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

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

2020 ◽  
Vol 10 (32) ◽  
pp. 183-193
Author(s):  
Gisele Andrade Menolli ◽  
Eleine Aparecida Penha Martins

Identificar a influência da gravidade do trauma e do atendimento intra-hospitalar no óbito, em vítimas de acidentes motociclísticos. Estudo transversal, quantitativo com 31 vítimas encaminhadas para o Hospital no norte do Paraná, entre dezembro de 2016 e março de 2017. 80,6% das vítimas eram homens, 48,4% das ocorrências aconteceram durante o dia. As escalas de trauma, Injury Severity Score (TRISS), Revised Trauma Score (RTS) e Injury Severity Score (ISS) evidenciaram escores leves com baixo risco de morte.  Houve associação entre gravidade do trauma e óbito, chegaram ao hospital com imobilizações corporais 61,3%; o protocolo de atendimento ao trauma foi utilizado em 45,2% dos casos; a cirurgia ortopédica compreendeu 43,4%; houve associação das cirurgias com o desfecho óbito; 90,3% das vítimas não tiveram infecção. A gravidade do trauma e cirurgias tiveram associação com o desfecho óbito, todas as vítimas de trauma devem ser atendidas conforme protocolo.Descritores: Serviço Hospitalar de Admissão de Paciente, Acidentes de Trânsito, Índices de Gravidade do Trauma, Motocicletas. Influence of accidents and in-hospital procedures on deathAbstract: Identification of the influence of trauma severity and the in-hospital care at death, in victims of motorcycle accidents. Cross-sectional, quantitative study, considering 31 victims referred to the Hospital in northern Paraná, between December 2016 and March 2017. 80.6% of the victims were men and 48.4% of the occurrences took place during the daytime. The trauma scales, Injury Severity Score (TRISS), Revised Trauma Score (RTS) and Injury Severity Score (ISS) presented soft scores of low risks of death. There was evidence of association between trauma severity and death, 61.3% of the patients arrived at the hospital with bodily immobilizations; the trauma care protocol was used in 45.2% of cases; surgery comprised 43.4% of cases; there was an association of surgeries with the outcome of death and 90.3% of the victims had no infection. The severity of trauma and surgeries were associated with the outcome of death; all trauma victims should be treated according to the protocol.Descriptors: Hospital Service for patient Admission, Traffic-Accidents, Trauma Severity Indices, Motorcycles. Influencia de los accidentes y procedimientos intrahospitales en la muerteResumen: Identificar la influencia de la gravedad del trauma y del atendimiento intrahospitalario en la muerte, en víctimas de accidentes motociclísticos. Estudio transversal, cuantitativo con 31 víctimas encaminadas para el Hospital en el Norte del Paraná, entre diciembre de 2016 y marzo de 2017. El 80.6% de las víctimas eran hombres, un 48.4% de los casos ocurrieron durante el día. La puntuación de los traumas, Injury Severity Score (TRISS), RevisedTrauma Score (RTS) y Injury Severity Score (ISS) evidenciaron scores leves con bajo riesgo de muerte. Hubo asociación entre la gravedad del trauma y la muerte, llegaron al hospital con inmovilizaciones corporales el 61.3%; el protocolo de atendimiento al trauma fué utilizado el 45.2% de los casos; la cirugía ortopédica comprendió 43.4%; hubo asociación de las cirugías con la muerte; el 90.3% de las víctimas no tuvieron infección. La gravedad del trauma y cirugías tuvieron asociación con la muerte, todas las víctimas de trauma deben ser atendidas según el protocolo.Descriptores: Servicio Hospitalar de Admisión de Paciente, Accidentes de Transito, Indices de Gravedad del Trauma, Motocicletas.


2015 ◽  
Vol 49 (spe) ◽  
pp. 138-146 ◽  
Author(s):  
Cristiane de Alencar Domingues ◽  
Lilia de Souza Nogueira ◽  
Cristina Helena Costanti Settervall ◽  
Regina Marcia Cardoso de Sousa

RESUMO Objetivo identificar estudos que realizaram ajustes na equação do Trauma and InjurySeverity Score (TRISS) e compararam a capacidade discriminatória da equação modificada com a original. Método Revisão integrativa de pesquisas publicadas entre 1990 e 2014 nas bases de dados LILACS, MEDLINE, PubMed e SciELO utilizando-se a palavra TRISS. Resultados foram incluídos 32 estudos na revisão. Dos 67 ajustes de equações do TRISS identificados, 35 (52,2%) resultaram em melhora na acurácia do índice para predizer a probabilidade de sobrevida de vítimas de trauma. Ajustes dos coeficientes do TRISS à população de estudo foram frequentes, mas nem sempre melhoraram a capacidade preditiva dos modelos analisados. A substituição de variáveis fisiológicas do Revised Trauma Score (RTS) e modificações do Injury Severity Score (ISS) na equação original tiveram desempenho variado. A mudança na forma de inclusão da idade na equação, assim como a inserção do gênero, comorbidades e mecanismo do trauma apresentaram tendência de melhora do desempenho do TRISS. Conclusão Diferentes propostas de ajustes no TRISS foram identificadas nesta revisão e indicaram, principalmente, fragilidades do RTS no modelo original e necessidade de alteração da forma de inclusão da idade na equação para melhora da capacidade preditiva do índice.


2017 ◽  
Vol 83 (6) ◽  
pp. 559-563 ◽  
Author(s):  
Brian Fletcher ◽  
Eric Bradburn ◽  
Christopher Baker ◽  
Bryan Collier ◽  
Mark Hamill ◽  
...  

The Functional Independence Measure (FIM) is used by rehabilitation professionals to access disability. The FIM score combines both motor and cognitive parameters to assess a patient's level of required assistance in performing activities of daily living (ADL). The geriatric trauma patient is becoming an increasingly important cohort for trauma services. FIM has been shown to predict discharge outcomes and those at high risk for falls. We hypothesized pretrauma FIM scores may predict survival in the geriatric trauma population. This was a retrospective study of patients 65 years and older that were admitted to our Level I trauma center from July 1, 2006 to July 1, 2012. A total 941 patients underwent stepwise regression to identify those factors predicting survival. Age, Injury Severity Score, revised trauma score, body mass index, and pretrauma FIM scores (12-point scale) were studied. The primary outcome was survival. Statistical significance reached at P value <0.05. Multiple logistic regression analysis was then performed. A total of 1315 patients were identified and complete data were available on 941 patients. Mean age was 78 (SD ± 8.2), mean Injury Severity Score was 13(SD ± 8.7), and mean body mass index was 26. Overall mortality was 11 per cent. The odds ratio of survival was 3.532 (95% confidence interval = 2.191–5.718) times greater for every 1-point increase in the preadmission FIM expression score. Glasgow Coma Scale, revised trauma score, gender, and pretrauma FIM expression scores were predictive of survival in the geriatric trauma patient. Pretrauma FIM expression can be used to predict survival in the elderly trauma victim. Further study is needed to establish the role of FIM as part of trauma scoring systems.


2008 ◽  
Vol 74 (3) ◽  
pp. 260-261
Author(s):  
Steven Clark ◽  
Alicia Mangram ◽  
Ernest Dunn

Car surfing is a dangerous new pastime for American youth. Car surfing is an activity that is defined as standing (or lying) on a vehicle while it is being driven. This activity frequently results in severe injuries that often require significant surgical intervention. Despite its destructive nature, however, there are many Internet sites that encourage this behavior and view it as amusing. As a result, car surfing is becoming increasingly popular. We conducted a retrospective chart review of all patients injured as a result of car surfing over the last 4 years at our Urban Level II trauma center. Data collected included Injury Severity Score (ISS), Revised Trauma Score (RTS), age, gender, injury pattern, surgical intervention, and length of stay. Eight car surfers were identified. The average age was 17. The average Revised Trauma Score was 6.8 with an average Injury Severity Score of 16.9. Five patients were admitted to the intensive care unit. Four of these five patients needed to be intubated for ventilatory support. Five of the eight patients had significant intracranial injuries. Two patients had epidural hematomas that required evacuation. Two other patients had subdural hematomas that were treated nonoperatively, and one patient had a subarachnoid hemorrhage that was also treated nonoperatively. Four of the eight patients required surgical intervention. There were no deaths in this study. Car surfing leads to severe injuries that can result in significant morbidity. American youth have access to Internet sites that project this activity as an acceptable behavior. Five of our eight patients had a significant intra-cranial injury. Trauma surgeons need to be more aware of this injury phenomenon.


2009 ◽  
Vol 36 (2) ◽  
pp. 123-130 ◽  
Author(s):  
Fábio Henrique de Carvalho ◽  
Paula Christina Marra Romeiro ◽  
Iwan Augusto Collaço ◽  
Giorgio Alfredo Pedroso Baretta ◽  
Alexandre Coutinho Teixeira de Freitas ◽  
...  

OBJETIVO: Identificar fatores prognósticos relacionados com a falha do tratamento não-operatório (TNO) de lesões esplênicas no trauma abdominal fechado. MÉTODOS: Análise prospectiva de 56 pacientes adultos submetidos à TNO e divididos em um grupo de sucesso e outro de falha, que foi definida como necessidade de laparotomia por qualquer indicação. As lesões foram diagnosticadas por tomografia computadorizada e classificadas de acordo com os critérios da AAST (American Association for Surgery of Trauma). Os parâmetros estudados foram: na admissão - pressão arterial sistólica, frequências cardíaca e respiratória, nível de consciência (Escala de Glasgow) e RTS (Revised Trauma Score); durante a hospitalização - presença de lesões associadas, transfusão sanguínea e parâmetros hematológicos, tempo de internação e ISS (Injury Severity Score). RESULTADOS: As falhas do TNO (19,6%) foram devidas à dor abdominal (45,4%), instabilidade hemodinâmica (36,4%), queda do volume globular associada a hematoma esplênico (9,1%) e abscesso esplênico (9,1%). Não foram observadas diferenças entre os grupos de sucesso e de falha nos dados na admissão. A taxa de falha de acordo com o grau da lesão esplênica foi 0% nos graus I e II agrupados; 17,5% nos graus III e IV agrupados e 80% no grau V (p = 0,0008). O uso de hemoderivados foi maior e mais frequente no grupo de falha (p=0,05). As relação do ISS (Injury Severity Score) com as taxas de falha foram 0% nos pacientes com ISS = 8; 15,9% nos com ISS entre 9 e 25, e 50% nos com ISS = 26 (p = 0,05). Não houve mortalidade e nem lesões de vísceras ocas despercebidas. CONCLUSÃO: O Injury Severity Score e grau da lesão esplênica relacionaram-se com a falha do tratamento não-operatório.


2006 ◽  
Vol 33 (6) ◽  
pp. 354-360 ◽  
Author(s):  
Gustavo Pereira Fraga ◽  
Elaine Barberato Genghini ◽  
Mario Mantovani ◽  
Larissa Garcia de Oliveira Cortinas ◽  
Waldemar Prandi Filho

OBJETIVO: Contesta-se a aplicação indiscriminada da toracotomia de reanimação (TR) no trauma. Este estudo objetiva reavaliar as indicações de TR na nossa instituição. MÉTODO: Estudo retrospectivo envolvendo 126 pacientes submetidos à TR entre janeiro de 1995 e dezembro de 2004. Definiram-se quatro grupos considerando os sinais vitais dos pacientes na admissão: morto ao chegar, fatal, agônico e choque profundo. O protocolo incluiu dados como mecanismo de trauma, sinais vitais, Escore de Trauma Revisado (Revised Trauma Score ou RTS), locais de lesão (identificados durante cirurgia ou autópsia), Índice de Gravidade da Lesão (Injury Severity Score ou ISS) e sobrevida. RESULTADOS: Setenta e dois (57,2%) pacientes apresentavam ferimento por projétil de arma de fogo, 11 (8,7%) ferimento por arma branca e 43 (34,1%) por trauma fechado. Nenhum dos sessenta pacientes (47,6%) dos grupos fatal e morto ao chegar sobreviveu, mas 13 (39,4%) dos pacientes fatais foram encaminhados ao centro cirúrgico (CC) para tratamento definitivo. Dos 66 pacientes dos grupos agônico e choque profundo, 44 (66,7%) foram submetidos a TR no prontosocorro (PS) e 31 (70,5%) destes foram transferidos até o CC. Nos 22 restantes, a parada cardiorrespiratória ocorreu já no CC, onde foi feita a TR. Dois pacientes do grupo choque profundo sobreviveram (1,6% do total) e receberam alta com função cerebral normal. O ISS médio foi 33, sendo exsangüinação a causa mais freqüente de óbito. CONCLUSÕES: Resultados ruins enfatizam a necessidade de uma abordagem mais seletiva para aplicar a TR. Um algoritmo baseado no mecanismo de trauma e nos sinais vitais na admissão é proposto para otimizar as indicações de TR.


Author(s):  
Abbasali Dehghani Tafti ◽  
Khadijeh Nasiriani ◽  
Majid Hajimaghsoudi ◽  
Mehri Maki ◽  
Samaneh Mirzaei ◽  
...  

Introduction: Due to the increasing mortality rate from trauma, determining the severity of injury has a very important role in the prognosis of the injured person. On the other hand, the quality of medical care provided to the casualties is evaluated using the Trauma Scoring System. Various scales were used to determine the trauma severity of injured. In this study, the most commonly used tools are investigated. Methods: This review was conducted by searching throughout the Persian data bases of Magiran, Barakat, SID and English databases of Scopus, Web of sciences, PubMed, and Google scholar. To conduct the search, the following keywords were used: "Severity of Trauma", "Trauma scoring", and "Trauma Scoring System" without considering any time intervals. Our early search resulted in 2125 articles. Finally, 17 articles were analyzed and different functions of traumatic assessment tools were compared and studied. Results: Traumatic assessment methods vary based on the anatomical and physiological parameters and composition of these two methods. In this study, the Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), and New Injury Severity Score (NISS) were considered as anatomical parameters; Revised Trauma Score (RTS) as physiological parameters; Trauma Score Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOST) were mentioned as a hybrid ranking system. Conclusion: Application of accurate scientific evaluations in trauma severity assessment methods and application of each method in its appropriate position would result in appropriate improvements in the development of trauma care.  In addition, these systems can play an important role in providing care to patients with traumatic injuries in the present and future.


2020 ◽  
Vol 72 (5) ◽  
Author(s):  
Roberto González L. ◽  
Alejandra Riquelme U. ◽  
Claudio Toloza A. ◽  
Rodrigo Reyes M. ◽  
Enrique Seguel S. ◽  
...  

Introducción: El hemotórax masivo (HM) se puede definir como el acúmulo súbito de >1.500 ml de sangre en la cavidad pleural o débito >200 ml/hr de sangre en 3-4 horas por pleurotomía; es considerada una complicación traumática grave. Objetivo: Describir las características clínicas, índices de gravedad de traumatismo (IGT), morbilidad y variables asociadas a mortalidad en pacientes con hemotórax masivo por traumatismo torácico operados (HMTT). Material y Método: Estudio analítico longitudinal. Período enero-1981 a diciembre-2018. Revisión prospectiva de base de datos, protocolos quirúrgicos y fichas clínicas. Descripción de características de HMTT. Se calcularon IGT: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Para mortalidad se realizó análisis univariado con cálculo de Odds Ratio. Resultados: Total 4.306 Traumas Torácico (TT), HMTT 119 (2,8%). Hombres 112 (94,1%), edad promedio 32±13,2 años, 91 (76,5%) pacientes presentaron TT aislado, 28 (23,5%) asociado a lesiones extratorácicas, de estos, 23 (19,3%) fueron politraumatismos. Fueron traumatismos penetrantes 102 (85,7%). El HMTT se atribuyó principalmente a: lesión de pared en 38 (31,9%) y lesión pulmonar en 29 (24,4%). De las cirugías torácicas: 87 (73,1%) fueron urgentes (£4hrs), 10 (8,4%) precoces (>4-24hrs) y 22 (18,5%) diferidas (>24hrs). Hospitalización postoperatoria promedio 7,9±6,4 días. Según IGT: ISS promedio 17,4±9,6, RTS-T promedio 10,2±2,7, TRISS promedio 12,7. Morbilidad 46 (38,7%) y mortalidad 15 (12,6%). Discusión: Los HMTT se atribuyeron principalmente a lesiones de pared y lesión pulmonar. En la mayoría se requirió cirugía torácica de urgencia.  La mortalidad observada es semejante a la esperada según IGT. Existen variables asociadas a mayor mortalidad.


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