The reliability of the ICD-AIS map in identifying serious road traffic injuries from the Helsinki Trauma Registry

Objective: The EU has recommended that its member countries compile statistics on the number of serious road traffic injuries. In Finland, the number of seriously injured road traffic patients is assessed using the International Classification of Diseases, 10th Revision (ICD-10) and the automatic conversion tool (ICD-AIS map) developed by The Association for the Advancement of Automotive Medicine (AAAM). The aim of this study was to assess how reliably the ICD-AIS map identifies both serious injuries and seriously injured patients due to road traffic accidents. Methods: Data was derived from the Helsinki Trauma Registry (HTR) and included 215 severe (New Injury Severity Score >15) trauma patients injured in road traffic accidents from the years 2016 and 2017. The severity ratings of injuries (Abbreviated Injury Scale, AIS 3+) and patients (Maximum Abbreviated Injury Scale, MAIS 3+) were determined by direct AIS coding of the HTR and were also generated by the ICD-AIS map based on ICD-10 injury codes. These two ratings were compared by injury mechanism and Injury Severity Score (155) body regions. The strength of agreement was described using Cohen's kappa. The most common injury codes with errors in severity rating by the ICD-AIS map were presented. Results: The number of seriously injured patients by the ICD-AIS map was 21% lower, and the number of serious injuries was 36% lower than the corresponding numbers by direct coding. The exact agreement of the injury ratings was 72% (kappa = 0.44, 95% CI 0.42-0.46). Most of the conversion errors were due to the simplicity of the ICD-10 codes used in Finland compared to those used in the ICD-AIS map (ICD-10-CM) and the missing codes from the ICD-AIS map. The most frequent misclassifications were due to multiple rib fractures, visceral organ injuries, some open fractures of extremities, and specific head injuries. Missing codes were most common in face, chest, and limb injuries. Conclusions: The ICD-10 injury codes presently used in Finland should be more specific to permit reliable conversion results by the ICD-AIS map. The problem with missing codes should be considered more closely. When implementing the ICD-11, all detailed injury codes should be introduced. (C) 2019 Elsevier Ltd. All rights reserved.Peer reviewe

Direct measurement of homovanillic, vanillylmandelic and 5-hydroxyindoleacetic acids in urine by capillary electrophoresis

Abstract Separation conditions in CE, with a neutral coated capillary and reversed polarity, have been optimised to make direct measurement of vanillylmandelic acid, homovanillic acid and 5-hydroxyindoleacetic acid possible in urine samples without pre-treatment. The method developed has been validated, presenting adequate parameters for linearity, accuracy and precision. Detection limits range from 0.03 to 2.5 mM. Finally the method has been applied to urine samples taken from patients, both adults and children, in hospital. Some of them were also measured by immunoassay and HPLCelectrochemical detection and results have been compared

Incidence of fractures requiring inpatient care

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Cemented or uncemented hemiarthroplasty for the treatment of femoral neck fractures?

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Increased mortality after upper extremity fracture requiring inpatient care

Background and purpose - Increased mortality after hip fracture is well documented. The mortality after hospitalization for upper extremity fracture is unknown, even though these are common injuries. Here we determined mortality after hospitalization for upper extremity fracture in patients aged >= 16 years. Patients and methods - We collected data about the diagnosis code (ICD10), procedure code (NOMESCO), and 7 additional characteristics of 5,985 patients admitted to the trauma ward of Central Finland Hospital between 2002 and 2008. During the study, 929 women and 753 men sustained an upper extremity fracture. The patients were followed up until the end of 2012. Mortality rates were calculated using data on the population at risk. Results - By the end of follow-up (mean duration 6 years), 179 women (19%) and 105 men (14%) had died. The standardized mortality ratio (SMR) for all patients was 1.5 (95% CI: 1.4-1.7). The SMR was higher for men (2.1, CI: 1.7-2.5) than for women (1.3, CI: 1.1-1.5) (p <0.001). The SMR decreased with advancing age, and the mortality rate was highest for men with humerus fractures. Interpretation - In men, the risk of death related to proximal humerus fracture was even higher than that reported previously for hip fracture. Compared to the general population, the SMR was double for humerus fracture patients, whereas wrist fracture had no effect on mortality.Peer reviewe

Increased mortality after lower extremity fractures in patients <65 years of age

Background and purpose The association between mortality and lower extremity fractures (other than hip fractures in older individuals) is unclear. We therefore investigated mortality in adults of all ages after lower extremity fractures that required inpatient care.Patients and methods Diagnosis code (ICD10), procedure code (NOMESCO), and 7 additional characteristics of patients admitted to the trauma ward at Central Finland Hospital were collected between 2002 and 2008 (n = 3,567). Patients were followed up until the end of 2012. Mortality rates were calculated for patients with all types of lower extremity fractures using data from the population at risk.Results During the study, 2,081 women and 1,486 men sustained a lower extremity fracture. By the end of follow-up (mean duration 5 years), 42% of the women and 32% of the men had died. For all lower extremity fractures, the standardized mortality ratio (SMR) was 1.9 (95% CI: 1.8-2.0) for women and 2.6 (CI: 2.4-2.9) for men. In patients aged 65 years, mortality was increased and of similar magnitude after fractures of the hip, femoral diaphysis, and knee (distal femur, patella, and proximal tibia). In patients agedPeer reviewe

Electrophysiological correlates of cross-linguistic semantic integration in hearing signers:. N400 and LPC

We explored semantic integration mechanisms in native and non-native hearing users of sign language and non-signing controls. Event-related brain potentials (ERPs) were recorded while participants performed a semantic decision task for priming lexeme pairs. Pairs were presented either within speech or across speech and sign language. Target-related ERP responses were subjected to principal component analyses (PCA), and neurocognitive basis of semantic integration processes were assessed by analyzing the N400 and the late positive complex (LPC) components in response to spoken (auditory) and signed (visual) antonymic and unrelated targets. Semantically-related effects triggered across modalities would indicate a similar tight interconnection between the signers&#39; two languages like that described for spoken language bilinguals. Remarkable structural similarity of the N400 and LPC components with varying group differences between the spoken and signed targets were found. The LPC was the dominant response. The controls&#39; LPC differed from the LPC of the two signing groups. It was reduced to the auditory unrelated targets and was less frontal for all the visual targets. The visual LPC was more broadly distributed in native than non-native signers and was left-lateralized for the unrelated targets in the native hearing signers only. Semantic priming effects were found for the auditory N400 in all groups, but only native hearing signers revealed a clear N400 effect to the visual targets. Surprisingly, the non-native signers revealed no semantically-related processing effect to the visual targets reflected in the N400 or the LPC; instead they appeared to rely more on visual post-lexical analyzing stages than native signers. We conclude that native and non-native signers employed different processing strategies to integrate signed and spoken semantic content. It appeared that the signers&#39; semantic processing system was affected by group-specific factors like language background and/or usage.</p