Trauma Severity Scoring Systems as Predictors of Nosocomial Infection

2002 ◽  
Vol 23 (5) ◽  
pp. 268-273 ◽  
Author(s):  
Silom Jamulitrat ◽  
Montha Na Narong ◽  
Somchit Thongpiyapoom
Keyword(s):  
Nosocomial Infection ◽  
Injury Severity Score ◽  
Nosocomial Infections ◽  
Severity Score ◽  
Injury Severity ◽  
Scoring Systems ◽  
Trauma Patients ◽  
Common Site ◽  
Site Specific ◽  
Severity Scoring

Objectives:To describe the patterns of nosocomial infections in patients with traumatic injuries and to compare the associations between injury severity, derived from various severity scoring systems, and subsequent nosocomial infections.Design:Prospective observational study.Setting:A 750-bed university hospital serving as a medical school and referral center for the southern part of Thailand.Participants:All trauma patients admitted to the hospital for more than 3 days during 1996 to 1999 were eligible for this study.Methods:The severity of injuries was measured in terms of injury severity score (ISS), revised trauma score (RTS), new injury severity score (NISS), and trauma injury severity score (TRISS). Infections acquired during hospitalization were categorized using Centers for Disease Control and Prevention criteria. The association between severity of injury and nosocomial infection was examined with Poisson regression models.Results:There were 222 nosocomial infections identified among 146 patients, yielding an infection rate of 0.8 infections per 100 patient-days. Surgical-site infection was the most common site-specific infection, accounting for 31.1% of all infections. The incidence of intravenous catheter–related bloodstream infection was 1.6 infections per 100 catheter-days. The bladder catheter–related urinary tract infection rate was 2.8 infections per 100 catheter-days. The rate of ventilator-associated pneumonia was 3.2 infections per 100 ventilator-days. The incidence of infection correlated well with injury severity. The infection incidence rate ratios for one severity category increment of ISS, NISS, RTS, and TRISS were 1.65 (95% confidence interval [CI95, 1.42 to 1.92), 1.79 (CI95, 1.55 to 2.05), 1.64 (CI95, 1.43 to 1.88), and 1.32 (CI95, 1.14 to 1.52), respectively.Conclusions:Surgical-site infection was the most common site-specific nosocomial infection. The NISS might be the most appropriate severity scoring system for adjustment of infection rates in trauma patients.

scholarly journals Evaluation of Facial Trauma Severity in Cipto Mangunkusumo Hospital Using FISS Scoring System

1970 ◽  
Vol 1 (2) ◽  
Author(s):  
Kristaninta Bangun ◽  
Ayu Diah Kesuma
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Scoring System ◽  
Injury Severity ◽  
Scoring Systems ◽  
Facial Trauma ◽  
Trauma Patients ◽  
Documentation System ◽  
Trauma Severity ◽  
Degree Of Severity

Many scoring systems were introduced to search prognostic value in trauma patients. Facial trauma is a special trauma because it can cause many disabilities in facial function. There have been several reports on facial severity scoring system, such as Facial Injury Severity Score (FISS) and Maxillofacial Injury Severity Score (MFISS). Although these scoring systems have been introduced in many journals, they are not yet used by many clinicians because of their unawareness of its beneficiary. In this study, we want to introduce and apply these scoring systems in our maxillofacial data, thus it can be used for documentation system, as a research tool, and have prediction value for prognosis We retrospectively collected data on patients with facial trauma in Cipto Mangunkusumo Hospital in 2009. The data collected were age, gender, etiology, use of helmet, type of fracture and treatment given. Each patient then evaluated by FISS score to obtain their degree of severity. Using FISS score introduced by Bagheri, we found the average FISS score ini this evaluation was 3,37 ± 1,9, with minimum value 1 and maximum value 9. Most patients have FISS score 2 (24,7%). From FISS scoring system, we found that most of maxillofacial trauma in Cipto Mangunkusumo hospital in 2009 was mild trauma. In order to evaluate if FISS scoring system has predictive value for prognosis, a large sample and complete maxillofacial database are needed.

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.

Predictors of blunt diaphragm injury in Australia

Trauma ◽  
2021 ◽  
pp. 146040862110418
Author(s):  
Annelise M Cocco ◽  
Vignesh Ratnaraj ◽  
Benjamin PT Loveday ◽  
Kellie Gumm ◽  
Phillip Antippa ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Major Trauma ◽  
Injury Severity ◽  
Rib Fractures ◽  
Organ Injury ◽  
Trauma Patients ◽  
Missed Injury ◽  
Diaphragm Injury ◽  
Trauma Service

Introduction Blunt diaphragm injury (BDI) is an uncommon, potentially fatal consequence of blunt torso injury. While associations between BDI and other factors such as mechanism of injury or other injuries have been described elsewhere, little recent research has been done in Australia into BDI. The aims of this study were to determine the incidence rate of BDI in our centre, identify how it was diagnosed, determine rates of missed injury and identify predictive factors for BDI. The hypothesis was that patients with BDI would significantly differ to those without BDI. Methods All major trauma patients with blunt torso injuries at our Level 1 major trauma service from 2010 to 2018 were included. Data for patient demographics, other injuries, diagnosis and treatment of BDI were extracted. Patients with BDI were compared with patients without BDI in order to identify differences that could be used to predict BDI in future patients. Results Of 5190 patients with a blunt torso injury, 51 (0.98%) had a BDI at a mean age of 53 ± 19.6 years, and median Injury Severity Score (ISS) of 27(IQR 21–38.5) compared with 5139 patients with a mean age of 48.2 ± 20.7 years and median ISS of 21.9(IQR 14–26) who did not have a BDI. The diagnosis of BDI was made at CT ( n = 35), surgery ( n = 14) or autopsy ( n = 2). Blunt diaphragm injury was missed on index imaging for 11 of 43 patients (25.6%). On multivariate analysis, each point increase in ISS (OR 1.03, p = 0.02); rib fractures (OR 4.65, p = 0.004); splenic injury (OR 2.60, p = 0.004); and liver injury (OR 2.78, p = 0.003) were independently associated with BDI. Conclusion Injury Severity Score, rib fractures and solid abdominal organ injury increase the likelihood of BDI. In patients with these injuries, BDI should be considered even in the presence of normal CT findings.

scholarly journals Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2156
Author(s):  
Alexander Omar ◽  
Marcel Winkelmann ◽  
Emmanouil Liodakis ◽  
Jan-Dierk Clausen ◽  
Tilman Graulich ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Injury Severity Score ◽  
Sensitivity And Specificity ◽  
Severity Score ◽  
Injury Severity ◽  
Scoring Systems ◽  
Apache Ii ◽  
Operating Characteristics ◽  
Aortic Injuries ◽  
Receiver Operating

Background: Most patients with blunt aortic injuries, who arrive alive in a clinic, suffer from traumatic pseudoaneurysms. Due to modern treatments, the perioperative mortality has significantly decreased. Therefore, it is unclear how exact the prediction of commonly used scoring systems of the outcome is. Methods: We analyzed data on 65 polytraumatized patients with blunt aortic injuries. The following scores were calculated: injury severity score (ISS), new injury severity score (NISS), trauma and injury severity score (TRISS), revised trauma score coded (RTSc) and acute physiology and chronic health evaluation II (APACHE II). Subsequently, their predictive value was evaluated using Spearman´s and Kendall´s correlation analysis, logistic regression and receiver operating characteristics (ROC) curves. Results: A proportion of 83% of the patients suffered from a thoracic aortic rupture or rupture with concomitant aortic wall dissection (54/65). The overall mortality was 24.6% (16/65). The sensitivity and specificity were calculated as the area under the receiver operating curves (AUC): NISS 0.812, ISS 0.791, APACHE II 0.884, RTSc 0.679 and TRISS 0.761. Logistic regression showed a slightly higher specificity to anatomical scoring systems (ISS 0.959, NISS 0.980, TRISS 0.957, APACHE II 0.938). The sensitivity was highest in the APACHE II with 0.545. Sensitivity and specificity for the RTSc were not significant. Conclusion: The predictive abilities of all scoring systems were very limited. All scoring systems, except the RTSc, had a high specificity but a low sensitivity. In our study population, the RTSc was not applicable. The APACHE II was the most sensitive score for mortality. Anatomical scoring systems showed a positive correlation with the amount of transfused blood products.

Proteinuria as a Predictor of Renal Dysfunction in Trauma Patients Receiving Intravenous Contrast

2011 ◽  
Vol 77 (9) ◽  
pp. 1194-1200 ◽  
Author(s):  
Justin J. Clark ◽  
Linda L. Wong ◽  
Fedor Lurie ◽  
Brad K. Kamitaki
Keyword(s):  
Injury Severity Score ◽  
Renal Dysfunction ◽  
Severity Score ◽  
Injury Severity ◽  
Fresh Frozen Plasma ◽  
Trauma Patients ◽  
Intravenous Contrast ◽  
Contrast Enhanced ◽  
Fresh Frozen ◽  
Enhanced Imaging

Trauma patients have unknown comorbidities, multiple injuries, and incomplete laboratory testing, yet require contrast-enhanced imaging to identify potentially life-threatening problems. Our goal was to characterize contrast-induced nephropathy (CIN) in this population. We retrospectively reviewed characteristics of 402 patients who presented to a Level II trauma center and received contrast-enhanced imaging. CIN was defined as creatinine rise of 0.5 mg/dL or greater or 25 per cent or greater from baseline within 48 hours. CIN occurred in 7.7 per cent and four patients required hemodialysis. Patients with CIN were older, had lower admission hemoglobin, higher Injury Severity Score, and received more blood products. Factors that predicted CIN included: male sex, age older than 46 years, body mass index less than 27 kg/m2, glomerular filtration rate less than 109 mL/min/1.73 m2, hemoglobin less than 12 mg/dL, hematocrit less than 36 per cent, proteinuria, 2 units or more of fresh-frozen plasma in 48 hours, and alcohol use. Odds ratio for developing CIN with two, five, or six of these factors was 3.39, 6.54, and 8.38, respectively. A match-controlled analysis for Injury Severity Score and age in patients with CIN versus non-CIN patients revealed the strongest predictor of CIN was proteinuria (relative risk, 2.5; confidence interval, 1.1 to 5.8). Although it is difficult to truly differentiate CIN from renal dysfunction related to injury severity in trauma patients, proteinuria may be an important factor in identifying nephropathy in this population.

Venous Thromboembolism in Trauma Patients

2007 ◽  
Vol 73 (11) ◽  
pp. 1173-1180 ◽  
Author(s):  
Om P. Sharma ◽  
Michael F. Oswanski ◽  
Rusin J. Joseph ◽  
Peter Tonui ◽  
Libby Westrick Pa-C ◽  
...  
Keyword(s):  
Risk Factor ◽  
Venous Thromboembolism ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Univariate Analysis ◽  
Trauma Patients ◽  
Vein Thrombosis ◽  
Cord Injury ◽  
Deep Vein

Serial venous duplex scans (VDS) were done in 507 trauma patients with at least one risk factor (RF) for venous thromboembolism (VTE) during a 2-year study period. Deep vein thrombosis (DVT) was detected in 31 (6.1%) patients. This incidence was 3.1 per cent in low (1–2 RFs), 3.4 per cent in moderate (3–5 RFs), and 7.7 per cent in high (≥6 RFs) VTE scores ( P = 0.172). Incidence was statistically different (3% vs 7.2%, P = 0.048) on reanalyzing patients in two risk categories, low-risk (1–4 RFs) and high-risk (≥5 RFs). Only 4 of 16 RFs had statistically higher incidence of DVT in patients with or without RFs: previous VTE (27.3% vs 5.6%, odds ratio (OR) 6.628, P = 0.024), spinal cord injury (22.6% vs 5%, OR 5.493, P = 0.001), pelvic fractures (11.4% vs 5.1%, OR 2.373, P = 0.042), and head injury with a greater than two Abbreviated Injury Score (10.5% vs 4.2%, OR 2.639, P = 0.014). On reanalyzing patients with ≥5 RFs vs <5RFs, obesity (14.3 vs 6.1%, P = 0.007), malignancy (5.6% vs 0.6%, P = 0.006), coagulopathy (10.8% vs 1.8%, P = 0.000), and previous VTE (3.2% vs 0%, P = 0.019) were significant on univariate analysis. Patients with DVT had 3.70 ± 1.75 RFs and a 9.61 ± 4.93 VTE score, whereas, patients without DVT had 2.66 ± 1.50 RFs and a 6.83 ± 3.91 VTE score ( P = 0.000). DVTs had a direct positive relationship with higher VTE scores, length of stay, and number of VDS (>1 r, P ≤ 0.001). Increasing age was a weak risk factor (0.03 r, P = 0.5). First two VDS diagnosed 77 per cent of DVTs. Patients with injury severity score of ≥15 and 25 had higher DVTs compared with the ones with lower injury severity score levels ( P ≤ 0.05). Pulmonary embolism was silent in 63 per cent and DVTs were asymptomatic in 68 per cent.

Is Blood Sugar the Next Lactate?

2006 ◽  
Vol 72 (7) ◽  
pp. 613-618 ◽  
Author(s):  
TherÈSe M. Duane ◽  
Tracey Dechert ◽  
Nicholas Dalesio ◽  
Luke G. Wolfe ◽  
Nicholas Dalesio ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Injury Severity Score ◽  
Blood Glucose Level ◽  
Blood Sugar ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Patients ◽  
Severely Injured ◽  
Infection Rates ◽  
Initial Blood

This study evaluates whether an initial blood glucose level is similarly predictive of injury severity and outcome as admission lactate in trauma patients. Between February 2004 and June 2005, we prospectively compared patients with presenting blood sugars of ≤150 mg/dL (LBS) with those with blood sugars >150 mg/dL (HBS). Fifty patients had BS above 150 mg/dL, whereas 176 patients were ≤150 mg/dL. These groups had similar demographics except for age. Injury Severity Score (ISS) of ≥15 was seen in 56.0 per cent of HBS patients versus 28.4 per cent of LBS patients (P = 0.0006). HBS patients had similar infection rates (12.0% HBS vs. 5.7% LBS, P = 0.13) but a higher mortality (30.0% HBS vs. 5.7% LBS, P < 0.0001). There was a linear relationship between ISS and BS (r2 = 0.18, P < 0.0001) and ISS and lactate (r2 = 0.17, P < 0.0001). Blood sugar trended with the lactate (r = 0.25, P = 0.0001). Hyperglycemic patients were more severely injured with higher mortality. BS correlated with lactate, and because it is easily obtainable, it may serve as a readily available predictor of injury severity and prognosis.

Epidemiology of Traumatic Esophageal Injury: An Analysis of the National Trauma Data Bank

2019 ◽  
Vol 85 (4) ◽  
pp. 342-349 ◽  
Author(s):  
Alexander A. Xu ◽  
Janis L. Breeze ◽  
Jessica K. Paulus ◽  
Nikolay Bugaev
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Data Bank ◽  
Esophageal Injury ◽  
Trauma Patients ◽  
Adult Age ◽  
National Trauma ◽  
National Trauma Data Bank

Existing literature on traumatic injury of the esophagus (TIE) is limited. We aimed to describe the clinical characteristics and outcomes of TIE. We reviewed the National Trauma Data Bank for the years 2010–2015. We described the demographics, characteristics, and outcomes of adult (age ≥16 years) TIE patients and also compared those factors in blunt versus penetrating TIE. The association between TIE and mortality was analyzed using multivariable logistic regression. Thousand four hundred eleven adult TIE patients were identified (37 per 100,000 trauma patients, 95% confidence intervals (CI): 35, 39). TIE patients were younger (38 vs 52 years), more likely to be male (81% vs 62%), and more severely injured (Injury Severity Score ≥ 25: 45% vs 7%) than patients without TIE (all P < 0.001). TIE was observed 16 times more frequently with penetrating injuries (257 per 100,000, 95% CI: 240, 270) than with blunt injuries (16 per 100,000, 95% CI: 15, 18). Inhospital TIE mortality was 19 per cent. TIE patients had greater risk of mortality than other trauma patients, after adjusting for age, gender, and Injury Severity Score (odds ratio = 1.4, 95% CI: 1.1, 1.7). Mortality in blunt and penetrating TIE did not differ. Although extremely rare, TIE is independently associated with a marked increase in mortality, even after adjusting for other risk factors.

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