scholarly journals Ten-year inhospital mortality trends for patients with trauma in Japan: a multicentre observational study

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018635 ◽  
Author(s):  
Isao Nagata ◽  
Toshikazu Abe ◽  
Masatoshi Uchida ◽  
Daizoh Saitoh ◽  
Nanako Tamiya
Keyword(s):  
Logistic Regression ◽  
Observational Study ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Whole Body ◽  
Inhospital Mortality ◽  
Regression Analyses ◽  
Mortality Trends ◽  
Multivariable Logistic Regression

ObjectivesTrauma is one of the main causes of death in Japan, and treatments and prognoses of these injuries are constantly changing. We therefore aimed to investigate a 10-year trend (2004–2013) in inhospital mortality among patients with trauma in Japan.DesignMulticentre observational study.SettingJapanese nationwide trauma registry (the Japan Trauma Data Bank) data.ParticipantsAll patients with trauma whose Injury Severity Score (ISS) were 3 and above, who were aged 15 years or older, and whose mechanisms of injury (MOI) were blunt and penetrating between 2004 and 2013 (n=90 833).Outcome measuresA 10-year trend in inhospital mortality.ResultsInhospital mortality for all patients with trauma significantly decreased over the study decade in our Cochran-Armitage test (P<0.001). Similarly, inhospital mortality for patients with ISS 16 or more and patients who scored 50% or better on the Trauma and Injury Severity Score (TRISS) probability of survival scale significantly decreased (P<0.001). In addition, the OR for inhospital mortality of these three patient groups decreased yearly after adjusting for age, gender, MOI, ISS, Glasgow Coma Scale, systolic blood pressure and respiratory rate on hospital arrival in multivariable logistic regression analyses. Furthermore, inhospital mortality for patient with blunt trauma significantly decreased in injury mechanism-stratified Mantel-extension testing (P<0.001). Finally, multivariable logistic regression analyses showed that the OR for inhospital mortality of patients with ISS 16 and over decreased each year after adding and adjusting for means of transportation and usage of whole-body CT.ConclusionInhospitalmortality for patients with trauma in Japan significantly decreased during the study decade after adjusting for patient characteristics, injury severity and the response environment after injury.

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.

Comparison of the Prognostic Significance of Initial Blood Lactate and Base Deficit in Trauma Patients

2017 ◽  
Vol 126 (3) ◽  
pp. 522-533 ◽  
Author(s):  
Keyword(s):  
Logistic Regression ◽  
Injury Severity Score ◽  
Blood Lactate ◽  
Severity Score ◽  
Injury Severity ◽  
Prognostic Significance ◽  
Base Deficit ◽  
Trauma Patients ◽  
Operating Characteristics ◽  
Initial Blood

Abstract Background Initial blood lactate and base deficit have been shown to be prognostic biomarkers in trauma, but their respective performances have not been compared. Methods Blood lactate levels and base deficit were measured at admission in trauma patients in three level 1 trauma centers. This was a retrospective analysis of prospectively acquired data. The association of initial blood lactate and base deficit with mortality was tested using receiver operating characteristics curve, logistic regression using triage scores (Revised Trauma Score and Mechanism Glasgow scale and Arterial Pressure score), and Trauma Related Injury Severity Score as a reference standard. The authors also used a reclassification method. Results The authors evaluated 1,075 trauma patients (mean age, 39 ± 18 yr, with 90% blunt and 10% penetrating injuries and a mortality of 13%). At admission, blood lactate was elevated in 425 (39%) patients and base deficit was elevated in 725 (67%) patients. Blood lactate was correlated with base deficit (R2 = 0.54; P &lt; 0.001). Using logistic regression, blood lactate was a better predictor of death than base deficit when considering its additional predictive value to triage scores and Trauma Related Injury Severity Score. This result was confirmed using a reclassification method but only in the subgroup of normotensive patients (n = 745). Conclusions Initial blood lactate should be preferred to base deficit as a biologic variable in scoring systems built to assess the initial severity of trauma patients.

scholarly journals Factors Predicting outcome of patients with polytrauma in tertiary center of western Nepal

2021 ◽  
Vol 2 (1) ◽  
pp. 13-18
Author(s):  
Pradeep Ghimire ◽  
Nikunja Yogi ◽  
Balgopal Karmacharya ◽  
Abhishek Poudel ◽  
Sushil Mishra
Keyword(s):  
Logistic Regression ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
Public Health Issue ◽  
P Value ◽  
Trauma Population ◽  
Tertiary Center

 Introduction: Trauma is a public health issue associated with substantial socioeconomic impacts and major adverse clinical outcomes. No single study has previously investigated the predictors of mortality in a general trauma population. In this study, we assessed different clinico-biochemical parameters to investigate the associations between those parameters and their effects in outcome of a polytrauma patient. Methods: An analytical study was done in between January 2020 to December 2020 in patients with polytrauma admitted to intensive care unit Department of Surgery in Manipal Teaching Hospital to assess the effect of various socio-demographic and clinic-radiologic variables in outcome (Glasgow outcome scale) of polytrauma patients. All the categorical data were tested using chi square test or Fischer Exact test and continuous variables were tested using student’s “t” test. P value <0.05 was determined significant. Those independent variables significant on univariate analysis were then subjected to binary logistic regression and the data was presented as level of significance, odds ratio and 95% confidence interval. Analysis was done using SPSS 23.0. Results: Out of 67 patients, 34 had favorable GOS and 33 had unfavorable GOS. Injury Severity Score (ISS) (P<0.01), abnormal pupils (P<0.01), RBS (0.04), low GCS during presentation (<0.01), higher CT Marshal Grade (0.01) had strong associations with unfavorable outcome in polytraumatic patient. ISS was the only significant parameter when all the other significant variables were kept constant in binary logistic regression model (OR=1.18, 95% CI=1.08-1.28). Conclusion: Injury Severity Score, abnormal pupils during presentation, high level of blood sugar after polytrauma, low GCS during presentation, higher CT Marshal Grade are strong predictors in outcomes of polytraumatic patient.

scholarly journals Ten-Year in-Hospital Mortality Trends among Paediatric Injured Patients in Japan: A Nationwide Observational Study

2020 ◽  
Vol 9 (10) ◽  
pp. 3273
Author(s):  
Chiaki Toida ◽  
Takashi Muguruma ◽  
Masayasu Gakumazawa ◽  
Mafumi Shinohara ◽  
Takeru Abe ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Data Bank ◽  
Surveillance Systems ◽  
Mortality Trends ◽  
Nationwide Observational Study ◽  
Injured Patients

Injury is a major cause of worldwide child mortality. This retrospective nationwide study aimed to evaluate the characteristics of paediatric injured patients in Japan and their in-hospital mortality trends from 2009 to 2018. Injured patients aged <17 years were enrolled. Data were extracted from the Japan Trauma Data Bank. In the Cochran-Armitage test, in-hospital mortality significantly decreased during the study period (p < 0.001), except among patients <1 year old, and yearly reductions were observed among those with an Injury Severity Score ≥16 and survival rate ≥50% (p < 0.001). In regression analyses, patients who underwent urgent blood transfusion within 24 h after hospital admission (odds ratio (OR) = 3.24, 95% confidence interval (CI) = 2.38–4.41) had a higher in-hospital mortality risk. Higher survival probability as per the Trauma and Injury Severity Score was associated with lower in-hospital mortality (OR = 0.92, 95% CI = 0.91–0.92), a risk which decreased from 2009 to 2018 (OR = 6.16, 95% CI = 2.94–12.88). Based on our results, there is a need for improved injury surveillance systems for establishment of injury prevention strategies along with evaluation of the quality of injury care and outcome measures.

scholarly journals Comparison of ISS, NISS, and RTS score as predictor of mortality in pediatric fall

2017 ◽  
Vol 5 ◽  
Author(s):  
Kapil Dev Soni ◽  
Santosh Mahindrakar ◽  
Amit Gupta ◽  
Subodh Kumar ◽  
Sushma Sagar ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Trauma Center ◽  
Injury Severity ◽  
Trauma Registry ◽  
Receiver Operating Curve ◽  
Inhospital Mortality ◽  
Level 1 ◽  
Trauma Score ◽  
Level 1 Trauma Center

Abstract Background Studies to identify an ideal trauma score tool representing prediction of outcomes of the pediatric fall patient remains elusive. Our study was undertaken to identify better predictor of mortality in the pediatric fall patients. Methods Data was retrieved from prospectively maintained trauma registry project at level 1 trauma center developed as part of Multicentric Project—Towards Improving Trauma Care Outcomes (TITCO) in India. Single center data retrieved from a prospectively maintained trauma registry at a level 1 trauma center, New Delhi, for a period ranging from 1 October 2013 to 17 February 2015 was evaluated. Standard anatomic scores Injury Severity Score (ISS) and New Injury Severity Score (NISS) were compared with physiologic score Revised Trauma Score (RTS) using receiver operating curve (ROC). Results Heart rate and RTS had a statistical difference among the survivors to nonsurvivors. ISS, NISS, and RTS were having 50, 50, and 86% of area under the curve on ROCs, and RTS was statistically significant among them. Conclusions Physiologically based trauma score systems (RTS) are much better predictors of inhospital mortality in comparison to anatomical based scoring systems (ISS and NISS) for unintentional pediatric falls.

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.

Disseminierte intravasale Gerinnung und Fibrinolyse in der Frühphase nach Polytrauma

1995 ◽  
Vol 15 (02) ◽  
pp. 79-86
Author(s):  
L. Lampl ◽  
M. Helm ◽  
M. Tisch ◽  
K. H. Bock ◽  
E. Seifried
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Tissue Type ◽  
Disseminierte Intravasale Gerinnung

ZusammenfassungGerinnungsstörungen nach einem Polytrauma werden eine große Bedeutung für die weitere Prognose der Patienten beigemessen. In einer prospektiv angelegten Studie wurden bei 20 polytraumatisierten Patienten Gerinnungsund Fibrinolyseparameter analysiert, um deren Veränderungen während der präklinischen Phase zu definieren. Die Blutentnahmen wurden zum frühestmöglichen Zeitpunkt am Unfallort und bei Klinikübergabe durchgeführt. Die gewonnenen Proben wurden mit Hilfe eines speziell konzipierten »Kleinlabors« noch vor Ort verarbeitet, um möglichst native Meßwerte zu erhalten. Die Patienten wurden dem Schweregrad der Verletzung entsprechend kategorisiert und hatten einen Verletzungsschweregrad nach NACA > IV und einen Injury Severity Score (ISS) > 20. Die Ergebnisse zeigen, daß bereits in der sehr frühen Phase nach Eintritt des Traumas schwerwiegende Veränderungen des Gerinnungsund Fibrinolysesystems eintreten. Die frühzeitige Thrombingenerierung führt zu einer Verbrauchskoagulopathie und reaktiven Hyperfibrinolyse. Zusätzlich erzeugt die Freisetzung von endothelständigem Tissue-type-Plasminogenaktivator eine primäre Hyperfibrinolyse. Die Veränderungen des Gerinnungsund Fibrinolysesystems in der frühen präklinischen Phase nach Polytrauma können zu schwerwiegenden klinischen Komplikationen wie Blutungen, thromboembolischen Komplikationen und zur Ausbildung von Schockorganen führen.

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.

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