Development of mine-blast trauma severity score for lower extremities in men

This study presented the results of the analysis of existing approaches to the assessment of the severity of lower extremity injuries protected with explosion-proof shoes in case of mine-explosive ammunition explosion. An increasing number of mine explosives are used in modern local wars and armed conflicts. At present, more than 110 million mines are planted and activated. Every year, nearly 10 thousand individuals are killed by explosive demolitions, and more than 20 thousand civilians sustain injuries. The necessity to clear minefields and to destroy located ammunition increases the risks of mine clearance specialists to mine-blast trauma of the lower extremities. To reduce the likelihood of severe trauma in this population, developing effective blast protective equipment, such as anti-mine boots, is necessary. The effectiveness evaluation of protective boots requires special methodology that should comprise relevant methods of mine-blast trauma severity estimation. Mine-blast trauma is a special type of surgical pathology where the injured individual has extremity avulsion or multiple injuries to extremity tissues accompanied by severe impairment of body functions. Almost all available domestic classifications of mine-explosive wounds have a pronounced clinical orientation, and foreign ones have terminologies that are not accepted in Russia and cannot be fully used for assessment purposes. The modified working classification, in the form of a rating scale, showed not only the characteristics of a given blast trauma but also the criteria of trauma severity estimation and feasibility of exposure to blast trauma. The results of the study demonstrated the potential for its use to estimate the protective features of mine clearance specialist boots when exposed to charge explosion, as well as recommendations to include this classification in documenting the science and technology that deal with the general specifications of protective equipment for specialists at the project stage.

A Data Augmentation Method for War Trauma Using the War Trauma Severity Score and Deep Neural Networks

The demand for large-scale analysis and research of data on trauma from modern warfare is increasing day by day, but the amount of existing data is not sufficient to meet such demand. In this study, an integrated modeling approach incorporating a war trauma severity scoring algorithm (WTSS) and deep neural networks (DNN) is proposed. First, the proposed WTSS, which uses multiple non-linear regression based on the characteristics of war trauma data and the medical evaluation by an expert panel, performed a standardized assessment of an injury and predicts its trauma consequences. Second, to generate virtual injury, based on the probability of occurrence, the injured parts, injury types, and complications were randomly sampled and combined, and then WTSS was used to assess the consequences of the virtual injury. Third, to evaluate the accuracy of the predicted injury consequences, we built a DNN classifier and then trained it with the generated data and tested it with real data. Finally, we used the Delphi method to filter out unreasonable injuries and improve data rationality. The experimental results verified that the proposed approach surpassed the traditional artificial generation methods, achieved a prediction accuracy of 84.43%, and realized large-scale and credible war trauma data augmentation.

Association of Trauma Severity with Antibody Seroconversion in Heparin-Induced Thrombocytopenia: A Multicenter, Prospective Observational Study

BACKground: Heparin administration can induce the production of anti-platelet factor 4 (PF4)/heparin antibodies with platelet-activating properties, causing heparin-induced thrombocytopenia (HIT). Previous studies have suggested that trauma severity influences HIT immune responses, but their relationship has not been fully explained. This study aimed to clarify this association by multicenter prospective observational study.methods: Trauma patients who met the criteria of age ≥18 years and Injury Severity Scores (ISS) ≥ 9 from March 2018 to February 2019 were included. Patients who did not receive any heparin and those who received it as flushes or for treatment were also included. A total of 184 patients were divided into three groups based on trauma severity (mild (9 ≤ ISS ≤ 15), moderate (16 ≤ ISS ≤ 24), severe (25 ≤ ISS)), and were compared by the seroconversion time and rate, as well as the disappearance rate of antibodies on day 30. RESULTS: Overall, the seroconversion rates of anti-PF4/heparin IgG and HIT antibodies by washed platelet activation assay were 26.6% and 16.3%, respectively. There was a significant difference in the seroconversion rates of anti-PF4/heparin IgG (p = 0.016) and HIT antibodies (p = 0.046) among the groups. Seroconversion rates in both assays increased with increasing trauma severity. The time required to achieve seroconversion was similar (between 5 and 10 days of trauma onset) regardless of heparin administration. Anti-PF4/heparin IgG and HIT antibodies were no longer detected on day 30 in 28.6% and 60.9% of seroconverted patients, respectively.Conclusions: Development of HIT antibodies was observed commonly in severely injured trauma patients. HIT antibody development may related to trauma severity, with high disappearance rate on day 30. HIT should be considered as a differential diagnosis in patients with thrombocytopenia or thromboembolism between 5 and 10 days after trauma.

A study of depression, partnership and sexual satisfaction in patients with post-traumatic olfactory disorders

Post-traumatic olfactory dysfunction (PTOD) is associated with a significant decrease in quality of life. The present study aimed to explore whether PTOD is associated with depression and changes in sexuality. There were two groups in this case–control study. The patient group consisted of patients with PTOD (n = 55), and the control group comprised healthy individuals without the olfactory disorder (n = 115). Olfactory function, depression, partnership, and sexual satisfaction were assessed using the Iranian version of the Sniffin’ Sticks test (Ir-SST), Beck Depression Inventory (BDI), Enrich Couple Scale (ECS) and Sexual Satisfaction Scale for Women (SSSW). The BDI scores were higher in the patient group than in the control group (p < 0.001). The SSSW score was lower in the patient group than in controls (p < 0.01), although the ECS score was not significantly different between patients and controls. Also, there was no significant difference in the severity of trauma between marital satisfaction and sexual satisfaction. However, the analysis showed a statistically significant difference in depression scores in connection with the head trauma severity. In the PTOD group, depression was increased and sexual satisfaction declined. Understanding the association of olfactory dysfunction with depression and sexuality allows patients and doctors to deal with less notable consequences of this disorder.

Management of Orthopaedic Injuries following 2015 Gorkha Earthquake: Our Experience in Public Health Concern Trust Nepal

Background: On April 25 2015, a magnitude of 7.8 earthquake struck in central Nepal, causing a huge physical and social disturbances. Physical impacts comprised casualties with deaths and injuries and damage to infrastructure, cultural heritage and natural environment while social impacts are demographic, psychological and economic consequences. We report our experience in treating victims who were brought at our centre via different means.Objectives: to provide an overview the caseload and provide analysis of earthquake victims for improving the future strategies in similar scenarios.Methods: A retrospective study of the clinical characteristics and patterns of hospitalised patient after the 2015 earthquake was conducted. Demographic evaluation, surgical procedures and morbidities were reviewed. The patients were followed up for an average of 24 months, detail records were kept on their recovery and function.Results: A total of 85 patients were treated with subsequent follow-up. The proportion of males admitted was similar to that of females (49.4% and 50.5% respectively). The highest number of admitted age group ranges (17- 45) was about 37.64%. Most injured site was lower limbs (68.23%) where fracture tibia and fibula had the highest incidence (56.89%). Out of all, 14.11% of cases were open fractures. Trauma severity was assessed with injury severity score and most of them categorized as mild one (95.29%). The most common procedure performed was closed reduction and pinning (n=28), followed by open reduction and fixation (n=24). Overall, mortality rate was 2.35% (2 of 85). Total 25 implants were removed within three years of period and 28.6% of patients were not returned to date.Conclusions: The injury epidemiology reported in this study showed quite congruence with most other earthquake related studies. Analysis profiles of injuries and clinical features of earthquake victims will definitely impact rescue efforts and treatment of fracture injuries in possible future natural calamities.

Trauma, alcohol and drugs misuse in car and motorcycle drivers: a prevalence study in a level one trauma center

Alcohol and drugs misuse represents an important social problem. There is no agreement about influence of ethanol and drugs on trauma severity and clinical course. The aim of this study was to investigate the impact of alcohol and drugs abuse on road related trauma managed to our Level I Trauma Center. Data of 1067 car or motorcycle drivers consecutively admitted in a 5 years period were retrospectively analyzed. The sample was divided into two groups: patients with alcohol and/or drugs misuse and patients without detectable plasmatic levels or not screened because no clinical suspicion of these substance. Demographic data, mechanism of trauma, severity of injury, daily and season time of trauma distribution, alcohol and drugs levels and outcomes were retrieved. Alcohol or drugs misuse were detected in 242 patients. Heavy alcohols levels were the 62.3%. Among drugs cannabis was the most detected substance. These patients were significantly younger than the overall study population (p = 0.011), with a higher ISS (p = 0.012) a lower RTS (p = 0.047), a lower GCS (p = 0.005) and an higher head injuries severity (p = 0.030). Regarding time distribution, Saturday was the day with the highest percentage of trauma associated with substance misuse (21%). Alcohol/drugs misuse plays a very important role in the epidemiology of road related trauma. Despite the higher severity of trauma scores and the higher incidence of severe head injuries in patients with alcohol or drugs consumption, there were no effects of this substances on mortality of injured patients involved in road crashes.

Longitudinal Associations between Hair Cortisol, PTSD Symptoms, and Sleep Disturbances in a Sample of Firefighters with Duty-related Trauma Exposure

Several studies have found evidence of altered cortisol levels in patients with posttraumatic stress disorder (PTSD). Based on these findings, it is assumed that these patients may show signs of cortisol dysregulation after trauma. Posttrauma cortisol levels are thus considered a potential biomarker of PTSD. However, longitudinal studies using indicators of long-term cortisol secretion (such as hair cortisol concentrations; HCC) are scarce. The current study investigated prospective associations between HCC and PTSD symptoms in a sample of Dutch firefighters taking into account varying levels of work-related trauma severity. In addition, we assessed posttraumatic sleep disturbances as a secondary outcome measure to investigate whether effects generalize to this frequent comorbidity of PTSD. Three hundred seventy-one Dutch firefighters with a mean of 14.01 years of work experience were included in the analyses. Baseline assessment included the collection of hair samples and the measurement of work-related trauma severity, PTSD symptoms, and sleep disturbances. PTSD symptoms and sleep disturbance were re-assessed after six and twelve months. Multilevel analyses indicate a significant positive correlation between HCC and baseline PTSD symptoms in those with average or above-average work-related trauma severity. A similar pattern was evident for posttraumatic sleep disturbances at baseline. Moreover, higher HCC predicted more posttraumatic sleep disturbances after 6 months in participants with above-average work-related trauma severity. No other associations emerged for PTSD symptoms or posttraumatic sleep disturbances at six or twelve months. As such, our study supports the existence of a cross-sectional association between HCC and trauma symptoms, which may vary for different levels of subjective trauma severity. The longitudinal stability of this association should be reinvestigated by future research.

Expression of HO1 and PER2 can predict the incidence of delirium in trauma patients with concomitant brain injury

Intensive care unit (ICU)-acquired delirium is associated with adverse outcome in trauma patients with concomitant traumatic brain injury (TBI), but diagnosis remains challenging. Quantifying circadian disruption by analyzing expression of the circadian gene period circadian regulator 2 (PER2) and heme oxygenase 1 (HO1), which determines heme turnover, may prove to be potential diagnostic tools. Expression of PER2 and HO1 was quantified using qPCR from blood samples 1 day and 7 days after trauma. Association analysis was performed comparing mRNA expression levels with parameters of trauma (ISS—injury severity score), delirium, acute kidney injury (AKI) and length of ICU stay. 48 polytraumatized patients were included (equal distribution of TBI versus non-TBI) corrected for ISS, age and gender using a matched pairs approach. Expression levels of PER2 and HO1 were independent of age (PER2: P = 0.935; HO1: P = 0.988), while expression levels were significantly correlated with trauma severity (PER2: P = 0.009; HO1: P < 0.001) and longer ICU length of stay (PER2: P = 0.018; HO1: P < 0.001). High expression levels increased the odds of delirium occurrence (PER2: OR = 4.32 [1.14–13.87]; HO1: OR = 4.50 [1.23–14.42]). Patients with TBI showed a trend towards elevated PER2 (OR = 3.00 [0.84–9.33], P = 0.125), but not towards delirium occurrence (P = 0.556). TBI patients were less likely to develop AKI compared to non-TBI (P = 0.022). Expression levels of PER2 and HO1 correlate with the incidence of delirium in an age-independent manner and may potentially improve diagnostic algorithms when used as delirium biomarkers.Trial registration: German Clinical Trials Register (Trial-ID DRKS00008981; Universal Trial Number U1111-1172-6077; Jan. 18, 2018).