Abstract 200: Discordance Between Monitor-measured and EMS Documented Respiratory Rates in Major Traumatic Brain Injury: Implications for Injury Scoring Systems

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Bruce J Barnhart ◽  
Daniel W Spaite ◽  
Eric Helfenbein ◽  
Dawn Jorgenson ◽  
Saeed Babaeizadeh ◽  
...  
Keyword(s):  
Scoring Systems ◽  
Trauma Research ◽  
Non Invasive ◽  
Revised Trauma Score ◽  
Trauma Scoring ◽  
End Tidal ◽  
Trauma Score ◽  
Spontaneously Breathing ◽  
The Relationship ◽  
Monitor Data

Background: Respiratory rate (RR) is a key component in commonly-used trauma scoring systems [e.g., Revised Trauma Score (RTS), TRISS]. Imprecise documentation of RR introduces misclassification when these tools are used in trauma research. By identifying each waveform, nasal cannula end tidal CO2 (NCCO2) accurately measures RR in non-intubated patients. Objective: Evaluate the relationship between EMS-documented RR measurements in patient care records (PCRs) vs. true RR recorded by non-invasive NCCO2 monitoring in major TBI patients who were never actively ventilated. Methods: Among spontaneously-breathing, major TBI cases (moderate/severe/critical), continuous NCCO2 data (Philips MRx™) were evaluated from the EPIC Prehospital TBI Study (NIH 1R01NS071049). RR classifications for RTS/TRISS were then established for each case using both PCR-documentation and monitor data. Routine monitor data (including RR) were available to EMS providers on the display at all times during care. Results: Included: 158 cases from 7 Arizona EMS agencies [(7/13-7/17; median age 55 (range 18-94); 65% male]. The Table shows RTS/TRISS case classification by PCR and monitor RR. PCR-documented RR frequently failed to correctly classify cases: RR <6 (0/10; 0%); 6-9 (3/21; 14.3%; >29: (11/34, 32.4%), normal (67/93, 72.0%; Table). In total, PCR documentation misclassified 48.7% of cases (77/158). Conclusion: These findings identify a major contributor to inaccurate trauma scoring. Since RTS and TRISS are used widely in research, this has important implications for study enrollment, case ascertainment, confounding, and risk-adjustment in injury studies. Whenever possible, QI and research studies should utilize monitor data to identify and evaluate RR and other vitals rather than relying on PCR documentation. Future development of monitor-based, real-time feedback technology might improve trauma scoring precision and provider identification of RR abnormalities.

Scoring acuity hours and costs of nursing for trauma care

1993 ◽  
Vol 2 (6) ◽  
pp. 436-443 ◽  
Author(s):  
AE Bond ◽  
FO Thomas ◽  
RL Menlove ◽  
P MacFarlane ◽  
P Petersen
Keyword(s):  
Resource Utilization ◽  
Injury Severity ◽  
Scoring Systems ◽  
Cost Of Care ◽  
Trauma Patients ◽  
Nursing Educators ◽  
Revised Trauma Score ◽  
Trauma Scoring ◽  
Level I ◽  
Trauma Score

OBJECTIVE: To determine nursing resource utilization (acuity hours and dollars) by trauma patients based on analysis of a nursing acuity system and five trauma scoring systems. METHODS: Retrospective review of 448 trauma patients who required transport by aircraft to a level I trauma center. Values from the institution's automated nursing acuity system were compared with the Glasgow Coma Scale score, trauma score, revised trauma score, CRAMS score and injury severity score to obtain acuity hours and financial cost of care for trauma patients. RESULTS: Consistently, analysis of scores computed by five scoring instruments confirmed that nursing resource utilization is greatest for patients who are severely injured but likely to recover. For example, patients with a trauma score of 1 required 49 (+/- 66) mean acuity hours of care; those with a trauma score of 8 needed 189 (+/- 229) mean acuity hours; and those with a trauma score of 16 used 73 (+/- 120) mean acuity hours. Mean dollar costs were $980 (+/- 1293), $3812 (+/- 4518) and $1492 (+/- 2473), respectively. CONCLUSIONS: Nursing resource utilization can be determined for trauma patients by using an automated nursing acuity system and trauma scoring systems. Data acquired in this way provide a concrete basis for healthcare and reimbursement reform, for administrators who design nursing allocations and for nursing educators who prepare graduates to meet the needs of healthcare consumers.

Abstract 233: Prehospital End-Tidal CO2 Measurement in Non-Intubated Traumatic Brain Injury Patients: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Octavio Perez ◽  
Daniel W Spaite ◽  
Eric Helfenbein ◽  
Saeed Babaeizadeh ◽  
Dawn B Jorgenson ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Study Objective ◽  
Non Invasive ◽  
Ventilation Setting ◽  
Data Tracking ◽  
End Tidal ◽  
Post Hoc ◽  
Monitor Data ◽  
End Tidal Co2

Background: End-Tidal CO2 (ETCO2) monitoring is valuable in the management of traumatic brain injury (TBI). In intubated patients it helps prevent hyper/over-ventilation. In non-intubated patients, placing a sensor in the nares allows accurate monitoring of respiratory rate and has other promising uses (e.g. monitoring ETCO2 trends in worsening TBI, COPD, etc). Study Objective: To identify how accurately EMS providers document ETCO2, we compared the values recorded in EMS patient care records (PCR) to monitor data in non-intubated TBI patients. Methods: Cases from 6 EMS agencies reporting continuous monitor data (Philips MRx) in the EPIC Study (NIH 1R01NS071049) were evaluated (4/13-3/17). All ETCO2 data available for this post-hoc review were displayed and accessible to the EMS providers during care. Concordance was defined in two ways (for both highest and lowest ETCO2): ≤5 and ≤3 mmHg difference between the monitor data and PCR-documented values. Results: 106 cases were included [median age: 47 (range: 9-91), 66% male]. The figure shows concordance between PCR documentation and monitor data for both the lowest and highest recorded ETCO2 values. Conclusion: The highest PCR-recorded vs monitor ETCO2 values had excellent concordance for a difference ≤5 mmHg (85.9%) and it was good (76.4%) even when defined at the limits of instrument precision (≤3 for ETCO2 compared to actual pCO2). However, for lowest ETCO2, concordance was very poor (only 42.5% for ≤5). The failure to accurately document low ETCO2 in a “passive-ventilation” setting may also have significant implications for improving ventilatory care among intubated patients because identifying and correcting hypocapnia/hyperventilation in actively-ventilated cases is extraordinarily important. The low concordance rates may be due to the emphasis on discreet, intermittent vital sign documentation rather than ongoing identification and documentation of significant ETCO2 variation.

Injury Assessment of Individuals Wounded in the Lushan Earthquake and the Emergency Department Workload: A Corresponding Correlation Study

2020 ◽  
pp. 1-4
Author(s):  
Shiyuan Tang ◽  
Fen Ni ◽  
Hai Hu ◽  
Xiaojiong Du ◽  
Shuheng Zhu ◽  
...  
Keyword(s):  
Correlation Study ◽  
Calculation Model ◽  
Lushan Earthquake ◽  
West China Hospital ◽  
West China ◽  
Revised Trauma Score ◽  
Trauma Scoring ◽  
Injury Assessment ◽  
Trauma Score ◽  
Abdominal Movement

ABSTRACT Objective: In this study, we aimed to evaluate the correlation between the trauma score of individuals wounded in the Lushan earthquake and emergency workload for treatment. We further created a trauma score-emergency workload calculation model. Methods: We included data from patients wounded in the Lushan earthquake and treated at West China Hospital, Sichuan University. We calculated scores per the following models separately: Revised Trauma Score (RTS), Prehospital Index (PHI), Circulation Respiration Abdominal Movement Speech (CRAMS), Therapeutic Intervention Scoring System (TISS-28), and Nursing Activities Score (NAS). We assessed the association between values for CRAMS, PHI, and RTS and those for TISS-28 and NAS. Subsequently, we built a trauma score-emergency workload calculation model to quantitative workload estimation. Results: Significant correlations were observed for all pairs of trauma scoring models with emergency workload scoring models. TISS-28 score was significantly associated with PHI score and RTS; however, no significant correlation was observed between the TISS-28 score and CRAMS score. Conclusions: CRAMS, PHI, and RTS were consistent in evaluating the injury condition of wounded individuals; TISS-28 and NAS scores were consistent in evaluating the required treatment workload. Dynamic changes in emergency workload in unit time were closely associated with wounded patient visits.

scholarly journals Comparison of Injury Severity Score, Glasgow Coma Scale, and Revised Trauma Score in Predicting the Mortality and Prolonged ICU Stay of Traumatic Young Children: A Cross-Sectional Retrospective Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Yii-Ting Huang ◽  
Ying-Hsien Huang ◽  
Ching-Hua Hsieh ◽  
Chao-Jui Li ◽  
I-Min Chiu
Keyword(s):  
Retrospective Study ◽  
Young Children ◽  
Glasgow Coma Scale ◽  
Injury Severity ◽  
Scoring Systems ◽  
Traumatic Injuries ◽  
Icu Stay ◽  
Revised Trauma Score ◽  
Prolonged Icu Stay ◽  
Trauma Score

Introduction. The purpose of this study was to examine the capacity of commonly used trauma scoring systems such as the Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) to predict outcomes in young children with traumatic injuries. Methods. This retrospective study was conducted for the period from 2009 to 2016 in Kaohsiung Chang Gung Memorial Medical Hospital, a level I trauma center. We included all children under the age of 6 years admitted to the hospital via the emergency department with any traumatic injury and compared the trauma scores of GCS, ISS, and RTS on patients’ outcome. The primary outcomes were mortality and prolonged Intensive Care Unit (ICU) stay, with the latter defined as an ICU stay longer than 14 days. The secondary outcome was the hospital length of stay (HLOS). Receiver operating characteristic (ROC) analysis was also adopted with the value of the area under the ROC curve (AUC) for comparing trauma score prediction with patient mortality. Cutoff values from each trauma score for mortality prediction were also measured by determining the point along the ROC curve where Youden’s index was maximum. Results. We included a total of 938 patients in this study, with a mean age of 3.1 ± 1.82 years. The mortality rate was 0.9%, and 93 (9.9%) patients had a prolonged ICU stay. An elevated ISS (34 ± 19.9 vs. 5 ± 5.1, p=0.004), lower GCS (8 ± 5.0 vs. 15 ± 1.3, p=0.006), and lower RTS (5.58 ± 1.498 vs. 7.64 ± 0.640, p=0.006) were all associated with mortality. All three scores were considered to be independent risk factors of mortality and prolonged ICU stay and had a linear correlation with increased HLOS. With regard to predicting mortality, ISS has the highest AUC value (ISS: 0.975; GCS: 0.864; and RTS: 0.899). The prediction cutoff values of ISS, GCS, and RTS on mortality were 15, 11, and 7, respectively. Conclusion. Regarding traumatic injuries in young children, worse ISS, GCS, and RTS were all associated with increased mortality, prolonged ICU stay, and longer hospital LOS. Of these scoring systems, ISS was the best at predicting mortality.

scholarly journals Comorbidities in Trauma Injury Severity Scoring System: Refining Current Trauma Scoring System

2019 ◽  
Vol 85 (1) ◽  
pp. 59-63
Author(s):  
Adel Elkbuli ◽  
Reed Yaras ◽  
Ahmad Elghoroury ◽  
Dessy Boneva ◽  
Shaikh Hai ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Scoring System ◽  
Injury Severity ◽  
Scoring Systems ◽  
Trauma Patients ◽  
Data Registry ◽  
Revised Trauma Score ◽  
Chi Squared ◽  
Trauma Scoring

The revised trauma score combined with the Injury Severity Score (ISS) remains the mostly commonly used system for predicting trauma mortality, but these scoring systems do not account for the patient's comorbidities. This study aims to evaluate the effect of comorbidities on ISS-related mortality and length of stay. A review of our trauma center's data registry from 2014 to 2016 was carried out. Patients were divided according to ISS into two groups: ISS ≤ 15 and ISS > 15. Each ISS group was then subdivided by number of comorbidities into two groups: 1 to 2 or ≥3 comorbidities. Demographic characteristics and outcome measures were compared. ANOVA, chi-squared, and t tests were used with significance defined as P < 0.05. A total 9845 adult trauma patients were admitted to our trauma center during the three-year study period. In the ISS ≤ 15 group, patients with <3 comorbidities had significantly higher mortality rate compared with patients with 1 to 2 comorbidities (1.50% vs 0.12%, P << 0.000007). Comparing the ISS ≤ 15 group with ≥3 comorbidities with the ISS > 15 group with 1 to 2 comorbidities, the mortality rate was significantly higher (23.40% vs 4.50%, P << 0.000002). The ICU length of stay was significantly higher in the ISS ≤ 15 groups (17 vs 10 days, P < 0.05) but similar in the ISS > 15 groups (31 vs 29 days) (P > 0.05). It was concluded that when controlling for injury severity, increased comorbidities are associated with a significantly higher mortality, indicating that they may serve as a marker of lower physiologic reserve and be an independent variable. Adding comorbidity parameters to the current trauma scoring systems can assist in predicting more accurate/reliable outcomes.

scholarly journals Thefeasibility, appropriateness, and applicability of trauma scoring systems in low and middle-income countries: a systematic review

2020 ◽  
Vol 5 (1) ◽  
pp. e000424
Author(s):  
Isabelle Feldhaus ◽  
Melissa Carvalho ◽  
Ghazel Waiz ◽  
Joel Igu ◽  
Zachary Matthay ◽  
...  
Keyword(s):  
Systematic Review ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Scoring Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Trauma Scoring ◽  
Trauma Score ◽  
Low And Middle Income

BackgroundAbout 5.8 million people die each year as a result of injuries, and nearly 90% of these deaths occur in low and middle-income countries (LMIC). Trauma scoring is a cornerstone of trauma quality improvement (QI) efforts, and is key to organizing and evaluating trauma services. The objective of this review was to assess the appropriateness, feasibility, and QI applicability of traditional trauma scoring systems in LMIC settings.Materials and methodsThis systematic review searched PubMed, Scopus, CINAHL, and trauma-focused journals for articles describing the use of a standardized trauma scoring system to characterize holistic health status. Studies conducted in high-income countries (HIC) or describing scores for isolated anatomic locations were excluded. Data reporting a score’s capacity to discriminate mortality, feasibility of implementation, or use for QI were extracted and synthesized.ResultsOf the 896 articles screened, 336 were included. Over half of studies (56%) reported Glasgow Coma Scale, followed by Injury Severity Score (ISS; 51%), Abbreviated Injury Scale (AIS; 24%), Revised Trauma Score (RTS; 19%), Trauma and Injury Severity Score (TRISS; 14%), and Kampala Trauma Score (7%). While ISS was overwhelmingly predictive of mortality, 12 articles reported limited feasibility of ISS and/or AIS. RTS consistently underestimated injury severity. Over a third of articles (37%) reporting TRISS assessmentsobserved mortality that was greater than that predicted by TRISS. Several articles cited limited human resources as the key challenge to feasibility.ConclusionsThe findings of this review reveal that implementing systems designed for HICs may not be relevant to the burden and resources available in LMICs. Adaptations or alternative scoring systems may be more effective.PROSPERO registration numberCRD42017064600.

scholarly journals Revised Trauma Score (RTS) as a Mortality Predictor on Abdominal Trauma

2018 ◽  
Vol 1 (1) ◽  
pp. 24-36
Author(s):  
Ade Dian Anggraini ◽  
Efman EU Manawan ◽  
Legiran
Keyword(s):  
Abdominal Trauma ◽  
Mean Value ◽  
Assessment System ◽  
Trauma Patients ◽  
Major Health Problem ◽  
Common Cause ◽  
Revised Trauma Score ◽  
The Mean ◽  
Trauma Score ◽  
The Relationship

Introduction: Trauma is a major health problem throughout the world. Trauma is the most common cause of death and the most common cause of disability in adults and young adults. Abdominal trauma accounts for 7-10% of all trauma sufferers and causes severe trauma. The purpose of this study was to determine the relationship between the Revised Trauma Score (RTS) to the mortality of abdominal trauma sufferers. Methods: This study was an observational analytic study with a retrospective design to assess the relationship between Revised Trauma Score (RTS) and mortality in abdominal trauma patients treated in the Emergency Department of RSUP DR. Mohammad Hoesin Palembang. Data collected were analyzed using SPSS-23 devices using the chi-square method and Mann Whitney Results: 144 abdominal trauma patients studied. The mean age was 28 ± 11,340 years, 97.4% were male, 64.0% of patients had abdominal trauma. The average RTS value was 7.429 ± 1,001. The mean value in the group of patients who died was 6.628 ± 0.795 and the mean value of the RTS in the group of patients who did not die was 7.459 ± 0.795. There was a significant relationship between RTS values ​​and mortality in abdominal trauma patients (p = 0.0.03). Conclusion: the results of this study indicate that RTS is a meaningful assessment system in predicting death in abdominal trauma patients

scholarly journals A Comparison of the Kampala Trauma Score with the Revised Trauma Score in a Cohort of Colombian Trauma Patients

2012 ◽  
Vol 1 (3) ◽  
pp. 146-149 ◽  
Author(s):  
Colin A Clarkson ◽  
Cain Clarkson ◽  
Andres M Rubiano ◽  
Mark Borgaonkar
Keyword(s):  
Hospital Stay ◽  
Scoring System ◽  
Trauma Registry ◽  
Length Of Hospital Stay ◽  
Trauma Patients ◽  
Revised Trauma Score ◽  
Trauma Scoring ◽  
Spss Software ◽  
Trauma Score ◽  
Better Than

ABSTRACT Introduction To date, no trauma scoring system has emerged as the gold standard for use in developing countries, where limited resources for data collection are a major issue. The purpose of this study is to compare the relatively recently developed and simply calculated KTS (Kampala Trauma Score) with the more widely used RTS (Revised Trauma Score) within a cohort of Colombian trauma patients. Materials and methods Data on over 2,200 patients was derived from a newly developed trauma registry in Colombia. A statistical analysis was done using SPSS software, and included simple linear and logistical regression as appropriate. Results Both the KTS and RTS were statistically significant in terms of their ability to predict death and length of stay in hospital with the KTS being a better predictor of both. The simplest model predicting death used only the neurologic component of the KTS. However, none of these three scores explained a very large amount of the variation in the dataset. Conclusion Although statistically significant, neither the KTS nor the RTS performed well at predicting death or length of hospital stay. However, the simpler KTS did perform somewhat better than the slightly more complex RTS. Using the extremely simple neurologic component of the KTS on its own proved to be the best predictor of length of hospital stay, and also outperformed the RTS in regards to death prediction. It is clear from this study that the optimal injury scoring system for use in under resourced environments remains allusive with further research warranted. How to cite this article Clarkson CA, Clarkson C, Rubiano AM, Borgaonkar M. A Comparison of the Kampala Trauma Score with the Revised Trauma Score in a Cohort of Colombian Trauma Patients. Panam J Trauma Critical Care Emerg Surg 2012;1(3):146-149.

scholarly journals The relationship between minute ventilation and end tidal CO2 in intubated and spontaneously breathing patients undergoing procedural sedation

PLoS ONE ◽  
2017 ◽  
Vol 12 (6) ◽  
pp. e0180187 ◽  
Author(s):  
Jaideep H. Mehta ◽  
George W. Williams ◽  
Brian C. Harvey ◽  
Navneet K. Grewal ◽  
Edward E. George
Keyword(s):  
Minute Ventilation ◽  
Procedural Sedation ◽  
End Tidal ◽  
Spontaneously Breathing ◽  
The Relationship ◽  
End Tidal Co2

scholarly journals Aplikasi revised trauma score, injury severity score, dan trauma and injury severity score dalam memrediksi mortalitas pada pasien multitrauma di IRDB BLU RSUP Prof. Dr. R. D. Kandou Manado

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Jassy S. R. Ranti ◽  
Heber B. Sapan ◽  
Laurens T. B. Kalesaran
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Scoring System ◽  
Traffic Accidents ◽  
Injury Severity ◽  
Scoring Systems ◽  
Correlation Study ◽  
Trauma Studies ◽  
Revised Trauma Score ◽  
Trauma Score

Abstract: Trauma is the main cause of deaths among teenagers and young adults. Most of the cases are due to traffic accidents, therefore, a scoring system that can transforms the trauma quality to numbers is very valuable. This scoring system is needed to predict mortality, compare therapeutic methods, function as a triage tool pre hospitalization and during the way to the hospital, evaluate quality improvement and prevention program, and as a tool in trauma studies. There are several available scoring systems usually used in trauma studies, as follows: Revised Trauma Score (RTS), Injury Severity Score (ISS), and Trauma Related Injury Severity Score (TRISS). This study aimed to obtain the easiest applicable scoring system to multitraumatic patients in Prof. Dr. R. D. Kandou Hospital Manado. This was an observational correlation study. Evaluation of mortality was done by using the scoring systems and then was compared to the results in the field. There were 37 multitraumatic patients consisted of 30 males and 7 females. Five patients died during this study. By using RTS, of score >7 there was 1 death; of score 6-7 there were 3 deaths; and of score-5 there was 1 death. By using ISS, all dead patients had score ≥25, meanwhile by using TRISS, 2 dead patients had score 81-100,1 dead patient had score 61-80, and 2 dead patients had score 41-60. Conclusion: RTS is the easiest applicable scoring system at triage and pre-hospitalization, and is recommended to be a part of management of multitraumatic patients. Along with ISS, RTS can be used as a mortality predictor among multitraumatic patients.Keywords: trauma, RTS, ISS, TRISS, mortalityAbstrak: Trauma merupakan penyebab kematian utama pada usia remaja dan dewasa muda. Sistim penilaian (skoring) yang dapat mengubah kualitas trauma ke dalam bentuk nilai diperlukan agar dapat meramalkan mortalitas, membandingkan metode terapi, merupakan alat triase pre- dan antar rumah sakit, menilai perbaikan kualitas dan program pencegahan, serta merupakan alat dalam studi trauma. Beberapa sistem skoring yang sering digunakan dalam penelitian ialah Revised Trauma Score (RTS), Injury Severity Score (ISS), dan Trauma Related Injury Severity Score (TRISS). Penelitian ini bertujuan untuk mendapatkan pilihan sistim skoring yang paling mudah diaplikasikan pada pasien multitrauma di BLU RSUP Prof. Dr. R. D. Kandou, Manado. Jenis penelitian ialah observasional korelatif. Penilaian ini mengaplikasikan masing-masing skor terhadap angka mortalitas dan dibandingkan dengan hasil yang diperoleh di lapangan. Dalam penelitian ini terdapat 37 pasien multitrauma, terdiri dari 30 laki-laki dan 7 perempuan. Jumlah pasien yang meninggal selama penelitian ialah 5 orang. Untuk RTS, dari pasien dengan skor >7 terdapat 1 kematian; dari pasien dengan skor 6-7 terdapat 3 kematian, dan dari pasien dengan skor 5 terdapat 1 kematian. Untuk ISS, semua pasien yang meninggal memiliki skor ≥25, sedangkan untuk TRISS, 2 pasien yang meninggal dengan skor 81-100, 1 pasien dengan skore 61-80, dan 2 pasien yang meninggal dengan skor 41-60. Simpulan: RTS paling mudah diaplikasikan saat triase dan fase pre rumah sakit, serta direkomendasikan untuk menjadi bagian dari pedoman penanganan kasus multitrauma. Bersama-sama dengan ISS, RTS dapat diaplikasikan sebagai prediktor mortalitas pasien multitrauma.Kata kunci: trauma, RTS, ISS, TRISS, mortalitas

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