Development and Validation of a Simplified Prehospital Triage Model Using Neural Network to Predict Mortality in Trauma Patients: The Ability to Follow Commands, Age, Pulse Rate, Systolic Blood Pressure and Peripheral Oxygen Saturation (CAPSO) Model

Objective: Most trauma scoring systems with high accuracy are difficult to use quickly in field triage, especially in the case of mass casualty events. We aimed to develop a machine learning model for trauma mortality prediction using variables easy to obtain in the prehospital setting.Methods: This was a retrospective prognostic study using the National Trauma Data Bank (NTDB). Data from 2013 to 2016 were used for model training and internal testing, and data from 2017 were used for validation. A neural network model (NN-CAPSO) was developed using the ability to follow commands (whether GCS-motor was <6), age, pulse rate, systolic blood pressure (SBP) and peripheral oxygen saturation, and a new score (the CAPSO score) was developed based on logistic regression. To achieve further simplification, a neural network model with the SBP variable removed (NN-CAPO) was also developed. The discrimination ability of different models and scores was compared based on the area under the receiver operating characteristic curve (AUROC). Furthermore, a reclassification table with three defined risk groups was used to compare NN-CAPSO and other models or scores.Results: The NN-CAPSO had an AUROC of 0.911(95% confidence interval 0.909 to 0.913) in the validation set, which was higher than the other trauma scores available for prehospital settings (all p < 0.001). The NN-CAPO and CAPSO score both reached the AUROC of 0.904 (95% confidence interval 0.902 to 0.906), and were no worse than other prehospital trauma scores. Compared with the NN-CAPO, CAPSO score, and the other trauma scores in reclassification tables, NN-CAPSO was found to more accurately classify patients to the right risk groups.Conclusions: The newly developed CAPSO system simplifies the method of consciousness assessment and has the potential to accurately predict trauma patient mortality in the prehospital setting.

Can an App-Based Maxillofacial Trauma Score Predict the Operative Time, ICU Need and Length of Stay?

Study design Retrospective chart review Objective Injury and trauma scores are the mainstay of predicting outcomes of trauma patients. ZS (Zeeshan and Simon) maxillofacial trauma score is based on 4 previous facial trauma scores and is user friendly, app-based visually coded facial trauma scoring system. Our study was designed to seek the application of an app-based ZS maxillofacial trauma score to predict the operative time, intensive care unit (ICU) need and length of stay. Methods We performed a retrospective chart review of patients who presented to a university medical college teaching hospital with maxillofacial fractures from October 2018 until October 2019. ZS maxillofacial trauma scoring app was used to calculate the ZS maxillofacial trauma severity score, which was our primary predictor variable. Our primary outcome of interest was operative time. Our secondary outcome of interest was ICU need and length of stay. Correlation analysis, linear regression and logistic regression were performed for statistical analysis. A statistical P-value of .05 was considered significant at a 95% confidence interval. Results There were 95 male and 5 female patients included in the study. The age ranged from 3 to 84 years with a mean of 30.76 (SD = 14.04). A statistically significant correlation between the ZS score and operative time ( r = 0.67, P < .001) was observed. ZS score predicted operative time ( b 1 = 7.67, P < .001) in our study sample . Increasing ZS trauma score was also significantly associated with ICU requirement ( X 2(3) = 13.682, P = .003), but the length of stay could not be predicted based on ZS score. Conclusion: ZS maxillofacial trauma score can predict the operative time, and an association was seen with the need for ICU with increasing ZS score, but could not predict the length of stay or the ICU need. It has potential for future integration with electronic health record systems.

Trauma Scores and Their Prognostic Value for the Outcome Following Pediatric Polytrauma

Purpose: The management and prognostic assessment of pediatric polytrauma patients can pose substantial challenges. Trauma scores developed for adults are not universally applicable in children. An accurate prediction of the severity of trauma and correct assessment of the necessity of surgical procedures are important for optimal treatment. Several trauma scores are currently available, but the advantages and drawbacks for use in pediatric patients are unclear. This study examines the value of the trauma scores Injury Severity Score (ISS), Pediatric Trauma Score (PTS), National Advisory Committee for Aeronautics (NACA), and Glasgow Coma Score (GCS) for the assessment of the polytraumatized child.Methods: In a retrospective study, 97 patients aged 0–17 years who presented with polytrauma and an ISS ≥16 in the trauma bay were included in the study. Patient records including radiological studies were analyzed. Pathological imaging findings and emergency surgery were assessed as outcome variables and the predictive value of the trauma scores were analyzed using receiver operator characteristic (ROC) curves. Statistical significance was set at an alpha level of P ≤ 0.05.Results: In this study, 35 of the 97 studied children had pathological cranial computed findings. These either underwent craniectomy or trepanation or a parenchymal catheter was placed for intracranial pressure monitoring. Abdominal trauma was present in 45 patients, 16 of which were treated surgically. Forty-three patients arrived with thoracic injuries, 10 of which received a thoracic drainage. One child underwent an emergency thoracotomy. Predictive accuracy for emergency surgery calculated using receiver-operator characteristic (ROC) curves was highest for ISS and NACA scores (0,732 and 0.683, respectively), and lower for GCS (0.246) and PTS (0.261).Conclusion: In our study cohort, initial ISS and NACA scores better predicted operative interventions and outcome than PTS or GCS for polytraumatized pediatric patients.

Childhood Trauma and Aggression in Persons Convicted for Homicide: An Exploratory Study Examines the Role of Plasma Oxytocin

Evidence has demonstrated the association between childhood trauma and criminality in adulthood, however, less is known about how best to explain the route from childhood trauma to adulthood aggression. Results from both human and animal studies have generated the hypothesis that dysfunction of the oxytocinergic system may correlate with pathological aggression. The current study represents a first exploratory examination to investigate the trajectory from childhood trauma to aggression, specifically, plasma oxytocin's role in this association. We assessed the childhood trauma experiences in a total of 108 participants, including 33 persons convicted for homicide and 75 non-offending healthy participants, using the Childhood Trauma Questionnaire, with in-depth clarification interviews for cross-validation. All participants were checked for aggression using the Modified Overt Aggression Scale and their plasma oxytocin levels were obtained. Results indicated that persons convicted for homicide had higher childhood trauma scores and lower plasma oxytocin levels than healthy controls. The plasma oxytocin levels were inversely correlated with childhood trauma in all participants. Further mediation models were constructed to explore these associations, in the best-fit model, the relationship between childhood trauma and aggression is mediated by plasma oxytocin levels in persons convicted for homicide. In conclusion, the association between childhood trauma and aggression of persons convicted for homicide is mediated by their plasma oxytocin levels. With leading to further theoretical consideration in the causality on how best to explain the interaction between childhood trauma and aggression, the current study may assist in developing further research and preventive strategies for aggression, particularly the importance of early identification of childhood trauma.

Survival among patients with severe high cervical spine injuries – a TraumaRegister DGU® database study

Background Trauma is a significant cause of death and impairment. The Abbreviated Injury Scale (AIS) differentiates the severity of trauma and is the basis for different trauma scores and prediction models. While the majority of patients do not survive injuries which are coded with an AIS 6, there are several patients with a severe high cervical spinal cord injury that could be discharged from hospital despite the prognosis of trauma scores. We estimate that the trauma scores and prediction models miscalculate these injuries. For this reason, we evaluated these findings in a larger control group. Methods In a retrospective, multi-centre study, we used the data recorded in the TraumaRegister DGU® (TR-DGU) to select patients with a severe cervical spinal cord injury and an AIS of 3 to 6 between 2002 to 2015. We compared the estimated mortality rate according to the Revised Injury Severity Classification II (RISC II) score against the actual mortality rate for this group. Results Six hundred and twelve patients (0.6%) sustained a severe cervical spinal cord injury with an AIS of 6. The mean age was 57.8 ± 21.8 years and 441 (72.3%) were male. 580 (98.6%) suffered a blunt trauma, 301 patients were injured in a car accident and 29 through attempted suicide. Out of the 612 patients, 391 (63.9%) died from their injury and 170 during the first 24 h. The group had a predicted mortality rate of 81.4%, but we observed an actual mortality rate of 63.9%. Conclusions An AIS of 6 with a complete cord syndrome above C3 as documented in the TR-DGU is survivable if patients get to the hospital alive, at which point they show a survival rate of more than 35%. Compared to the mortality prognosis based on the RISC II score, they survived much more often than expected.

The comparison of assault and falling in elder patients over 65 years of age

Objective: The aim of the present study was to determine suspected events for elder abuse, and to increase awareness of the clinicians by comparing traumatic elder abuse and falling. Methods: The study was conducted retrospectively on individuals older than 65 years referred due to traumatic abuse and falling between 1 June 2014 and 30 September 2019. The patients were evaluated for age, gender, co-morbidity, trauma location, trauma scores at referral [injury severity score (ISS), Glasgow coma scale (GCS)], and vital parameters at referral [mean arterial pressure (MAP), and the pulse rate]. Variable distribution was evaluated by Kolmogorov-Simirnov test. Mann Whitney U test was used for analysis of quantitative data; chi-square test was utilized for analysis of independent qualitative data; Fischer’s test was used when chi-square conditions are provided. Results: The median age of the patients exposed to abuse was 73 (IQR: 11) years and 48% of these patients were male. The age median of the patients exposed to abuse was significantly higher; frequency of female patients were significantly more (p < 0.05). Fracture incidence was higher in the patients who have fallen; however, soft tissue trauma was higher in the patients who have been abused (p < 0.05). Hospitalization prevalence of assaulted cases was higher (p < 0.05); however, mortality prevalence was similar (p ＞ 0.05). Conclusion: Consequently, abuse causes severe traumas when compared with accident and falling. The probability of abuse should be considered in elder trauma cases with specific locations (upper limbs and face etc.).

The comparison of assault and falling in elder patients over 65 years of age

Objective: The aim of the present study was to determine suspected events for elder abuse, and to increase awareness of the clinicians by comparing traumatic elder abuse and falling. Methods: The study was conducted retrospectively on individuals older than 65 years referred due to traumatic abuse and falling between 1 June 2014 and 30 September 2019. The patients were evaluated for age, gender, co-morbidity, trauma location, trauma scores at referral [injury severity score (ISS), Glasgow coma scale (GCS)], and vital parameters at referral [mean arterial pressure (MAP), and the pulse rate]. Variable distribution was evaluated by Kolmogorov-Simirnov test. Mann Whitney U test was used for analysis of quantitative data; chi-square test was utilized for analysis of independent qualitative data; Fischer’s test was used when chi-square conditions are provided. Results: The median age of the patients exposed to abuse was 73 (IQR: 11) years and 48% of these patients were male. The age median of the patients exposed to abuse was significantly higher; frequency of female patients were significantly more (p < 0.05). Fracture incidence was higher in the patients who have fallen; however, soft tissue trauma was higher in the patients who have been abused (p < 0.05). Hospitalization prevalence of assaulted cases was higher (p < 0.05); however, mortality prevalence was similar (p ＞ 0.05). Conclusion: Consequently, abuse causes severe traumas when compared with accident and falling. The probability of abuse should be considered in elder trauma cases with specific locations (upper limbs and face etc.).

A Selection of Trauma Scores Might Not Correlate with Coagulation Factor Activity following Multiple Injuries: A Retrospective Observational Study from a Level 1 Trauma Center

Loss and dilution of coagulation factors have been observed following multiple trauma. Timely recognition of reduced clotting factor activity might facilitate therapeutic action to restore normal coagulation function. This study investigates the potential role of some well-known trauma scores in predicting coagulation factor activity after multiple injuries. A dataset comprising the coagulation factor activities of 68 multiply injured adult patients was analyzed. The following trauma scores were evaluated: AIS, ISS, NISS, GCS, RTS, TRISS, RISC, and TASH score. To investigate the effect of trauma severity with respect to a single anatomic injury location, two groups according to the AIS (<3 vs. ≥3 points) were formed. Differences between these two groups were analyzed for five different body regions (head, thorax, abdomen, pelvis, extremities) using the Mann–Whitney U -test. Spearman’s rank correlation coefficient rho was calculated to reveal possible relationships between trauma scores and clotting factor activities. The analysis showed clearly reduced clotting factor activities with a significant reduction of FII (83 vs. 50%; P = .021 ) and FV (83 vs. 46%; P = .008 ) for relevant ( AIS ≥ 3 points ) pelvic injuries. In contrast, traumatic brain injury according to the AIS head or the GCS does not appear to lead to a significant decrease in coagulation factor activities. Furthermore, the other scores studied show at best a fair correlation with coagulation factor activity. In this context, the RTS score seems to be the most suitable. Additionally, the predictive value of the TASH score, which was specifically developed to predict the need for mass transfusion, was also limited in this study. We would like to explicitly point out that this is not a criticism of the trauma scores, since they were developed in a completely different context.