Assessment of earthquake casualties and comparison of accuracy of five injury triage methods: evidence from a retrospective study

ObjectiveThe use of an injury triage method among earthquake injury patients can facilitate the reasonable allocation of resources, but the various existing injury triage methods need further confirmation. This study aims to assess the accuracy of several injury triage methods, namely, the Simple Triage and Rapid Treatment (START) technique; CareFlight Injury Triage (CareFlight); Rapid Emergency Medicine Score (REMS); Triage Revised Trauma Score (T-RTS) and Triage Early Warning Score (TEWS), based on their effects on earthquake injury patients.DesignData in the Huaxi Earthquake Casualty Database were analysed retrospectively.SettingThis study was conducted in China.ParticipantsData on 29 523 earthquake casualties were separately evaluated using the START technique, CareFlight, REMS, T-RTS and TEWS, with these being the five types of injury triage studied.Primary outcome measureThe receiver operating characteristic (ROC) curves for the five injury triages were calculated based on hospital deaths, injury severity scores greater than 15 points, and whether casualties stayed in the intensive care unit.ResultsThe ROC curve areas of the START technique, CareFlight, REMS, T-RTS and TEWS were 0.750, 0.737, 0.835, 0.736 and 0.797, respectively. Among the five injury triages, the most accurate in predicting hospital deaths was REMS, with an average area under the curve (AUC) of 0.835, with this due to the inclusion of more evaluation indicators.ConclusionAll methods had an effect on the triage of earthquake mass casualties. Among them, the REMS injury triage method had the largest AUC of the five triage methods. Except for REMS, no obvious difference was found in the effect of the other four injury triage methods.

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Retrospective Evaluation Of The Accuracy Of Five Different Severity Scores To Predict The Mortality In Burns Patients

Journal of Burn Care & Research ◽

10.1093/jbcr/irab057 ◽

2021 ◽

Author(s):

Viviane Fernandes de Carvalho ◽

André Oliveira Paggiaro ◽

Alexandre Goldner ◽

Rolf Gemperli

Keyword(s):

Characteristic Curve ◽

Area Under The Curve ◽

Roc Curves ◽

Severity Index ◽

Apache Ii ◽

Saps Ii ◽

Logistic Organ Dysfunction ◽

Severity Scores ◽

Clinical Impairment ◽

Extensive Burns

Abstract Background Patients with great clinical impairment, due to extensive burns, need to be admitted to intensive care units, in these treatment sites, indices are used to classify the severity of patients. The aim of the study was to compare the accuracy of the FLAMES score in relation to the Acute Physiologic and Chronic Health Evaluation II (APACHE II), the Simplified Acute Physiologic Score II (SAPS II), the Logistic Organ Dysfunction System (LODS) and the Abbreviated Burn Severity Index (ABSI) applied to the severe burn patient facing mortality in an ICU of a reference center for burns in Brazil. Methods A retrospective study conducted in ICU comparing the accuracy the APACHE II, SAPS II, LODS, ABSI and FLAMES instruments were applied to all the selected medical records. To evaluate the accuracy of the SIs, the Receiver Operating Characteristic curve was calculated and the area under the curve (AUC). Results Among the 574 patients included in the study, male individuals (70.13%), with an average age of 44.01 ± 28.64 prevailed and the majority of the burns were caused by accidents (76.53%). The outcome accounted for 35.29% of deaths. It was observed that the FLAMES and ABSI presented the two largest areas under the ROC curves and the highest sensitivities (96% and 89%, respectively). The APACHE II, SAPS II and LODS presented sensitivities equal to or greater than 80%. Conclusions It has been demonstrated that indices specifically developed for burn patients, specifically the FLAMES and ABSI indices, presented better accuracies and prediction performances.

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Comparison of manual and computer assigned injury severity scores

Injury Prevention ◽

10.1136/injuryprev-2019-043224 ◽

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.

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Can mid-regional pro-adrenomedullin (MR-proADM) increase the prognostic accuracy of NEWS in predicting deterioration in patients admitted to hospital with mild to moderately severe illness? A prospective single-centre observational study

BMJ Open ◽

10.1136/bmjopen-2017-020337 ◽

2018 ◽

Vol 8 (11) ◽

pp. e020337 ◽

Cited By ~ 3

Author(s):

Sara Graziadio ◽

Rachel Amie O’Leary ◽

Deborah D Stocken ◽

Michael Power ◽

A Joy Allen ◽

...

Keyword(s):

Observational Study ◽

Outcome Measure ◽

Area Under The Curve ◽

Value Added ◽

Clinical Information ◽

Primary Outcome Measure ◽

Early Warning Score ◽

Severe Illness ◽

Chronic Obstructive ◽

Prognostic Accuracy

ObjectiveTo assess the value added to the National Early Warning Score (NEWS) by mid-regional pro-adrenomedullin (MR-proADM) blood level in predicting deterioration in mild to moderately ill people.DesignProspective observational study.SettingThe Medical Admissions Suite of the Royal Victoria Infirmary, Newcastle.Participants300 adults with NEWS between 2 and 5 on admission. Exclusion criteria included receiving palliative care, or admitted for social reasons or self-harming. Patients were enrolled between September and December 2015, and followed up for 30 days after discharge.Outcome measureThe primary outcome measure was the proportion of patients who, within 72 hours, had anacuity increase, defined as any combination of an increase of at least 2 in the NEWS; transfer to a higher-dependency bed or monitored area; death; or for those discharged from hospital, readmission for medical reasons.ResultsNEWS and MR-proADM together predictedacuity increasemore accurately than NEWS alone, increasing the area under the curve (AUC) to 0.61 (95% CI 0.54 to 0.69) from 0.55 (95% CI 0.48 to 0.62). When the confounding effects of presence of chronic obstructive pulmonary disease or heart failure and interaction with MR-proADM were included, the prognostic accuracy further increased the AUC to 0.69 (95% CI 0.63 to 0.76).ConclusionsMR-proADM is potentially a clinically useful biomarker for deterioration in patients admitted to hospital with a mild to moderately severe acute illness, that is, with NEWS between 2 and 5. As a growing number of National Health Service hospitals are routinely recording the NEWS on their clinical information systems, further research should assess the practicality and use of developing a decision aid based on admission NEWS, MR-proADM level, and possibly other clinical data and other biomarkers that could further improve prognostic accuracy.

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Machine learning for the detection of early immunological markers as predictors of multi-organ dysfunction

Scientific Data ◽

10.1038/s41597-019-0337-6 ◽

2019 ◽

Vol 6 (1) ◽

Cited By ~ 2

Author(s):

Laura Bravo-Merodio ◽

Animesh Acharjee ◽

Jon Hazeldine ◽

Conor Bentley ◽

Mark Foster ◽

...

Keyword(s):

Immune Response ◽

Organ Dysfunction ◽

Injury Severity ◽

Area Under The Curve ◽

Post Injury ◽

New Injury Severity Score ◽

Probability Of Survival ◽

Severity Scores ◽

Patients At Risk ◽

Cd63 Expression

AbstractThe immune response to major trauma has been analysed mainly within post-hospital admission settings where the inflammatory response is already underway and the early drivers of clinical outcome cannot be readily determined. Thus, there is a need to better understand the immediate immune response to injury and how this might influence important patient outcomes such as multi-organ dysfunction syndrome (MODS). In this study, we have assessed the immune response to trauma in 61 patients at three different post-injury time points (ultra-early (<=1 h), 4–12 h, 48–72 h) and analysed relationships with the development of MODS. We developed a pipeline using Absolute Shrinkage and Selection Operator and Elastic Net feature selection methods that were able to identify 3 physiological features (decrease in neutrophil CD62L and CD63 expression and monocyte CD63 expression and frequency) as possible biomarkers for MODS development. After univariate and multivariate analysis for each feature alongside a stability analysis, the addition of these 3 markers to standard clinical trauma injury severity scores yields a Generalized Liner Model (GLM) with an average Area Under the Curve value of 0.92 ± 0.06. This performance provides an 8% improvement over the Probability of Survival (PS14) outcome measure and a 13% improvement over the New Injury Severity Score (NISS) for identifying patients at risk of MODS.

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All-terrain vehicle–related injuries and deaths in Newfoundland and Labrador between 2003 and 2013: a retrospective trauma registry review

CJEM ◽

10.1017/cem.2017.51 ◽

2017 ◽

Vol 20 (2) ◽

pp. 207-215 ◽

Cited By ~ 1

Author(s):

Holly Black ◽

Desmond Whalen ◽

Sabrina Alani ◽

Peter Rogers ◽

Cathy MacLean

Keyword(s):

Public Education ◽

Newfoundland And Labrador ◽

Injury Severity ◽

Trauma Registry ◽

Physician Practice ◽

Helmet Use ◽

M 10 ◽

Severity Scores ◽

Hospital Deaths ◽

Canadian Provinces

AbstractBackgroundInjury and death involving all-terrain vehicles (ATV) has been reported in a number of Canadian provinces. The objective of this study is to describe the frequency, nature, severity, population affected, immediate health costs, efficacy of related legislation, and helmet use in ATV related injuries and deaths in Newfoundland and Labrador (NL).MethodsA retrospective review of injured or deceased ATV riders of all ages entered in the Newfoundland and Labrador Trauma Registry from 2003 to 2013 was conducted. Variables studied included demographics, injury type and severity, use of helmets, admission/discharge dates, and referring/receiving institution. Data was also obtained from the Newfoundland and Labrador Center for Health Information (NLCHI) and included all in-hospital deaths and hospitalizations due to ATVs between 1995 and 2013.ResultsThere were a total of 298 patients registered in the trauma registry, resulting in 2759 admission days, nine deaths, and a total estimated immediate healthcare system cost in excess of $1.6 million. More males (N=253, 84.9%) than females (N=45, 15.1%) were injured in ATV related incidents, t(20)=7.12, p<.0001. Head and thorax injuries were the most serious. 38.6% of patients were confirmed to be wearing helmets. Mean injury severity scores are as follows: head injury (M=11, SD=9.51), thorax (M=10, SD=8.3), abdominal/pelvis (M=9, SD=7.62), upper extremity (M=9, SD=8.53), other injuries (M=9, SD=10.56) lower extremity (M=8, SD=8.34), and spine (M=8, SD=6.52).ConclusionsThis study describes ATV related injuries and deaths in NL. Information from this study may guide physician practice, public education, and future legislation.

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Evaluation of the clot burden score (cbs) for acute ischemic stroke (ais) in intent-to-treat patients.

Journal Of Cardiovascular, Neurovascular & Stroke ◽

10.32896/cvns.v1n1.11-15 ◽

2019 ◽

Vol 1 (1) ◽

pp. 11-15 ◽

Cited By ~ 1

Author(s):

Sarah Yaziz ◽

Ahmad Sobri Muda ◽

Wan Asyraf Wan Zaidi ◽

Nik Azuan Nik Ismail

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Predictive Value ◽

Area Under The Curve ◽

Rank Correlation ◽

Treatment Decision ◽

Roc Curves ◽

Significant Negative Correlation ◽

Clot Burden

Background : The clot burden score (CBS) is a scoring system used in acute ischemic stroke (AIS) to predict patient outcome and guide treatment decision. However, CBS is not routinely practiced in many institutions. This study aimed to investigate the feasibility of CBS as a relevant predictor of good clinical outcome in AIS cases. Methods: A retrospective data collection and review of AIS patients in a teaching hospital was done from June 2010 until June 2015. Patients were selected following the inclusion and exclusion criteria. These patients were followed up after 90 days of discharge. The Modified Rankin scale (mRS) was used to assess their outcome (functional status). Linear regression Spearman Rank correlation was performed between the CBS and mRS. The quality performance of the correlations was evaluated using Receiver operating characteristic (ROC) curves. Results: A total of 89 patients with AIS were analysed, 67.4% (n=60) male and 32.6% (n=29) female. Twenty-nine (29) patients (33.7%) had a CBS ?6, 6 patients (6.7%) had CBS <6, while 53 patients (59.6%) were deemed clot free. Ninety (90) days post insult, clinical assessment showed that 57 (67.6%) patients were functionally independent, 27 (30.3%) patients functionally dependent, and 5 (5.6%) patients were deceased. Data analysis reported a significant negative correlation (r= -0.611, p<0.001). ROC curves analysis showed an area under the curve of 0.81 at the cut-off point of 6.5. This showed that a CBS of more than 6 predicted a good mRS clinical outcome in AIS patients; with sensitivity of 98.2%, specificity of 53.1%, positive predictive value (PPV) of 76%, and negative predictive value (NPV) of 21%. Conclusion: CBS is a useful additional variable for the management of AIS cases, and should be incorporated into the routine radiological reporting for acute ischemic stroke (AIS) cases.

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Nonoperative management of splenic injury in closely monitored patients with reduced consciousness is safe and feasible

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-019-0668-5 ◽

2019 ◽

Vol 27 (1) ◽

Cited By ~ 2

Author(s):

Michel Teuben ◽

Roy Spijkerman ◽

Taco Blokhuis ◽

Roman Pfeifer ◽

Henrik Teuber ◽

...

Keyword(s):

Mental Status ◽

Injury Severity ◽

Splenic Injury ◽

Nonoperative Management ◽

Splenic Trauma ◽

Blunt Splenic Injury ◽

Icu Stay ◽

Severity Scores ◽

Gcs Score ◽

The Impact

Abstract Background Treatment of blunt splenic injury has changed over the past decades. Nonoperative management (NOM) is the treatment of choice. Adequate patient selection is a prerequisite for successful NOM. Impaired mental status is considered as a relative contra indication for NOM. However, the impact of altered consciousness in well-equipped trauma institutes is unclear. We hypothesized that impaired mental status does not affect outcome in patients with splenic trauma. Methods Our prospectively composed trauma database was used and adult patients with blunt splenic injury were included during a 14-year time period. Treatment guidelines remained unaltered over time. Patients were grouped based on the presence (Group GCS: < 14) or absence (Group GCS: 14–15) of impaired mental status. Outcome was compared. Results A total of 161 patients were included, of whom 82 were selected for NOM. 36% of patients had a GCS-score < 14 (N = 20). The median GCS-score in patients with reduced consciousness was 9 (range 6–12). Groups were comparable except for significantly higher injury severity scores in the impaired mental status group (19 vs. 17, p = 0.007). Length of stay (28 vs. 9 days, p < 0.001) and ICU-stay (8 vs. 0 days, p = 0.005) were longer in patients with decreased GCS-scores. Failure of NOM, total splenectomy rates, complications and mortality did not differ between both study groups. Conclusion This study shows that NOM for blunt splenic trauma is a viable treatment modality in well-equipped institutions, regardless of the patients mental status. However, the presence of neurologic impairment is associated with prolonged ICU-stay and hospitalization. We recommend, in institutions with adequate monitoring facilities, to attempt nonoperative management for blunt splenic injury, in all hemodynamically stable patients without hollow organ injuries, also in the case of reduced consciousness.

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Structured and Systematic Team and Procedure Training in Severe Trauma: Going from ‘Zero to Hero’ for a Time-Critical, Low-Volume Emergency Procedure Over Three Time Periods

World Journal of Surgery ◽

10.1007/s00268-021-05980-1 ◽

2021 ◽

Vol 45 (5) ◽

pp. 1340-1348

Author(s):

Maryam Meshkinfamfard ◽

Jon Kristian Narvestad ◽

Johannes Wiik Larsen ◽

Arezo Kanani ◽

Jørgen Vennesland ◽

...

Keyword(s):

Injury Severity ◽

Trauma System ◽

Severe Trauma ◽

Emergency Procedure ◽

Emergency Thoracotomy ◽

Severity Scores ◽

Time Periods ◽

Low Volume ◽

Time Critical ◽

Over Time

Abstract Background Resuscitative emergency thoracotomy is a potential life-saving procedure but is rarely performed outside of busy trauma centers. Yet the intervention cannot be deferred nor centralized for critically injured patients presenting in extremis. Low-volume experience may be mitigated by structured training. The aim of this study was to describe concurrent development of training and simulation in a trauma system and associated effect on one time-critical emergency procedure on patient outcome. Methods An observational cohort study split into 3 arbitrary time-phases of trauma system development referred to as ‘early’, ‘developing’ and ‘mature’ time-periods. Core characteristics of the system is described for each phase and concurrent outcomes for all consecutive emergency thoracotomies described with focus on patient characteristics and outcome analyzed for trends in time. Results Over the study period, a total of 36 emergency thoracotomies were performed, of which 5 survived (13.9%). The “early” phase had no survivors (0/10), with 2 of 13 (15%) and 3 of 13 (23%) surviving in the development and mature phase, respectively. A decline in ‘elderly’ (>55 years) patients who had emergency thoracotomy occurred with each time period (from 50%, 31% to 7.7%, respectively). The gender distribution and the injury severity scores on admission remained unchanged, while the rate of patients with signs on life (SOL) increased over time. Conclusion The improvement over time in survival for one time-critical emergency procedure may be attributed to structured implementation of team and procedure training. The findings may be transferred to other low-volume regions for improved trauma care.

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Endothelial glycocalyx degradation is associated with early organ impairment in polytrauma patients

BMC Emergency Medicine ◽

10.1186/s12873-021-00446-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Feng Qi ◽

Hao Zhou ◽

Peng Gu ◽

Zhi-He Tang ◽

Bao-Feng Zhu ◽

...

Keyword(s):

Injury Severity ◽

Early Stage ◽

Endothelial Glycocalyx ◽

Control Group ◽

Metabolic System ◽

Metabolic Systems ◽

Organ Systems ◽

Severity Scores ◽

Polytrauma Patients ◽

Trauma Group

Abstract Background Endothelial glycocalyx (EG) abnormal degradation were widely found in critical illness. However, data of EG degradation in multiple traumas is limited. We performed a study to assess the EG degradation and the correlation between the degradation and organ functions in polytrauma patients. Methods A prospective observational study was conducted to enroll health participants (control group) and polytrauma patients (trauma group) at a University affiliated hospital between Feb 2020 and Oct 2020. Syndecan1 (SDC1) and heparin sulfate (HS) were detected in serum sample of both groups. In trauma group, injury severity scores (ISS) and sequential organ failure assessments (SOFA) were calculated. Occurrences of acute kidney injury (AKI), trauma-induced coagulopathy (TIC) within 48 h and 28-day all-cause mortality in trauma group were recorded. Serum SDC1 and HS levels were compared between two groups. Correlations between SDC1/HS and the indicators of organ systems in the trauma group were analyzed. ROC analyses were performed to assess the predictive value of SDC1 and HS for AKI, TIC within 48 h, and 28-day mortality in trauma group. Results There were 45 polytrauma patients and 15 healthy participants were collected, totally. SDC1 and HS were significantly higher in trauma group than in control group (69.39 [54.18–130.80] vs. 24.15 [13.89–32.36], 38.92 [30.47–67.96] vs. 15.55 [11.89–23.24], P < 0.001, respectively). Trauma group was divided into high degradation group and low degradation group according to SDC1 median. High degradation group had more severe ISS, SOFA scores, worse organ functions (respiratory, kidney, coagulation and metabolic system), and higher incidence of hypothermia, acidosis and shock. The area under the receiver operator characteristic curves (AUC) of SDC1 to predict AKI, TIC occurrence within 48 h and 28-day mortality were 0.838 (95%CI: 0.720–0.957), 0.700 (95%CI: 0.514–0.885) and 0.764 (95%CI: 0.543–0.984), respectively. Conclusions EG degradation was elevated significantly in polytrauma patients, and the degradation was correlated with impaired respiratory, kidney, coagulation and metabolic systems in early stage. Serum SDC1 is a valuable predictive indicator of early onset of AKI, TIC, and 28-day mortality in polytrauma patients.

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Magnetic resonance cisternography imaging findings related to the leakage of Gadolinium into the subarachnoid space

Japanese Journal of Radiology ◽

10.1007/s11604-021-01137-1 ◽

2021 ◽

Author(s):

Rei Nakamichi ◽

Toshiaki Taoka ◽

Hisashi Kawai ◽

Tadao Yoshida ◽

Michihiko Sone ◽

...

Keyword(s):

Magnetic Resonance ◽

Subarachnoid Space ◽

Area Under The Curve ◽

Rank Correlation ◽

Predictive Performance ◽

Roc Curves ◽

Imaging Findings ◽

Spearman’S Rank Correlation ◽

Sagittal Sinus ◽

Magnetic Resonance Cisternography

Abstract Purpose To identify magnetic resonance cisternography (MRC) imaging findings related to Gadolinium-based contrast agent (GBCA) leakage into the subarachnoid space. Materials and methods The number of voxels of GBCA leakage (V-leak) on 3D-real inversion recovery images was measured in 56 patients scanned 4 h post-intravenous GBCA injection. Bridging veins (BVs) were identified on MRC. The numbers of BVs with surrounding cystic structures (BV-cyst), with arachnoid granulations protruding into the superior sagittal sinus (BV-AG-SSS) and the skull (BV-AG-skull), and including any of these factors (BV-incl) were recorded. Correlations between these variables and V-leak were examined based on the Spearman’s rank correlation coefficient. Receiver-operating characteristic (ROC) curves were generated to investigate the predictive performance of GBCA leakage. Results V-leak and the number of BV-incl were strongly correlated (r = 0.609, p < 0.0001). The numbers of BV-cyst and BV-AG-skull had weaker correlations with V-leak (r = 0.364, p = 0.006; r = 0.311, p = 0.020, respectively). The number of BV-AG-SSS was not correlated with V-leak. The ROC curve for contrast leakage exceeding 1000 voxels and the number of BV-incl had moderate accuracy, with an area under the curve of 0.871. Conclusion The number of BV-incl may be a predictor of GBCA leakage and a biomarker for waste drainage function without using GBCA.

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