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 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.

Abstract 200: Discordance Between Monitor-measured and EMS Documented Respiratory Rates in Major Traumatic Brain Injury: Implications for Injury Scoring Systems

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Bruce J Barnhart ◽  
Daniel W Spaite ◽  
Eric Helfenbein ◽  
Dawn Jorgenson ◽  
Saeed Babaeizadeh ◽  
...  
Keyword(s):  
Scoring Systems ◽  
Trauma Research ◽  
Non Invasive ◽  
Revised Trauma Score ◽  
Trauma Scoring ◽  
End Tidal ◽  
Trauma Score ◽  
Spontaneously Breathing ◽  
The Relationship ◽  
Monitor Data

Background: Respiratory rate (RR) is a key component in commonly-used trauma scoring systems [e.g., Revised Trauma Score (RTS), TRISS]. Imprecise documentation of RR introduces misclassification when these tools are used in trauma research. By identifying each waveform, nasal cannula end tidal CO2 (NCCO2) accurately measures RR in non-intubated patients. Objective: Evaluate the relationship between EMS-documented RR measurements in patient care records (PCRs) vs. true RR recorded by non-invasive NCCO2 monitoring in major TBI patients who were never actively ventilated. Methods: Among spontaneously-breathing, major TBI cases (moderate/severe/critical), continuous NCCO2 data (Philips MRx™) were evaluated from the EPIC Prehospital TBI Study (NIH 1R01NS071049). RR classifications for RTS/TRISS were then established for each case using both PCR-documentation and monitor data. Routine monitor data (including RR) were available to EMS providers on the display at all times during care. Results: Included: 158 cases from 7 Arizona EMS agencies [(7/13-7/17; median age 55 (range 18-94); 65% male]. The Table shows RTS/TRISS case classification by PCR and monitor RR. PCR-documented RR frequently failed to correctly classify cases: RR <6 (0/10; 0%); 6-9 (3/21; 14.3%; >29: (11/34, 32.4%), normal (67/93, 72.0%; Table). In total, PCR documentation misclassified 48.7% of cases (77/158). Conclusion: These findings identify a major contributor to inaccurate trauma scoring. Since RTS and TRISS are used widely in research, this has important implications for study enrollment, case ascertainment, confounding, and risk-adjustment in injury studies. Whenever possible, QI and research studies should utilize monitor data to identify and evaluate RR and other vitals rather than relying on PCR documentation. Future development of monitor-based, real-time feedback technology might improve trauma scoring precision and provider identification of RR abnormalities.

scholarly journals Comparison of Injury Severity Score, Glasgow Coma Scale, and Revised Trauma Score in Predicting the Mortality and Prolonged ICU Stay of Traumatic Young Children: A Cross-Sectional Retrospective Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Yii-Ting Huang ◽  
Ying-Hsien Huang ◽  
Ching-Hua Hsieh ◽  
Chao-Jui Li ◽  
I-Min Chiu
Keyword(s):  
Retrospective Study ◽  
Young Children ◽  
Glasgow Coma Scale ◽  
Injury Severity ◽  
Scoring Systems ◽  
Traumatic Injuries ◽  
Icu Stay ◽  
Revised Trauma Score ◽  
Prolonged Icu Stay ◽  
Trauma Score

Introduction. The purpose of this study was to examine the capacity of commonly used trauma scoring systems such as the Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) to predict outcomes in young children with traumatic injuries. Methods. This retrospective study was conducted for the period from 2009 to 2016 in Kaohsiung Chang Gung Memorial Medical Hospital, a level I trauma center. We included all children under the age of 6 years admitted to the hospital via the emergency department with any traumatic injury and compared the trauma scores of GCS, ISS, and RTS on patients’ outcome. The primary outcomes were mortality and prolonged Intensive Care Unit (ICU) stay, with the latter defined as an ICU stay longer than 14 days. The secondary outcome was the hospital length of stay (HLOS). Receiver operating characteristic (ROC) analysis was also adopted with the value of the area under the ROC curve (AUC) for comparing trauma score prediction with patient mortality. Cutoff values from each trauma score for mortality prediction were also measured by determining the point along the ROC curve where Youden’s index was maximum. Results. We included a total of 938 patients in this study, with a mean age of 3.1 ± 1.82 years. The mortality rate was 0.9%, and 93 (9.9%) patients had a prolonged ICU stay. An elevated ISS (34 ± 19.9 vs. 5 ± 5.1, p=0.004), lower GCS (8 ± 5.0 vs. 15 ± 1.3, p=0.006), and lower RTS (5.58 ± 1.498 vs. 7.64 ± 0.640, p=0.006) were all associated with mortality. All three scores were considered to be independent risk factors of mortality and prolonged ICU stay and had a linear correlation with increased HLOS. With regard to predicting mortality, ISS has the highest AUC value (ISS: 0.975; GCS: 0.864; and RTS: 0.899). The prediction cutoff values of ISS, GCS, and RTS on mortality were 15, 11, and 7, respectively. Conclusion. Regarding traumatic injuries in young children, worse ISS, GCS, and RTS were all associated with increased mortality, prolonged ICU stay, and longer hospital LOS. Of these scoring systems, ISS was the best at predicting mortality.

Improving Mortality Predictions in Trauma Patients Undergoing Damage Control Strategies

2011 ◽  
Vol 77 (6) ◽  
pp. 778-782 ◽  
Author(s):  
Carlos A. Ordoñez ◽  
Marisol Badiel ◽  
ÁLvaro I. SÁNchez ◽  
Marcela Granados ◽  
Alberto F. GarcÍA ◽  
...  
Keyword(s):  
Injury Severity ◽  
Damage Control ◽  
Characteristic Curve ◽  
Mortality Prediction ◽  
P Value ◽  
Trauma Patients ◽  
Clinical Model ◽  
Severity Scores ◽  
Revised Trauma Score ◽  
Trauma Score

The increased use of damage control surgery in complex trauma patients requires accurate prognostic indicators. We compared the discriminatory capacity of commonly used trauma and intensive care unit (ICU) scores, including revised trauma score, injury severity scores, trauma score-injury severity scores, acute physiology and chronic health evaluations II, and clinical and laboratory parameters, on 83 consecutive trauma patients admitted to the ICU, undergoing damage control. Logistic regressions were built for mortality prediction within 30 days. Performances of the models were assessed in terms of discrimination and calibration. Areas under the receiver operating characteristic curve from the models were compared. Overall mortality was 38.5 per cent. A “clinical” model was constructed including ICU admission pH and hypothermia (≤ 35 C °) and the number of packed red blood cells during the first 24 hours. This model was adjusted for age and demonstrated better discrimination for mortality prediction (areas under the receiver operating characteristic curve = 0.8054) than injury severity score ( P value = 0.049), abdominal trauma index ( P value = 0.049), and acute physiology and chronic health evaluations II ( P value = 0.001). There was no statistically significant difference in discrimination for mortality prediction between the “clinical” model and revised trauma score ( P value = 0.4) and trauma score-injury severity score ( P value = 0.4). We concluded that the combination of ICU admission pH and hypothermia and blood transfusions during 24 hours provided an excellent discriminatory capacity for mortality prediction in this complex patient population.

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.

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.

Lethal abdominal gunshot wounds at a level I trauma center: analysis of TRISS (revised trauma score and injury severity score) fallouts

1998 ◽  
Vol 187 (2) ◽  
pp. 123-129 ◽  
Author(s):  
Edward E. Cornwell ◽  
George C. Velmahos ◽  
Thomas V. Berne ◽  
Raymond Tatevossian ◽  
Howard Belzberg ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Trauma Center ◽  
Injury Severity ◽  
Gunshot Wounds ◽  
Revised Trauma Score ◽  
Level I ◽  
Trauma Score ◽  
Abdominal Gunshot Wounds
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