New injury severity score(NISS)outperforms injury severity score(ISS)in the evaluation of severe blunt trauma patients

Purpose:The injury severity score(ISS)and new injury severity score(NISS)have been widely used in trauma evaluation.However,which scoring system is better in trauma outcome prediction is still disputed.The purpose of this study is to evaluate the value of the two scoring systems in predicting trauma outcomes,including mortality,intensive care unit(ICU)admission and ICU length of stay.Methods:The data were collected retrospectively from three hospitals in Zhejiang province,China.The comparisons of NISS and ISS in predicting outcomes were performed by using receiver operator characteristic(ROC)curves and Hosmer-Lemeshow statistics.Results:A total of 1825 blunt trauma patients were enrolled in our study.Finally,1243 patients were admitted to ICU,and 215 patients died before discharge.The ISS and NISS were equivalent in predicting mortality(area under ORC curve[AUC]:0.886 vs.0.887,p=0.9113).But for the patients with ISS>25,NISS showed better performance in predicting mortality.NISS was also significantly better than ISS in predicting ICU admission and prolonged ICU length of stay.Conclusion:NISS outperforms ISS in predicting the outcomes for severe blunt trauma and can be an essential supplement of ISS.Considering the convenience of NISS in calculation,it is advantageous to promote NISS in China's primary hospitals.

Comparison of the new injury severity score and the injury severity score in multiple trauma patients

Objective： To assess whether these characteristics of less misclassification and greater area under receiver operator characteristic （ROC） curve of the new injury severity score （NISS） are better than the injury severity score （ISS） as applying it to our multiple trauma patients registered into the emergency intensive care unit （EICU）. Methods： This was a retrospective review of registry data from 2 286 multiple trauma patients consecutively registered into the EICU from January 1,1997 to December 31, 2006 in the Second Affiliated Hospital, Medical School of Zhejiang University in China. Comparisons between ISS and NISS were made using misclassification rates, ROC curve analysis, and the H-L statistics by univariate and multivariate logistic progression model. Results： Among the 2 286 patients, 176 （7.7%） were excluded because of deaths on arrival or patients less than 16 years of age. The study population therefore comprised 2 1 10 patients. Mean EICU length of stay （LOS） was 7.8 days ± 2.4 days. Compared with the blunt injury group, the penetrating injury group had a higher percentage of male, lower mean EICU LOS and age. The most frequently injured body regions were extremities and head/neck, followed by thorax, face and abdomen in the blunt injury group; whereas, thorax and abdomen were more frequently seen in the penetrating injury group. The minimum misclassification rate for NISS was slightly less than ISS in all groups （4.01% versus 4.49%）. However, NISS had more tendency to misclassify in the penetrating injury group. This, we noted, was attributed mainly to a higher false-positive rate （21.04% versus 15.55% for IS S, t=-3.310, P〈0.001）, resulting in an overall misclassification rate of 23.57% for NISS versus 18.79% for ISS （t=3.290, P〈0.001）. In the whole sample, NISS presented equivalent discrimination （area under ROC curve： NISS=0.938 versus ISS=0.943）. The H-L statistics showed poorer calibration （48.64 versus 32.11, t=3.305, P〈0.001） in the penetrating injury group. Conclusions： NISS should not replace ISS because Lhey share similar accuracy and calibration in predicting multiple blunt trauma patients. NISS may be more sensitive but less specific than ISS in predicting mortality in certain penetrating injury patients.

Application of injury severity score to multiple injuries headed by spinal cord injury

Objective： To evaluate the application of injury severity score （ISS） to multiple injuries headed by spinal cord injury. Methods： The data of 55 cases （40 males and 15 females, aged 17-69 years, mean = 41 years） of multiple injuries headed by spinal cord injury treated in our hospital from January 2000 to December 2004 were reviewed and analyzed with ISS （Version of AIS-2005 ） to explore their relationship. Results ： The ISS values increased with the number of injured regions, so did the complications. The recovery rate was negatively related to ISS values. During the period of immunity observation, the patients with ISS 〉 25 could undergo planned operations safely. Conclusions： Treatment for multiple injuries headed by spinal cord injury closely depends on the general and local conditions of the patients. ISS may provide useful data for the choice of treatment methods.

Fibrinogen degradation product levels on arrival for trauma patients requiring a transfusion even without head injury

BACKGROUND: There have been few reports on the clinical significance of the fibrinogen degradation product(FDP) level in trauma patients with and without head injury. We retrospectively analyzed trauma patients with or without head injury to investigate the clinical signifi cance of the FDP level.METHODS: From April 2013 to June 2015, a medical chart review was retrospectively performed for all patients with trauma. The exclusion criteria included patients who did not receive a transfusion. The patients were divided into two groups: a FDP>100 group, which included patients who had an FDP level on arrival over 100 ng/m L, and a FDP≤100 group.RESULTS: The ratio of open fractures and the prothrombin ratio in the FDP>100 group were significantly smaller than those observed in the FDP≤100 group. The average age, ratio of blunt injury, Injury Severity Score(ISS), volume of transfusion and mortality ratio in the FDP>100 group were signifi cantly greater than those in the FDP≤100 group. There was a weakly positive correlation between the FDP level and ISS(R=0.35, P=0.002), but it was not associated with the transfusion volume. The results of an analysis excluding patients with head injury showed a similar tendency.CONCLUSION: The FDP levels may be a useful biochemical parameter for the initial evaluation of the severity of trauma and mortality even in blunt traumatized patients without head injury or with stable vital signs.

The Buffering analysis to identify common geographical factors within the vicinity of severe injury related to motor vehicle crash in Malaysia

BACKGROUND:The main objective was to identify common geographical buildup within the100-meter buffer of severely injured based on injury severity score(ISS) among the motor vehicle crash(MVC) victims in Malaysia.METHODS:This was a prospective cohort study from July 2011 until June 2013 and involved all MVC patients attending emergency departments(ED) of two tertiary centers in a district in Malaysia.A set of digital maps was obtained from the Town Planning Unit of the district Municipal Office(local district map).Vector spaces were spanned over these maps using GIS software(ARCGIS 10.1licensed to the study center),and data from the identified severe injured cases based on ISS of 16 or more were added.Buffer analysis was performed and included all events occurring within a 100-meter perimeter around a reference point.RESULTS:A total of 439 cases were recruited over the ten-month data collection period.Fifty two(11%) of the cases were categorized as severe cased based on ISS scoring of 16 and more.Further buffer analysis looking at the buildup areas within the vicinity of the severely injured locations showed that most of the severe injuries occurred at locations on municipal roads(15,29%),straight roads(16,30%) and within villages buildup(suburban) areas(18,35%).CONCLUSION:This study has successfully achieved its objective in identifying common geographical factors and buildup areas within the vicinity of severely injured road traffic cases.

Assessment of load-sharing thoracolumbar injury: A modified scoring system

BACKGROUND Many classification systems of thoracolumbar spinal fractures have been proposed to enhance treatment protocols,but none have achieved universal adoption.AIM To develop a new patient scoring system for cases with thoracolumbar injury classification and severity score(TLICS)=4,namely the load-sharing thoracolumbar injury score(LSTLIS).METHODS Based on thoracolumbar injury classification and severity score,this study proposes the use of the established load-sharing classification(LSC)to develop an improved classification system(LSTLIS).To prove the reliability and reproducibility of LSTLIS,a retrospective analysis for patients with thoracolumbar vertebral fractures has been conducted.RESULTS A total of 102 cases were enrolled in the study.The scoring trend of LSTLIS is roughly similar as the LSC scoring,however,the average deviation based on the former method is relatively smaller than that of the latter.Thus,the robustness of the LSTLIS scoring method is better than that of LSC.LSTLIS can further classify patients with TLICS=4,so as to assess more accurately this particular circumstance,and the majority of LSTLIS recommendations are consistent with actual clinical decisions.LSTLIS is a scoring system that combines LSC and TLICS to compensate for the lack of appropriate inclusion of anterior and middle column compression fractures with TLICS.Following preliminary clinical verification,LSTLIS has greater feasibility and reliability value,is more practical in comprehensively assessing certain clinical circumstances,and has better accuracy with clinically significant guidelines.

A mouse model of weight-drop closed head injury:emphasis on cognitive and neurological deficiency

Traumatic brain injury（TBI） is a leading cause of death and disability in individuals worldwide.Producing a clinically relevant TBI model in small-sized animals remains fairly challenging.For good screening of potential therapeutics,which are effective in the treatment of TBI,animal models of TBI should be established and standardized.In this study,we established mouse models of closed head injury using the Shohami weight-drop method with some modifications concerning cognitive deficiency assessment and provided a detailed description of the severe TBI animal model.We found that 250 g falling weight from 2 cm height produced severe closed head injury in C57BL/6 male mice.Cognitive disorders in mice with severe closed head injury could be detected using passive avoidance test on day 7 after injury.Findings from this study indicate that weight-drop injury animal models are suitable for further screening of brain neuroprotectants and potentially are similar to those seen in human TBI.

Impact of lockdown policies during the COVID-19 outbreak on a trauma center of a tertiary hospital in China

BACKGROUND Coronavirus disease 2019(COVID-19)is a major and costly public health emergency.AIM To investigate the impact of China’s lockdown policies during the COVID-19 outbreak on the level I trauma center of a tertiary comprehensive hospital of Traditional Chinese Medicine.METHODS All patients admitted to our trauma center during a lockdown in 2020 and the same period in 2019 were enrolled.We collected data on demographics,daily visits,injury type,injury mechanism,injury severity score,and patient management for comparative analysis.RESULTS The total number of patients in the trauma center of our hospital decreased by 50.38%during the COVID-19 Lockdown in 2020 compared to the same period in 2019.The average number of trauma visits per day in 2019 was 47.94,compared to 23.79 in 2020.Comparing the patients’demographic data,loss of employment was the most predominate characteristic in 2020 compared to 2019,while there was no significant difference in gender,age,and marital status between both periods.During the lockdown period,the proportion of traffic accident-related injuries,injuries due to falls greater than 1.5 m,and mechanical injuries decreased significantly,whereas the proportion of injuries caused by falls less than 1.5 m,cuts,assault,bites,and suicidal tendencies and other injuries increased relatively.In addition,the proportion of patients with minor injuries increased and serious injuries decreased during the lockdown.The hospitalization rate increased significantly,and there was no significant difference in emergency surgery and death rates.CONCLUSION The lockdown policies during the COVID-19 outbreak significantly altered the number and mechanism of traumatic events in our hospital,which can be monitored regularly.Our results suggest that mandatory public health prevention and control measures by the government can reduce the incidence of traumatic events and the severity of traumatic injuries.Emergency surgery and mortality rates remain high,increased because of factors such as family injury and penetrating injury,and hospitalization rates have increased significantly.Therefore,our trauma center still needs to be fully staffed.Finally,from the perspective of the injury mechanism,indoor trauma is a major risk during a lockdown,and it is particularly important to develop prevention strategies for such trauma to reduce the medical burden of the next catastrophic epidemic.

Early changes in white blood cell,C-reactive protein and procalcitonin levels in children with severe multiple trauma

BACKGROUND:To analyze early changes in white blood cells(WBCs),C-reactive protein(CRP)and procalcitonin(PCT)in children with multiple trauma,before secondary inflammation develops.METHODS:This single-center retrospective study collected data from patients with blunt traumatic injury admitted to the pediatric intensive care unit(PICU).According to the prognostic outcome of 28 d after admission to the PICU,patients were divided into survival group(n=141)and non-survival group(n=36).Characteristics between the two groups were compared.Receiver operation characteristic(ROC)curve analysis was conducted to evaluate the capacity of different biomarkers as predictors of mortality.RESULTS:The percentages of children with elevated WBC,CRP,and PCT levels were 81.36%,31.07%,and 95.48%,respectively.Patients in the non-survival group presented a statistically significantly higher injury severity score(ISS)than those in the survival group:37.17±16.11 vs.22.23±11.24(t=6.47,P<0.01).WBCs were also higher in non-survival group than in the survival group([18.70±8.42]×109/L vs.[15.89±6.98]×109/L,t=2.065,P=0.040).There was no significant difference between the survival and non-survival groups in PCT or CRP.The areas under the ROC curves of PCT,WBC and ISS for predicting 28-day mortality were 0.548(P=0.376),0.607(P=0.047)and 0.799(P<0.01),respectively.CONCLUSIONS:Secondary to multiple trauma,PCT levels increased in more patients,even if their WBC and CRP levels remained unchanged.However,early rising WBC and ISS were superior to PCT at predicting the mortality of multiple trauma patients in the PICU.

Evaluation of Therapeutic Effect of Maneuver-Dominated Method in 30 Cases of Cervical Spondylotic Myelopathy

Thirty cases of cervical spondylotic myelopathy (CSM) were treated by a maneuver-dominated non-surgical therapy. Eighteen cases were recovered to grade E according to the criteria set by the American Spinal Injury Association. The effect was definite. Indications and contraindications of the maneuver were proposed on the basis of the pathogenesis of CSM and the principles of this manual method.

Association between homicide injury severity and benzodiazepine influence

There are case reports of offenders inflicting excessive injuries on their victims when under the influence of benzodiazepines.However,the potential association between benzodiazepine influence on the offender and victim injury severity in a general homicide population has not been studied.We investigated associations between offender positive testing for benzodiazepines or z-drugs(zolpidem,zopiclone and zaleplon)and victim injury severity.Data were drawn from 95 Swedish homicide cases from 2007–2009 in which offenders had known toxicology.There were no significant differences in injury severity between cases in which the offender tested positive vs.negative for benzodiazepines/z-drugs.Thus,the findings do not support the hypothesis that there is an association between benzodiazepine influence on the offender and victim injury severity in a general homicide population.

Association of low non-invasive near-infrared spectroscopic measurements during initial trauma resuscitation with future development of multiple organ dysfunction

BACKGROUND: Near-infrared spectroscopy(NIRS) non-invasively monitors muscle tissue oxygen saturation(St O2). It may provide a continuous noninvasive measurement to identify occult hypoperfusion, guide resuscitation, and predict the development of multiple organ dysfunction(MOD) after severe trauma. We evaluated the correlation between initial St O2 and the development of MOD in multi-trauma patients.METHODS: Patients presenting to our urban, academic, Level I Trauma Center/Emergency Department and meeting standardized trauma-team activation criteria were enrolled in this prospective trial. NIRS monitoring was initiated immediately on arrival with collection of St O2 at the thenar eminence and continued up to 24 hours for those admitted to the Trauma Intensive Care Unit(TICU). Standardized resuscitation laboratory measures and clinical evaluation tools were collected. The primary outcome was the association between initial St O2 and the development of MOD within the f irst 24 hours based on a MOD score of 6 or greater. Descriptive statistical analyses were performed; numeric means, multivariate regression and rank sum comparisons were utilized. Clinicians were blinded from the StO 2 values.RESULTS: Over a 14 month period, 78 patients were enrolled. Mean age was 40.9 years(SD 18.2), 84.4% were male, 76.9% had a blunt trauma mechanism and mean injury severity score(ISS) was 18.5(SD 12.9). Of the 78 patients, 26(33.3%) developed MOD within the first 24 hours. The MOD patients had mean initial St O2 values of 53.3(SD 10.3), signifi cantly lower than those of nonMOD patients 61.1(SD 10.0); P=0.002. The mean ISS among MOD patients was 29.9(SD 11.5), significantly higher than that of non-MODS patients, 12.1(SD 9.1)(P<0.0001). The mean shock index(SI) among MOD patients was 0.92(SD 0.28), also signifi cantly higher than that of non-MODS patients, 0.73(SD 0.19)(P=0.0007). Lactate values were not signifi cantly different between groups.CONCLUSION: Non-invasive, continuous St O2 near-infrared spectroscopy values during initial trauma resuscitation correlate with the later development of multiple organ dysfunction in this patient population.

Comparative Study on the Trans-Province Transfer of the Multiple Trauma Patients after Sichuan Earthquake

Background: Trans-province transfer of the patients has been successfully carried out and has greatly relieved the burden of the hospitals in Sichuan Province after Sichuan earthquake. The aim of the study was to retrospectively analyze the efficacy and feasibility of the trans-province transfer of the multiple trauma patients after Sichuan earthquake. Methods: A retrospective and descriptive analysis was conducted based on the medical records of the multiple trauma patients (ISS ≥ 16) transferred to the Grade 3A hospitals outside Sichuan province. The patients were divided into two groups based on the distance to Sichuan province, i.e., Group A (the seismic patients transferred to Chongqing) and Group B (the seismic patients transferred to the other provinces/ municipalities). A comparison was done in aspects of distance of transfer, time from injury to transfer, vital signs, the infection rates (at transfer and on discharge), injury severity and prognostic indices (cure rate, disability rate and mortality). Results: The distance between Chengdu and the other places was at a wide range of 313 - 1653 km, whereas the time from injury to transfer showed no statistical difference between groups (P > 0.05). There were no significant differences between both groups with respects to patient demographics, injury mechanism, time from injury to transfer, vital signs, infection rate and injury severity. The prognostic indices showed no significant difference, except for FIM scores (P < 0.05). Conclusions: The results of the study indicate that the different distance of the transfer of the multiple trauma patients does not aggravate the severity or deteriorate the prognosis, which proves that the medical supportive transfer system is acceptable, effective and worthy of further implementation in China, which may be ascribed to the advanced transportation system and high level of therapeutic capacity of the hospitals. In the meantime, attention should be paid to psychological intervention and functional rehabilitation during the treatment of the transferred seismic patients.

Evaluating mechanism and severity of injuries among trauma patients admitted to Sina Hospital,the National Trauma Registry of Iran

Purpose:Injuries are one of the leading causes of death and lead to a high social and financial burden.Injury patterns can vary significantly among different age groups and body regions.This study aimed to evaluate the relationship between mechanism of injury,patient comorbidities and severity of injuries.Methods:The study included trauma patients from July 2016 to June 2018,who were admitted to Sina Hospital,Tehran,Iran.The inclusion criteria were all injured patients who had at least one of the following:hospital length of stay more than 24 h,death in hospital,and transfer from the intensive care unit of another hospital.Data collection was performed using the National Trauma Registry of Iran minimum dataset.Results:The most common injury mechanism was road traffic injuries(49.0%),followed by falls(25.5%).The mean age of those who fell was significantly higher in comparison with other mechanisms(p<0.001).Severe extremity injuries occurred more often in the fall group than in the vehicle collision group(69.0%vs.43.5%,p<0.001).Moreover,cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls(27.8%vs.12.9%,p=0.003).Conclusion:Comparing falls with motor vehicle collisions,patients who fell were older and sustained more extremity injuries.Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls.Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.

Reliability of a patient survey assessing ＂Short Form Injury Questionnaire 7＂ in Iran

Objective： Injury is a major cause of morbidity and mortality in the world. The assessment of patterns and severity of injury in high-risk groups is crucial for planning and service development. On a large scale na- tional household survey, we estimated the annual incidence and the patterns of injury, the demographics of the injured people, as well as the service use for all injuries in Iran. The current study aims at assessing the reliability of the ques- tionnaire before carrying out a national survey. Methods： In a pilot study using cluster random sam- pling approach, 73 people were interviewed. The interview- ers asked the participants to report all injuries occurred in them and the care provided during the previous 12 months, based on ＂Short Form Injury Questionnaire 7＂. About two weeks later, the interview was repeated by another interviewer. Results： In our test-retest reliability, Kappa score was good for three and moderate for four questions. The ques- tion on the injured organ had the highest test-retest reliabil- ity with a Kappa score of 0.84. Conclusions： The reliability of the questionnaire and the procedure of questioning are confirmed. The ques- tionnire is proper for utilization in large national surveies.

Chertsey Outcome Score for Trauma： Development and validation of a new unifying patient reported outcome measure for orthopaedic trauma

Purpose： Lately there is an increasing tendency of using Patient Reported Outcome Measures （PROMs） as a final indicator of the outcome of many surgical treatments in orthopaedics and in other medical specialties. Currently there are many outcome scores in orthopaedics and most of them are site specific. In the contrary there is a lack of trauma specific outcome scores. Methods： We have designed a new PROM especially for orthopaedic trauma patients, in order to measure in what extent the patients manage to return to their pre-injury state. This score uses as baseline the preinjury status of the patient and has the aim to determine the percentage of rehabilitation after treatment for any injury. Results： A total of 60 Chertsey Outcome Score for Trauma （COST） questionnaires were gathered in our outpatients department. The participants were 57% male （aged 46.81 years ± 18.5 years） and the questionnaires collected at mean 10 months post-injury. A Cronbach＇s Alpha value of 0.89 was identified for the whole construct. The three dimensions of the scale had good internal consistency as well （Cronbach＇s Alpha test values 0.74, 0.84 and 0.81 for symptoms, function and mental status respectively）. Strong/moderate correlation （Spearman＇s Rho test 0.43-0.65） was observed between the respective physical/mental dimensions of the COST and SF-12v2 questionnaires. Conclusion： There is a need among the orthopaedic trauma society for a specific PROM of trauma. COST is a useful and easy to use tool for every trauma surgeon.

Application of revised trauma evaluation program in emergency treatment of multiple injuries

Recently, with the rapid development of highway ,and high-rise buildings, trauma shows a tendency to increase continuously. The proportion of trauma patients with multiple injuries has increased and trauma arising from multiple injuries has become ＂the first public hazard＂.

Value of multidetector spiral CT in diagnosis of acute thoracolumbar spinal fracture and fracture-dislocation

Objective: To investigate the diagnostic value of multidetector spiral CT (MSCT) in acute thoracolumbar spinal fracture and fracture-dislocation. Methods: CT imaging files of 152 consecutive traumatic patients with thoracolumbar fractures were retrospectively reviewed. MSCT scannings were performed with a collimation of 3-5 mm and a pitch of (5.5). The postprocessing included sagittal and coronal multiplannar reconstruction, and 3-D reconstruction.Results: There were 88 cases of compression fracture, 54 cases of burst fracture and 10 cases of fracture-dislocation. Transverse images of MSCT could visualize all fractures directly and determine whether spinal canal was intact. Postprocessing image was helpful in depicting the displacement of fragment and orientation of dislocation.Conclusions: MSCT plays an important role in diagnosis and management of acute thoracolumbar spinal fracture and fracture-dislocation.

Analysis on care outcome of patients with polytrauma and coma

Objective ： To make further improvement of outcome of patients with polytrauma and coma. Methods： The data of 3 361 patients （2 378 males and 983 females, aged from 5-95 years, 38. 2 years on average） with severe polytrauma and coma admitted to Chongqing Emergency Medical Center （Level I Trauma Center ）, Chongqing, China, from November 1978 to December 2004 were analyzed retrospectively in this study. Results： The overall survival rate and mortality were 93.2%（3 133/3 361 ）and 6.8%（228/3 361 ）, respectively. The mortalities in patients with coma duration 〈 1 hour and combined with neural dysfunction and in patients with coma duration ≥ 1 hour and combined with or without neural dysfunction were signifieantly higher than that of those with coma duration 〈 1 hour but without neural dysfunction [39.5%（136/344）vs 3.0%（92/3 017）, P 〈0.01]. There existed significant differences in GCS, ISS, and revised trauma score （RTS） between the death group and the survival group （P 〈 0. 01 ）. RTS was in good correspondence with patient＇ s pathophysiological status and outcome in patients with multiple trauma and coma for different groups of systolic blood pressure （SBP）. The mortality in patients with SBP 〈90 nun Hg was significantiy higher than that of those with SBP ≥ 90 mm Hg [ 33. 3 % （68/204） vs5.1%（160/3 157）, P 〈0.01]. The mortality in polytranma patients combined with serious head injury （AIS≥3） was8.2%, among which, 76.5% died from lung complications. The morbidity rate of lung complications and mortality rate increased in patients with head injury complicated with chest or abdomen injury （23.9%, 61.1% vs 27.3 %, 50.0 % ）. The mortality reached up to 61.9 % in patients complicated with severe head, chest and abdomen injuries simultaneously. Conclusions： It plays a key role to establish a fast and effective trauma care system and prompt and definite surgical procedures and to strengthen the management of complications for improving the survival rate of patients with severe palytrauma and coma.

Spontaneous diuresis and negative fluid balance predicting recovery and survival in patients with trauma-hemorragic shock

Most patients with trauma-hemorragic shock, prior to ICU admission, have been resuscitated and stabilized in the emergency room (ER) and/or operation room (OR). Many of them suffer from systemic edema. This extra-vascular fluid is caused by massive infusion of fluid and blood for the maintenance of blood pressure. During the recovery stage, the patients exhibit spontaneous diuresis followed by negative fluid balance. Urine volumes of some patients are more than 10000 ml/d. Do we need to maintain a balance between daily input and output of water at this situation? There are many references in the medical literature and textbooks about fluid resuscitation and the principles in maintaining the balance between input and output of water, but rarely about when and how to restrict it, that is, when and how to permit a negative balance. In this retrospective review, we examined the resuscitation records of 205 patients with systemic edema after trauma-hemorragic shock.