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iss >15

Maria E Linnaus, David M Notrica, Crystal S Langlais, Shawn D St Peter, Charles M Leys, Daniel J Ostlie, R Todd Maxson, Todd Ponsky, David W Tuggle, James W Eubanks, Amina Bhatia, Adam C Alder, Cynthia Greenwell, Nilda M Garcia, Karla A Lawson, Prasenjeet Motghare, Robert W Letton
BACKGROUND: Age-adjusted pediatric shock index (SIPA) does not require knowledge of age-adjusted blood pressure norms, yet correlates with mortality, serious injury, and need for transfusion in trauma. No prospective studies support its validity. METHODS: A multicenter prospective observational study of patients 4-16years presenting April 2013-January 2016 with blunt liver and/or spleen injury (BLSI). SIPA (maximum heart rate/minimum systolic blood pressure) thresholds of >1...
September 23, 2016: Journal of Pediatric Surgery
Melvin E Stone, Stanley Kalata, Anna Liveris, Zachary Adorno, Shira Yellin, Edward Chao, Srinivas H Reddy, Michael Jones, Carlos Vargas, Sheldon Teperman
BACKGROUND: Critical administration threshold (≥3 units of packed red blood cells/h or CAT+) has been proposed as a new definition for massive transfusion (MT) that includes volume and rate of blood transfusion. CAT+ has been shown to eliminate survivor bias and be a better predictor of mortality than the traditional MT (>10 units/24h). End-tidal CO2 (ET CO2) negatively correlates with lactate and is an early predictor of shock in trauma patients. We conducted a pilot study to test the hypothesis that low ET CO2 on admission predicts CAT+...
July 5, 2016: Injury
Kelly A Feldman, Jun Tashiro, Casey J Allen, Eduardo A Perez, Holly L Neville, Carl I Schulman, Juan E Sola
BACKGROUND: Although firearms account for less than 5 % of all pediatric injuries, they have the highest associated case fatality rate. METHODS: The registry at a Level-1 trauma center was used to identify firearm injuries (<18 years of age) from 1991 to 2011. Descriptive statistics and risk-adjusted multivariate analyses (MVA) were performed. RESULTS: Overall, 1085 patients were identified. Immediate operations were performed in 33 % (n = 358) of patients with most having abdominal surgery (n = 214)...
September 28, 2016: Pediatric Surgery International
A M K Harmsen, G F Giannakopoulos, M Terra, E S M de Lange de Klerk, F W Bloemers
PURPOSE: Many changes have been made to improve trauma care. Improved trauma team response and usage of a hybrid resuscitation room are examples of how this trauma center has developed. The aim was to assess how the outcome of the trauma population was influenced by the maturation. METHODS: A cohort comparison, between June 2004-July 2005 and 2014, was performed. All adult trauma patients with an Injury Severity Score (ISS) >15 were included. Variables collected were: patient demographics, mechanism of trauma, total prehospital time, pre- and inhospital trauma scores, vital signs, blood values and interventions, and physician staffed helicopter emergency medical services (P-HEMS) involvement and outcome...
September 15, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Stefan Candefjord, Ruben Buendia, Eva-Corina Caragounis, Bengt Arne Sjöqvist, Helen Fagerlind
OBJECTIVE: The objective of this study was to evaluate the proportion and characteristics of patients sustaining major trauma in road traffic crashes (RTCs) who could benefit from direct transportation to a trauma center (TC). METHODS: Currently, there is no national classification of TC in Sweden. In this study, 7 university hospitals (UHs) in Sweden were selected to represent a TC level I or level II. These UHs have similar capabilities as the definition for level I and level II TC in the United States...
September 2016: Traffic Injury Prevention
James M Feeney, Matthew Neulander, Monica DiFiori, Lilla Kis, David S Shapiro, Vijay Jayaraman, William T Marshall, Stephanie C Montgomery
METHODS: We queried our Trauma Quality Improvement Program registry for patients who presented between 6/1/2011 and 9/1/2015 with severe (injury severity score (ISS)>15) blunt traumatic injury during anticoagulant use. Patients were then grouped into those prescribed warfarin and patients prescribed any of the available novel Direct Oral Anticoagulants (DOAC) medications. We excluded severe (AIS≧4) head injuries. RESULTS: There were no differences between DOAC and warfarin groups in terms of age, gender mean ISS, median hospital or intensive care unit lengths of stay, complication proportions, numbers of complications per patient, or the proportion of patients requiring transfusion...
August 27, 2016: Injury
Richard Trafford Spence, Eiman Zargaran, S Morad Hameed, Pradeep Navsaria, Andrew Nicol
BACKGROUND: The burden of data collection associated with injury severity scoring has limited its application in areas of the world with the highest incidence of trauma. MATERIAL AND METHODS: Since January 2014, electronic records (electronic Trauma Health Records [eTHRs]) replaced all handwritten records at the Groote Schuur Hospital Trauma Unit in South Africa. Data fields required for Glasgow Coma Scale, Revised Trauma Score, Kampala Trauma Score, Injury Severity Score (ISS), and Trauma Score-Injury Severity Score calculations are now prospectively collected...
August 2016: Journal of Surgical Research
Trond Dehli, Svein Arne Monsen, Knut Fredriksen, Kristian Bartnes
BACKGROUND: Correct triage based on prehospital information contributes to a better outcome for potentially seriously injured patients. In 2011 we changed the trauma team activation (TTA) criteria in our center in order to improve the high over- and undertriage properties of the protocol. Five criteria that were unable to predict severe injury were removed. In the present study, we evaluated the protocol revision by comparing over- and undertriage in the former and present set of criteria...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Isidro Martínez Casas, María Auxiliadora Amador Marchante, Mihai Paduraru, Ana Isabel Fabregues Olea, Andreu Nolasco, Juan Carlos Medina
OBJECTIVE: To determine the predictive and diagnostic value of thorax trauma severity score (TTSS) in a population of thoracic trauma patients admitted to a secondary level trauma center. METHODS: A Retrospective analysis of patients admitted over a period of two years with IDC-9 codes related to thoracic trauma was undertaken. The association of TTSS with complications and mortality was evaluated. We also determined the predictive value of TTSS using receiver operating characteristic curve (ROC)...
July 2016: Bulletin of Emergency and Trauma
Alasdair R Corfield, Danny F MacKay, Jill P Pell
BACKGROUND: Trauma remains a leading cause of morbidity and mortality in the UK and throughout the world. Socioeconomic deprivation has been linked with many types of ill-health and previous studies have shown an association with injury in other parts of the world. The aim of this study was to investigate the association between socioeconomic deprivation and trauma incidence and case-fatality in Scotland. METHODS: The study included nine thousand two hundred and thirty eight patients attending Emergency Departments following trauma across Scotland in 2011-12...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Gaël Gosteli, Bertrand Yersin, Cédric Mabire, Mathieu Pasquier, Roland Albrecht, Pierre-Nicolas Carron
INTRODUCTION: Extreme sports (ESs) are increasingly popular, and accidents due to ESs sometimes require helicopter emergency medical services (HEMSs). Little is known about their epidemiology, severity, specific injuries and required rescue operations. AIM: Our aims were to perform an epidemiological analysis, to identify specific injuries and to describe the characteristic of prehospital procedures in ES accidents requiring HEMSs. METHODS: This is a retrospective study, reviewing all rescue missions dedicated to ESs provided by HEMS REGA Lausanne, from 1 January 1998 to 31 December 2008...
July 2016: Injury
Steven R Niedermeier, Safdar N Khan
STUDY DESIGN: Retrospective comparative study. OBJECTIVE: To examine perioperative characteristics among polytraumatized patients with operative, unstable spine fractures with and without concomitant operative long-bone injuries. SUMMARY OF BACKGROUND DATA: Treatment of polytrauma patients has delicate and time-sensitive protocols to ensure successful recovery. The literature defines standards for vertebral injury and surgical intervention...
May 18, 2016: Clinical Spine Surgery
Poya Ghorbani, Kjetil Gorseth Ringdal, Morten Hestnes, Nils Oddvar Skaga, Torsten Eken, Anders Ekbom, Lovisa Strömmer
BACKGROUND: Assessment of trauma-system performance is important for improving the care of injured patients. The aim of the study was to compare risk-adjusted survival in two Scandinavian Level-I trauma centres. METHODS: This was an observational, retrospective study of prospectively-collected trauma registry data for patients >14 years from Karolinska University Hospital - Solna (KUH), Sweden, and Oslo University Hospital - Ullevål (OUH), Norway, from 2009-2011...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Mauricio A Escobar, Carolynn J Morris
BACKGROUND: The American College of Surgeons Committee on Trauma (ACS-COT) view over- and undertriage rates based on trauma team activation (TTA) criteria as surrogate markers for quality trauma patient care. Undertriage occurs when classifying patients as not needing a TTA when they do. Over-triage occurs when a TTA is unnecessarily activated. ACS-COT recommends undertriage <5% and overtriage 25-35%. We sought to improve the under-triage and over-triage rates at our Level II Pediatric Trauma Center by updating our outdated trauma team activation criteria in an evidence-based fashion to better identify severely injured children and improving adherance to following established trauma team activation criteria...
September 2016: Journal of Pediatric Surgery
S Kritsaneepaiboon, A Jutiyon, A Krisanachinda
PURPOSE: To estimate the cumulative radiation exposure and lifetime attributable risk (LAR) of radiation-induced cancer from computed tomographic (CT) scanning of adult patients with multiple-injury traumas. METHODS: The study comprises 328 multiple-injury adult patients who underwent diagnostic CT during 2013. Each patient's cumulative CT radiation exposure was calculated and the biological effects of ionizing radiation VII methodology was used to estimate the LAR of cancer incidence on the basis of sex and age at each exposure...
March 24, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Bellal Joseph, Ansab Haider, Kareem Ibraheem, Narong Kulvatunyou, Andrew Tang, Asad Azim, Terence O'Keeffe, Lynn Gries, Gary Vercruysse, Peter Rhee
INTRODUCTION: Although variability in vital parameters has been shown to predict outcomes, the role of change in shock index (delta SI) as a predictive tool remains unknown. METHODS: The National Trauma Data Bank (2011-2012) was abstracted for all patients aged 18 to 85 years and Injury Severity Score more than 15 with complete data. Transferred patients and patients dead on arrival were excluded. Patient demographics and injury parameters were recorded, and SI in the field, SI in the emergency department (ED), and change in SI (delta SI = ED SI-field SI) were calculated...
September 2016: Shock
C C H M van Delft-Schreurs, M A C van Son, M A C de Jongh, T Gosens, M H J Verhofstad, J de Vries
UNLABELLED: In this cross-sectional study the psychometric properties are examined of the adapted Dutch translation of the Short Musculoskeletal Function Assessment (SMFA) questionnaire in severely injured patients (ISS>15). PATIENTS AND METHODS: Patients (N=173) completed the SMFA, the World Health Organization Quality of Life assessment instrument-BREF (WHOQOL-BREF), the Dutch Impact of Event Scale (IES), the Hospital Anxiety and Depression Scale (HADS) and the Cognitive Failure Questionnaire (CFQ)...
September 2016: Injury
Giovanni Bellanova, Francesco Buccelletti, Riccardo Berletti, Marco Cavana, Giorgio Folgheraiter, Francesca Groppo, Chiara Marchetti, Amelia Marzano, Alessandro Massè, Antonio Musetti, Tina Pelanda, Nicola Ricci, Gregorio Tugnoli, Damiano Papadia, Claudio Ramponi
AIM: Aim of this study is to analyze how the starting of Course of Trauma in our hospital improved survival and organization in management of polytraumatized patients. MATERIAL OF STUDY: We analysed all major trauma patients (Injury Severity Score (Injury Severity Score (ISS)> 15) treated at Emergency Department of the Santa Chiara Hospital between January 2011 and December 2014. The training courses (TC) were named "management of polytrauma" (MP) and "clinical cases discussion" (CCD), and started in November 2013...
2016: Annali Italiani di Chirurgia
Stephen C Gale, Joann Peters, Ashley Hansen, Viktor Y Dombrovskiy, Paul W Detwiler
OBJECTIVES: After rural injury, evaluation at local hospitals with transfer to regional trauma centres may delay definitive care. This study sought to determine the impact of such delays on outcomes in patients with TBI within a mature regional trauma system. METHODS: The ETMC Level 1 Trauma registry was queried from 2008-2013 for patients with blunt TBI, aged ≥ 18 and admitted ≤ 24 hours from injury and stratified them as 'transfer' vs 'direct' admission. Demographics, transfer distance, transfer times and outcomes were compared using Chi-square, t-test and multivariable logistic regression; p < 0...
March 10, 2016: Brain Injury: [BI]
Rebecka Rubenson Wahlin, Sari Ponzer, Markus B Skrifvars, Hans Morten Lossius, Maaret Castrén
BACKGROUND: Trauma systems and regionalized trauma care have been shown to improve outcome in severely injured trauma patients. The aim of this study was to evaluate the implementation of a prehospital trauma care protocol and transport directive, and to determine its effects on the number of primary admissions and secondary trauma transfers in a large Scandinavian city. METHODS: We performed a retrospective observational study based on local trauma registries and hospital and ambulance records in Stockholm County; patients > 15 years of age with an Injury Severity Score (ISS) > 15 transported to any emergency care hospitals in the Stockholm area were included for the years 2006 and 2008...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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