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.

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.

scholarly journals Evaluation of Facial Trauma Severity in Cipto Mangunkusumo Hospital Using FISS Scoring System

1970 ◽  
Vol 1 (2) ◽  
Author(s):  
Kristaninta Bangun ◽  
Ayu Diah Kesuma
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Scoring System ◽  
Injury Severity ◽  
Scoring Systems ◽  
Facial Trauma ◽  
Trauma Patients ◽  
Documentation System ◽  
Trauma Severity ◽  
Degree Of Severity

Many scoring systems were introduced to search prognostic value in trauma patients. Facial trauma is a special trauma because it can cause many disabilities in facial function. There have been several reports on facial severity scoring system, such as Facial Injury Severity Score (FISS) and Maxillofacial Injury Severity Score (MFISS). Although these scoring systems have been introduced in many journals, they are not yet used by many clinicians because of their unawareness of its beneficiary. In this study, we want to introduce and apply these scoring systems in our maxillofacial data, thus it can be used for documentation system, as a research tool, and have prediction value for prognosis We retrospectively collected data on patients with facial trauma in Cipto Mangunkusumo Hospital in 2009. The data collected were age, gender, etiology, use of helmet, type of fracture and treatment given. Each patient then evaluated by FISS score to obtain their degree of severity. Using FISS score introduced by Bagheri, we found the average FISS score ini this evaluation was 3,37 ± 1,9, with minimum value 1 and maximum value 9. Most patients have FISS score 2 (24,7%). From FISS scoring system, we found that most of maxillofacial trauma in Cipto Mangunkusumo hospital in 2009 was mild trauma. In order to evaluate if FISS scoring system has predictive value for prognosis, a large sample and complete maxillofacial database are needed.

The Impact of Enhanced Intensive Care on Outcome of Major Trauma Patients in a Regional Hospital in Hong Kong

2008 ◽  
Vol 15 (4) ◽  
pp. 218-229
Author(s):  
ANL Chan ◽  
ACH Lit
Keyword(s):  
Hong Kong ◽  
Intensive Care ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Major Trauma ◽  
Injury Severity ◽  
Regional Hospital ◽  
Blunt Injury ◽  
Trauma Patients ◽  
The Impact

Objectives To describe an updated epidemiology of major trauma cases presenting to a regional hospital in Hong Kong and to analyse the impact of enhanced intensive care on the outcome of major trauma patients. Methods This was a retrospective comparative study. In late 2004, we amended our trauma care system with enhancement of intensive care in the management of major trauma patients. An 18-month period was chosen before and after the amendment respectively and patients' data and crude mortality rate between the two periods were compared. Stratified analyses based on mechanism of injury, injury severity and physiological parameters were also performed. Finally, a TRISS analysis was included. Results Altogether 163 and 155 patients were included in our study from the two periods respectively. The majority involved blunt injury and one third of them had injury severity score (ISS) greater than 15. Road traffic accidents and fall from height remained as the two leading causes of major trauma. The median length of stay in the intensive care unit increased for one day (p<0.01) in the later period but the median total length of stay in hospital remained the same. The mortality rate decreased from 10.4% to 9.7% (p=0.82). Conclusion With enhanced intensive care, there is an apparent decrease in mortality of major trauma patients but its significance needs to be determined with a larger scale study.

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 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

scholarly journals A retrospective cohort study of 27,049 polytraumatized patients age 60 and above: identifying changes over 16 years

2021 ◽  
Author(s):  
Y. Kalbas ◽  
M. Lempert ◽  
F. Ziegenhain ◽  
J. Scherer ◽  
V. Neuhaus ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Descriptive Analysis ◽  
Patient Characteristics ◽  
Severe Trauma ◽  
Diagnostic Tools ◽  
Trauma Patients ◽  
Treatment Algorithms ◽  
Injured Patients ◽  
Over Time

Abstract Purpose The number of severely injured patients exceeding the age of 60 has shown a steep increase within the last decades. These patients present with numerous co-morbidities, polypharmacy, and increased frailty requiring an adjusted treatment approach. In this study, we establish an overview of changes we observed in demographics of older severe trauma patients from 2002 to 2017. Methods A descriptive analysis of the data from the TraumaRegister DGU® (TR-DGU) was performed. Patients admitted to a level one trauma center in Germany, Austria and Switzerland between 2002 and 2017, aged 60 years or older and with an injury severity score (ISS) over 15 were included. Patients were stratified into subgroups based on the admission: 2002–2005 (1), 2006–2009 (2), 2010–2013 (3) and 2014–2017 (4). Trauma and patient characteristics, diagnostics, treatment and outcome were compared. Results In total 27,049 patients with an average age of 73.9 years met the inclusion criteria. The majority were males (64%), and the mean ISS was 27.4. The proportion of patients 60 years or older [(23% (1) to 40% (4)] rose considerably over time. Trauma mechanisms changed over time and more specifically low falls (< 3 m) rose from 17.6% (1) to 40.1% (4). Altered injury patterns were also identified. Length-of-stay decreased from 28.9 (1) to 19.5 days (4) and the length-of-stay on ICU decreased from 17.1 (1) to 12.7 days (4). Mortality decreased from 40.5% (1) to 31.8% (4). Conclusion Length of stay and mortality decreased despite an increase in patient age. We ascribe this observation mainly to increased use of diagnostic tools, improved treatment algorithms, and the implementation of specialized trauma centers for older patients allowing interdisciplinary care.

scholarly journals Does emergency medicine length of stay predict trauma outcomes at a Level 1 Trauma Center?

2015 ◽  
Vol 4 (5) ◽  
pp. 1 ◽  
Author(s):  
Erin Powers Kinney ◽  
Kamal Gursahani ◽  
Eric Armbrecht ◽  
Preeti Dalawari
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Hospital Capacity ◽  
Significant Difference ◽  
Level 1 ◽  
Level 1 Trauma Center

Objective: Previous studies looking at emergency department (ED) crowding and delays of care on outcome measures for certain medical and surgical patients excluded trauma patients. The objectives of this study were to assess the relationship of trauma patients’ ED length of stay (EDLOS) on hospital length of stay (HLOS) and on mortality; and to examine the association of ED and hospital capacity on EDLOS.Methods: This was a retrospective database review of Level 1 and 2 trauma patients at a single site Level 1 Trauma Center in the Midwest over a one year period. Out of a sample of 1,492, there were 1,207 patients in the analysis after exclusions. The main outcome was the difference in hospital mortality by EDLOS group (short was less than 4 hours vs. long, greater than 4 hours). HLOS was compared by EDLOS group, stratified by Trauma Injury Severity Score (TRISS) category (< 0.5, 0.51-0.89, > 0.9) to describe the association between ED and hospital capacity on EDLOS.Results: There was no significant difference in mortality by EDLOS (4.8% short and 4% long, p = .5). There was no significant difference in HLOS between EDLOS, when adjusted for TRISS. ED census did not affect EDLOS (p = .59), however; EDLOS was longer when the percentage of staffed hospital beds available was lower (p < .001).Conclusions: While hospital overcrowding did increase EDLOS, there was no association between EDLOS and mortality or HLOS in leveled trauma patients at this institution.

scholarly journals Orthopedic injuries due to parachute jumping in soldiers and the effect of trauma scoring systems in determining injury level:  A prospective observational study

2020 ◽  
Author(s):  
Taner Sahin ◽  
Sabri Batin
Keyword(s):  
Injury Severity ◽  
Demographic Data ◽  
Military Training ◽  
Scoring Systems ◽  
The Body ◽  
Treatment Methods ◽  
Severity Of Injury ◽  
Common Diagnosis ◽  
Trauma Scoring ◽  
Orthopedic Injuries

Abstract Background During parachute jumping in soldiers, minör or life-threatining majör injuries may be occur in various parts of the body. Various trauma scoring systems have been developed to determine the severity of these injuries. The aim of this study is to determine orthopedic injuries and other injuries due to parachute jumping for military training who admitted to ED and the severity of their injuries using by anatomical and physiological trauma scores (AIS and ISS), to examine applied treatment methods, their hospitalization conditions and the length of hospital stay prospectively over a 44-month period between January 2016 and August 2019. Methods 200 military personnel were included in the study, between the ages of 18-52, who were injured as a result of daytime static parachute jumping for military training. Demographic data such as age, gender, ISS trauma region classification, anatomical injury sites, AIS and ISS scores, diagnosis, treatment methods applied, hospitalization status and duration of hospitalization were examined prospectively in a total of 185 patients. Results Among 184 individuals included in the study, 184 were male and 1 was female. The most common injured body site were 33.5% foot. and the most common diagnosis was 64.3% soft tissue trauma. Considering the treatment methods applied, 51.4% was determined as medication cold application, 42.7% as splint plaster, and 5.9% as surgery. The mean ISS of the patients was 5.16 ± 3.92. The hospitalization rate of patients with a critical AIS score was significantly higher than those with a severe AIS score (p <0.001). Conclusions The use of trauma scoring systems in determining the severity of injury to patients who come to ED due to parachute injury may facilitate treatment selection. Key words: Parachuting injuries, Abbreviated Injury Scale ve Injury Severity Score

scholarly journals CORRELATION OF FACIAL INJURY SEVERITY SCALE (FISS) WITH LENGTH OF STAY, THE NEED FOR SURGERY AND THE INVOLVEMENT OF OTHER SPECIALISTS IN MAXILLOFACIAL TRAUMA PATIENTS AT H. ADAM MALIK GENERAL HOSPITAL MEDAN

2019 ◽  
pp. 1-3
Author(s):  
Darwin Firmansyah Siregar ◽  
Frank Bietra Buchari ◽  
Utama Abdi Tarigan ◽  
Aznan Lelo
Keyword(s):  
Length Of Stay ◽  
General Hospital ◽  
Injury Severity ◽  
The Body ◽  
Maxillofacial Trauma ◽  
Mandibular Fractures ◽  
Trauma Patients ◽  
Facial Injury ◽  
Single Operator ◽  
Surgery Department

Background: Facial Injury Severity Severity Score (FISS) has been used to assess the severity of facial injuries. However, FISS scores as a useful predictor of length of stay and changes between FISS scores and injuries to other parts of the body have not evaluated. In this study, we want to know the relationship between FISS score as the clinical assessment of maxillofacial trauma with the length of stay, the need for surgery, and the involvement of other specialist elds. Method: This research was conducted using analytical research through a retrospective approach by looking at the medical records of patients who suffered maxillofacial trauma at H. Adam Malik General Hospital Medan from June to August 2019. Result : From a total of 43 patients included in the study, there were 22 mandibular fractures, with mandibular angulus (29.0%), parasymphysis (22.4%), and mandibular corpus (21.5%). Thirty subjects (69.8%) needed surgery, and xation of the fracture and subjects without intervention were 13 (30.2%). Patients who needed surgical intervention, the average time needed for hospitalization was 10.98 + 7.72 days (p = 0.007). The most collaboration found with neurosurgeons specialists, 39.53% of subjects who performed the surgery. A total of 55.8% of surgeries performed by a single operator from the plastic surgery department. Relationship between the length of stay with FISS, obtained for FISS> 3 (OR 14.37) (p = 0.01), meaning that patients with FISS> 3 are likely to stay longer for 14 times. Subsequent results related to the need for surgery obtained signicant results (OR = 8.26, p = 0.026). signicant (p = 0.059). Conclusion: A FISS score signicantly affects the length of stay for a maxillofacial trauma patient. FISS score also affects the involvement of other specialists in maxillofacial trauma patients but not statistically signicant.

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