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.

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.

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.

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.

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.

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＂.

Outcome of severely injured trauma patients at a designated trauma centre in the Hong Kong Special Administrative Region

Background The Hong Kong Special Administrative Region （HKSAR） of the People＇s Republic of China （PRC） has seen significant changes in its trauma service over the last ten years including the implementation of a regional trauma system. The author＇s institution is one of the five trauma centres designated in 2003. This article reports our initial clinical experience. Methods A prospective single-centre trauma registry from January 2004 to December 2008 was reviewed. The primary clinical outcome measure was hospital mortality. The Trauma and Injury Severity Score （TRISS） methodology was used for bench-marking with the North America Major Trauma Outcome Study （MTOS） database. Results There were 1451 patients. The majority （83.9%） suffered from blunt injury. The overall mortality rate was 7.8%. Severe injury, defined as the Injury Severity Score 〉15, occurred in 22.5% of patients, and was associated with a mortality rate of 31.6%. A trend of progressive improvement was noted. The M-statistic was 0.99, indicating comparable case-mix with the MTOS. The Z- and W-statistics of each individual year revealed fewer, but not significantly so, number of survivors than expected. Conclusions Trauma centre designation was feasible in the HKSAR and was associated with a gradual improvement in patient care. Trauma system implementation may be considered in regions equipped with the necessary socio-economic and organizational set-up.

Factors influencing the length of emergency room stay and hospital stay in non-fatal bicycle accidents:A retrospective analysis

Purpose:Lengthy hospitalization places a burden on patients and healthcare resources.However,the factors affecting the length of hospital stay(LHoS)and length of emergency room stay(LERS)in non-fatal bicycle accidents are currently unclear.We investigated these factors to inform efforts to minimize hospitalization.Methods:We performed a retrospective analysis of data from non-fatal injured bicyclists admitted to the Emergency and Critical Care Center at Kyoto Medical Center between January 2012 and December 2016.We measured LHoS,LERS,mechanism of injury,head injury prevalence,polytrauma,operations performed,injury severity score(ISS),abbreviated injury scale(AIS)score,maximum AIS score,and trauma and injury severity score probability of survival.We conducted multiple regression analysis to determine predictors of LHoS and LERS.Results:Within the study period,82 victims met the inclusion and exclusion criteria and were included.Mean age was(46.0±24.7)years.Overall mean LHoS was(16.8±25.2)days,mean LERS was(10.6±14.7)days,median ISS was 9(interquartile range(IQR):3-16),median maximum AIS was 3(IQR:1-4),and median trauma and injury severity score probability of survival was 98.0%(IQR:95.5%-99.6%).Age,maximum AIS,ISS,and prevalence of surgery were significantly greater in long LHoS and LERS group compared with short LHoS and LERS group(p<0.05).Performance of surgery independently explained LHoS(p=0.0003)and ISS independently explained LERS(p=0.0009).Conclusion:Surgery was associated with long hospital stays and ISS was associated with long emergency room stays.To improve the quality life of the bicyclists,preventive measures for reducing injury severity or avoiding injuries needing operation are required.

Pattern of injuries due to wild animal attack among patients presenting to the emergency department:A retrospective observational study

Purpose:The human-wildlife conflicts(HWCs)causing nuisances and injuries are becoming a growing public health concern over recent years worldwide.We aimed to study the demographic profile,mode of injury,pattern of injury,and outcome of wild animal attack victims presented to the emergency department.Methods:This retrospective cross-sectional study was conducted in the emergency department of a tertiary-care hospital in Eastern India.Data were retrieved from the medical records from May 2017 to May 2021.Patients of all ages and genders attacked by wild animals and secondary injuries were included in this study.Patients with incomplete data,injuries due to the attack of stray and domestic animals and trauma due to other causes were excluded.Demographic profile,mode of injury,the pattern of injury,injury severity score(ISS),radiological pattern,and outcome were recorded.Statistical analysis with R(version 3.6.1.)was conducted.Results:A total of 411 wild animal attack victims were studied,of which 374(90.9%)were snakebite injuries and 37(9.1%)were wild mammalian(WM)attack injuries.The mean age of WM attack victims was 46 years,and the male-to-female ratio was 4:1.Elephant attack injury(40.5%)was the most common WM attack injury reported.Most WM attacks(43.2%)occurred between 4:00 a.m.to 8:00 a.m.The median ISS was 18.5(13-28),where 54.2%of patients had polytrauma(ISS>15).Elephant attack was associated with a higher ISS,but the difference was not significant compared to other animal types(p=0.2).Blunt trauma was common pattern of injury in the elephant attack injury cases.Lacerations and soft tissue injuries were common patterns in other animal attacks.Among snakebites,neurotoxic was the most common type(55.4%),and lower extremity was the most common site involved.Conclusion:The young male population is the major victim of HWCs;and elephant is the most common animal involved.There is a need to design scientifically sound preventive strategies for HWCs and to strengthen the preparedness in health establishments to manage victims effectively.

Impact of hospital type on risk-adjusted,traffic-related 30-day mortality:a population-based registry study

Background:Traffic incidents are still a major contributor to hospital admissions and trauma-related mortality.The aim of this nationwide study was to examine risk-adjusted traffic injury mortality to determine whether hospital type was an independent survival factor.Methods:Data on all patients admitted to Swedish hospitals with traffic-related injuries,based on International Classification of Diseases codes,between 2001 and 2011 were extracted from the Swedish inpatient and cause of death registries.Using the binary outcome measure of death or survival,data were analysed using logistic regression,adjusting for age,sex,comorbidity,severity of injury and hospital type.The severity of injury was established using the International Classification of Diseases Injury Severity Score(ICISS).Results:The final study population consisted of 152,693 hospital admissions.Young individuals(0–25 years of age)were overrepresented,accounting for 41%of traffic-related injuries.Men were overrepresented in all age categories.Fatalities at university hospitals had the lowest mean(SD)ICISS 0.68(0.19).Regional and county hospitals had mean ICISS 0.75(0.15)and 0.77(0.15),respectively,for fatal traffic incidents.The crude overall mortality in the study population was 1193,with a mean ICISS 0.72(0.17).Fatalities at university hospitals had the lowest mean ICISS 0.68(0.19).Regional and county hospitals had mean ICISS 0.75(0.15)and 0.77(0.15),respectively,for fatal traffic incidents.When regional and county hospitals were merged into one group and its risk-adjusted mortality compared with university hospitals,no significant difference was found.A comparison between hospital groups with the most severely injured patients(ICISS0.85)also did not show a significant difference(odds ratio,1.13;95%confidence interval,0.97–1.32).Conclusions:This study shows that,in Sweden,the type of hospital does not influence risk adjusted traffic related mortality,where the most severely injured patients are transported to the university hospitals and centralization of treatment is common.