scholarly journals Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2156
Author(s):  
Alexander Omar ◽  
Marcel Winkelmann ◽  
Emmanouil Liodakis ◽  
Jan-Dierk Clausen ◽  
Tilman Graulich ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Injury Severity Score ◽  
Sensitivity And Specificity ◽  
Severity Score ◽  
Injury Severity ◽  
Scoring Systems ◽  
Apache Ii ◽  
Operating Characteristics ◽  
Aortic Injuries ◽  
Receiver Operating

Background: Most patients with blunt aortic injuries, who arrive alive in a clinic, suffer from traumatic pseudoaneurysms. Due to modern treatments, the perioperative mortality has significantly decreased. Therefore, it is unclear how exact the prediction of commonly used scoring systems of the outcome is. Methods: We analyzed data on 65 polytraumatized patients with blunt aortic injuries. The following scores were calculated: injury severity score (ISS), new injury severity score (NISS), trauma and injury severity score (TRISS), revised trauma score coded (RTSc) and acute physiology and chronic health evaluation II (APACHE II). Subsequently, their predictive value was evaluated using Spearman´s and Kendall´s correlation analysis, logistic regression and receiver operating characteristics (ROC) curves. Results: A proportion of 83% of the patients suffered from a thoracic aortic rupture or rupture with concomitant aortic wall dissection (54/65). The overall mortality was 24.6% (16/65). The sensitivity and specificity were calculated as the area under the receiver operating curves (AUC): NISS 0.812, ISS 0.791, APACHE II 0.884, RTSc 0.679 and TRISS 0.761. Logistic regression showed a slightly higher specificity to anatomical scoring systems (ISS 0.959, NISS 0.980, TRISS 0.957, APACHE II 0.938). The sensitivity was highest in the APACHE II with 0.545. Sensitivity and specificity for the RTSc were not significant. Conclusion: The predictive abilities of all scoring systems were very limited. All scoring systems, except the RTSc, had a high specificity but a low sensitivity. In our study population, the RTSc was not applicable. The APACHE II was the most sensitive score for mortality. Anatomical scoring systems showed a positive correlation with the amount of transfused blood products.

Comparison of the Prognostic Significance of Initial Blood Lactate and Base Deficit in Trauma Patients

2017 ◽  
Vol 126 (3) ◽  
pp. 522-533 ◽  
Author(s):  
Keyword(s):  
Logistic Regression ◽  
Injury Severity Score ◽  
Blood Lactate ◽  
Severity Score ◽  
Injury Severity ◽  
Prognostic Significance ◽  
Base Deficit ◽  
Trauma Patients ◽  
Operating Characteristics ◽  
Initial Blood

Abstract Background Initial blood lactate and base deficit have been shown to be prognostic biomarkers in trauma, but their respective performances have not been compared. Methods Blood lactate levels and base deficit were measured at admission in trauma patients in three level 1 trauma centers. This was a retrospective analysis of prospectively acquired data. The association of initial blood lactate and base deficit with mortality was tested using receiver operating characteristics curve, logistic regression using triage scores (Revised Trauma Score and Mechanism Glasgow scale and Arterial Pressure score), and Trauma Related Injury Severity Score as a reference standard. The authors also used a reclassification method. Results The authors evaluated 1,075 trauma patients (mean age, 39 ± 18 yr, with 90% blunt and 10% penetrating injuries and a mortality of 13%). At admission, blood lactate was elevated in 425 (39%) patients and base deficit was elevated in 725 (67%) patients. Blood lactate was correlated with base deficit (R2 = 0.54; P < 0.001). Using logistic regression, blood lactate was a better predictor of death than base deficit when considering its additional predictive value to triage scores and Trauma Related Injury Severity Score. This result was confirmed using a reclassification method but only in the subgroup of normotensive patients (n = 745). Conclusions Initial blood lactate should be preferred to base deficit as a biologic variable in scoring systems built to assess the initial severity of trauma patients.

Comparison of APACHE II, trauma score, and injury severity score as predictors of outcome in critically injured trauma patients

1993 ◽  
Vol 166 (3) ◽  
pp. 244-247 ◽  
Author(s):  
Robert Rutledge ◽  
Samir Fakhry ◽  
Edmond Rutherford ◽  
Farid Muakkassa ◽  
Anthony Meyer
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Apache Ii ◽  
Trauma Patients ◽  
Predictors Of Outcome ◽  
Trauma Score

scholarly journals A Comparative Study Between Two Combat Injury Severity Scores

2021 ◽  
Author(s):  
Rafael García Cañas ◽  
Ricardo Navarro Suay ◽  
Carlos Rodríguez Moro ◽  
Diana M Crego Vita ◽  
Javier Arias Díaz ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Scoring Systems ◽  
Combat Injury ◽  
New Injury Severity Score ◽  
Severity Scores ◽  
Trauma Scoring ◽  
Combat Casualties ◽  
The Military

ABSTRACT Introduction In recent years, specific trauma scoring systems have been developed for military casualties. The objective of this study was to examine the discrepancies in severity scores of combat casualties between the Abbreviated Injury Scale 2005-Military (mAIS) and the Military Combat Injury Scale (MCIS) and a review of the current literature on the application of trauma scoring systems in the military setting. Methods A cross-sectional, descriptive, and retrospective study was conducted between May 1, 2005, and December 31, 2014. The study population consisted of all combat casualties attended in the Spanish Role 2 deployed in Herat (Afghanistan). We used the New Injury Severity Score (NISS) as reference score. Severity of each injury was calculated according to mAIS and MCIS, respectively. The severity of each casualty was calculated according to the NISS based on the mAIS (Military New Injury Severity Score—mNISS) and MCIS (Military Combat Injury Scale-New Injury Severity Score—MCIS-NISS). Casualty severity were grouped by severity levels (mild—scores: 1-8, moderate—scores: 9-15, severe—scores: 16-24, and critical—scores: 25-75). Results Nine hundred and eleven casualties were analyzed. Most were male (96.37%) with a median age of 27 years. Afghan patients comprised 71.13%. Air medevac was the main casualty transportation method (80.13). Explosion (64.76%) and gunshot wound (34.68%) mechanisms predominated. Overall mortality was 3.51%. Median mNISS and MCIS-NISS were similar in nonsurvivors (36 [IQR, 25-49] vs. [IQR, 25-48], respectively) but different in survivors, 9 (IQR, 4-17) vs. 5 (IQR, 2-13), respectively (P < .0001). The mNISS and MCIS-NISS were discordant in 34.35% (n = 313). Among cases with discordant severity scores, the median difference between mNISS and MCIS-NISS was 9 (IQR, 4-16); range, 1 to 57. Conclusion Our study findings suggest that discrepancies in injury severity levels may be observed in one in three of the casualties when using mNISS and MCIS-NISS.

Both the multiplicative and single-worst-injury International Classification of Diseases Injury Severity Score underperform in urban Indian hospitals

Trauma ◽  
2018 ◽  
Vol 21 (4) ◽  
pp. 301-309
Author(s):  
Mattias Sterner ◽  
Jonatan Attergrim ◽  
Alice Claeson ◽  
Vineet Kumar ◽  
Monty Khajanchi ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Trauma Care ◽  
Severity Score ◽  
Injury Severity ◽  
International Classification Of Diseases ◽  
International Classification ◽  
Operating Characteristics ◽  
Trauma Severity ◽  
Classification Of Diseases

Introduction Trauma accounts for 9% of all deaths worldwide, killing almost five million people annually. As India accounts for more than one million of these deaths, research on local trauma care is of great importance. A key aspect of such research is outcome comparisons between contexts. One tool to adjust these comparisons for trauma severity is the International Classification of Diseases Injury Severity Score. The aim was to assess two versions of this score in India. Methods The data used were from the project Towards Improved Trauma Care Outcomes in India. Published survival risk ratios were used to calculate multiplicative-International Classification of Diseases Injury Severity Score and single-worst-injury-International Classification of Diseases Injury Severity Score for the 200 most recent non-surviving patients and the surviving patients during the same period. Score performance was measured in discrimination and calibration. Results The 30-day prediction single-worst-injury-International Classification of Diseases Injury Severity Score discriminated best with an area under the receiver operating characteristics curve of 0.668 (95% CI 0.645–0.690) and a calibration slope of 0.830 (95% CI 0.708–0.940). Conclusions The single-worst-injury-International Classification of Diseases Injury Severity Score applied on 30-day mortality was the only score to calibrate on a satisfactory level. None of the scores had an acceptable discrimination. In interpreting these findings, we see that none of the tested scores can currently be implemented in the studied hospitals.

scholarly journals Ten-year inhospital mortality trends for patients with trauma in Japan: a multicentre observational study

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018635 ◽  
Author(s):  
Isao Nagata ◽  
Toshikazu Abe ◽  
Masatoshi Uchida ◽  
Daizoh Saitoh ◽  
Nanako Tamiya
Keyword(s):  
Logistic Regression ◽  
Observational Study ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Whole Body ◽  
Inhospital Mortality ◽  
Regression Analyses ◽  
Mortality Trends ◽  
Multivariable Logistic Regression

ObjectivesTrauma is one of the main causes of death in Japan, and treatments and prognoses of these injuries are constantly changing. We therefore aimed to investigate a 10-year trend (2004–2013) in inhospital mortality among patients with trauma in Japan.DesignMulticentre observational study.SettingJapanese nationwide trauma registry (the Japan Trauma Data Bank) data.ParticipantsAll patients with trauma whose Injury Severity Score (ISS) were 3 and above, who were aged 15 years or older, and whose mechanisms of injury (MOI) were blunt and penetrating between 2004 and 2013 (n=90 833).Outcome measuresA 10-year trend in inhospital mortality.ResultsInhospital mortality for all patients with trauma significantly decreased over the study decade in our Cochran-Armitage test (P<0.001). Similarly, inhospital mortality for patients with ISS 16 or more and patients who scored 50% or better on the Trauma and Injury Severity Score (TRISS) probability of survival scale significantly decreased (P<0.001). In addition, the OR for inhospital mortality of these three patient groups decreased yearly after adjusting for age, gender, MOI, ISS, Glasgow Coma Scale, systolic blood pressure and respiratory rate on hospital arrival in multivariable logistic regression analyses. Furthermore, inhospital mortality for patient with blunt trauma significantly decreased in injury mechanism-stratified Mantel-extension testing (P<0.001). Finally, multivariable logistic regression analyses showed that the OR for inhospital mortality of patients with ISS 16 and over decreased each year after adding and adjusting for means of transportation and usage of whole-body CT.ConclusionInhospitalmortality for patients with trauma in Japan significantly decreased during the study decade after adjusting for patient characteristics, injury severity and the response environment after injury.

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.

scholarly journals Factors Predicting outcome of patients with polytrauma in tertiary center of western Nepal

2021 ◽  
Vol 2 (1) ◽  
pp. 13-18
Author(s):  
Pradeep Ghimire ◽  
Nikunja Yogi ◽  
Balgopal Karmacharya ◽  
Abhishek Poudel ◽  
Sushil Mishra
Keyword(s):  
Logistic Regression ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
Public Health Issue ◽  
P Value ◽  
Trauma Population ◽  
Tertiary Center

 Introduction: Trauma is a public health issue associated with substantial socioeconomic impacts and major adverse clinical outcomes. No single study has previously investigated the predictors of mortality in a general trauma population. In this study, we assessed different clinico-biochemical parameters to investigate the associations between those parameters and their effects in outcome of a polytrauma patient. Methods: An analytical study was done in between January 2020 to December 2020 in patients with polytrauma admitted to intensive care unit Department of Surgery in Manipal Teaching Hospital to assess the effect of various socio-demographic and clinic-radiologic variables in outcome (Glasgow outcome scale) of polytrauma patients. All the categorical data were tested using chi square test or Fischer Exact test and continuous variables were tested using student’s “t” test. P value <0.05 was determined significant. Those independent variables significant on univariate analysis were then subjected to binary logistic regression and the data was presented as level of significance, odds ratio and 95% confidence interval. Analysis was done using SPSS 23.0. Results: Out of 67 patients, 34 had favorable GOS and 33 had unfavorable GOS. Injury Severity Score (ISS) (P<0.01), abnormal pupils (P<0.01), RBS (0.04), low GCS during presentation (<0.01), higher CT Marshal Grade (0.01) had strong associations with unfavorable outcome in polytraumatic patient. ISS was the only significant parameter when all the other significant variables were kept constant in binary logistic regression model (OR=1.18, 95% CI=1.08-1.28). Conclusion: Injury Severity Score, abnormal pupils during presentation, high level of blood sugar after polytrauma, low GCS during presentation, higher CT Marshal Grade are strong predictors in outcomes of polytraumatic patient.

scholarly journals The incidence of geriatric trauma is increasing and comparison of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Libing Jiang ◽  
Zhongjun Zheng ◽  
Mao Zhang
Keyword(s):  
Hospital Mortality ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Apache Ii ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Survival Group ◽  
Saps Ii ◽  
Scoring Tools

Abstract Purpose The study aimed to examine the changing incidence of geriatric trauma and evaluate the predictive ability of different scoring tools for in-hospital mortality in geriatric trauma patients. Methods Annual reports released by the National Trauma Database (NTDB) in the USA from 2005 to 2015 and the Trauma Register DGU® in Germany from 1994 to 2012 were analyzed to examine the changing incidence of geriatric trauma. Secondary analysis of a single-center cohort study conducted among 311 severely injured geriatric trauma patients in a level I trauma center in Switzerland was completed. According to the in-hospital survival status, patients were divided into the survival and non-survival group. The differences of the ISS (injury severity score), NISS (new injury severity score), TRISS (Trauma and Injury Severity Score), APACHE II (Acute Physiology and Chronic Health Evaluation II), and SPAS II (simplified acute physiology score II) between two groups were evaluated. Then, the areas under the receiver-operating characteristic curve (AUC-ROC) of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients were calculated. Results The analysis of the NTDB showed that the increase in the number of geriatric trauma ranged from 18 to 30% between 2005 and 2015. The analysis of the DGU® showed that the mean age of trauma patients rose from 39.11 in 1993 to 51.10 in 2013, and the proportion of patients aged ≥ 60 years rose from 16.5 to 37.5%. The findings from the secondary analysis showed that 164 (52.73%) patients died in the hospital. The ISS, NISS, APACHE II, and SAPS II in the death group were significantly higher than those in the survival group, and the TRISS in the death group was significantly lower than those in the survival group. The AUCs of the ISS, NISS, TRISS, APACHE II, and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients were 0.807, 0.850, 0.828, 0.715, and 0.725, respectively. Conclusion The total number of geriatric trauma is increasing as the population ages. The accuracy of ISS, NISS and TRISS was higher than the APACHE II and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients.

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.

Sign in / Sign up

Export Citation Format

Share Document