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.

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 Factors affecting mortality in major trauma patients in Trinidad and Tobago – A view from the developing world

Trauma ◽  
2019 ◽  
Vol 22 (3) ◽  
pp. 220-228
Author(s):  
Saleem Varachhia ◽  
Vidya Ramcharitar Maharaj ◽  
Joanne F Paul ◽  
Paula Robertson ◽  
Paula Nunes ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Trinidad And Tobago ◽  
Severity Score ◽  
Major Trauma ◽  
Injury Severity ◽  
Developing World ◽  
Motor Vehicle ◽  
Motor Vehicle Accidents ◽  
Trauma Patients ◽  
Vehicle Accidents

Introduction There are few data on major trauma in the developing world. This study investigated the characteristics and outcomes of seriously injured patients in Trinidad and Tobago, using Trauma and Injury Severity Score (TRISS) methodology. We also aimed to assess the predictive accuracy of the TRISS model in patients in Trinidad and Tobago. Methods Retrospective data from major trauma patients attending the Emergency Department of a tertiary hospital in Trinidad between 2010 and 2014 were analysed. Patients ≥18 years having an Injury Severity Score >15 were included. The impact of age, gender, comorbidities, mechanisms and patterns of injury on mortality was investigated. Using TRISS methodology, predicted mortality was calculated and compared to actual mortality. Results Of 323 patients analysed, 284 were male and 24 were aged ≥65 years. The commonest injury mechanisms in younger people were motor vehicle accidents (34.1%) and stabbings (30.8%) compared to falls (66.7%) and motor vehicle accidents (20.8%) in people aged ≥65 years. The commonest areas injured were the chest in younger patients (81.9%) and the head and neck in patients aged ≥65 years (58.3%). Women’s mortality rates were similar to men (RR 1.8; 95% CI 0.7–4.9). Mortality was higher with age ≥65 years (RR 7.0; 95% CI 3.1–15.9), blunt trauma (RR 7.6; 95% CI 1.8–32.4) and Charlson Comorbidity Index of 1 or more (RR 3.2; 95% CI 1.3–8.0). The TRISS model performed well at lower ISS scores and was excellent at predicting survival (discrimination statistic 0.94). Conclusion Multiple factors influence mortality in major trauma patients in Trinidad and Tobago, including age, co-morbidities and injury mechanism. TRISS methodology accurately predicted survival in this population but was better at predicting mortality in patients with lower Injury Severity Score.

1 Simultaneous trauma patients in emergency departments: a difference in mortality?

2018 ◽  
Vol 164 (3) ◽  
pp. 224.1-224
Author(s):  
L Morrow ◽  
T Nutbeam ◽  
O Bouamra
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Major Trauma ◽  
Injury Severity ◽  
Research Network ◽  
Trauma Patients ◽  
Icu Stay ◽  
Patient Category ◽  
The Uk ◽  
The Impact

BackgroundThe presentation of multiple simultaneous trauma patients to an Emergency Department is likely to place significant stress and strain on trauma care resources. Currently there is limited literature and no UK or multicentre data available to understand this impact. The aim of this study was to identify patient outcomes when there are simultaneous major trauma patients. We hypothesised that with increasing numbers of simultaneous trauma patients an increase in mortality may be seen.MethodsThe Trauma Audit and Research Network (TARN) database was interrogated from 2010–2015 to identify simultaneous major trauma patients. We defined simultaneous trauma as occurring when there was more than one trauma patient within an Emergency Department at any one time.Patient age, sex, Glasgow Coma Scale and Injury Severity Score (ISS) were recorded. A standardised comparison using a stratified Ws statistic was conducted to compare mortality between groups. Secondary outcomes included length of hospital and intensive care (ICU) stay.ResultsOf 2 07 094 patients, 33.7% were eligible simultaneous trauma patients. 55.7% of patients were male, median age was 61 and median ISS was 9. No increase in mortality was seen with increasing patient numbers (table 1).Abstract 1 Table 1 Ws statistic with increasing simultaneous patient numbersIsolated2 patients3 patients4 patients5 patients6+patientsTotal1 37 360 51 466 13 820 3539 671 185 Ws statistic0.05 0.38 0.72 0.53 0.39 2.70 A statistically significant increase in length of ICU stay was observed for the 6+patient category (p=0.047) but no difference was reported in hospital stay.ConclusionThe impact of simultaneous trauma patients on patient outcomes within the UK has not been previously defined. Simultaneous trauma patients do not appear to have an impact on mortality (as measured by Ws statistic).

scholarly journals Mechanisms, patterns and outcomes of paediatric polytrauma in a UK major trauma centre

2017 ◽  
Vol 99 (1) ◽  
pp. 39-45 ◽  
Author(s):  
G Naqvi ◽  
G Johansson ◽  
G Yip ◽  
A Rehm ◽  
A Carrothers ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Major Trauma ◽  
Injury Severity ◽  
Age Groups ◽  
Trauma Centre ◽  
Team Approach ◽  
Paediatric Trauma ◽  
Major Trauma Centre ◽  
The Uk

IntroductionPaediatric trauma is a significant burden to healthcare worldwide and accounts for a large proportion of deaths in the UK.MethodsThis retrospective study examined the epidemiological data from a major trauma centre in the UK between January 2012 and December 2014, reviewing all cases of moderate to severe trauma in children. Patients were included if aged ≤16 years and if they had an abbreviated injury scale score of ≥2 in one or more body region.ResultsA total of 213 patients were included in the study, with a mean age of 7.8 years (standard deviation [SD]: 5.2 years). The most common cause of injury was vehicle related incidents (46%). The median length of hospital stay was 5 days (interquartile range [IQR]: 4–10 days). Approximately half (52%) of the patients had to stay in the intensive care unit, for a median of 1 day (IQR: 0–2 days). The mortality rate was 6.6%. The mean injury severity score was 19 (SD: 10). Pearson’s correlation coefficient showed a positive correlation for injury severity score with length of stay in hospital (p<0.001).ConclusionsThere is significant variation in mechanism of injury, severity and pattern of paediatric trauma across age groups. A multidisciplinary team approach is imperative, and patients should be managed in specialist centres to optimise their care and eventual functional recovery. Head injury remained the most common, with significant mortality in all age groups. Rib fractures and pelvic fractures should be considered a marker for the severity of injury, and should alert doctors to look for other associated injuries.

scholarly journals Clinical outcomes following major trauma for patients with a diagnosis of depression: a large UK database analysis

2021 ◽  
Vol 6 (1) ◽  
pp. e000819
Author(s):  
Jamie Large ◽  
David N Naumann ◽  
Jodie Fellows ◽  
Clare Connor ◽  
Zubair Ahmed
Keyword(s):  
Clinical Outcomes ◽  
Major Trauma ◽  
Injury Severity ◽  
Management Strategies ◽  
Research Network ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Logistic Regression Models ◽  
The Uk

BackgroundMore than a quarter of the UK population are affected by depression during their lifetime. For major trauma patients, postinjury depression can result in poorer long-term outcomes, but there is limited evidence regarding outcomes for patients with pre-existing depression. This study investigated the relationship between a diagnosis of depression prior to hospital admission and clinical outcomes after major trauma.MethodsTrauma patients at a UK major trauma center were identified during a 6.5-year period using the Trauma Audit and Research Network database. Patients with Injury Severity Score >15 who did not die in the emergency department (ED) were included. Logistic regression models were used to compare in-hospital mortality (excluding ED), requirement for surgery, and length of stay (LOS) between those with depression and those without.ResultsThere were 4602 patients included in the study and 6.45% had a diagnosis of depression. Depression was associated with a significant reduction in mortality (OR 0.54, 95% CI 0.30 to 0.91; p=0.026). However, patients with depression were more likely to have longer LOS (OR 124, 95% CI 8.5 to 1831; p<0.001) and intensive care unit LOS (OR 9.69, 95% CI 3.14 to 29.9; p<0.001). Patients with depression were also more likely to undergo surgery (OR 1.36, 95% CI 1.06 to 1.75; p=0.016).DiscussionA pre-existing diagnosis of depression has complex association with clinical outcomes after major trauma, with reduced mortality but longer LOS and higher likelihood of surgical intervention. Further prospective investigations are warranted to inform optimal management strategies for major trauma patients with pre-existing depression.Level of evidenceIII.

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.

National temporal variation in major trauma in England, Wales and Northern Ireland

Trauma ◽  
2021 ◽  
pp. 146040862098226
Author(s):  
Will Kieffer ◽  
Daniel Michalik ◽  
Jason Bernard ◽  
Omar Bouamra ◽  
Benedict Rogers
Keyword(s):  
Northern Ireland ◽  
Temporal Variation ◽  
Major Trauma ◽  
Injury Severity ◽  
Research Network ◽  
Trauma Patients ◽  
Trauma Outcomes ◽  
Causes Of Mortality ◽  
Injured Patients ◽  
Time Of Admission

Introduction Trauma is one of the leading causes of mortality worldwide, but little is known of the temporal variation in major trauma across England, Wales and Northern Ireland. Proper workforce and infrastructure planning requires identification of the caseload burden and its temporal variation. Materials and Methods The Trauma Audit Research Network (TARN) database for admissions attending Major Trauma Centres (MTCs) between 1st April 2011 and 31st March 2018 was analysed. TARN records data on all trauma patients admitted to hospital who are alive at the time of admission to hospital. Major trauma was classified as an Injury Severity Score (ISS) >15. Results A total of 158,440 cases were analysed. Case ascertainment was over 95% for 2013 onwards. There was a statistically significant variation in caseload by year (p < 0.0001), times of admissions (p < 0.0001), caseload admitted during weekends vs weekdays, 53% vs 47% (p < 0.0001), caseload by season with most patients admitted during summer (p < 0.0001). The ISS varied by time of admission with most patients admitted between 1800 and 0559 (p < 0.0001), weekend vs weekday with more severely injured patients admitted during the weekend (p < 0.0001) and by season p < 0.0001). Discussion and Conclusion: There is a significant national temporal variation in major trauma workload. The reasons are complex and there are multiple theories and confounding factors to explain it. This is the largest dataset for hospitals submitting to TARN which can help guide workforce and resource allocation to further improve trauma outcomes.

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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