.81). Pre-hospital tranexamic acid treatment of trauma patients with a BATT score of 2 or more would avoid 210 bleeding deaths by treating 61,598 patients instead of avoiding 55 deaths by treating 9915 as currently. Conclusion The BATT score identifies trauma patient at risk of significant haemorrhage. A score of 2 or more would be an appropriate threshold for pre-hospital tranexamic acid treatment.

scholarly journals Impact of Implementation of Sequential Trauma Education Programs (STEPs) Course on Missed Injuries in Emergency Polytrauma Patients, Ismailia, Egypt

2021 ◽  
Author(s):  
Adel Hamed Elbaih ◽  
Maged El-Setouhy ◽  
Jon Mark Hirshon ◽  
Hazem Mohamed El-Hariri ◽  
Mohamed El-Shinawi
Keyword(s):  
Low Income ◽  
Life Support ◽  
University Hospital ◽  
Low Income Countries ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Education Programs ◽  
Missed Injuries ◽  
Polytrauma Patients ◽  
Trauma Education

Abstract IntroductionTrauma deaths account for 8% of all deaths in Egypt. Patients with multiple injuries are at high risk but may be saved with a good triage system and a well-trained trauma team in dedicated institutions. The incidence of missed injuries in the Emergency Department (ED) of Suez Canal University Hospital (SCUH) was found to be 9.0% after applying Advanced Trauma Life Support (ATLS) guidelines. However, this rate is still high compared with many trauma centers.AimImprove the quality of management of polytrauma patients by decreasing the incidence of missed injuries by implementing the Sequential Trauma Education Programs (STEPs) course in the ED at SCUH.MethodsThis interventional training study was conducted in the SCUH ED that adheres to CONSORT guidelines. The study was conducted during the 1-month precourse and for 6 months after the implementation of the STEPs course for ED physicians. Overall, 458 polytrauma patients were randomly selected, of which 45 were found to have missed injuries after applying the inclusion and exclusion criteria. We assessed the clinical relevance of these cases for missed injuries before and after the STEPs course.ResultsOverall, 45 patients were found to have missed injuries, of which 15 (12%) were pre-STEPs and 30 (9%) were post-STEPs course. The STEPs course significantly increased adherence to vital data recording, but the reduction of missed injuries (3.0%) was not statistically significant in relation to demographic and trauma findings. However, the decrease in missed injuries in the post-STEPs course group was an essential clinically significant finding.ConclusionSTEPs course implementation decreased the incidence of missed injuries in polytrauma patients. Thus, the STEPs course can be considered at the same level of other advanced trauma courses as a training skills program or possibly better in dealing with trauma patients. Repetition of this course by physicians should be mandatory to prevent more missed injuries. Therefore, the validation of STEPs course certification should be completed at least every 2 years to help decrease the number of missed injuries, especially in low-income countries and low-resource settings.Trial RegistrationProject manager for the Pan African Clinical Trial Registry (www.pactr.org) database has been accepted with the date of approval:18/11/2020. Current Controlled Trials number for the registry is PACTR202011853914203. Please note that the article state Retrospectively registered that my study adheres to CONSORT guidelines.

Trauma surgery

2014 ◽  
Author(s):  
Sebastian Dawson-Bowling ◽  
Serena Ledwidge
Keyword(s):  
Life Support ◽  
Trauma Surgery ◽  
Clinical Signs ◽  
Tension Pneumothorax ◽  
Trauma Team ◽  
Definitive Treatment ◽  
Advanced Trauma Life Support ◽  
Mortality And Morbidity ◽  
Golden Hour ◽  
The Uk

Appreciation of the ‘golden hour’ for resuscitation, and adoption of prin­ciples of the advanced trauma life support (ATLS) system are key factors in improving outcome for the patient with major injuries. Adherence to the strict protocols of the ABCDEs of the primary survey enables the trauma team to identify and deal with life-threatening conditions, prior to definitive treatment of problems with lesser immediacy. The clinician who understands the mechanism of injury will main­tain heightened levels of suspicion for clinical signs which point to well-recognized conditions resulting in early mortality and morbidity, for instance, tension pneumothorax, cardiac tamponade, and rising intrac­ranial pressure. This chapter will probe your grasp of the principles of trauma manage­ment. You will also be tested on common patterns of thoracic, abdomi­nal, vascular, and cranial injuries. Whilst clinical presentations of civilian trauma have remained consist­ent in recent years, the impact of military trauma in worldwide theatres of conflict has stimulated numerous advances in the management of trauma. The current impetus for reorganization of trauma services in the UK is tacit acknowledgement of the improvement in outcomes that can be achieved by adherence to recognized protocols in this challenging and demanding field of surgery.

Accuracy of Preoperative MDCT in Patients With Penetrating Abdominal and Pelvic Trauma

2020 ◽  
Vol 71 (2) ◽  
pp. 231-237 ◽  
Author(s):  
Zonia Ghumman ◽  
Sandra Monteiro ◽  
Vincent Mellnick ◽  
Angela Coates ◽  
Paul Engels ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Injury Severity ◽  
Study Cohort ◽  
Trauma Patients ◽  
Gi Tract ◽  
Qualitative Review ◽  
Radiology Reports ◽  
Organ Systems ◽  
Absolute Agreement ◽  
Clinically Significant

Purpose: This study aims to evaluate the overall diagnostic accuracy of preoperative multidetector computed tomography (MDCT) in penetrating abdominal and pelvic injuries (PAPI). Method and Materials: We used our hospitals’ trauma registry to retrospectively identify patients with PAPI from January 1, 2006, to December 31, 2016. Only patients who had a 64-MDCT scan at presentation and subsequently underwent laparotomy or laparoscopy were included in our study cohort. Each finding noted on MDCT was rated using a 5-point scale to indicate certainty of injury, with a score of 0 being definitive. Using surgical findings as the gold standard, the accuracy of radiology reports was analyzed in 2 ways. A κ statistic was calculated to evaluate each pair of values for absolute agreement, and ratings for all organ systems were analyzed using a repeated measures analysis of variance (ANOVA) to determine whether radiology and surgical findings were similar enough to be clinically meaningful. Qualitative review of the radiology and surgical reports focused on the gastrointestinal (GI) tract was conducted. Results: Our cohort consisted of 38 males and 4 females with a median age of 29 years and a median injury severity score of 15.6. For this study, 12 different organ groups were categorized and analyzed. Of those organ groups, absolute agreement between MDCT and surgical findings was found only for liver and spleen (κ values ranging from 0.2 to 0.5). Additionally, the ANOVA revealed an interaction between finding type and organ system ( F 1, 33 = 7.4, P < .001). The most clinically significant discrepancies between MDCT and surgical findings were for gallbladder, bowel, mesenteric, and diaphragmatic injuries. Qualitative review of the GI tract revealed that radiologists can detect significant findings such as presence of injury, however, localization and extent of injury pose a challenge. Conclusion: The detection of clinically significant injuries to solid organs in trauma patients with PAPI on 64-MDCT is adequate. However, detection of injury to the remaining organ groups on MDCT, especially bowel, mesentery, and diaphragm, remains a challenge.

Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

2013 ◽  
Vol 33 (6) ◽  
pp. 18-24 ◽  
Author(s):  
Stavros Gourgiotis ◽  
George Gemenetzis ◽  
Hemant M. Kocher ◽  
Stavros Aloizos ◽  
Nikolaos S. Salemis ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Life Support ◽  
Operative Management ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Permissive Hypotension ◽  
Randomized Controlled Clinical Trials ◽  
Resuscitation Fluid ◽  
Crystalloid Solutions ◽  
Prehospital Trauma Life Support

Severity of hemorrhage and rate of bleeding are fundamental factors in the outcomes of trauma. Intravenous administration of fluid is the basic treatment to maintain blood pressure until bleeding is controlled. The main guideline, used almost worldwide, Advanced Trauma Life Support, established by the American College of Surgeons in 1976, calls for aggressive administration of intravenous fluids, primarily crystalloid solutions. Several other guidelines, such as Prehospital Trauma Life Support, Trauma Evaluation and Management, and Advanced Trauma Operative Management, are applied according to a patient’s current condition. However, the ideal strategy remains unclear. With permissive hypotension, also known as hypotensive resuscitation, fluid administration is less aggressive. The available models of permissive hypotension are based on hypotheses in hypovolemic physiology and restricted clinical trials in animals. Before these models can be used in patients, randomized, controlled clinical trials are necessary.

scholarly journals Impact of the COVID-19 outbreak on severe trauma trends and healthcare system reassessment in Lombardia, Italy: an analysis from the regional trauma registry

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Riccardo Giudici ◽  
Armando Lancioni ◽  
Hedwige Gay ◽  
Gabriele Bassi ◽  
Osvaldo Chiara ◽  
...  
Keyword(s):  
Injury Severity ◽  
Life Support ◽  
Trauma Registry ◽  
Demographic Data ◽  
Advanced Life Support ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Icu Admission ◽  
Patient Admissions ◽  
High Level

Abstract Backgrounds The COVID-19 pandemic drastically strained the health systems worldwide, obligating the reassessment of how healthcare is delivered. In Lombardia, Italy, a Regional Emergency Committee (REC) was established and the regional health system reorganized, with only three hospitals designated as hubs for trauma care. The aim of this study was to evaluate the effects of this reorganization of regional care, comparing the distribution of patients before and during the COVID-19 outbreak and to describe changes in the epidemiology of severe trauma among the two periods. Methods A cohort study was conducted using retrospectively collected data from the Regional Trauma Registry of Lombardia (LTR). We compared the data of trauma patients admitted to three hub hospitals before the COVID-19 outbreak (September 1 to November 19, 2019) with those recorded during the pandemic (February 21 to May 10, 2020) in the same hospitals. Demographic data, level of pre-hospital care (Advanced Life Support-ALS, Basic Life Support-BLS), type of transportation, mechanism of injury (MOI), abbreviated injury score (AIS, 1998 version), injury severity score (ISS), revised trauma score (RTS), and ICU admission and survival outcome of all the patients admitted to the three trauma centers designed as hubs, were reviewed. Screening for COVID-19 was performed with nasopharyngeal swabs, chest ultrasound, and/or computed tomography. Results During the COVID-19 pandemic, trauma patients admitted to the hubs increased (46.4% vs 28.3%, p < 0.001) with an increase in pre-hospital time (71.8 vs 61.3 min, p < 0.01), while observed in hospital mortality was unaffected. TRISS, ISS, AIS, and ICU admission were similar in both periods. During the COVID-19 outbreak, we observed substantial changes in MOI of severe trauma patients admitted to three hubs, with increases of unintentional (31.9% vs 18.5%, p < 0.05) and intentional falls (8.4% vs 1.2%, p < 0.05), whereas the pandemic restrictions reduced road- related injuries (35.6% vs 60%, p < 0.05). Deaths on scene were significantly increased (17.7% vs 6.8%, p < 0.001). Conclusions The COVID-19 outbreak affected the epidemiology of severe trauma patients. An increase in trauma patient admissions to a few designated facilities with high level of care obtained satisfactory results, while COVID-19 patients overwhelmed resources of most other hospitals.

“A-OK”: Chest Radiograph during Primary Survey Facilitates Faster, More Accurate Endotracheal Tube Position in Injured Children

2019 ◽  
Vol 85 (5) ◽  
pp. 479-487
Author(s):  
Andrea N. Doud ◽  
Michaela Gaffley ◽  
Olivia Hostetter ◽  
Jennifer W. Talton ◽  
John K. Petty
Keyword(s):  
Endotracheal Tube ◽  
Life Support ◽  
Pediatric Trauma ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Primary Survey ◽  
Breath Sounds ◽  
Before And After ◽  
Chest X Ray ◽  
Baseline Characteristics

The Advanced Trauma Life Support algorithm recommends bedside confirmatory techniques to confirm correct endotracheal tube (ETT) depth, a critical component in the care of pediatric trauma patients. We hypothesized that bedside confirmatory techniques are inaccurate and that early chest X-ray (CXR) would overcome such inaccuracies, allowing for faster intervention of malpositioned ETTs. An “A-OK” algorithm of immediate CXR following intubation in injured children aged <16 years was implemented. Eligible patients the years before and after implementation were identified. The accuracy of bedside confirmatory techniques (use of length-based depths and auscultation of breath sounds) was assessed. Post-“A-OK” patients were compared with pre-“A-OK” controls regarding the speed of malpositioned ETTrepositioning. Twenty-eight post-“A-OK” cases and 23 pre-“A-OK” controls were identified. The groups did not differ in baseline characteristics. Bedside confirmatory techniques were accurate in only 61 per cent (length-based depth) and 58 per cent (auscultation of breath sounds) of patients. Time to ETT repositioning was significantly longer in pre-“A-OK” controls than in post-“A-OK” cases (35.2 ± 15.9 minutes vs 21.1 ± 11.8 minutes, P = 0.03). Bedside confirmatory techniques to determine ETT positioning are inaccurate in children. Inclusion of CXR in the primary survey is safe and allows for more rapid repositioning of malpositioned ETTs.

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