Trauma Early Mortality Prediction Tool (TEMPT) for assessing 28-day mortality.

Background:Prior mortality prediction models have incorporated severity of anatomic injury quantified by Abbreviated Injury Severity Score (AIS). Using a prospective cohort, a new score independent of AIS was developed using clinical and laboratory markers present on emergency department presentation to predict 28-day mortality. Methods:All patients (n=1427) enrolled in an ongoing prospective cohort study were included. Demographic, laboratory, and clinical data were recorded on admission. True random number generator technique divided the cohort into derivation (n=707) and validation groups (n=720). Using Youden indices, threshold values were selected for each potential predictor in the derivation cohort. Logistic regression was used to identify independent predictors. Significant variables were equally weighted to create a new mortality prediction score, the Trauma Early Mortality Prediction Tool (TEMPT) score. Area under the curve (AUC) was tested in the validation group. Pairwise comparison of Trauma Injury Severity Score (TRISS), Revised Trauma Score, Glasgow Coma Scale, and Injury Severity Score were tested against the TEMPT score. Results:There was no difference between baseline characteristics between derivation and validation groups. In multiple logistic regression, a model with presence of traumatic brain injury, increased age, elevated systolic blood pressure, decreased base excess, prolonged partial thromboplastin time, increased international normalized ratio (INR), and decreased temperature accurately predicted mortality at 28 days (AUC 0.93, 95% CI 0.90 to 0.96, P<0.001). In the validation cohort, this score, termed TEMPT, predicted 28-day mortality with an AUC 0.94 (95% CI 0.92 to 0.97). The TEMPT score preformed similarly to the revised TRISS score for severely injured patients and was highly predictive in those having mild to moderate injury. Discussion:TEMPT is a simple AIS-independent mortality prediction tool applicable very early following injury. TEMPT provides an AIS-independent score that could be used for early identification of those at risk of doing poorly following even minor injury. Level of evidence:Level II

Gambaran Skor Trauma Pada Pasien Di Ugd RSUD Dr Soedarso Pontianak Menggunakan Revised Trauma Score (Rts) Periode Tahun 2012

Latar Belakang: Trauma merupakan masalah kesehatan yang besar di negara berkembang yang jumlahnya meningkat sebanding denganperkembangan industri dan transportasi. Beberapa sistem skors telahdiajukan, salah satu sistem skor yang dapat digunakan adalah RevisedTrauma Score (RTS). Tujuan: Penelitian ini bertujuan untuk mengetahuigambaran skor trauma pada pasien di UGD RSUD dr. SoedarsoPontianak menggunakan Revised Trauma Score (RTS). Metodologi:Penelitian ini merupakan penelitian deskriptif dengan pendekatanretrospektif. Pengumpulan data yang diambil dari rekam medis pasienUGD RSUD dr. Soedarso Pontianak. Data yang diambil berupa nilaiGlasgow coma scale, tekanan darah sistolik, dan frekuensi napas dari 120pasien trauma. Hasil: Dari penelitian diketahui 85 orang (70,8%) berjeniskelamin laki-laki, kelompok usia terbanyak adalah kelompok usia 15-23tahun (40,83%), dan 101 orang (84,2%) dengan nilai RTS 12.Kesimpulan: Pasien trauma di UGD RSUD dr Soedarso kebanyakanberjenis kelamin laki-laki, pada usia produktif, memiliki nilai RTS yangtinggi dan prognosis yang baik

Trauma Exposure Among Women in the Pacific Rim

Purpose Healthcare professionals who provide services in the immediate or long‐term aftermath of traumatic events need to understand the nature and frequency of traumatic events in the lives of women. However, research on trauma exposure in women has only recently begun to assess events other than intimate partner and sexual violence and has not supported direct statistical comparison of cross‐national and cross‐cultural data. The purpose of this descriptive, correlational study was to describe and compare trauma exposure prevalence and type in community‐based samples of women in the United States, Colombia, and Hong Kong. Design Women were recruited through posted notices at community health sites, snowball sampling, and online advertisements (N = 576). The Life Stressor Checklist‐Revised (total score range 0 to 30) was used to determine the type and prevalence of trauma exposure. Data were collected by native language members of the research team. Methods Descriptive statistics were used to summarize demographic characteristics and trauma exposure for the total sample and each community‐based sample (location). Between‐location differences were tested using Fisher\u27s exact tests for categorical measures and general linear models with pairwise a posteriori least squares t‐test for continuous measures. Responses to open‐ended questions were translated and categorized. Findings Over 99% of women in the total sample reported at least one traumatic life event. The mean number of traumatic life events per participant was 7, ranging from 0 to 24. Although there was consistency in the most commonly reported trauma exposures across locations, the rates of specific events often differed. Conclusions Historical, political, geographic, and cultural factors may explain differences in trauma exposure among women in the four locations studied. Clinical Relevance This study offers relevant knowledge for providers in diverse locations who provide services to women who have experienced traumatic events and provides evidence for the need for future research to further enhance knowledge of trauma exposure among women, and on the effects of trauma in women\u27s lives

Trauma team activation varies across Dutch emergency departments: a national survey

Background Tiered trauma team response may contribute to efficient in-hospital trauma triage by reducing the amount of resources required and by improving health outcomes. This study evaluates current practice of trauma team activation (TTA) in Dutch emergency departments (EDs). Methods A survey was conducted among managers of all 102 EDs in the Netherlands, using a semi-structured online questionnaire. Results Seventy-two questionnaires were analysed. Most EDs use a one-team system (68 %). EDs with a tiered-response receive more multi trauma patients (p < 0.01) and have more trauma team alerts per year (p < 0.05) than one-team EDs. The number of trauma team members varies from three to 16 professionals. The ED nurse usually receives the pre-notification (97 %), whereas the decision to activate a team is made by an ED nurse (46 %), ED physician (30 %), by multiple professionals (20 %) or other (4 %). Information in the pre-notification mostly used for trauma team activation are Airway-Breathing-Circulation (87 %), Glasgow Coma Score (90 %), and Revised Trauma Score (85 %) or Paediatric Trauma Score (86 %). However, this information is only available for 75 % of the patients or less. Only 56 % of the respondents were satisfied with their current in-hospital trauma triage system. Conclusions Trauma team activation varies across Dutch EDs and there is room for improvement in the trauma triage system used, size of the teams and the professionals involved. More direct communication and more uniform criteria could be used to efficiently and safely activate a specific trauma team. Therefore, the implementation of a revised national consensus guideline is recommende

Calculation of the Probability of Survival for Trauma Patients Based on Trauma Score and the Injury Severity Score Model in Fatemi Hospital in Ardabil

Background: Trauma, in addition to economic and social costs, is the fourth cause of death in the world and in the year 2000 alone, it led to the death of more than 6000000 people. In Iran, Trauma has the first burden of disease and also needs a long medical surveillance. Objectives: The aim of this study was to evaluate the outcome of trauma cases using the trauma score and the injury severity score (TRISS) model and then comparing this with the results of a major trauma outcome study (MTOS) carried out in the US. Patients and Methods: This study is a retrospective, descriptive and analytical study on 1000 patients aged 2 - 82 years old with closed or penetrating traumas staying at Ardebil Fatemi hospital. In this study, injury severity score (ISS), revised trauma score (RTS), and TRISS were calculated and patients\' viability ratios were obtained. Results: The results showed that 714 patients (71.4%) were male and 286 patients (28.6%) female with the mean age of 35.68 years. In this study 45 (4.5%) and 955 patients (95.5%) had penetrating and blunt traumas, respectively, whereby the head and neck were the most prevalent (74%) areas of injury. The most common reason for these traumas was, accident with vehicles with 670 cases (67%), which resulted in hospitalization. From this group, ninety-seven cases (9.7%) died in the hospital. From these results, calculations of ISS and RTS were 15.50 ± 11.31 and 7.49 ± 0.79, respectively. According to the calculation of the TRISS model, 91.5% of trauma victims should be survived, while only 90.3% survived practically. Conclusions: We can conclude that the surveillance presented to our injured group probably had some defects that need to be revised in therapeutic services to enhance survival requirements

Classificação do atendimento pré-hospitalar pediátrico como instrumento para otimizar a alocação de recursos no atendimento do trauma na cidade de São Paulo, Brasil

PURPOSE: To evaluate the pediatric prehospital care in São Paulo, the databases from basic life support units (BLSU) and ALSU, and to propose a simple and effective method for evaluating trauma severity in children at the prehospital phase. METHODS: A single firemen headquarter coordinates all prehospital trauma care in São Paulo city. Two databases were analyzed for children from 0 to 18 years old between 1998 and 2001: one from the Basic Life Support Units (BLSU - firemen) and one from the Advanced Life Support Units (ALSU - doctor and firemen). During this period, advanced life support units provided medical reports from 604 victims, while firemen provided 12.761 reports (BLSU+ALSU). Pre-Hospital Pediatric Trauma Classification is based on physiological status, trauma mechanism and anatomic injuries suggesting high energy transfer. In order to evaluate the proposed classification, it was compared to the Glasgow Coma Score and to the Revised Trauma Score. RESULTS: There was a male predominance in both databases and the most common trauma mechanism was transport related, followed by falls. Mortality was 1.6% in basic life support units and 9.6% in ALSU. There was association among the proposed score, the Glasgow Coma Score and to the Revised Trauma Score (p<0.0001). CONCLUSION: Pre-Hospital Pediatric Trauma Classification is a simple and reliable method for assessment, triage and recruitment of pediatric trauma resources.OBJETIVO: Avaliar o atendimento pré-hospitalar de crianças e adolescentes em São Paulo, avaliar o banco de dados das Unidades de Suporte Básico (UR) e Avançado (USA) e propor um método simples e eficaz para a avaliação da gravidade do trauma pediátrico na fase pré-hospitalar. MÉTODOS: Uma única central do Corpo de Bombeiros (COBOM) coordena todo o atendimento pré-hospitalar em São Paulo. Dois bancos de dados foram analisados para crianças de 0 a 18 anos de idade, entre 1998 e 2001: um das Unidades de Suporte Básico de Vida (UR- bombeiros) e outra de Unidades de Suporte Avançado (USA - médico e bombeiros). Neste período, o Serviço de Atendimento Médico de Urgência do Estado de São Paulo (SAMU) forneceu relatórios médicos de 604 vítimas, enquanto os bombeiros forneceram relatórios de 12.761 vitimas (UR+USA). A classificação do trauma pré-hospitalar pediátrico é baseada na condição fisiológica, mecanismo de trauma e lesões anatômicas das vítimas. A classificação do trauma pré-hospitalar pediátrico foi comparada à Escala de Coma de Glasgow (GCS) e ao Escore de Trauma Revisado (RTS). RESULTADOS: Houve predominância do sexo masculino em ambos bancos de dados. O mecanismo de trauma mais freqüente foi relacionado a transporte, seguido de quedas. A mortalidade foi 1,6% nas Unidades Básicas e 9,6% no Suporte Avançado. Houve associação entre a classificação do trauma pré-hospitalar pediátrico, Escala de Coma de Glasgow (GCS) e ao Escore de Trauma Revisado (RTS) GCS e RTS (p<0,0001). CONCLUSÃO: A classificação do trauma pré-hospitalar pediátrico é um método simples e confiável para a avaliação, triagem e recrutamento de recursos para o atendimento pré-hospitalar do trauma pediátrico.Universidade Federal de São Paulo (UNIFESP) Department of SurgeryUNIFESP, Department of SurgerySciEL

Selective Use of Pericardial Window and Drainage as Sole Treatment for Hemopericardium from Penetrating Chest Trauma

Background Penetrating cardiac injuries (PCIs) are highly lethal, and a sternotomy is considered mandatory for suspected PCI. Recent literature suggests pericardial window (PCW) may be sufficient for superficial cardiac injuries to drain hemopericardium and assess for continued bleeding and instability. This study objective is to review patients with PCI managed with sternotomy and PCW and compare outcomes. Methods All patients with penetrating chest trauma from 2000 to 2016 requiring PCW or sternotomy were reviewed. Data were collected for patients who had PCW for hemopericardium managed with only pericardial drain, or underwent sternotomy for cardiac injuries grade 1–3 according to the American Association for the Surgery of Trauma (AAST) Cardiac Organ Injury Scale (OIS). The PCW+drain group was compared with the Sternotomy group using Fisher’s exact and Wilcoxon rank-sum test with P\u3c0.05 considered statistically significant. Results Sternotomy was performed in 57 patients for suspected PCI, including 7 with AAST OIS grade 1–3 injuries (Sternotomy group). Four patients had pericardial injuries, three had partial thickness cardiac injuries, two of which were suture-repaired. Average blood drained was 285mL (100–500 mL). PCW was performed in 37 patients, and 21 had hemopericardium; 16 patients proceeded to sternotomy and 5 were treated with pericardial drainage (PCW+drain group). All PCW+drain patients had suction evacuation of hemopericardium, pericardial lavage, and verified bleeding cessation, followed by pericardial drain placement and admission to intensive care unit (ICU). Average blood drained was 240mL (40–600 mL), and pericardial drains were removed on postoperative day 3.6 (2–5). There was no significant difference in demographics, injury mechanism, Revised Trauma Score exploratory laparotomies, hospital or ICU length of stay, or ventilator days. No in-hospital mortality occurred in either group. Conclusions Hemodynamically stable patients with penetrating chest trauma and hemopericardium may be safely managed with PCW, lavage and drainage with documented cessation of bleeding, and postoperative ICU monitoring. Level of evidence Therapeutic study, level IV

Is whole-body trauma MDCT justified in patients in good clinical condition but with dangerous trauma mechanism?

Background: To assess whether whole body MDCT is justified in patients in good clinical condition yet with dangerous trauma mechanism. Material/Methods: The study included 81 patients who were examined between January and July 2008 with wholebody trauma CT protocol. Inclusion into the study was based on a dangerous trauma mechanism and the possibility of an unbiased calculation of the weighted revised trauma score (RTSw). All examinations were performed with 16 row MDCT scanner located in emergency department. The cut off of the RTSw over 6.0 was used to separate the patients in good clinical condition. The CT examinations and medical records of patients were reviewed to assess the number of significant injuries, the need for emergency surgery and other types of medical treatment, the number of negative CT examinations, the number of patients admitted to hospital, and mortality. Results: 28 life-threatening injuries were found in 21 of 61 patients with RTS over 6.0 (34.4%). Only two of those patients required emergency surgery (laparotomy). CT studies were negative for traumatic injuries in 22 patients from this group (36.0%). Conclusions: Whole-body MDCT may detect injuries in patients in good clinical condition, with some of them demanding medical treatment. Still, further studies are required to balance the advantages of MDCT and potentially harmful effects of radiation dose, especially better triage systems and lowdose protocols are needed

Application of neural networks and sensitivity analysis to improved prediction of trauma survival

Application of neural networks and sensitivity analysis to improved prediction of trauma surviva