Intentional fallers with complex pelvic and acetabular fractures do not have worse radiological and functional outcomes than accidental fallers

Abstract Intentional fallers with complex pelvic and acetabular fractures were thought to have a worse prognosis because of their mental disorders. We aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis surgeries and to compare the radiological and functional outcomes between intentional and accidental fallers.Methods Between 2014 and 2017, fallers with complex pelvic and acetabular fractures who survived from resuscitation and complete surgical treatments were enrolled and investigated.Results Forty-nine fallers who underwent osteosynthesis for pelvic and acetabular fractures were included. Sixteen patients were intentional fallers, whereas the rest of the patients fell accidently. All patients who fell intentionally had pre-existing mental disorders, and the major diagnosis was adjustment disorder. Intentional fallers presented with younger age, higher injury severity score and new injury severity score, longer intensive care unit and hospital stay, early loss to follow-up, and worse functional outcomes at the 6-month follow-up. However, the radiological and functional outcomes at the 12-month follow-up did not significantly differ between the intentional and accidental fallers.Conclusion In conclusion, the intentional fallers with complex pelvic and acetabular fractures may have worse clinical presentations initially, but their radiological and functional outcomes may become comparable to those of accidental fallers after treatments.

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Intentional Fallers with Complex Pelvic and Acetabular Fractures Do Not have Worse Radiological and Functional Outcomes than Accidental Fallers

10.21203/rs.2.16780/v2 ◽

2020 ◽

Author(s):

Yi-Hsun Yu ◽

Ying-Chao Chou ◽

Yung-Heng Hsu ◽

I-Jung Chen ◽

Lien-Chung Wei

Keyword(s):

Functional Outcomes ◽

Injury Severity ◽

Adjustment Disorder ◽

Acetabular Fractures ◽

Clinical Parameters ◽

Severe Injuries ◽

Severity Scores ◽

Surgical Treatments ◽

Major Diagnosis

Abstract Background: Individuals who fell from heights of >6 m accidentally or intentionally can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. We aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and to compare the radiological and functional outcomes between intentional and accidental fallers.Methods: Between 2014 and 2017, individuals who fell from heights of >6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatments were enrolled. The fallers were divided into the intentional and accidental fallers, and their clinical parameters were statistically evaluated and compared.Results: Forty-nine fallers who underwent osteosynthesis for pelvic and acetabular fractures were included. Sixteen patients were intentional fallers, whereas the rest of the patients fell accidentally. All patients who fell intentionally had pre-existing mental disorders, and the major diagnosis was adjustment disorder. The group with intentional fallers had female sex predominance, higher injury and new injury severity scores, and longer hospital stay. However, the early loss of fixation (less than three month) and functional outcomes (6- and 12-month follow-up) did not significantly differ between the intentional and accidental fallers. Conclusions: The intentional fallers with pelvic and acetabular fractures might be accompanied by more severe injuries compared to accidental fallers. However, the radiological and functional outcomes of the intentional fallers after osteosynthesis were not inferior to those of the accidental fallers.

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Intentional Fallers with Complex Pelvic and Acetabular Fractures Do Not have Worse Radiological and Functional Outcomes than Accidental Fallers

10.21203/rs.3.rs-101439/v1 ◽

2020 ◽

Author(s):

Yi-Hsun Yu ◽

Ying-Chao Chou ◽

Yung-Heng Hsu ◽

I-Jung Chen ◽

Lien-Chung Wei

Keyword(s):

Functional Outcomes ◽

Injury Severity ◽

Adjustment Disorder ◽

Acetabular Fractures ◽

Clinical Parameters ◽

Severe Injuries ◽

Severity Scores ◽

Surgical Treatments ◽

Major Diagnosis

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Intentional Fallers with Complex Pelvic and Acetabular Fractures Do Not Have worse Radiological and Functional Outcomes than Accidental Fallers

BioMed Research International ◽

10.1155/2022/8292345 ◽

2022 ◽

Vol 2022 ◽

pp. 1-6

Author(s):

Yi-Hsun Yu ◽

Ying-Chao Chou ◽

Bo-Yan Yeh ◽

Yung-Heng Hsu ◽

I-Jung Chen ◽

...

Keyword(s):

Functional Outcomes ◽

Injury Severity ◽

Adjustment Disorder ◽

Acetabular Fractures ◽

Rehabilitation Programs ◽

Severity Scores ◽

Common Diagnosis ◽

Hospital Stays ◽

Combined Injuries

Individuals who fall from heights of ≥6 m can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. Therefore, we aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and compare the radiological and functional outcomes between intentional and accidental fallers. We retrospectively reviewed 49 fallers who fell from heights of ≥6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatment between 2014 and 2017. Fallers were divided into intentional and accidental fallers. Sixteen patients were intentional fallers, whereas the rest of the patients were accidental fallers. Psychiatric counseling was provided to each of the intentional fallers during follow-up. All intentional fallers had preexisting mental disorders, and the most common diagnosis was adjustment disorder. The group of intentional fallers predominantly comprised females that had a higher injury and new injury severity scores and longer hospital stays. However, early loss of fixation (<3 months) and functional outcomes (Merle d’Aubigné and Majeed hip scores at 6- and 12-month follow-ups) did not significantly differ between intentional and accidental fallers. We found that intentional fallers with pelvic and acetabular fractures may have more severe combined injuries compared to accidental fallers. However, the radiological and functional outcomes of the intentional fallers after osteosynthesis were not inferior to those of the accidental fallers with the implementation of well-designed surgical protocols and individualized physical and mental rehabilitation programs.

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Intentional fallers with complex pelvic and acetabular fractures do not have worse radiological and functional outcomes than accidental fallers

10.21203/rs.2.16780/v3 ◽

2021 ◽

Author(s):

Yi-Hsun Yu ◽

Ying-Chao Chou ◽

Bo-Yan Yeh ◽

Yung-Heng Hsu ◽

I-Jung Chen ◽

...

Keyword(s):

Functional Outcomes ◽

Injury Severity ◽

Adjustment Disorder ◽

Rehabilitation Program ◽

Acetabular Fractures ◽

Severity Scores ◽

Surgical Treatments ◽

Combined Injuries ◽

Major Diagnosis

Abstract Individuals who fell from heights of > 6 m can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. We aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and to compare the radiological and functional outcomes between intentional and accidental fallers. We retrospectively reviewed forty-nine fallers who fell from heights of > 6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatments between 2014 and 2017. The fallers were divided into the intentional and accidental fallers. Sixteen patients were intentional fallers, whereas the rest of the patients fell accidentally. Psychiatric counselling was performed for each intentional fallers during their follow ups. All patients who fell intentionally had pre-existing mental disorders, and the major diagnosis was adjustment disorder. The group with intentional fallers had female sex predominance, higher injury and new injury severity scores, and longer hospital stay. However, the early loss of fixation (less than three month) and functional outcomes (Merle d'Aubigné and Majeed hip scores at 6- and 12-month follow-up) did not significantly differ between the intentional and accidental fallers. We found that the intentional fallers with pelvic and acetabular fractures might be accompanied by more severe combined injuries compared to accidental fallers. Under a standardized perioperative protocol and individualized physical and mental rehabilitation program, the functional and radiological outcomes of the intentional fallers could be comparable to those of the accidental fallers.

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Schockraum- und Schwerverletztenversorgung als „Verlustgeschäft“

Der Unfallchirurg ◽

10.1007/s00113-020-00937-w ◽

2020 ◽

Author(s):

Thomas Gross ◽

Felix Amsler

Keyword(s):

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Diagnosis Related Groups ◽

Case Mix ◽

Multivariate Analyse ◽

New Injury Severity Score ◽

Case Mix Index

Zusammenfassung Hintergrund Es galt herauszufinden, wie kostendeckend die Versorgung potenziell Schwerverletzter in einem Schweizer Traumazentrum ist, und inwieweit Spitalgewinne bzw. -verluste mit patientenbezogenen Unfall‑, Behandlungs- oder Outcome-Daten korrelieren. Methodik Analyse aller 2018 im Schockraum (SR) bzw. mit Verletzungsschwere New Injury Severity Score (NISS) ≥8 notfallmäßig stationär behandelter Patienten eines Schwerverletztenzentrums der Schweiz (uni- und multivariate Analyse; p < 0,05). Ergebnisse Für das Studienkollektiv (n = 513; Ø NISS = 18) resultierte gemäß Spitalkostenträgerrechnung ein Defizit von 1,8 Mio. CHF. Bei einem Gesamtdeckungsgrad von 86 % waren 66 % aller Fälle defizitär (71 % der Allgemein- vs. 42 % der Zusatzversicherten; p < 0,001). Im Mittel betrug das Defizit 3493.- pro Patient (allg. Versicherte, Verlust 4545.-, Zusatzversicherte, Gewinn 1318.-; p < 0,001). Auch „in“- und „underlier“ waren in 63 % defizitär. SR-Fälle machten häufiger Verlust als Nicht-SR-Fälle (73 vs. 58 %; p = 0,002) wie auch Traumatologie- vs. Neurochirurgiefälle (72 vs. 55 %; p < 0,001). In der multivariaten Analyse ließen sich 43 % der Varianz erhaltener Erlöse mit den untersuchten Variablen erklären. Hingegen war der ermittelte Deckungsgrad nur zu 11 % (korr. R2) durch die Variablen SR, chirurgisches Fachgebiet, Intensivaufenthalt, Thoraxverletzungsstärke und Spitalletalität zu beschreiben. Case-Mix-Index gemäß aktuellen Diagnosis Related Groups (DRG) und Versicherungsklasse addierten weitere 13 % zu insgesamt 24 % erklärter Varianz. Diskussion Die notfallmäßige Versorgung potenziell Schwerverletzter an einem Schweizer Traumazentrum erweist sich nur in einem Drittel der Fälle als zumindest kostendeckend, dies v. a. bei Zusatzversicherten, Patienten mit einem hohen Case-Mix-Index oder einer IPS- bzw. kombinierten Polytrauma- und Schädel-Hirn-Trauma-DRG-Abrechnungsmöglichkeit.

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Determining Pediatric Trauma (New Injury Severity Score and Trauma Injury Severity Score)

Journal of Pediatric Surgical Nursing ◽

10.1097/jps.0000000000000314 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Amy Brammer

Keyword(s):

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Pediatric Trauma ◽

New Injury Severity Score ◽

Trauma Injury

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Ten years of new injury severity score (NISS): is it a possible change?

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692008000200022 ◽

2008 ◽

Vol 16 (2) ◽

pp. 314-319 ◽

Cited By ~ 17

Author(s):

Lilia de Souza Nogueira ◽

Cristiane de Alencar Domingues ◽

Miriam de Araújo Campos ◽

Regina Márcia Cardoso de Sousa

Keyword(s):

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Trauma Studies ◽

New Injury Severity Score ◽

Dependent Variables ◽

Actual Range

The article is a bibliographic review which intends to present the actual range of researches comparing the Injury Severity Score (ISS) and the New Injury Severity Score (NISS). Databases were searched using the keyword NISS, with 42 articles, 23 of which didn't compare the two indexes. Most part of the 19 selected articles showed that NISS has been more accurate in predicting the outcomes (dependent variables) than ISS, moreover in severe and specific trauma. Studies with populations between 1,000 and 10,000 resulted in NISS-favorable results, whereas studies with populations larger than 10,000 or smaller than 1,000 showed either NISS-favorable results or no difference between the two groups. However, there were no studies showing ISS-favorable results. These results and the easier calculation of NISS lead to a future replacement of ISS by NISS.

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Measuring trauma severity using the 1998 and 2005 revisions of the Abbreviated Injury Scale

Revista da Escola de Enfermagem da USP ◽

10.1590/s0080-623420140000400010 ◽

2014 ◽

Vol 48 (4) ◽

pp. 641-648 ◽

Cited By ~ 3

Author(s):

Maria Carolina Barbosa Teixeira Lopes ◽

Iveth Yamaguchi Whitaker

Keyword(s):

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Sao Paulo ◽

São Paulo ◽

Abbreviated Injury Scale ◽

New Injury Severity Score ◽

Trauma Severity

Objetivo: Comparar a gravidade das lesões e do trauma mensurada pelas versões da Abbreviated Injury Scale 1998 e 2005 e verificar a mortalidade nos escores Injury Severity Score e New Injury Severity Score nas duas versões.Método: Estudo transversal e retrospectivo analisou lesões de pacientes de trauma, de três hospitais universitários do município de São Paulo, Brasil. Cada lesão foi codificada com Abbreviated Injury Scale 1998 e 2005. Os testes estatísticos aplicados foram Wilcoxon, McNemar-Bowker, Kappa e teste Z.Resultados: A comparação das duas versões resultou em discordância significante de escores em algumas regiões corpóreas. Com a versão 2005 os níveis de gravidade da lesão e do trauma foram significantemente reduzidos e a mortalidade foi mais elevada em escores mais baixos. Conclusão: Houve redução da gravidade da lesão e do trauma e alteração no percentual de mortalidade com o uso da Abbreviated Injury Scale 2005.    

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Clinical Outcome and Management for Geriatric Traumatic Injury: Analysis of 2688 Cases in the Emergency Department of a Teaching Hospital in Taiwan

Journal of Clinical Medicine ◽

10.3390/jcm7090255 ◽

2018 ◽

Vol 7 (9) ◽

pp. 255 ◽

Cited By ~ 1

Author(s):

Meng-Yu Wu ◽

Yu-Long Chen ◽

Giou-Teng Yiang ◽

Chia-Jung Li ◽

Amy Lin

Keyword(s):

Clinical Outcome ◽

Injury Severity Score ◽

Clinical Outcomes ◽

Severity Score ◽

Injury Severity ◽

Strong Predictor ◽

Traumatic Injury ◽

Geriatric Trauma ◽

Shock Index ◽

New Injury Severity Score

Geriatric traumatic injuries in emergency departments are frequent and associated with higher mortality rates and catastrophic functional outcomes. Several prediction scores have been established to manage traumatic patients, including the shock index (SI), revised trauma score (RTS), injury severity score (ISS), trauma injury severity score (TRISS), and new injury severity score (NISS). However, it was necessary to investigate the effectiveness and efficiency of care for the geriatric traumatic population. In addition, image studies such as computed tomography and magnetic resonance imaging play an important role in early diagnosis and timely intervention. However, few studies focus on this aspect. The association between the benefit of carrying out more image studies and clinical outcomes remains unclear. In this study, we included a total of 2688 traumatic patients and analyzed the clinical outcomes and predicting factors in terms of geriatric trauma via pre-hospital and in-hospital analysis. Our evaluation revealed that a shock index ≥1 may be not a strong predictor of geriatric trauma due to the poor physical response in the aging population. This should be modified in geriatric patients. Other systems, like RTS, ISS, TRISS, and NISS, were significant in terms of predicting the clinical outcome.

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Follow-Up Abdominal CT is not Necessary in Low-Grade Splenic Injury

The American Surgeon ◽

10.1177/000313480707300104 ◽

2007 ◽

Vol 73 (1) ◽

pp. 13-18 ◽

Cited By ~ 9

Author(s):

James M. Haan ◽

Sharon Boswell ◽

Deborah Stein ◽

Thomas M. Scalea

Keyword(s):

Injury Severity Score ◽

Vascular Injury ◽

Severity Score ◽

Injury Severity ◽

Splenic Injury ◽

Nonoperative Management ◽

Low Grade ◽

Abdominal Ct ◽

Simple Observation

Nonoperative management of splenic injury has become the standard of care in the hemodynamically stable patient. The time period of observation and the utility of follow-up scanning remain an area of debate. This study examined the utility of follow-up abdominal CT for detection of delayed vascular injury in patients with low-grade splenic injury. A retrospective review of all patients with low-grade splenic injuries undergoing nonoperative management from June 2000 to June 2004 was performed. Patients underwent follow-up abdominal CT 48 to 72 hours after admission to rule out delayed vascular injury and were discharged if the results were negative. Charts were reviewed for demographic data, abdominal CT results, and splenic salvage. A total of 472 patients underwent nonoperative management for splenic injury, with 140 patients treated with simple observation during this protocol. All patients were successfully managed with simple observation with no nonoperative failures; there were two instances of delayed vascular injury on follow-up CT. Both patients with progression of injury had decreasing hematocrit levels during admission prior to follow-up abdominal CT scan. Overall, the injury severity score was 22 points and the American Association for the Surgery of Trauma (AAST) splenic injury severity score was 1.8 points. Length of hospital stay was 2.8 days for patients with predominately splenic injury and 10 days for the overall cohort. Follow-up abdominal CT confers no benefit in patients with low-grade splenic injury, and a stable hematocrit level and abdominal exam.

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