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"Trauma" AND ("Injury Severity" OR "ISS")

E Brooke Lerner, Jonathan R Studnek, Nicole Fumo, Anjishnu Banerjee, Igli Arapi, Lorin R Browne, Daniel G Ostermayer, Stacy Reynolds, Manish I Shah
BACKGROUND: Although all emergency departments (ED) should be ready to treat children, some may have illnesses or injuries that require higher-level pediatric resources that are not available at all hospitals. There are no national guidelines for EMS providers about when to directly transport children to hospitals with higher-level pediatric resources, with the exception of severe trauma. Variability exists in EMS protocols about when children warrant transport to hospitals with higher-level pediatric care...
October 21, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Isaac Ng, Nikolay Bugaev, Ron Riesenburger, Aaron C Shpiner, Janis L Breeze, Sandra S Arabian, Reuven Rabinovici
Infratentorial traumatic intracranial bleeds (ICBs) are rare and the distribution of subtypes is unknown. To characterize this distribution the National Trauma Data Bank (NTDB) 2014 was queried for adults with single type infratentorial ICB, n = 1,821: subdural hemorrhage (SDH), subarachnoid hemorrhage (SAH), epidural hemorrhage (EDH), and intraparenchymal hemorrhage (IPH). Comparisons were made between the groups with statistical significance determined using chi squared and t-tests. SDH occurred in 29% of patients, mostly in elderly on anti-coagulants (13%) after a fall (77%), 42% of them underwent craniotomy, their mortality was the lowest (4%)...
October 17, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Walter Robert Hsiang, Catherine McGeoch, Sarah Lee, William Cheung, Robert Becher, Kimberly A Davis, Kevin Schuster
INTRODUCTION: Increased use of opioids has led to higher rates of overdose and hospital admissions. Studies in trauma populations have focused on outcomes associated with acute intoxications rather than addiction. We hypothesize that clinical outcomes after injury would be inferior for opioid-dependent patients compared to opioid-naïve patients. METHODS: We identified all opioid-dependent adult patients admitted to an academic level I trauma center in 2016 with an Injury Severity Score (ISS) ≥ 5...
October 15, 2018: Injury
Reinier B Beks, David Reetz, Mirjam B de Jong, Rolf H H Groenwold, Falco Hietbrink, Michael J R Edwards, Luke P H Leenen, Roderick Marijn Houwert, Jan Paul M Frölke
BACKGROUND: Over the years, a trend has evolved towards operative treatment of flail chest although evidence is limited. Furthermore, little is known about operative treatment for patients with multiple rib fractures without a flail chest. The aim of this study was to compare rib fixation based on a clinical treatment algorithm with nonoperative treatment for both patients with a flail chest or multiple rib fractures. METHODS: All patients with ≥ 3 rib fractures admitted to one of the two contributing hospitals between January 2014 and January 2017 were retrospectively included in this multicenter cohort study...
October 19, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Adel Elkbuli, Rudy Flores, Brianna Dowd, Shaikh Hai, Dessy Boneva, Mark McKenney
BACKGROUND: Cardio Pulmonary Resuscitation (CPR) for traumatized patients in the field portends poor survival but the outcome of trauma patients who arrive in-extremis and undergo CPR shortly after arrival has not been well studied. The purpose of our review is to evaluate survival to discharge for trauma patients with CPR from 1 to 120 minutes (min) after arrival. METHODS: The NTDB Research Data Set (RDS) was reviewed. Patients with vitals in the field who underwent CPR from 1 to 120 min after arrival were divided according to injury type and Injury Severity Score (ISS)...
September 19, 2018: American Journal of Emergency Medicine
Shao-Chun Wu, Cheng-Shyuan Rau, Pao-Jen Kuo, Hang-Tsung Liu, Shiun-Yuan Hsu, Ching-Hua Hsieh
Background : For elderly trauma patients, a prognostic tool called the Geriatric Trauma Outcome Score (GTOS), where GTOS = (age) + (ISS × 2.5) + (22 if any packed red blood cells (pRBCs) were transfused within 24 h after admission), was developed for predicting mortality. In such calculation, a score of 22 was added in the calculation of GTOS regardless of the transfused units of blood. This study aimed to assess the effect of transfused blood units on the mortality outcomes of the elderly trauma patients who received blood transfusion (BT)...
October 18, 2018: International Journal of Environmental Research and Public Health
Hiroyuki Otsuka, Toshiki Sato, Keiji Sakurai, Hiromichi Aoki, Takeshi Yamagiwa, Shinichi Iizuka, Sadaki Inokuchi
Aim: Despite recent advancements in trauma management following introduction of interventional radiology (IVR) and damage-control strategies, challenges remain regarding optimal use of resources for severe trauma. Methods: In October 2014, we implemented a trauma management system comprising emergency physicians competent in severe trauma management, surgical techniques, and IVR. To evaluate this system, of 5,899 trauma patients admitted to our hospital from January 2011 to January 2018, we selected 107 patients with severe trauma (injury severity score ≥ 16) who presented with persistent hypotension (two or more systolic blood pressure measurements <90 mmHg), regardless of primary resuscitation...
October 2018: Acute Medicine & Surgery
Lindsey L Perea, Joshua P Hazelton, Nicole Fox, John P Gaughan, John Porter, Anna Goldenberg
OBJECTIVES: Vascular injury in pediatric trauma patients is uncommon but associated with a reported mortality greater than 19% in some series. The purpose of this study was to characterize pediatric major vascular injuries (MVIs) and analyze mortality at a high-volume combined adult and pediatric trauma center. METHODS: A retrospective review (January 2000 to May 2016) was conducted of all pediatric (<18 years old) trauma patients who presented with a vascular injury...
October 17, 2018: Pediatric Emergency Care
Jennifer A Sees, Gretchen J Cutler, Henry W Ortega
OBJECTIVE: This study aimed to identify risk factors for compartment syndrome (CS) in pediatric trauma populations. METHODS: We included patients younger than 19 years treated at trauma centers contributing to the National Trauma Data Bank between 2009 and 2012. Multivariable logistic regression was used to examine the association between risk factors and the development of CS. The final model adjusted for age, sex, race, number of comorbidities, Glascow Coma Scale, Injury Severity Score, mechanism of injury, and fracture of the lower limb...
October 17, 2018: Pediatric Emergency Care
Amanda Nicole Fletcher, Richard M Schwend, Mitchell Solano, Christopher Wester, Dale E Jarka
BACKGROUND: Unintentional injuries are the leading cause of morbidity and mortality among children 0 to 18 years of age in the U.S. An estimated 9,400 to 17,000 pediatric lawn-mower injuries occur each year. The aims of this study were to better define the epidemiology of lawn-mower injuries and to identify predictors of severe lawn-mower injuries to optimize public education and injury prevention. METHODS: All patients 0 to 18 years of age who presented to Children's Mercy Hospital (CMH), Kansas City, Missouri, during the period of 1995 to 2015 after sustaining a lawn-mower injury were identified using International Classification of Diseases, 9th Revision (ICD-9) codes...
October 17, 2018: Journal of Bone and Joint Surgery. American Volume
Ryne Jenkins, Nicholas A Morris, Bryce Haac, Richard Van Besien, Deborah M Stein, Wan-Tsu Chang, Gary Schwartzbauer, Gunjan Parikh, Neeraj Badjatia
BACKGROUND: Data regarding who will require tracheostomy are lacking which may limit investigations into therapeutic effects of early tracheostomy. METHODS: We performed an observational study of adult traumatic brain injury (TBI) patients requiring intensive care unit (ICU) admission for ≥ 72 h and mechanical ventilation for ≥ 24 h between January 2014 and December 2014 at a level 1 trauma center. Patients who had life-sustaining measures withdrawn were excluded...
October 17, 2018: Neurocritical Care
Michael L Kelly, Jack He, Mary Jo Roach, Timothy A Moore, Michael P Steinmetz, Jeffrey A Claridge
BACKGROUND: The effect of regionalized trauma care (RT) on hospital-based outcomes for traumatic spine injury (TSI) in the United States is unknown. OBJECTIVE: To test the hypothesis that RT would be associated with earlier time to surgery and decreased length of stay (LOS). METHODS: TSI patients >14 yr were identified using International Classification of Diseases Ninth Revision Clinical Modification diagnostic codes. Data from 2008 through 2012 were analyzed before and after RT in 2010...
October 16, 2018: Neurosurgery
Priti P Parikh, Pratik Parikh, Logan Mamer, Mary C McCarthy, Joseph V Sakran
Importance: Studies show that secondary overtriage (SO) contributes significantly to the economic burden of injured patients; thus, the association of SO with use of the trauma system has been examined. However, the association of the underlying trauma system design with such overtriage has yet to be evaluated. Objectives: To evaluate whether the distribution of trauma centers in a statewide trauma system is associated with SO and to identify clinical and demographic factors that may lead to SO...
September 19, 2018: JAMA Surgery
Rym Hamed, Amel Maaref, Feten Amira, Houssem Aouni, Imen Mekki, Amina Jebali
BACKGROUND: Severe Trauma is a misleading cause of death in young people. Early assessment of prognosis is the cornerstone in the management of such patients. Several prognostic scores have been proposed during the last decade. AIM: To evaluate the prognostic performance of trauma scores in terms of mortality in severe trauma patients admitted to the emergency department. METHODS: This was a prospective, observational and prognostic study with inclusion of severe trauma patients admitted to the emergency department over a 20 months period...
March 2018: La Tunisie Médicale
Xavier R J Moors, Stef J M Bouman, Joost H Peters, Pascal Smulders, Michelle B Oude Alink, Dennis Den Hartog, Robert Jan Stolker
OBJECTIVE: In the prehospital setting, the Nijmegen and Rotterdam helicopter emergency medical services administer packed red blood cells to critically ill or injured pediatric patients. Blood is given on scene or during transport and is derived from nearby hospitals. We summarize our experience with prehospital blood use in pediatric patients. METHODS: The databases from both the Nijmegen and Rotterdam helicopter emergency medical services were reviewed for all pediatric (< 18 years) patients who received packed red blood cells on scene or during transport to the hospital...
September 2018: Air Medical Journal
Christopher Melinosky, Shiming Yang, Peter Hu, HsiaoChi Li, Catriona H T Miller, Imad Khan, Colin Mackenzie, Wan-Tsu Chang, Gunjan Parikh, Deborah Stein, Neeraj Badjatia
Background: In the acute resuscitation period after traumatic brain injury (TBI), one of the goals is to identify those at risk for secondary neurological decline (ND), represented by a constellation of clinical signs that can be identified as objective events related to secondary brain injury and independently impact outcome. We investigated whether continuous vital sign variability and waveform analysis of the electrocardiogram (ECG) or photoplethysmogram (PPG) within the first hour of resuscitation may enhance the ability to predict ND in the initial 48 hours after traumatic brain injury (TBI)...
2018: Frontiers in Neurology
Thomas Gross, Philipp Braken, Felix Amsler
PURPOSE: According to the American College of Surgeons (ACS) recommendations, the benchmark for trauma center need (TCN) is an Injury Severity Score (ISS) > 15. In contrast, Swiss highly specialized medicine (HSM) regulations set out TCN for all patients with an ISS > 19 or an Abbreviated Injury Severity (AIS) of the head ≥ 3. This investigation assessed to what extent the modification might be justified. METHODS: Consecutive analysis of all significantly injured (new ISS, NISS ≥ 8) adults treated in a trauma center from 2010 to 2016 based on their ISS and AIS head and in respect to utilized resources and outcome...
October 13, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Rena Hirani, Melinda M Dean, Zsolt J Balogh, Natalie J Lott, Julie Seggie, Jeremy M Hsu, Susan Taggart, Peter Maitz, Lesley Survela, Anthony Joseph, Mark Gillett, David O Irving
BACKGROUND: The potential for the co-existence of genetically disparate cells (microchimerism) and associated cytokine profiles following red blood cell (RBC) transfusion in trauma patients has not been well characterized to date. This study investigated the incidence of surviving donor white blood cells (known as transfused-associated microchimerism (TAM)) and cytokine changes following blood transfusion in trauma patients. STUDY DESIGN AND METHODS: Trauma patients with an injury severity score (ISS) >12 who had been transfused between 2012-2016 with at least 5 units of RBC units over a 4 h period were recruited...
October 10, 2018: Molecular Immunology
Christopher W Snyder, Jeremy D Kauffman, Etienne E Pracht, Paul D Danielson, David J Ciesla, Nicole M Chandler
BACKGROUND: Effective and sustainable pediatric trauma care requires systems of regionalization and interfacility transfer. Avoidable transfer, also known as secondary overtriage, occurs when a patient is transferred to a regional trauma center after initial evaluation at another facility that is capable of providing definitive care. The purpose of this study was to identify risk factors for avoidable transfer among pediatric trauma patients in southwest Florida. METHODS: All pediatric trauma patients two years and older transferred from outlying hospitals to the emergency department (ED) of a single state-designated pediatric trauma center between 2009 and 2017 were obtained from the institutional registry...
October 11, 2018: Journal of Trauma and Acute Care Surgery
Zhi-Jie Hong, Cheng-Jueng Chen, De-Chuan Chan, Teng-Wei Chen, Jyh-Cherng Yu, Sheng-Der Hsu
The trauma team leader is a professional who receives and treats trauma patients. We aimed to evaluate whether or not the seniority of a qualified trauma team leader was a prognostic factor for multiple-trauma patients managed by a trauma team. This was a retrospective cohort study conducted at a Level I Trauma Center in North Taiwan. From January 2009 to December 2013, 284 patients were randomly assigned to one of two trauma team leaders (junior and senior leaders) on duty, irrespective of the seniority of the qualified trauma team leader...
October 9, 2018: Surgery Today
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