scholarly journals Interobserver variability of injury severity assessment in polytrauma patients: does the anatomical region play a role?

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Eftychios Bolierakis ◽  
Sylvia Schick ◽  
Kai Sprengel ◽  
Kai Oliver Jensen ◽  
Frank Hildebrand ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Interobserver Variability ◽  
Severity Assessment ◽  
Severely Injured ◽  
X Rays ◽  
Severely Injured Patients ◽  
Anatomical Region ◽  
Injured Patients

Abstract Background The Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) are widely used to assess trauma patients. In this study, the interobserver variability of the injury severity assessment for severely injured patients was analyzed based on different injured anatomical regions, and the various demographic backgrounds of the observers. Methods A standardized questionnaire was presented to surgical experts and participants of clinical polytrauma courses. It contained medical information and initial X-rays/CT-scans of 10 cases of severely injured patients. Participants estimated the severity of each injury based on the AIS. Interobserver variability for the AIS, ISS, and New Injury Severity Score (NISS) was calculated by employing the statistical method of Krippendorff's α coefficient. Results Overall, 54 participants were included. The major contributing medical specialties were orthopedic trauma surgery (N = 36, 67%) and general surgery (N = 13, 24%). The measured interobserver variability in the assessment of the overall injury severity was high (α ISS: 0.33 / α NISS: 0.23). Moreover, there were differences in the interobserver variability of the maximum AIS (MAIS) depending on the anatomical region: αhead and neck: 0.06, αthorax: 0.45, αabdomen: 0.27 and αextremities: 0.55. Conclusions Interobserver agreement concerning injury severity assessment appears to be low among clinicians. We also noted marked differences in variability according to injury anatomy. The study shows that the assessment of injury severity is also highly variable between experts in the field. This implies the need for appropriate education to improve the accuracy of trauma evaluation in the respective trauma registries.

scholarly journals Evaluation of the Georgia trauma system using the American College of Surgeons Needs Based Assessment of Trauma Systems tool

2018 ◽  
Vol 3 (1) ◽  
pp. e000188 ◽  
Author(s):  
Dennis W Ashley ◽  
Etienne E Pracht ◽  
Laura E Garlow ◽  
Regina S Medeiros ◽  
Elizabeth V Atkins ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma System ◽  
Severely Injured ◽  
Trauma Systems ◽  
Severely Injured Patients ◽  
American College Of Surgeons ◽  
Level I ◽  
Injured Patients

BackgroundThe American College of Surgeons Needs Based Assessment of Trauma Systems (NBATS) tool was developed to help determine the optimal regional distribution of designated trauma centers (DTC). The objectives of our current study were to compare the current distribution of DTCs in Georgia with the recommended allocation as calculated by the NBATS tool and to see if the NBATS tool identified similar areas of need as defined by our previous analysis using the International Classification of Diseases, Ninth Revision, Clinical Modification Injury Severity Score (ICISS).MethodsPopulation counts were acquired from US Census publications. Transportation times were estimated using digitized roadmaps and patient zip codes. The number of severely injured patients was obtained from the Georgia Discharge Data System for 2010 to 2014. Severely injured patients were identified using two measures: ICISS<0.85 and Injury Severity Score >15.ResultsThe Georgia trauma system includes 19 level I, II, or III adult DTCs. The NBATS guidelines recommend 21; however, the distribution differs from what exists in the state. The existing DTCs exactly matched the NBATS recommended number of level I, II, or III DTCs in 2 of 10 trauma service areas (TSAs), exceeded the number recommended in 3 of 10 TSAs, and was below the number recommended in 5 of 10 TSAs. Densely populated, or urban, areas tend to be associated with a higher number of existing centers compared with the NBATS recommendation. Other less densely populated TSAs are characterized by large rural expanses with a single urban core where a DTC is located. The identified areas of need were similar to the ones identified in the previous gap analysis of the state using the ICISS methodology.DiscussionThe tool appears to underestimate the number of centers needed in extensive and densely populated areas, but recommends additional centers in geographically expansive rural areas. The tool signifies a preliminary step in assessing the need for state-wide inpatient trauma center services.Level of evidenceEconomic, level IV.

Delays in Transfer of Elderly Less-injured Trauma Patients Can Have Deadly Consequences

2014 ◽  
Vol 80 (11) ◽  
pp. 1132-1135 ◽  
Author(s):  
Peter E. Fischer ◽  
Paul D. Colavita ◽  
Gregory P. Fleming ◽  
Toan T. Huynh ◽  
A. Britton Christmas ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Trauma Patients ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Local Trauma ◽  
Level 1 ◽  
Poor Outcomes ◽  
Injured Patients ◽  
Level 1 Trauma Center

Transfer of severely injured patients to regional trauma centers is often expedited; however, transfer of less-injured, older patients may not evoke the same urgency. We examined referring hospitals’ length of stay (LOS) and compared the subsequent outcomes in less-injured transfer patients (TP) with patients presenting directly (DP) to the trauma center. We reviewed the medical records of less-injured (Injury Severity Score [ISS] 9 or less), older (age older than 60 years) patients transferred to a regional Level 1 trauma center to determine the referring facility LOS, demographics, and injury information. Outcomes of the TP were then compared with similarly injured DP using local trauma registry data. In 2011, there were 1657 transfers; the referring facility LOS averaged greater than 3 hours. In the less-injured patients (ISS 9 or less), the average referring facility LOS was 3 hours 20 minutes compared with 2 hours 24 minutes in more severely injured patients (ISS 25 or greater, P < 0.05). The mortality was significantly lower in the DP patients (5.8% TP vs 2.6% DP, P = 0.035). Delays in transfer of less-injured, older trauma patients can result in poor outcomes including increased mortality. Geographic challenges do not allow for every patient to be transported directly to a trauma center. As a result, we propose further outreach efforts to identify potential causes for delay and to promote compliance with regional referral guidelines.

Vasopressor Use during Emergency Trauma Surgery

2014 ◽  
Vol 80 (5) ◽  
pp. 472-478 ◽  
Author(s):  
Robert M. Van Haren ◽  
Chad M. Thorson ◽  
Evan J. Valle ◽  
Gerardo A. Guarch ◽  
Jassin M. Jouria ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Mortality Rate ◽  
Odds Ratio ◽  
Injury Severity ◽  
Trauma Surgery ◽  
Vital Signs ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Vasopressor Use ◽  
Injured Patients

Most evidence suggests early vasopressor use is associated with death after trauma, but no previous study has focused on patients requiring emergency operative intervention (OR). We test the hypothesis that vasopressors are harmful in this population. Records from 746 patients requiring OR from July 2009 to March 2013 were retrospectively reviewed and stratified based on vasopressor use (epinephrine [EPI], phenylephrine, ephedrine, norepinephrine, dobutamine, vasopressin) or no vasopressor use. Vasopressors were administered to 225 patients (30%) during OR; 59 patients (8%) received multiple vasopressors. Patients who received vasopressors were older, more severely injured, had worse vital signs, and increased mortality rate (all P < 0.001). EPI was independently associated with mortality (odds ratio, 6.88; P = 0.001). If patients who received EPI were excluded, there was no difference in mortality between those who received vasopressors alone or in combination and those that did not (5 vs 6%, P = 0.523), although multiple markers of injury severity were worse. We conclude that vasopressor use is relatively common in the most severely injured patients requiring OR and is associated with mortality. EPI is most often used for cardiac arrest, whereas other vasopressors are used for their vasoconstrictive properties. This suggests that, except for EPI, vasopressors during OR are not independently associated with mortality.

Is Blood Sugar the Next Lactate?

2006 ◽  
Vol 72 (7) ◽  
pp. 613-618 ◽  
Author(s):  
TherÈSe M. Duane ◽  
Tracey Dechert ◽  
Nicholas Dalesio ◽  
Luke G. Wolfe ◽  
Nicholas Dalesio ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Injury Severity Score ◽  
Blood Glucose Level ◽  
Blood Sugar ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Patients ◽  
Severely Injured ◽  
Infection Rates ◽  
Initial Blood

This study evaluates whether an initial blood glucose level is similarly predictive of injury severity and outcome as admission lactate in trauma patients. Between February 2004 and June 2005, we prospectively compared patients with presenting blood sugars of ≤150 mg/dL (LBS) with those with blood sugars >150 mg/dL (HBS). Fifty patients had BS above 150 mg/dL, whereas 176 patients were ≤150 mg/dL. These groups had similar demographics except for age. Injury Severity Score (ISS) of ≥15 was seen in 56.0 per cent of HBS patients versus 28.4 per cent of LBS patients (P = 0.0006). HBS patients had similar infection rates (12.0% HBS vs. 5.7% LBS, P = 0.13) but a higher mortality (30.0% HBS vs. 5.7% LBS, P < 0.0001). There was a linear relationship between ISS and BS (r2 = 0.18, P < 0.0001) and ISS and lactate (r2 = 0.17, P < 0.0001). Blood sugar trended with the lactate (r = 0.25, P = 0.0001). Hyperglycemic patients were more severely injured with higher mortality. BS correlated with lactate, and because it is easily obtainable, it may serve as a readily available predictor of injury severity and prognosis.

Despite Trauma Center Closures, Trauma System Regionalization Reduces Mortality and Time to Definitive Care in Severely Injured Patients

2017 ◽  
Vol 83 (6) ◽  
pp. 591-597 ◽  
Author(s):  
Jack C. He ◽  
David Schechtman ◽  
Debra L. Allen ◽  
Jillian J. Cremona ◽  
Jeffrey A. Claridge
Keyword(s):  
Median Time ◽  
Injury Severity ◽  
Trauma System ◽  
Relative Reduction ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Trauma Outcomes ◽  
Hospital Systems ◽  
Injured Patients ◽  
Patient Subgroups

The Northern Ohio Trauma System (NOTS), consisting of multiple hospital systems, was established in 2010 to improve trauma outcomes. This study assessed its impact on mortality and time to definitive care, focusing especially on the severely injured patients. NOTS trauma registry was queried for all trauma activations from 2008 to 2013. The years between 2008–2009 and 2011–2013 were designated as pre- and post-NOTS, respectively. Data from 2010 was excluded as a transitional year. Two trauma centers (TCs) closed in 2010. Predetermined patient subgroups were analyzed. A total of 27,843 patients were examined. Mean age was 46 and 64 per cent were male. Median Injury Severity Score (ISS) was five, and 87 per cent sustained blunt injuries. Of these, 10,641 patients were pre-NOTS and 17,202 were post-NOTS. Comparing the two groups, mortality decreased from 5 to 4 per cent post-NOTS (P < 0.001); median time to definitive care increased by 12 minutes post-NOTS. Multivariate logistic regression showed that NOTS implementation was an independent predictor for survival (P = 0.008), whereas time to definitive care was not. Subgroup analyses demonstrated mortality reductions post-NOTS for all subgroups except patients with penetrating injuries, where mortality remained the same despite an increase in ISS. Patients with ISS ≥15 had a 23 per cent relative reduction in mortality, and their median time to definitive care decreased by 12 minutes. Implementation of a collaborative, regional trauma system was associated with mortality reduction and shortened time to definitive care in the severely injured patients. These findings highlight the importance of collaboration in the future development of regional trauma systems.

Relationship between injury severity and lactate levels in severely injured patients

2003 ◽  
Vol 29 (8) ◽  
pp. 1300-1305 ◽  
Author(s):  
Ognjen Cerović ◽  
Vesna Golubović ◽  
Ana Špec-Marn ◽  
Boriana Kremžar ◽  
Gaj Vidmar
Keyword(s):  
Injury Severity ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Lactate Levels ◽  
Injured Patients

Regional Health System Response to the 2007 Greensburg, Kansas, EF5 Tornado

2007 ◽  
Vol 1 (2) ◽  
pp. 90-95 ◽  
Author(s):  
Elizabeth Ablah ◽  
Annie M. Tinius ◽  
Kurt Konda ◽  
Carolyn Synovitz ◽  
Italo Subbarao
Keyword(s):  
Injury Severity Score ◽  
Emergency Medical Services ◽  
Severity Score ◽  
Injury Severity ◽  
Medical Services ◽  
System Response ◽  
Emergency Medical ◽  
Included Patient ◽  
Injured Patients ◽  
Regional Hospitals

ABSTRACTBackground: On May 4, 2007 an EF5 tornado hit the rural community of Greensburg, KS, destroying 95% of the town and resulting in 12 fatalities.Methods: Data was requested from the emergency medical services units that initially responded and the regional hospitals that received people injured in the tornado within 24 hours following the tornado. Requested data included patient age and sex, and injury severity score or ICD-9 codes. Critical mortality, or the number of deaths of critically injured patients, was also calculated.Results: The extensive damage caused by the tornado effectively destroyed the infrastructure of the community and created enormous challenges for emergency medical services responders, who were unable to record any triage data. Area hospitals treated 90 patients, who had an average injury severity score of 6.4. Age was found to be related to injury severity, but no relationship between sex and injury severity was found. Critical mortality was found to be 18% for this event.Conclusions: Injury severity score has seldom been used to analyze natural disasters, especially tornadoes, although such analysis is helpful for understanding the magnitude of the disaster, comparing to other disasters, and preparing for future incidents. Advanced warning and personal preparedness are important factors in reducing tornado-related injuries and deaths. (Disaster Med Public Health Preparedness. 2007;1:90–95)

Sign in / Sign up

Export Citation Format

Share Document