Thermomechanical Combination Injuries: A Rare But Life-Threatening Entity

2021 ◽  
Author(s):  
Matthias Muenzberg ◽  
Kathrin Kaeppler ◽  
Gabriel Hundeshagen ◽  
Theresa Kenngott ◽  
Benjamin Ziegler ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Multiple Trauma ◽  
Severity Score ◽  
Injury Severity ◽  
Highly Qualified ◽  
Inclusion Criteria ◽  
Burn Care ◽  
Life Threatening ◽  
The Mean ◽  
Level 1

Abstract Thermomechanical combination injuries (TMCIs) are feared for their demanding preclinical and clinical management and bear the risk of high mortality compared to the single injury of a severe burn or multiple trauma. There remains a significant lack of standardized algorithms for diagnostics and therapy of this rare entity. The objective of the present study was to profile TMCI aiming at standardized procedures. In this study, TMCIs were extracted from our burn database of a level 1 burn and trauma center. From 2004 to 2017, all patients with TMCI were retrospectively analyzed. Further inclusion criteria were multiple trauma accompanied by burn with ≥10% TBSA. Patient and injury characteristics including injury severity score and outcome parameter were analyzed. A total of 45 patients matched the selective inclusion criteria of TMCI, comprising 4% of all burn injuries during the period. The average age was 38 years (range: 14–86), with a mean TBSA of 43% (range: 10–97%). The mean recorded temperature at admission was 34.8°C (range: 29.6–37.1) with 2215 ml volume of resuscitation fluids (range: 500–8000) administered preclinically in total. The mean injury severity score was 16. The overall mortality rate was 22%. TMCIs are rare and life-threatening events that require highly qualified management in combined level 1 trauma and burn centers to address both burn and trauma treatment. The multiple injury pattern is diverse, complicating standardized management in view of burn care-specific measures, as normothermia and restrictive volume management. The present study reveals further profiles and underlines the need for addressing TMCIs in ABLS®, ATLS®, and PHTLS® programs.

scholarly journals Skor prediksi sindrom disfungsi multi-organ pada pasien multitrauma

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Leo Rendy ◽  
Heber B. Sapan ◽  
Laurens T. B. Kalesaran ◽  
Julius H. Lolombulan
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Injury Severity Score ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Risk Score ◽  
Severity Score ◽  
Injury Severity ◽  
Failure Assessment ◽  
The Mean

Abstract: Multiple organ dysfunction syndrome (MODS) in patients with major trauma remains to be frequent and devastating complication during clinical course in emergency department and intensive care unit (ICU). The ability to easily and accurately identify patients at risk for MODS postinjury especially in multitrauma cases would be very valuable. This study aimed to construct an instrument for prediction of the development of MODS in adult multitrauma patients using clinical and laboratory data available in the first day at prahospital and emergency department (hospital) setting. This was a prospective study. Samples were adult multitrauma patients with Injury Severity Score (ISS) ≥16, aged 16-65 years old, admitted to 4 academic Level-I trauma center from September 2014 to September 2015. Sequential organ failure assessment (SOFA) score was used to determine MODS during hospitalization. A risk score created from the final regression model consisted of significant variables as MODS predictor. The results showed that there were 98 multitrauma patients as samples. The mean age was 35.2 years old; mostly male (85.71%); the mean of ISS was 23.6; mostly (76.53%) were caused by blunt injury mechanism. MODS was encountered in 43 patients (43.87%). The prediction risk score consists of Revised Trauma Score (RTS) (<7.25) and serum lactate level ≥2 mmol/L. This study also verified several independent risk factors for post multitrauma MODS, such as ISS >25, presence of SIRS, shock grade 2 or more, and white blood cell count >12,000/mm3. Conclusion: We derived a novel, simple, and applicable instrument to predict MODS in adult following multitrauma. The use of this scoring system may allow early identification of multitrauma patients who are at risk for MODS and result in more aggressive targeted resuscitation and better referral allocation based on regional trauma system.Keywords: MODS, multitrauma, emergency department, MODS prediction scoreAbstrak: Sindrom disfungsi multi-organ (MODS) merupakan komplikasi buruk yang sering terjadi sepanjang perjalanan klinis pasien trauma mayor di Unit Gawat Darurat (UGD) maupun di ruang perawatan intensif. Suatu nilai patokan yang dapat memprediksi MODS pascatrauma secara akurat sejak dini tentunya sangat berharga bagi tatalaksana pasien terutama pada kasus multitrauma. Penelitian ini bertujuan untuk membuat suatu instrumen yang dapat memrediksi perkembangan MODS pada pasien dewasa multitrauma dengan menggunakan data klinis dan laboratorium yang tersedia pada 24 jam pertama pasca trauma pada seting fase prahospital maupun di fase hospital sejak di UGD. Jenis penelitian ini prospektif, mengumpulkan pasien multitrauma dengan Injury Severity Score (ISS) ≥16, rentang usia 16-65 tahun, di 4 pusat trauma level-1 rumah sakit pendidikan selama 1 tahun (September 2014-2015). Dilakukan pencatatan data klinis dan laboratorium sesuai perkembangan pasien. Skor sequential organ failure assessment (SOFA) digunakan untuk menentukan adanya MODS selama perawatan. Skor prediksi dibuat dengan membangun model regresi logistik yang signifikan untuk memrediksi terjadinya MODS pasca multitrauma. Hasil penelitian mendapatkan 98 sampel multitrauma yang memenuhi kriteria inklusi dengan rerata usia 35,2 tahun, sebagian besar laki-laki (85,71%) dengan rerata ISS 23,6, dan disebabkan oleh trauma tumpul (76,53%). MODS terjadi pada 43 pasien (43,87%). Skor prediksi terdiri dari RTS dengan (cut off point 7,25) dan kadar laktat serum (cut off point 3,44 mmol/mL). Penelitian ini juga memverifikasi beberapa faktor risiko individual terjadinya MODS pasca multitrauma yaitu ISS>25, adanya SIRS, syok derajat 2 atau lebih, dan leukositosis >12.000. Simpulan: Kami melaporkan instrumen baru yang praktis untuk memrediksi MODS pada pasien multitrauma dewasa. Skor ini memungkinkan identifikasi dini pasien trauma yang berisiko akan mengalami MODS sehingga dapat menjadi tanda alarm dilakukannya resusitasi yang lebih agresif dan tepat serta alokasi rujukan pasien yang lebih efisien berdasarkan sistem trauma regional.Kata kunci: MODS, multitrauma, UGD, skor prediksi MODS

scholarly journals Epidemiology of penetrating injury in an urban versus rural level 1 trauma center in the Netherlands

2020 ◽  
pp. 102490792090419
Author(s):  
Quinten GH Rikken ◽  
Abdes Chadid ◽  
Joost Peters ◽  
Leo MG Geeraedts ◽  
Georgios F Giannakopoulos ◽  
...  
Keyword(s):  
The Netherlands ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Medical Center ◽  
Penetrating Injury ◽  
Penetrating Injuries ◽  
Level 1 ◽  
Universal Definition ◽  
Definition Of

Background: Penetrating injury can encompass a large spectrum of injuries dependent on the penetrating object, the location of entry, and the trajectory of the object through the human body. Therefore, the management of penetrating injuries can be challenging and often requires rapid assessment and intervention. No universal definition of penetrating injury exists in the literature and little is known about the demographics and outcome of penetrating injury in the Netherlands. Objective: A research was carried out to ascertain the size and outcome of penetrating injuries in two level-one trauma centers in the Netherlands. Methods: Using the trauma registry of the Radboud University Medical Center in Nijmegen and VU University Medical Center in Amsterdam, all patients with penetrating injury were identified who were admitted to these level 1 trauma centers in the period between January 1, 2009, and January 1, 2014. Penetrating injury was defined as an injury that caused disruption of the body surface and extended into the underlying tissue or into a body cavity. Data concerning age, gender, mechanism of injury, Glasgow Coma Scale, number of injuries, type of injury, and Injury Severity Score were collected and analyzed. Patient results were stratified by Injury Severity Score. Results: In total, 354 patients were identified, making up around 2% of all admitted trauma patients 3.1% (VU Medical Center) and 1.6% (Radboud Medical Center). Patients were overwhelmingly male (83.1%) and median age was 36 years (range = 1–88 years). Most injuries were caused by stabbings (51.1%) followed by shootings (26.3%). Admission to the intensive care unit occurred in 41.1% of all patients. Median stay in the intensive care unit was 5.1 days (range = 1–96 days) and median total hospital stay was 8 days (range = 1–95 days). Mortality among these patients was 7.1%, ranging from 0% among patients with Injury Severity Score 1–8 to 100% in patients with Injury Severity Score > 34. High mortality figures were associated with injuries caused by firearms (19.4%), injuries to the head (27.9%), and alleged assaults (10.9%). Differences in demographics between the two centers were not significant. Conclusion: Penetrating injury is a relative rare occurrence in the Netherlands compared with other countries. It is associated with high mortality and substantial hospital costs. The incidence of penetrating injuries is higher in metropolitan areas than in rural areas. A universal definition of penetrating trauma should be agreed upon in order to ensure that future studies remain free of bias, and also to ensure that data remain homogeneous.

scholarly journals Comparison of the new injury severity score and the injury severity score in multiple trauma patients

2008 ◽  
Vol 11 (6) ◽  
pp. 368-371 ◽  
Author(s):  
Xiao-gang ZHAO ◽  
Yue-feng MA ◽  
Mao ZHANG ◽  
Jian-xin GAN ◽  
Shao-wen XU ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Multiple Trauma ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Patients ◽  
New Injury Severity Score ◽  
Multiple Trauma Patients

scholarly journals Survival and quality of hospital care for victims of car crashes in Western Azerbaijan, Iran

2020 ◽  
pp. 1-6
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Hospital Care ◽  
Injury Severity ◽  
Male And Female ◽  
Mean Values ◽  
Significant Difference ◽  
The Mean ◽  
Car Crashes

Background and aim: Car crashes are among the prevalent incidents seriously threatening public health. This study aimed to assess the survival and quality of hospital care for patients of car accidents in Western Azerbaijan, Iran. Methods: This cross-sectional study was conducted on 1,697 trauma victims admitted to Imam Khomeini hospital in Urmia, Iran, during 2016. The data, including systolic pressure, Glasgow Coma Scale, respiratory rate prior to admittance, severity of injuries based on surgery description, limbs and brain computed tomography scan, and diagnostic ultrasound by an specialist, were collected from medical records. The survival chance of patients was estimated using Trauma and Injury Severity Score (TRISS). To evaluate the quality of hospital service, Z and W statistics were utilized. Results: Out of 1,697 admitted victims, 1,226 (72.3%) and 471 (27.7%) subjects were male and female, respectively. The patients were within the age range of 15-54 years, including 901 (75%) male and 296 (25%) female subjects. The predominant educational levels were under diploma and illiterate in male and female patients, respectively. The mean values of the Revised Trauma Score for the recovered and deceased patients were 7.75±0.38 and 6.19±1.59, respectively; however, the mean values of the Injury Severity Score for the recovered and deceased patients were 14.57±13.72 and 52.03±27.02, respectively, indicating a statistically significant difference between the two groups. The number of observed mortalities was 69; nevertheless, the expected mortalities were 60 cases. Furthermore, the quantified W and Z statistics were -9 and 0.02, respectively. Conclusions: The results showed that the observed mortality exceeded the expected morality indicating the low quality of hospital care.

scholarly journals Care Management für Polytrauma-Patientinnen und -Patienten in einem überregionalen Level-1- Traumazentrum

Praxis ◽  
2020 ◽  
Vol 109 (13) ◽  
pp. 1039-1049
Author(s):  
Gerrolt N. Jukema ◽  
Faraneh Farokhzad ◽  
Jörk Volbracht ◽  
Klaus Steigmiller ◽  
Ulrike Held ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Care Management ◽  
Injury Severity ◽  
Diagnosis Related Groups ◽  
Level 1

Zusammenfassung. Im Zeitraum 2014 bis 2018 zeigt sich in unserem überregionalen Level-1-Traumazentrum für (Poly)trauma-Patientinnen und -Patienten (Injury Severity Score (ISS) >15) eine überdurchschnittliche verlängerte Verweildauer von 5,1 Tagen im Vergleich zu Swiss Diagnosis-Related Groups (Swiss-DRG), falls sie eine stationäre Weiterbehandlung in einer Rehabilitationsklinik benötigen. Nachdem zuerst innerhalb des Traumazentrums die einzelnen Behandlungspfade analysiert und optimiert wurden, stellte sich zum Schluss heraus, dass eine unzureichende akute stationäre Behandlungskapazität für (Poly)trauma-Patientinnen und -Patienten in Rehabilitationskliniken eine frühzeitige Verlegung in die Rehabilitation verzögerte. Reguläre Trauma-Patientinnen und -Patienten, die keine stationäre Rehabilitationsbehandlung brauchen, sind davon nicht betroffen. In dieser Gruppe konnte eine reguläre Verweildauer im Einklang mit Swiss-DRG festgestellt werden. Die längere stationäre Verweildauer der (Poly)trauma-Patientinnen und -Patienten führt zu erheblichen finanziellen Mehrkosten für das Level-1-Traumazentrum, die nicht von Versicherungsträgern vergütet werden.

Costs of Multiple Trauma Patients Treatment During the Acute Phase

Swiss Surgery ◽  
2003 ◽  
Vol 9 (6) ◽  
pp. 268-274 ◽  
Author(s):  
Ganzoni ◽  
Zellweger ◽  
Trentz
Keyword(s):  
Injury Severity Score ◽  
Multiple Trauma ◽  
Acute Phase ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Patients ◽  
Multiple Trauma Patients

Alljährlich steigende Kosten im schweizerischen Gesundheitswesen geben immer wieder Anlass zu Diskussionen. Klarheit und Fakten über die differenzierten Behandlungskosten liegen keine vor. Ziel dieser Arbeit ist es, die Akuttherapiekosten von Polytraumatisierten am Universitätsspital Zürich zu untersuchen. Basierend auf den Schlussabrechnungen von gemäss Spitalleistungskatalog (SLK) abgerechneten Patientinnen und Patienten untersuchten wir in 16 Fällen mit einem mittleren Injury Severity Score (ISS) von 33.9 die Behandlungskosten der Akuttherapie. Wir entwarfen ein Konzept zur Bewertung des mittleren Verlustes pro Grund- und Unfallversicherten, welche über Tagespauschalen abgerechnet werden und den überwiegenden Teil der hospitalisierten Patienten stellen. Die mittleren in Rechnung gestellten Behandlungskosten beliefen sich auf 128'135 Franken (31'266-310'358 CHF). Es zeigte sich, dass nach Verwendung des Gewinns von Zusatzversicherten zur Subvention der Grund-, Unfallversicherten und Sozialfällen, eine Differenz je nach Verletzungskombination und Versicherungsstatus zwischen 42% und 65%, in absoluten Zahlen 33'703 bis 138'829 Franken, bestand. Verlangt man von Spitälern kostendeckend zu arbeiten, so ist ein solcher Verlust, welcher durch das Grundversicherungssystem bedingt ist, nicht zu vernachlässigen. Bei der Einführung von neuen Abrechnungsformen müssen die hohen Kosten, die diese Patientengruppe verursacht, berücksichtigt werden.

Farm Accidents in Children

PEDIATRICS ◽  
1985 ◽  
Vol 76 (4) ◽  
pp. 562-566
Author(s):  
Thomas H. Cogbill ◽  
Henry M. Busch ◽  
Gary R. Stiers
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Trauma Center ◽  
Injury Severity ◽  
Educational Programs ◽  
Mechanism Of Injury ◽  
Optimal Outcome ◽  
Safety Measures ◽  
Life Threatening

During a 6½ year period, 105 children were admitted to the hospital as the result of trauma that occurred on farms. The mechanism of injury was animal related in 42 (40%), tractor or wagon accident in 28 (26%), farm machinery in 21 (20%), fail from farm building in six (6%), and miscellaneous in eight (8%). Injury Severity Score was calculated for each patient. An Injury Severity Score of greater than or equal to 25 was determined for 11 children (11%). Life-threatening injuries, therefore, are frequently the result of childhood activities that take place in agricultural environments. The most common injuries were orthopedic, neurologic, thoracoabdominal, and maxillofacial. There was one death in the series, and only one survivor sustained major long-term disability. Such injuries are managed with optimal outcome in a regional trauma center. Educational programs with an emphasis on prevention and safety measures may reduce the incidence of farm accidents.

Curiosity or underdiagnosed? Thoracolumbar spinal column injuries with concomitant trauma of the pancreas

2020 ◽  
Author(s):  
Jakob Hax ◽  
Sascha Halvachizadeh ◽  
Kai Oliver Jensen ◽  
Till Berk ◽  
Henrik Teuber ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Spinal Injury ◽  
Thoracolumbar Spine ◽  
Pancreatic Injury ◽  
Spinal Injuries ◽  
Spine Injury ◽  
The Mean

Abstract Background: The pancreas is an organ which is at risk of damage as a consequence of thoracolumbar spine injury. However, to our knowledge, no studies have provided any prevalence data to support this assumption. Therefore, the coincidence of pancreatic trauma in patients with spine injury is still unknown. Data from the TraumaRegister DGU® (TR-DGU) was analysed to estimate the prevalence of this correlation and to determine its influence on clinical outcome.Methods: A retrospective investigation of cases documented in the TR-DGU between 2008 and 2017 was performed. We included data of patients admitted to participating European trauma centres who had thoracic or lumbar spine injuries and met the following criteria: i) Injury Severity Score (ISS) ≥ 9, ii) blunt trauma, and iii) no early transfer out of hospital. We investigated the coincidence of pancreas injury in patients with at least an Abbreviated Injury Scale (AIS) of 2 of the thoracic or lumbar spine. Therefore, we included all kind of relevant injuries of the thoracolumbar spine.Results: In the group with thoracolumbar injury with concomitant pancreatic injury, the mean age was 43.1 ± 18.6 years, and 68% of these patients were male. The most frequent mechanisms of trauma were car (38%) and motorbike (17%) accidents, as well as high falls (23.8%). The mean Injury Severity Score was 35.7 ± 16.0 points and the in-hospital mortality rate was 17.5%. The overall prevalence of pancreatic injury was 60.7 (0.61%; 95% confidence interval (CI), 0.58–0.65) per 10,000 patients. Patients with severe spinal injuries (AIS ≥ 2) were more likely to present with a concomitant pancreatic injury compared to patients with no or only minor spinal injury (AIS 0–1) (Odds ratio (OR) 1.78; 95%CI, 1.57–2.01).Conclusions: Concomitant pancreatic injury in patients with spinal injuries of the thoracolumbar spine is rare. However, patients with more severe spinal injuries were overall more likely (OR 1.78) to present with an accompanying pancreatic injury than those with minor thoracolumbar injuries. Therefore, trauma surgeons treating severely injured patients must be alert not to overlook this rare concomitant injury, because it does not clearly correlate with the severity of spinal injury.

scholarly journals Validitas New Injury Severity Score (NISS) dalam Mendeteksi Terjadinya Koagulopati pada Pasien Multiple Trauma

2017 ◽  
Vol 1 (1) ◽  
pp. 15
Author(s):  
I Komang Yose Antara ◽  
I Ketut Wiargitha ◽  
Tjokorda G. B. Mahadewa
Keyword(s):  
Injury Severity Score ◽  
Multiple Trauma ◽  
Severity Score ◽  
Area Under Curve ◽  
Injury Severity ◽  
Cross Sectional ◽  
New Injury Severity Score

Tujuan: untuk mencari validitas new injury severity score (NISS) dalam mendeteksi koagulopati akut pada pasien multiple trauma. Metode: penelitian ini adalah uji diagnostik dengan rancangan cross sectional, dilakukan untuk mencari validitas NISS dalam mendeteksi terjadinya koagulopati akut pada 61 pasien multiple trauma dengan ISS >16. Penelitian dilakukan di RSUP Sanglah Denpasar sejak bulan Januari 2014 hingga November 2015. Data dianalisis dengan menggunakan kurva ROC dan uji diagnostik tabel 2x2 sehingga didapatkan area under curve, cut off point, sensitifitas, spesifisitas, nilai prediksi positif, nilai prediksi negatif, rasio kemungkinan positif, dan rasio kemungkinan negatif. Hasil: didapatkan cut off point NISS 41 dengan AUC 0,8851 (>0,7). Sensitifitas dan spesifisitas NISS cukup baik dalam mendeteksi terjadinya koagulopati akut pada pasien multiple trauma yaitu sebesar 79,2% dan 91,8% (CI 95%: 0,78-0,98). Hasil nilai prediksi positif 86,4%, nilai prediksi negatif 87,2%, rasio kemungkinan positif 9,76 dan rasio kemungkinan negatif 0,227 mendukung bahwa nilai diagnostik NISS cukup baik. Simpulan: validitas NISS cukup baik dalam mendeteksi terjadinya koagulopati akut pada pasien multiple trauma.

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