Alcohol- and Drug-Associated Injury Outcomes Among Older Adults Involved in Car Crashes

Understanding how recent alcohol or drug use among older adults involved in car crashes can inform emergency care team on the morbidity and mortality risks. This study aimed to assess the odds of worsened health outcomes among older adults with evidence of alcohol or drug ingestion. This cross-sectional analysis used crash census data from the National EMS Information System. The outcome variable was the health outcome after EMS care, measured on a four-point ordinal scale: lower acuity, emergent, critical, and dead. The predictor variable was alcohol/drug use (present/not present). Age, race, gender, part of the body injured, and the revised trauma score of the patients were used as confounders. Odds ratio were calculated using proportional ordinal logistic regression. A total of 42,992 individuals, aged 65 years and older, were involved in car crash events, which required EMS activation. About 22.9% needed emergent care, 4.4% were classified as critical, and 0.4% died without resuscitation efforts. At the time of crash, 3.8% of the older population had evidence of alcohol or drug use. After adjusting for age, gender, race, injury location and revised trauma score of the crash patients, alcohol/drugs were associated with 54% increased odds of worse clinical outcome (AOR:1.54; 95% CI: 1.32-1.80). The adjusted odds remained elevated in urban (AOR: 1.69; 95% CI: 1.42-2.02) and suburban (AOR: 2.21; 95% CI: 1.12-4.35) and not significantly elevated in rural areas. Study findings can inform EMS service and emergency room care as well as policies that strengthen the urban and suburban EMS.

Prehospital Variables Alone Can Predict Mortality After Blunt Trauma: A Novel Scoring Tool

Background We sought to develop a novel Prehospital Injury Mortality Score (PIMS) to predict blunt trauma mortality using only prehospital variables. Study Design The 2017 Trauma Quality Improvement Program database was queried and divided into two equal sized sets at random (derivation and validation sets). Multiple logistic regression models were created to determine the risk of mortality using age, sex, mechanism, and trauma activation criterion. The PIMS was derived using the weighted average of each independent predictor. The discriminative power of the scoring tool was assessed by calculating the area under the receiver operating characteristics (AUROC) curve. The PIMS ability to predict mortality was then assessed by using the validation cohort. The score was compared to the Revised Trauma Score (RTS) using the AUROC curve, including a subgroup of patients with normal vital signs. Results The derivation and validation groups each consisted of 163 694 patients. Seven independent predictors of mortality were identified, and the PIMS was derived with scores ranging from 0 to 20. The mortality rate increased from 1.4% to 43.9% and then 100% at scores of 1, 10, and 19, respectively. The model had very good discrimination with an AUROC of .79 in both the derivation and validation groups. When compared to the RTS, the AUROC were similar (.79 vs. .78). On subgroup analysis of patients with normal prehospital vital signs, the PIMS was superior to the RTS (.73 vs. .56). Conclusion The PIMS is a novel scoring tool to predict mortality in blunt trauma patients using prehospital variables. It had improved discriminatory power in blunt trauma patients with normal vital signs compared to the RTS.

Retrospective review of work-related injuries sustained by foreign workers: a single centre experience over 10 years

ObjectivesTo investigate current patterns of work-related injuries sustained by foreign workers in Singapore and compare them to a decade ago. Secondary aim to analyse usefulness of selected trauma scores in this context.DesignRetrospective review of trauma registry of a single centre, from 1 April to 30 June 2015. Data compared with those from similar study performed at same centre in 2004.SettingEmergency department (ED) of 1500-bedded acute urban public hospital in Singapore.Participants1094 foreign workers with work-related injuries were included. Tourists, foreign students, non-work-related injuries, re-attendances for the same condition were excluded.ResultsMean age of participants was 32.8 years (SD 7.8), 90.0% were men. ED attendance was lowest on Sundays. Mechanism of injury: blunt (78.2%), penetrating (19.2%), burns (2.6%). Compared to 2004, 5% of foreign workers required admission (vs 19.6% in 2004, p≤0.0001), 8.0% underwent day or inpatient surgical procedures (vs 13.2% in 2004, p≤0.0001), 41.6% were referred to specialist outpatient clinics (vs 27.6% in 2004, p≤0.0001), 12.5% were referred to primary care follow-up (vs 29.9% in 2004, p≤0.0001). Mean duration of sick days was 4.3 (vs 5.1 in 2004, p≤0.0001). Of admitted patients, 49.1% had extremity injuries and 36.3% had head and neck injuries. Mean Injury Severity Score (ISS) for admitted patients was 3.64 (SD 3.1) (vs 4.3 (SD 5.5) in 2004, p=0.39). Mean Revised Trauma Score (RTS) for admitted patients was 7.74 (SD 0.39) (vs 7.8 (SD 0.2) in 2004, p=0.07). Of discharged patients, 48.9% had extremity injuries and 48.9% had external injuries. There was no death.ConclusionCompared to 2004, there were fewer major/fatal work-related injuries and an increased proportion of minor injuries. ISS and RTSs were of limited use in this setting.

Adjustment of Trauma and Injury Severity Sccore (TRISS) and Revised Trauma Score (RTS) in Predicting Mortality of Multitraumapatients in Sanglah Hospital Bali

Background: The Trauma and Injury Severity Score (TRISS) is the most applied tool to predict the multi-trauma outcome. It is shown that the predictive value of TRISS could be improved by adjusting the coefficient. Originally this study aims to evaluate our hospital in treating multitrauma patients, with good outcome we propose adjustment to TRISS formula. Methodology:This study is a diagnostic test to determine the accuracy of TRISS scores to predict mortality of multitrauma patients treated in Sanglah General Hospital. Result: Fifty two multitrauma patients with ISS score > 18 with at least 2 body regions being injured. The TRISS diagnostic test was obtained with a sevsitivity 81.8%, specificity 97.6%, positive predictive value 90%, negative predictive value 95.2%, prevalence 21%, accuracy rate of 94.2%. Conclusion: Adjustment to TRISS formula coefficient for better prediction is proposed. Physiological parameter in RTS that does not include respiratory rate shows reliable prediction, which can be used in emergency setting when anatomical diagnostic has not yet to be obtained.

Predictive value of Modified Early Warning Score (MEWS) and Revised Trauma Score (RTS) for the short-term prognosis of emergency trauma patients: a retrospective study

ObjectivesThis study aimed to assess the predictive value of the Modified Early Warning Score (MEWS) and Revised Trauma Score (RTS) for emergency trauma patients who died within 24 hours.DesignA retrospective, single-centred study.SettingThis study was conducted at a tertiary hospital in Southern China.ParticipantsA total of 1739 patients with acute trauma, aged 16 years or older who presented to the emergency department from 1 November 2016 to 30 November 2019, were included.Interventions noneNone.Outcome24-hour mortality was the primary outcome of trauma.Results1739 patients were divided into the survival group (1709 patients,98.27%), and the non-survival group (30 patients,1.73%). Crude OR and adjusted OR of MEWS were 1.99, 95% CI (1.73 to 2.29), and 2.00, 95% CI (1.74 to 2.31), p<0.001, respectively. Crude OR and adjusted OR of RTS were 0.62, 95% CI (0.55 to 0.69) and 0.61, 95% CI (0.55 to 0.68), p<0.001, respectively. The area under the curve of MEWS was significantly higher than that of RTS (p=0.005): 0.927, 95% CI (0.914 to 0.939) vs 0.799, 95% CI (0.779 to 0.817).ConclusionsBoth MEWS and RTS were independent predictors of the short-term prognosis in emergency trauma patients, MEWS had better predictive efficacy.

Índices de gravidade em vítimas de trauma contuso na terapia intensiva: capacidade preditiva de mortalidade

RESUMO Objetivo: Identificar a capacidade preditiva de mortalidade dos índices Revised Trauma Score, Rapid Emergency Medicine Score, modified Rapid Emergency Medicine Score e Simplified Acute Physiology Score III em vítimas de trauma contuso internadas em unidade de terapia intensiva e comparar seu desempenho. Método: Coorte retrospectiva de pacientes com trauma contuso de uma unidade de terapia intensiva a partir do registro em prontuários. Receiver Operating Characteristic e intervalo de confiança de 95% da área sob a curva foram analisados para comparar os resultados. Resultados: Dos 165 pacientes analisados, 66,7% tiveram tratamento cirúrgico. A mortalidade na unidade de terapia intensiva e no hospital foi de 17,6% e 20,6%, respectivamente. Para mortalidade na terapia intensiva, houve variação das áreas sob a curva entre 0,672 e 0,738; porém, melhores resultados foram observados em pacientes cirúrgicos (0,747 a 0,811). Resultados similares foram observados para mortalidade hospitalar. Em todas as análises, as áreas sob a curva dos índices não diferiram significativamente. Conclusão: Houve acurácia moderada dos índices de gravidade, com melhora na performance quando aplicados em pacientes cirúrgicos. Os quatro índices apresentaram predição similar para os desfechos analisados.