Medicine › Emergency Medicine

Trauma and Emergency Care Studies

Works Count: 71236

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Description

This cluster of papers focuses on the impact of trauma care systems, including trauma centers, prehospital care, and emergency surgery, on mortality and health outcomes. It also explores topics such as injury severity, geriatric trauma, transportation of critically ill patients, and triage criteria for trauma patients. The research aims to improve the quality of trauma care and reduce mortality rates.

Keywords

Trauma Center; Injury Severity; Prehospital Care; Mortality; Emergency Surgery; Geriatric Trauma; Health Outcomes; Transportation; Triage Criteria; Quality Improvement

Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score.

1987-04-01

Carl Boyd , M Tolson , Wayne S. Copes

Evaluation of trauma care must be an integral part of any system designed for care of seriously injured patients. However, outcome review should offer comparability to national standards or norms. … Evaluation of trauma care must be an integral part of any system designed for care of seriously injured patients. However, outcome review should offer comparability to national standards or norms. The TRISS method offers a standard approach for evaluating outcome of trauma care. Anatomic, physiologic, and age characteristics are used to quantify probability of survival as related to severity of injury. TRISS offers a means of case identification for quality assurance review on a local basis, as well as a means of comparison of outcome for different populations of trauma patients. Methods for calculating statistics associated with TRISS are presented. The Z and M statistics are explained with the nonstatistician in mind. We feel this article is a source for those interested in developing or upgrading trauma care evaluation.

Emergency Medicine: A Comprehensive Study Guide

1992-10-15

Judith E. Tintinalli , Ronald L. Krome , Ernest Ruiz

A study guide for clinical emergency medicine management and for those preparing for board or recertification examinations. This edition contains 308 chapters. New two-colour figures have been added, along with … A study guide for clinical emergency medicine management and for those preparing for board or recertification examinations. This edition contains 308 chapters. New two-colour figures have been added, along with additional tables and algorithms. A new compact atlas features emergency medicine pictures in colour, and many sections have been completely revised, including Toxicology and Pediatrics, and there are new sections on Nontraumatic Musculo-Skeletal Disorders and Special Patients.

The Prospective, Observational, Multicenter, Major Trauma Transfusion (PROMMTT) Study

2012-10-15

John B. Holcomb , Deborah J. del Junco , Erin E. Fox +7 more

To relate in-hospital mortality to early transfusion of plasma and/or platelets and to time-varying plasma:red blood cell (RBC) and platelet:RBC ratios.Prospective cohort study documenting the timing of transfusions during active … To relate in-hospital mortality to early transfusion of plasma and/or platelets and to time-varying plasma:red blood cell (RBC) and platelet:RBC ratios.Prospective cohort study documenting the timing of transfusions during active resuscitation and patient outcomes. Data were analyzed using time-dependent proportional hazards models.Ten US level I trauma centers.Adult trauma patients surviving for 30 minutes after admission who received a transfusion of at least 1 unit of RBCs within 6 hours of admission (n = 1245, the original study group) and at least 3 total units (of RBCs, plasma, or platelets) within 24 hours (n = 905, the analysis group).In-hospital mortality.Plasma:RBC and platelet:RBC ratios were not constant during the first 24 hours (P < .001 for both). In a multivariable time-dependent Cox model, increased ratios of plasma:RBCs (adjusted hazard ratio = 0.31; 95% CI, 0.16-0.58) and platelets:RBCs (adjusted hazard ratio = 0.55; 95% CI, 0.31-0.98) were independently associated with decreased 6-hour mortality, when hemorrhagic death predominated. In the first 6 hours, patients with ratios less than 1:2 were 3 to 4 times more likely to die than patients with ratios of 1:1 or higher. After 24 hours, plasma and platelet ratios were unassociated with mortality, when competing risks from nonhemorrhagic causes prevailed.Higher plasma and platelet ratios early in resuscitation were associated with decreased mortality in patients who received transfusions of at least 3 units of blood products during the first 24 hours after admission. Among survivors at 24 hours, the subsequent risk of death by day 30 was not associated with plasma or platelet ratios.

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Improving the Outcomes of Coronary Artery Bypass Surgery in New York State

1994-03-09

Edward L. Hannan

To assess changes in outcomes of coronary artery bypass graft (CABG) surgery in New York since 1989, when the State Department of Health began collecting, analyzing, and disseminating information regarding … To assess changes in outcomes of coronary artery bypass graft (CABG) surgery in New York since 1989, when the State Department of Health began collecting, analyzing, and disseminating information regarding risk factors, mortality, and complications of CABG surgery. These new data stimulated specific quality improvement activities at hospitals throughout the state.A clinical database was used to identify significant independent risk factors and to assess risk-adjusted provider mortality rates.All 30 hospitals performing CABG surgery in New York during the period 1989 through 1992.All 57,187 patients undergoing isolated CABG surgery who were discharged from New York State hospitals in 1989 through 1992.Actual, expected (from a logistic regression model), and risk-adjusted in-hospital mortality.Actual mortality decreased from 3.52% in 1989 to 2.78% in 1992. Because average patient severity of illness increased, risk-adjusted mortality decreased even more--a decrease of 41% from 4.17% in 1989 to 2.45% in 1992. The risk-adjustment model performed well; there were no clinically or statistically significant differences between actual and predicted numbers of deaths at any of 10 levels of patient severity.We believe that this quality improvement program, based on the collection and dissemination of risk-adjusted mortality data for CABG surgery, played a significant role in the observed decline in the death rate from this procedure. Quality improvement programs based on similar principles for other procedures and conditions should be undertaken.

Structured Interviews for the Glasgow Outcome Scale and the Extended Glasgow Outcome Scale: Guidelines for Their Use

1998-08-01

Lindsay Wilson , Laura E. L. Pettigrew , Graham M. Teasdale

The Glasgow Outcome Scale (GOS) is the most widely used outcome measure after traumatic brain injury, but it is increasingly recognized to have important limitations. It is proposed that shortcomings … The Glasgow Outcome Scale (GOS) is the most widely used outcome measure after traumatic brain injury, but it is increasingly recognized to have important limitations. It is proposed that shortcomings of the GOS can be addressed by adopting a standard format for the interview used to assign outcome. A set of guidelines are outlined that are directed at the main problems encountered in applying the GOS. The guidelines cover the general principles underlying the use of the GOS and common practical problems of applying the scale. Structured interview schedules are described for both the five-point GOS and an extended eight-point GOS (GOSE). An interrater reliability study of the structured interviews for the GOS and GOSE yielded weighted kappa values of 0.89 and 0.85, respectively. It is concluded that assessment of the GOS using a standard format with a written protocol is practical and reliable.

Combat Wounds in Operation Iraqi Freedom and Operation Enduring Freedom

2008-02-01

Brett D. Owens , John F Kragh , Joseph C. Wenke +3 more

Background: There have been no large cohort reports detailing the wounding patterns and mechanisms in the current conflicts in Iraq and Afghanistan. Methods: The Joint Theater Trauma Registry was queried … Background: There have been no large cohort reports detailing the wounding patterns and mechanisms in the current conflicts in Iraq and Afghanistan. Methods: The Joint Theater Trauma Registry was queried for all US service members receiving treatment for wounds (International Classification of Diseases-9th Rev. codes 800–960) sustained in Operation Iraqi Freedom and Operation Enduring Freedom from October 2001 through January 2005. Returned-to-duty and nonbattle injuries were excluded from final analysis. Results: This query resulted in 3,102 casualties, of which 31% were classified as nonbattle injuries and 18% were returned-to-duty within 72 hours. A total of 1,566 combatants sustained 6,609 combat wounds. The locations of these wounds were as follows: head (8%), eyes (6%), ears (3%), face (10%), neck (3%), thorax (6%), abdomen (11%), and extremity (54%). The proportion of head and neck wounds is higher (p < 0.0001) than the proportion experienced in World War II, Korea, and Vietnam wars (16%–21%). The proportion of thoracic wounds is a decrease (p < 0.0001) from World War II and Vietnam (13%). The proportion of gunshot wounds was 18%, whereas the proportion sustained from explosions was 78%. Conclusions: The wounding patterns currently seen in Iraq and Afghanistan resemble the patterns from previous conflicts, with some notable exceptions: a greater proportion of head and neck wounds, and a lower proportion of thoracic wounds. An explosive mechanism accounted for 78% of injuries, which is the highest proportion seen in any large-scale conflict.

Alcohol Interventions in a Trauma Center as a Means of Reducing the Risk of Injury Recurrence

1999-10-01

Larry M. Gentilello , Frederick P. Rivara , Dennis M. Donovan +6 more

Objective Alcoholism is the leading risk factor for injury. The authors hypothesized that providing brief alcohol interventions as a routine component of trauma care would significantly reduce alcohol consumption and … Objective Alcoholism is the leading risk factor for injury. The authors hypothesized that providing brief alcohol interventions as a routine component of trauma care would significantly reduce alcohol consumption and would decrease the rate of trauma recidivism. Methods This study was a randomized, prospective controlled trial in a level 1 trauma center. Patients were screened using a blood alcohol concentration, gamma glutamyl transpeptidase level, and short Michigan Alcoholism Screening Test (SMAST). Those with positive results were randomized to a brief intervention or control group. Reinjury was detected by a computerized search of emergency department and statewide hospital discharge records, and 6- and 12-month interviews were conducted to assess alcohol use. Results A total of 2524 patients were screened; 1153 screened positive (46%). Three hundred sixty-six were randomized to the intervention group, and 396 to controls. At 12 months, the intervention group decreased alcohol consumption by 21.8 ± 3.7 drinks per week; in the control group, the decrease was 6.7 ± 5.8 (p = 0.03). The reduction was most apparent in patients with mild to moderate alcohol problems (SMAST score 3 to 8); they had 21.6 ± 4.2 fewer drinks per week, compared to an increase of 2.3 ± 8.3 drinks per week in controls (p < 0.01). There was a 47% reduction in injuries requiring either emergency department or trauma center admission (hazard ratio 0.53, 95% confidence interval 0.26 to 1.07, p = 0.07) and a 48% reduction in injuries requiring hospital admission (3 years follow-up). Conclusion Alcohol interventions are associated with a reduction in alcohol intake and a reduced risk of trauma recidivism. Given the prevalence of alcohol problems in trauma centers, screening, intervention, and counseling for alcohol problems should be routine.

Epidemiology of Trauma Deaths

1995-02-01

Angela Sauaia , Frederick A. Moore , Ernest E. Moore +4 more

Objective Recognizing the impact of the 1977 San Francisco study of trauma deaths in trauma care, our purpose was to reassess those findings in a contemporary trauma system. Design Cross-sectional. … Objective Recognizing the impact of the 1977 San Francisco study of trauma deaths in trauma care, our purpose was to reassess those findings in a contemporary trauma system. Design Cross-sectional. Material and Methods All trauma deaths occurring in Denver City and County during 1992 were reviewed; data were obtained by cross-referencing four databases: paramedic trip reports, trauma registries, coroner autopsy reports and police reports. Measurements and Main Results There were 289 postinjury fatalities; mean age was 36.8 +/- 1.2 years and mean Injury Severity Score (ISS) was 35.7 +/- 1.2. Predominant injury mechanisms were gunshot wounds in 121 (42%), motorvehicle accidents in 75 (38%) and falls in 23 (8%) cases. Seven (2%) individuals sustained lethal burns. Ninety eight (34%) deaths occurred in the pre-hospital setting. The remaining 191 (66%) patients were transported to the hospital. Of these, 154 (81%) died in the first 48 hours (acute), 11 (6%) within three to seven days (early) and 26 (14%) after seven days (late). Central nervous system injuries were the most frequent cause of death (42%), followed by exsanguination (39%) and organ failure (7%). While acute and early deaths were mostly due to the first two causes, organ failure was the most common cause of late death (61%). Conclusions In comparison with the previous report, we observed similar injury mechanisms, demographics and causes of death. However, in our experience, there was an improved access to the medical system, greater proportion of late deaths due to brain injury and lack of the classic trimodal distribution.

Prevalence of Long-Term Disability From Traumatic Brain Injury in the Civilian Population of the United States, 2005

2008-11-01

Eduard Zaloshnja , Ted R. Miller , Jean Langlois +1 more

To estimate the prevalence of long-term disability associated with traumatic brain injury (TBI) in the civilian population of the United States.We first estimated how many people experienced long-term disability from … To estimate the prevalence of long-term disability associated with traumatic brain injury (TBI) in the civilian population of the United States.We first estimated how many people experienced long-term disability from TBI each year in the past 70 years. Then, accounting for the increased mortality among TBI survivors, we estimated their life expectancy and calculated how many were expected to be alive in 2005.An estimated 1.1% of the US civilian population or 3.17 million people (95% CI: 3.02-3.32 million) were living with a long-term disability from TBI at the beginning of 2005. Under less conservative assumptions about TBI's impact on lifespan, this estimate is 3.32 million (95% CI: 3.16-3.48 million).Substantial long-term disability occurs among the US civilians hospitalized with a TBI.

A Revision of the Trauma Score

1989-05-01

Howard R. Champion , William J. Sacco , Wayne S. Copes +3 more

The Trauma Score (TS) has been revised. The revision includes Glasgow Coma Scale (GCS), systolic blood pressure (SBP), and respiratory rate (RR) and excludes capillary refill and respiratory expansion, which … The Trauma Score (TS) has been revised. The revision includes Glasgow Coma Scale (GCS), systolic blood pressure (SBP), and respiratory rate (RR) and excludes capillary refill and respiratory expansion, which were difficult to assess in the field. Two versions of the revised score have been developed, one for triage (T-RTS) and another for use in outcome evaluations and to control for injury severity (RTS). T-RTS, the sum of coded values of GCS, SBP, and RR, demonstrated increased sensitivity and some loss in specificity when compared with a triage criterion based on TS and GCS values. T-RTS correctly identified more than 97% of nonsurvivors as requiring trauma center care. The T-RTS triage criterion does not require summing of the coded values and is more easily implemented than the TS criterion. RTS is a weighted sum of coded variable values. The RTS demonstrated substantially improved reliability in outcome predictions compared to the TS. The RTS also yielded more accurate outcome predictions for patients with serious head injuries than the TS.

Traumatic Brain Injury in the United States: A Public Health Perspective

1999-12-01

David J. Thurman , Clinton J. Alverson , Kathleen Dunn +2 more

Traumatic brain injury (TBI) is a leading cause of death and disability among persons in the United States. Each year, an estimated 1.5 million Americans sustain a TBI. As a … Traumatic brain injury (TBI) is a leading cause of death and disability among persons in the United States. Each year, an estimated 1.5 million Americans sustain a TBI. As a result of these injuries, 50,000 people die, 230,000 people are hospitalized and survive, and an estimated 80,000-90,000 people experience the onset of long-term disability. Rates of TBI-related hospitalization have declined nearly 50% since 1980, a phenomenon that may be attributed, in part, to successes in injury prevention and also to changes in hospital admission practices that shift the care of persons with less severe TBI from inpatient to outpatient settings. The magnitude of TBI in the United States requires public health measures to prevent these injuries and to improve their consequences. State surveillance systems can provide reliable data on injury causes and risk factors, identify trends in TBI incidence, enable the development of cause-specific prevention strategies focused on populations at greatest risk, and monitor the effectiveness of such programs. State follow-up registries, built on surveillance systems, can provide more information regarding the frequency and nature of disabilities associated with TBI. This information can help states and communities to design, implement, and evaluate cost-effective programs for people living with TBI and for their families, addressing acute care, rehabilitation, and vocational, school, and community support.

LACTATE CLEARANCE AND SURVIVAL FOLLOWING INJURY

1993-10-01

David L. Abramson , Thomas M. Scalea , Robyn Hitchcock +3 more

Previous reports cite optimization of O2 delivery (DO2) to 660 mL/min/m2, O2 consumption (VO2) to 170 mL/min/m2, and cardiac index (CI) of 4.5 L/min as predicting survival. We prospectively evaluated … Previous reports cite optimization of O2 delivery (DO2) to 660 mL/min/m2, O2 consumption (VO2) to 170 mL/min/m2, and cardiac index (CI) of 4.5 L/min as predicting survival. We prospectively evaluated 76 consecutive patients with multiple trauma admitted directly to the ICU from the operating room or emergency department. Patients had serum lactate levels and oxygen transport measured on ICU admission and at 8, 16, 24, 36, and 48 hours. Patients were analyzed with respect to survival (S) versus nonsurvival (NS), lactate clearance to normal (< or = 2 mmol/L) by 24 and 48 hours, hemodynamic optimization as defined above, as well as Injury Severity Score (ISS), ICU stay (LOS), and admission blood pressure. All patients achieved non-flow-dependent VO2. There was no difference in CI, DO2, VO2, or ISS when S was compared with NS. All 27 patients whose lactate level normalized in 24 hours survived. If lactate levels cleared to normal between 24 and 48 hours, the survival rate was 75%. Only 3 of the 22 patients who did not clear their lactate level to normal by 48 hours survived. Ten of the 25 nonsurvivors (40%) achieved the above arbitrary optimization criteria. Fifteen of the survivors never achieved any of these criteria. Optimization alone does not predict survival. However, the time needed to normalize serum lactate levels is an important prognostic factor for survival in severely injured patients.

An Analysis of Outcomes of Reconstruction or Amputation after Leg-Threatening Injuries

2002-12-11

Michael J. Bosse , Ellen J. MacKenzie , James F. Kellam +7 more

Limb salvage for severe trauma has replaced amputation as the primary treatment in many trauma centers. However, long-term outcomes after limb reconstruction or amputation have not been fully evaluated.We performed … Limb salvage for severe trauma has replaced amputation as the primary treatment in many trauma centers. However, long-term outcomes after limb reconstruction or amputation have not been fully evaluated.We performed a multicenter, prospective, observational study to determine the functional outcomes of 569 patients with severe leg injuries resulting in reconstruction or amputation. The principal outcome measure was the Sickness Impact Profile, a multidimensional measure of self-reported health status (scores range from 0 to 100; scores for the general population average 2 to 3, and scores greater than 10 represent severe disability). Secondary outcomes included limb status and the presence or absence of major complications resulting in rehospitalization.At two years, there was no significant difference in scores for the Sickness Impact Profile between the amputation and reconstruction groups (12.6 vs. 11.8, P=0.53). After adjustment for the characteristics of the patients and their injuries, patients who underwent amputation had functional outcomes that were similar to those of patients who underwent reconstruction. Predictors of a poorer score for the Sickness Impact Profile included rehospitalization for a major complication, a low educational level, nonwhite race, poverty, lack of private health insurance, poor social-support network, low self-efficacy (the patient's confidence in being able to resume life activities), smoking, and involvement in disability-compensation litigation. Patients who underwent reconstruction were more likely to be rehospitalized than those who underwent amputation (47.6 percent vs. 33.9 percent, P=0.002). Similar proportions of patients who underwent amputation and patients who underwent reconstruction had returned to work by two years (53.0 percent and 49.4 percent, respectively).Patients with limbs at high risk for amputation can be advised that reconstruction typically results in two-year outcomes equivalent to those of amputation.

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Relationship Between Trauma Center Volume and Outcomes

2001-03-07

Avery B. Nathens

gionalization of trauma care is that optimal outcomes can be achieved at greatest efficiency if care is restricted to relatively few dedicated trauma centers.Limitation of the number of trauma centers … gionalization of trauma care is that optimal outcomes can be achieved at greatest efficiency if care is restricted to relatively few dedicated trauma centers.Limitation of the number of trauma centers based on community need has been proposed as a critical component of regional trauma systems and, in a recent evaluation of systems across the country, one of their most frequent deficiencies. 1,2Implicit in this premise is that higher patient volumes will lead to greater experience and that this experience translates into better outcomes.4][5][6][7] In contrast, no such relationship is evident when less complex procedures like cholecystectomy or operative management of hip fractures are considered, 8 suggesting that the association between volume and outcomes is dependent on the complexity of care and the potential for adverse outcomes.Care of trauma patients poses 2 challenges not encountered in other aspects of surgical care.First, time to definitive care is a critical factor influencing patient survival.The primacy of time renders an ad hoc approach to trauma care inappropriate, potentially increasing the magnitude of the relationship between institutional experience and outcomes.Second, polytrauma patients often require complex, cross-specialty surgical care.The necessity for interdis-ciplinary surgical management lessens the impact of any particular individual and increases the importance of institutional experience.These challenges suggest that a clear association between volume and outcomes should ex-

The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care.

1974-03-01

Susan P. Baker , Brian O’Neill , William F. Haddon +1 more

A method for comparing death rates of groups of injured persons was developed, using hospital and medical examiner data for more than two thousand persons. The first step was determination … A method for comparing death rates of groups of injured persons was developed, using hospital and medical examiner data for more than two thousand persons. The first step was determination of the extent to which injury severity as rated by the Abbreviated Injury Scale correlates with patient survival. Substantial correlation was demonstrated. Controlling for severity of the primary injury made it possible to measure the effect on mortality of additional injuries. Injuries that in themselves would not normally be life-threatening were shown to have a marked effect on mortality when they occurred in combination with other injuries. An Injury Severity Score was developed that correlates well with survival and provides a numerical description of the overall severity of injury for patients with multiple trauma. Results of this investigation indicate that the Injury Severity Score represents an important step in solving the problem of summarizing injury severity, especially in patients with multiple trauma.

A Systematic Review and Meta-Analysis Comparing Outcome of Severely Injured Patients Treated in Trauma Centers Following the Establishment of Trauma Systems

2006-02-01

Brian G. Celso , Joseph J. Tepas , Barbara Langland‐Orban +4 more

Background: The establishment of trauma systems was anticipated to improve overall survival for the severely injured patient. We systematically reviewed the published literature to assess if outcome from severe traumatic … Background: The establishment of trauma systems was anticipated to improve overall survival for the severely injured patient. We systematically reviewed the published literature to assess if outcome from severe traumatic injury is improved for patients following the establishment of a trauma system. Methods: A systematic literature review of all population-based studies that evaluated trauma system performance was conducted. A qualitative analysis of each study's design and methodology and a meta-analysis was performed to evaluate the evidence to date of trauma system effectiveness. Results: A search of the literature yielded 14 published articles. Trauma systems demonstrated improved odds of survival in 8 of the 14 reports. The overall quality-weighted odds ratio was 0.85 lower mortality following trauma system implementation. Conclusions: The results of the meta-analysis showed a 15% reduction in mortality in favor of the presence of a trauma system. Evaluation of trauma system effectiveness must remain an uncompromising commitment to optimal outcome for the injured patient.

Blood Transfusion

1997-06-01

Frederick A. Moore

To determine if blood transfusion is a consistent risk factor for postinjury multiple organ failure (MOF), independent of other shock indexes.A 55-month inception cohort study ending on August 30, 1995. … To determine if blood transfusion is a consistent risk factor for postinjury multiple organ failure (MOF), independent of other shock indexes.A 55-month inception cohort study ending on August 30, 1995. Data characterizing postinjury MOF were prospectively collected. Multiple logistic regression analysis was performed on 5 sets of data. Set 1 included admission data (age, sex, comorbidity, injury mechanism, Glasgow Coma Scale, Injury Severity Score, and systolic blood pressure determined in the emergency department) plus the amount of blood transfused within the first 12 hours. In the subsequent 4 data sets, other indexes of shock (early base deficit, early lactate level, late base deficit, and late lactate level) were sequentially added. Additionally, the same multiple logistic regression analyses were performed with early MOF and late MOF as the outcome variables.Denver General Hospital, Denver, Colo, is a regional level I trauma center.Five hundred thirteen consecutive trauma patients admitted to the trauma intensive care unit with an Injury Severity Score greater than 15 who were older than 16 years and who survived longer than 48 hours.None.The relationship of blood transfusions and other shock indexes with the outcome variable, MOF.A dose-response relationship between early blood transfusion and the later development of MOF was identified. Despite the inclusion of other indexes of shock, blood transfusion was identified as an independent risk factor in 13 of the 15 multiple logistic regression models tested; the odds ratios were high, especially in the early MOF models.Blood transfusion is an early consistent risk factor for postinjury MOF, independent of other indexes of shock.

The Injury Severity Score Revisited

1988-01-01

Wayne S. Copes , Howard R. Champion , William J. Sacco +3 more

COPES, WAYNE S. Ph.D.; CHAMPION, HOWARD R. F.R.C.S. (EDIN), F.A.C.S.; SACCO, WILLIAM J. Ph.D.; LAWNICK, MARY M. R.N., B.S.N.; KEAST, SUSAN L. R.N., B.S.N.; BAIN, LAWRENCE W. B.S. Author Information COPES, WAYNE S. Ph.D.; CHAMPION, HOWARD R. F.R.C.S. (EDIN), F.A.C.S.; SACCO, WILLIAM J. Ph.D.; LAWNICK, MARY M. R.N., B.S.N.; KEAST, SUSAN L. R.N., B.S.N.; BAIN, LAWRENCE W. B.S. Author Information

A National Evaluation of the Effect of Trauma-Center Care on Mortality

2006-01-25

Ellen J. MacKenzie , Frederick P. Rivara , Gregory J. Jurkovich +5 more

Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. To address this gap, we examined differences in mortality between level 1 trauma centers … Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. To address this gap, we examined differences in mortality between level 1 trauma centers and hospitals without a trauma center (non–trauma centers).

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A Modification of the Injury Severity Score That Both Improves Accuracy and Simplifies Scoring

1997-12-01

Turner Osler , Susan P. Baker , William B. Long

Objectives The Injury Severity Score (ISS) has served as the standard summary measure of anatomic injury for more than 20 years. Nevertheless, the ISS has an idiosyncrasy that both impairs … Objectives The Injury Severity Score (ISS) has served as the standard summary measure of anatomic injury for more than 20 years. Nevertheless, the ISS has an idiosyncrasy that both impairs its predictive power and complicates its calculation. We present here a simple modification of the ISS called the New Injury Severity Score (NISS), which significantly outperforms the venerable but dated ISS as a predictor of mortality. Design Retrospective calculation of NISS and comparison of NISS with prospectively calculated ISS. Materials and Methods The NISS is defined as the sum of the squares of the Abbreviated Injury Scale scores of each of a patient's three most severe Abbreviated Injury Scale injuries regardless of the body region in which they occur. NISS values were calculated for every patient in two large independent data sets: 3,136 patients treated during a 4-year period at the American College of Surgeons' Level I trauma center in Albuquerque, New Mexico, and 3,449 patients treated during a 4-year period at the American College of Surgeons' Level I trauma center at the Emanuel Hospital in Portland, Oregon. The power of NISS to predict mortality was then compared with previously calculated ISS values for the same patients in each of the two data sets. Measurements and Main Results We find that NISS is not only simple to calculate but more predictive of survival as well (Albuquerque: receiver operating characteristic (ROC) ISS = 0.869, ROC NISS = 0.896, p < 0.001; Portland: ROC ISS = 0.896, ROC NISS = 0.907, p < 0.004). Moreover, NISS provides a better fit throughout its entire range of prediction (Hosmer Lemeshow statistic for Albuquerque ISS = 29.12, NISS = 8.88; Hosmer Lemeshow statistic for Portland ISS = 83.48, NISS = 19.86). Conclusion NISS should replace ISS as the standard summary measure of human trauma.

Epidemiology of trauma deaths

1980-07-01

Christopher C. Baker , L. Oppenheimer , Boyd G. Stephens +2 more

Early Coagulopathy Predicts Mortality in Trauma

2003-07-01

Jana B. A. MacLeod , Mauricio Lynn , Mark McKenney +2 more

Coagulopathy and hemorrhage are known contributors to trauma mortality; however, the actual relationship of prothrombin time (PT) and partial thromboplastin time (PTT) to mortality is unknown. Our objective was to … Coagulopathy and hemorrhage are known contributors to trauma mortality; however, the actual relationship of prothrombin time (PT) and partial thromboplastin time (PTT) to mortality is unknown. Our objective was to measure the predictive value of the initial coagulopathy profile for trauma-related mortality.We reviewed prospectively collected data on trauma patients presenting to a Level I trauma center. A logistic regression analysis was performed of PT, PTT, platelet count, and confounders to determine whether coagulopathy is a predictor of all-cause mortality.From a trauma registry cohort of 20103 patients, 14397 had complete disposition data for initial analysis and 7638 had complete data for all variables in the final analysis. The total cohort was 76.2% male, the mean age was 38 years (range, 1-108 years), and the median Injury Severity Score was 9. There were 1276 deaths (all-cause mortality, 8.9%). The prevalence of coagulopathy early in the postinjury period was substantial, with 28% of patients having an abnormal PT (2994 of 10790) and 8% of patients having an abnormal PTT (826 of 10453) on arrival at the trauma bay. In patients with disposition data and a normal PT, 489 of 7796 died, as compared with 579 of 2994 with an abnormal PT (6.3% vs. 19.3%; chi2 = 414.1, p < 0.001). Univariate analysis generated an odds ratio of 3.6 (95% confidence interval [CI], 3.15-4.08; p < 0.0001) for death with abnormal PT and 7.81 (95% CI, 6.65-9.17; p < 0.001) for deaths with an abnormal PTT. The PT and PTT remained independent predictors of mortality in a multiple regression model, whereas platelet count did not. The model also included the independent risk factors age, Injury Severity Score, scene and trauma-bay blood pressure, hematocrit, base deficit, and head injury. The model generated an adjusted odds ratio of 1.35 for PT (95% CI, 1.11-1.68; p < 0.001) and 4.26 for PTT (95% CI, 3.23-5.63; p < 0.001).The incidence of coagulation abnormalities, early after trauma, is high and they are independent predictors of mortality even in the presence of other risk factors. An initial abnormal PT increases the adjusted odds of dying by 35% and an initial abnormal PTT increases the adjusted odds of dying by 326%.

Crystalloids vs. colloids in fluid resuscitation

1999-01-01

P. Choi , Gordon Yip , Luis G. Quiñonez +1 more

Objective To systematically review the effects of isotonic crystalloids compared with colloids in fluid resuscitation. Data Sources Computerized bibliographic search of published research and citation review of relevant articles. Study … Objective To systematically review the effects of isotonic crystalloids compared with colloids in fluid resuscitation. Data Sources Computerized bibliographic search of published research and citation review of relevant articles. Study Selection All randomized clinical trials of adult patients requiring fluid resuscitation comparing isotonic crystalloids vs. colloids were included. Pulmonary edema, mortality, and length of stay were evaluated. Independent review of 105 articles identified 17 relevant primary studies of 814 patients. Weighted kappa about article inclusion was high (0.76). Data Extraction Data on population, interventions, outcomes, and methodologic quality of the studies were obtained by duplicate independent review with differences resolved by consensus. Weighted kappa on the validity assessment was moderate (0.54). Data Synthesis No difference was observed overall between crystalloid and colloid resuscitation with respect to mortality and pulmonary edema; however, the power of the aggregated data was insufficient to detect small but potentially clinically important differences. Subgroup analysis suggested a statistically significant difference in mortality in trauma in favor of crystalloid resuscitation (relative risk 0.39, 95% confidence intervals: 0.17 to 0.89). Several methodologic issues are noteworthy regarding the primary studies, including lack of blinding (except in three studies). The type, dose, and duration of fluid administration and outcomes measured were different across these trials. Conclusions Overall, there is no apparent difference in pulmonary edema, mortality, or length of stay between isotonic crystalloid and colloid resuscitation. Crystalloid resuscitation is associated with a lower mortality in trauma patients. Methodologic limitations preclude any evidence-based clinical recommendations. Larger well-designed randomized trials are needed to achieve sufficient power to detect potentially small differences in treatment effects if they truly exist. (Crit Care Med 1999;27:200-210)

PREDICTING OUTCOME IN INDIVIDUAL PATIENTS AFTER SEVERE HEAD INJURY

1976-05-01

B. Jennett , Graham M. Teasdale , R. Braakman +2 more

The Major Trauma Outcome Study: establishing national norms for trauma care.

1990-11-01

H R Champion , Wayne S. Copes , William J. Sacco +5 more

The Major Trauma Outcome Study (MTOS) is a retrospective descriptive study of injury severity and outcome coordinated through the American College of Surgeons' Committee on Trauma. From 1982 through 1987, … The Major Trauma Outcome Study (MTOS) is a retrospective descriptive study of injury severity and outcome coordinated through the American College of Surgeons' Committee on Trauma. From 1982 through 1987, 139 North American hospitals submitted demographic, etiologic, injury severity, and outcome data for 80,544 trauma patients. Motor vehicle related injuries were most frequent (34.7%). Twenty-one per cent of patients had penetrating injuries. The overall mortality rate was 9.0%. The mortality rate for direct admissions was strongly related to the presence of serious head injury, 5.0% and 40.0%, when head injuries were less than or equal to AIS (Abbreviated Injury Scale) 3 or greater than or equal to AIS 4, respectively. Survival probability norms use the Revised Trauma Score, Injury Severity Score, patient age, and injury mechanism. Patients with unexpected outcomes were identified and statistical comparisons of actual and expected numbers of survivors made for each institution. Results provide a description of injury and outcome and support evaluation and quality assurance activities.

Guidelines for the inter- and intrahospital transport of critically ill patients*

2004-01-01

Jonathan Warren , Robert E. Fromm , Richard A. Orr +2 more

Objective The development of practice guidelines for the conduct of intra- and interhospital transport of the critically ill patient. Data Source Expert opinion and a search of Index Medicus from … Objective The development of practice guidelines for the conduct of intra- and interhospital transport of the critically ill patient. Data Source Expert opinion and a search of Index Medicus from January 1986 through October 2001 provided the basis for these guidelines. A task force of experts in the field of patient transport provided personal experience and expert opinion. Study Selection and Data Extraction Several prospective and clinical outcome studies were found. However, much of the published data comes from retrospective reviews and anecdotal reports. Experience and consensus opinion form the basis of much of these guidelines. Results of Data Synthesis Each hospital should have a formalized plan for intra- and interhospital transport that addresses a) pretransport coordination and communication; b) transport personnel; c) transport equipment; d) monitoring during transport; and e) documentation. The transport plan should be developed by a multidisciplinary team and should be evaluated and refined regularly using a standard quality improvement process. Conclusion The transport of critically ill patients carries inherent risks. These guidelines promote measures to ensure safe patient transport. Although both intra- and interhospital transport must comply with regulations, we believe that patient safety is enhanced during transport by establishing an organized, efficient process supported by appropriate equipment and personnel.

The Prehospital Emergency Care System in Mexico City: A System's Performance Evaluation

2006-04-01

Luis Mauricio Pinet Peralta

Mexico City has one of the highest mortality rates in Mexico, with non-intentional injuries as a leading cause of death among persons 1-44 years of age. Emergency medical services (EMS) … Mexico City has one of the highest mortality rates in Mexico, with non-intentional injuries as a leading cause of death among persons 1-44 years of age. Emergency medical services (EMS) in Mexico can achieve high levels of efficiency by offering high quality medical care at a low cost through adequate system design.The objective of this study was to determine whether the prehospital EMS system in Mexico City meets the criteria standards established by the American Ambulance Association Guide for Contracting Emergency Medical Services (AAA Guide) for highly efficient EMS systems.This retrospective, descriptive study, evaluated the structure of Mexico City's EMS system and analyzed EMS response times, clinical capacity, economic efficiency, and customer satisfaction. These results were compared with the AAA guide, according to the soc ial, economic, and political context in Mexico. This paper describes the healthcare system structure in Mexico, followed by a description of the basic structure of EMS in Mexico City, and of each tenet described in the AAA guide. The p aper includesdata obtained from official documents and databases of government agencies, and operative and administrative data from public and private EMS providers.The quality of the data for response times (RT) were insufficient and widely varied among providers, with a minimum RT of 6.79 minutes (min) and a maximum RT of 61 min. Providers did not define RT clearly, and measured it with averages, which can hide potentially poor performance practices. Training institutions are not required to follow a standardized curriculum. Certifications are the responsibility of the individual training centers and have no government regulation. There was no evidence of active medical control involvement in direct patient care, and providers did not report that quality assurance programs were in place. There also are limited career advancement opportunities for EMS personnel. Small economies of scale may not allow providers to be economically efficient, unit hours are difficult to calculate, and few economic data are available. There is no evidence of customer satisfaction data.Emergency medical services in Mexico City did not meet the AAA requirements for high-quality, prehospital, emergency care. Coordination among EMS providers is difficult to achieve, due, in part, to the lack of: (1) an authoritative structure; (2) sound system design; and (3) appropriate legislation. The government, EMS providers, stakeholders, and community members should work together to build a high quality EMS system at the lowest possible cost.

Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study

2009-03-26

Stefan Huber‐Wagner , Rolf Lefering , Lars-Mikael Qvick +6 more

Disability in young people and adults one year after head injury: prospective cohort study

2000-06-17

S. Thornhill

<h3>Abstract</h3> <b>Objective:</b> To determine the frequency of disability in young people and adults admitted to hospital with a head injury and to estimate the annual incidence in the community. <b>Design:</b> … <h3>Abstract</h3> <b>Objective:</b> To determine the frequency of disability in young people and adults admitted to hospital with a head injury and to estimate the annual incidence in the community. <b>Design:</b> Prospective, hospital based cohort study, with one year follow up of sample stratified by coma score. <b>Setting:</b> Five acute hospitals in Glasgow. <b>Subjects:</b> 2962 patients (aged 14 years or more) with head injury; 549 (71%) of the 769 patients selected for follow up participated. <b>Main outcome measures:</b> Glasgow outcome scale and problem orientated questionnaire. <b>Results:</b> Survival with moderate or severe disability was common after mild head injury (47%, 95% confidence interval 42% to 52%) and similar to that after moderate (45%, 35% to 56%) or severe injury (48%, 36% to 60%). By extrapolation from the population identified (90% of whom had mild injuries), it was estimated that annually in Glasgow (population 909 498) 1400 young people and adults are still disabled one year after head injury. <b>Conclusion:</b> The incidence of disability in young people and adults admitted with a head injury is higher than expected. This reflects the high rate of sequelae previously unrecognised in the large number of patients admitted to hospital with an apparently mild head injury.

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The impact of traumatic brain injuries: A global perspective

2007-12-07

Adnan A. Hyder , Colleen A. Wunderlich , Prasanthi Puvanachandra +2 more

Traumatic brain injury (TBI), according to the World Health Organization, will surpass many diseases as the major cause of death and disability by the year 2020. With an estimated 10 … Traumatic brain injury (TBI), according to the World Health Organization, will surpass many diseases as the major cause of death and disability by the year 2020. With an estimated 10 million people affected annually by TBI, the burden of mortality and morbidity that this condition imposes on society, makes TBI a pressing public health and medical problem. The burden of TBI is manifest throughout the world, and is especially prominent in Low and Middle Income Countries which face a higher preponderance of risk factors for causes of TBI and have inadequately prepared health systems to address the associated health outcomes. Latin America and Sub Saharan Africa demonstrate a higher TBI-related incidence rate varying from 150-170 per 100,000 respectively due to RTIs compared to a global rate of 106 per 100,000. As highlighted in this global review of TBI, there is a large gap in data on incidence, risk factors, sequelae, financial costs, and social impact of TBI. This should be addressed through planning of comprehensive TBI prevention programs in LMICs through well-established surveillance systems. Greater resources for research and prioritized interventions are critical to promote evidence-based policy for TBI.

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The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013

2015-12-03

Juanita A. Haagsma , Nicholas Graetz , Ian Bolliger +7 more

The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides … The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country.Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures.In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries.Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made.

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A Prospective Study of Venous Thromboembolism After Major Trauma

1997-10-01

Peggy Hollingsworth-Fridlund , W. Geerts , Karen I. Code +3 more

Hollingsworth-Fridlund, Peggy BSN, RN; Geerts, W. H.; Code, K. I.; Jay, R. M.; Chen, E.; Szalai, J. P. Hollingsworth-Fridlund, Peggy BSN, RN; Geerts, W. H.; Code, K. I.; Jay, R. M.; Chen, E.; Szalai, J. P.

Immediate versus Delayed Fluid Resuscitation for Hypotensive Patients with Penetrating Torso Injuries

1994-10-27

William H Bickell , Matthew J. Wall , Paul E. Pepe +4 more

Fluid resuscitation may be detrimental when given before bleeding is controlled in patients with trauma. The purpose of this study was to determine the effects of delaying fluid resuscitation until … Fluid resuscitation may be detrimental when given before bleeding is controlled in patients with trauma. The purpose of this study was to determine the effects of delaying fluid resuscitation until the time of operative intervention in hypotensive patients with penetrating injuries to the torso.

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Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

2016-10-01

Theo Vos , Christine A. Allen , Megha Arora +7 more

Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many … Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015.

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Traumatic Brain Injury–Related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2007 and 2013

2017-03-16

Christopher A. Taylor , Jeneita M. Bell , Matthew J. Breiding +1 more

Traumatic brain injury (TBI) has short- and long-term adverse clinical outcomes, including death and disability. TBI can be caused by a number of principal mechanisms, including motor-vehicle crashes, falls, and … Traumatic brain injury (TBI) has short- and long-term adverse clinical outcomes, including death and disability. TBI can be caused by a number of principal mechanisms, including motor-vehicle crashes, falls, and assaults. This report describes the estimated incidence of TBI-related emergency department (ED) visits, hospitalizations, and deaths during 2013 and makes comparisons to similar estimates from 2007.

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Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths

2006-01-01

Jean Langlois , Wesley Rutland-Brown , Karen E. Thomas

Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research

2017-11-07

Andrew I.R. Maas , David Menon , P. David Adelson +7 more

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Clinical physiology in obstetrics

1999-01-01

T.K.A.B. Eskes

Estimating the global incidence of traumatic brain injury

2018-04-27

Michael C. Dewan , Abbas Rattani , Saksham Gupta +7 more

Traumatic brain injury (TBI)-the "silent epidemic"-contributes to worldwide death and disability more than any other traumatic insult. Yet, TBI incidence and distribution across regions and socioeconomic divides remain unknown. In … Traumatic brain injury (TBI)-the "silent epidemic"-contributes to worldwide death and disability more than any other traumatic insult. Yet, TBI incidence and distribution across regions and socioeconomic divides remain unknown. In an effort to promote advocacy, understanding, and targeted intervention, the authors sought to quantify the case burden of TBI across World Health Organization (WHO) regions and World Bank (WB) income groups.

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Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

2018-11-26

Spencer L James , Alice Theadom , Richard G. Ellenbogen +7 more

Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical … Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury.

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Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial

2019-10-14

Tranexamic acid reduces surgical bleeding and decreases mortality in patients with traumatic extracranial bleeding. Intracranial bleeding is common after traumatic brain injury (TBI) and can cause brain herniation and death. … Tranexamic acid reduces surgical bleeding and decreases mortality in patients with traumatic extracranial bleeding. Intracranial bleeding is common after traumatic brain injury (TBI) and can cause brain herniation and death. We aimed to assess the effects of tranexamic acid in patients with TBI.

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Trauma score

1981-09-01

Howard R. Champion , William J. Sacco , Anthony J. Carnazzo +2 more

The Trauma Score (TS), a simple physiological measure of injury severity, is presented as a modification of the previously reported Triage Index by consensus physician peer review. Performance of the … The Trauma Score (TS), a simple physiological measure of injury severity, is presented as a modification of the previously reported Triage Index by consensus physician peer review. Performance of the Trauma Score is presented as an index of injury severity both alone and in combination with an anatomic index of injury severity, the Injury Severity Score (ISS) and patient age. The application of these tools for field triage and evaluation of care of the trauma victim is proposed.

Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: The Traumatic Life Events Questionnaire.

2000-01-01

Edward S. Kubany , Mary Beth Leisen , Aaron S. Kaplan +4 more

Trauma

1983-08-01

Donald D. Trunkey

Epidemiology of trauma: Frequency and impact of different potentially traumatic events on different demographic groups.

1992-06-01

Fran H. Norris

The Major Trauma Outcome Study

1990-11-01

Howard R. Champion , Wayne S. Copes , William J. Sacco +3 more

The Major Trauma Outcome Study (MTOS) is a retrospective descriptive study of injury severity and outcome coordinated through the American College of Surgeons' Committee on Trauma. From 1982 through 1987, … The Major Trauma Outcome Study (MTOS) is a retrospective descriptive study of injury severity and outcome coordinated through the American College of Surgeons' Committee on Trauma. From 1982 through 1987, 139 North American hospitals submitted demographic, etiologic, injury severity, and outcome data for 80,544 trauma patients. Motor vehicle related injuries were more frequent (34.7%). Twenty-one per cent of patients had penetrating injuries. The overall mortality rate was 9.0%. The mortality rate for direct admissions was strongly related to the presence of serious head injury, 5.0% and 40.0%, when head injuries were ± AIS (Abbreviated Injury Scale) 3 or ± AIS 4, respectively. Survival probability norms use the Revised Trauma Score, Injury Severity Score, patient age, and injury mechanism. Patients with unexpected outcomes were identified and statistical comparisons of actual and expected numbers of survivors made for each institution. Results provide a description of injury and outcome and support evaluation and quality assurance activities.

Trauma

1995-01-01

Cathy Caruth

Evaluating Trauma Care

1987-04-01

Carl Boyd , Mary Ann Tolson , Wayne S. Copes

Development and Validation of Machine Learning Models for Predicting 7-Day Mortality in Critically Ill Patients with Traumatic Spinal Cord Injury: A Multicenter Retrospective Study

2025-06-25

Yixi Wang , Xiaolong Luo , Jingjie Wang +3 more | Neurocritical Care

Association Among Fragmented Trauma Care, Mortality, and Major Complications: Optimizing Care for the Injured Beyond the Initial Hospitalization

2025-06-25

Benjamin K. Wang , Allen Green , Cheryl K. Zogg +3 more | Annals of Surgery Open

Objective: This study aimed to characterize the nationwide burden of fragmented care among adult trauma patients and evaluate associations between readmission to index versus nonindex hospital and mortality, major complications, … Objective: This study aimed to characterize the nationwide burden of fragmented care among adult trauma patients and evaluate associations between readmission to index versus nonindex hospital and mortality, major complications, and other outcomes during readmission. Background: Fragmented care from readmission to a nonindex hospital has been associated with worse outcomes across multiple disciplines. The nonelective nature of traumatic injury and the high prevalence of social vulnerability risk factors renders trauma patients at high risk of fragmented care. Methods: In this retrospective observational cohort study using the 2019 and 2020 National Readmissions Database, we identified the rate of fragmented care among adult trauma patients who experience a 90-day readmission and the most prevalent principal readmission diagnoses. Multivariable regression analysis using least absolute shrinkage and selector regression and 10-fold cross-validation identified risk factors for readmission to nonindex hospitals and the associations between readmission to nonindex hospitals and outcomes. Results: Among 906,531 injured adult patients, 108,246 (11.9%) experienced 90-day readmission after discharge from initial hospitalization. Twenty-eight percent (n = 30,153) were readmitted to a nonindex hospital. Septicemia was the most common principal readmission diagnosis, and urinary tract infections and pneumonia were the most common concomitant infectious diagnoses. Compared with patients readmitted to their index hospital, those readmitted to a nonindex hospital had 11% higher adjusted odds of mortality [OR (95% confidence interval {CI}): 1.11 (1.02–1.21)] and 12% higher adjusted odds of major complications [OR (95% CI): 1.12 (1.07–1.17)]. Conclusions: Ninety-day readmissions are not uncommon among adult trauma patients, and many experience fragmented care. Fragmented care is associated with higher odds of mortality and major complications during readmission. There is an urgent need to identify modifiable risk factors for readmission during the index injury hospitalization and develop strategies to prevent readmission and the consequences of fragmented care.

A qualitative needs assessment of Lima's prehospital emergency trauma system: Identifying challenges and opportunities for improvement

2025-06-24

Jaclyn A Gellings , Allison Dentice , Gabriela Zavala-Wong +7 more | Surgery

Analysis of Massive Transfusion Protocol Utilization in Trauma Across Sociodemographic Groups

2025-06-24

Monique Arnold , Bharti Sharma , M. Conn +7 more | Medicina

Background and Objectives: Blood shortages are a national crisis, creating dangerous scenarios for patients requiring the use of a massive transfusion protocol (MTP). A judicious use of blood products is … Background and Objectives: Blood shortages are a national crisis, creating dangerous scenarios for patients requiring the use of a massive transfusion protocol (MTP). A judicious use of blood products is critical to rescue salvageable patients while refraining from unnecessary MTP to save precious resources. This study examines effect of trauma characteristics, socioeconomic variables and markers of futility on the likelihood of activating and receiving MTP in the trauma setting. Materials and Methods: In this retrospective study, emergency department (ED) trauma activations from a database of an urban Level I trauma center were analyzed from 1 January 2017 to 30 June 2022, inclusive. In-ED mortality, RBC transfusion volumes during initial resuscitation, patient sociodemographic data, and trauma event factors were analyzed. The primary outcomes were the dichotomous outcomes of MTP activation and MTP transfusion. Univariable analyses and logistic regressions were conducted, with class balancing sensitivities applied to the multivariable regressions to adjust for imbalance in the data. p < 0.05 was considered statistically significant. Results: Among the 8670 trauma activations, there was a 0.3% in-ED mortality rate. MTP activation and MTP transfusion were associated with higher in-ED mortality rates (3.8% and 15.4%, respectively, compared to 0.2% without MTP). Younger patients, male patients, and Medicaid recipients were more likely to undergo MTP activation; Medicare patients were less likely. Penetrating trauma substantially increased the likelihood of both MTP activation (odds ratio (OR) 5.81) and transfusion (OR 3.63). The logistic regression models identified the presence of penetrating trauma, lower probability of survival, and age as the most important covariates. Models demonstrated high discriminatory value (area under the curve (AUC) of the receiver operating characteristic curve (ROC) of 0.876 for MTP activation, 0.935 for MTP transfusion) and precision (0.974 for activation, 0.994 for transfusion), with class balancing further improving model performance and precision scores. Conclusions: These results are significant as assessing the futility of MTP should be equitable, and future transfusion guidelines should consider salvageability in cases with a low probability of survival despite age and mechanism.

Racial and ethnic disparities in emergency medical transport: A comparative analysis of trauma admissions at a county hospital and academic health center in a major U.S. city

2025-06-23

Fezaan Kazi , Ajay Patel , Ali Sualeh +7 more | Trauma

Objectives Trauma patients often cannot communicate a preferred hospital destination to emergency medical services (EMS) due to injuries or impaired consciousness. EMS teams, therefore, determine hospital destinations, potentially influencing access … Objectives Trauma patients often cannot communicate a preferred hospital destination to emergency medical services (EMS) due to injuries or impaired consciousness. EMS teams, therefore, determine hospital destinations, potentially influencing access to care. This study examines differences in level 1 trauma admissions between a county hospital (CH) and an academic health center (AHC) within two miles of each other, focusing on transport patterns and their association with patient demographics. Methods We conducted a retrospective review of patient charts and EMS transport records, analyzing demographic data, hospital destinations, EMS pickup locations, and documented reasons for hospital selection. Results Among 1520 patients transported to CH and 625 to AHC, significant differences in transport patterns were observed. White patients were more likely than minority patients to be taken to the nearest hospital (53.1% vs 46.4%, p = 0.003) and less likely to bypass it (21.2% vs 33.0%, p < 0.001). Minority patients disproportionately bypassed AHC for CH (46.6% vs 24.6%, p < 0.001), while only 3.8% bypassed CH for AHC. AHC admitted more Black patients (47.4% vs 37.1%, p < 0.001), while CH admitted more Hispanic patients (10.1% vs 5.6%, p < 0.001). AHC patients had higher Medicare and Medicaid coverage, whereas CH had more uninsured patients. Conclusion EMS transport patterns reveal disparities in trauma care access linked to race, ethnicity, and insurance status, underscoring the need for equitable EMS protocols and resource allocation.

Change in resuscitation influenced development and severity of inflammatory complications in severely injured

2025-06-23

Karlijn J. P. van Wessem , Kim E.M. Benders , Luke P. H. Leenen +1 more | European Journal of Trauma and Emergency Surgery

Flight Nurses' Experiences With Interhospital Transportation of Critically Ill Patients

2025-06-23

Lina Stokkebekk , Monica Evelyn Kvande , Simen A. Steindal | Journal of Clinical Nursing

To explore flight nurses' experiences with interhospital transportation of critically ill patients in fixed-wing aircraft. The study had a qualitative explorative and descriptive design. Nine flight nurses working at five … To explore flight nurses' experiences with interhospital transportation of critically ill patients in fixed-wing aircraft. The study had a qualitative explorative and descriptive design. Nine flight nurses working at five different air bases across Norway were interviewed. Systematic text condensation was used to analyse the data. The study was reported according to the COREQ checklist. The data analysis resulted in three categories: Flight nurses being one step ahead when preparation for transporting patients in out-of-hospital environments, Flight nurses' strategies for effective and safe patient transport within the aircraft environment, and Flight nurses' need for a structured and organised handover of patients. The flight nurses emphasised the need for extensive preparation prior to aeromedical transport to enhance patients' safety. The aircraft environment was a challenge that required them to be creative with the limited resources available and to have a well-functioning interprofessional teamwork. Knowledge about flight nurses' experiences with interhospital transportations could provide a path to standardisation and inform strategies to enhance interprofessional teamwork. Such knowledge could also contribute to humanising nursing practice during the transportation of critical care patients. There were no patient or public contributions.

“Could She/He Walk Out of the Hospital?”: Implementing AI Models for Recovery Prediction and Doctor-Patient Communication in Major Trauma

2025-06-22

Li-Chin Cheng , Chung‐Feng Liu , Chin-Choon Yeh | Diagnostics

Background and Objectives: Major trauma ranks among the leading causes of mortality and handicap in both developing and developed countries, consuming substantial healthcare resources. Its unpredictable nature and diverse clinical … Background and Objectives: Major trauma ranks among the leading causes of mortality and handicap in both developing and developed countries, consuming substantial healthcare resources. Its unpredictable nature and diverse clinical presentations often lead to rapid and challenging-to-predict changes in patient conditions. An increasing number of models have been developed to address this challenge. Given our access to extensive and relatively comprehensive data, we seek assistance in making a meaningful contribution to this topic. This study aims to leverage artificial intelligence (AI)/machine learning (ML) to forecast potential adverse effects in major trauma patients. Methods: This retrospective analysis considered major trauma patient admitted to Chi Mei Medical Center from 1 January 2010 to 31 December 2019. Results: A total of 5521 major trauma patients were analyzed. Among five AI models tested, XGBoost showed the best performance (AUC 0.748), outperforming traditional clinical scores such as ISS and GCS. The model was deployed as a web-based application integrated into the hospital information system. Preliminary clinical use demonstrated improved efficiency, interpretability through SHAP analysis, and positive user feedback from healthcare professionals. Conclusions: This study presents a predictive model for estimating recovery probabilities in severe burn patients, effectively integrated into the hospital information system (HIS) without complex computations. Clinical use has shown improved efficiency and quality. Future efforts will expand predictions to include complications and treatment outcomes, aiming for broader applications as technology advances.

Identifying the Patterns: Prevalence and Management of Trauma and Surgical Emergencies in a Tertiary Care Hospital in Peshawar

2025-06-20

Muhammad Raheel , Hameed Ullah , Abdul Haseeb +5 more | Cureus

Review of trauma scoring systems in geriatric patients

2025-06-20

Chunrong Wang , Songyao Tian , Chu Wang | Medicine

As the aging population progresses, more and more traumatic events involve the elderly. Given the systemic "frailty" of the elderly, there is currently no universally accepted method for geriatric trauma … As the aging population progresses, more and more traumatic events involve the elderly. Given the systemic "frailty" of the elderly, there is currently no universally accepted method for geriatric trauma assessment. The existing methods for assessing geriatric trauma patients - the Geriatric Trauma Outcome Score (GTOS), the Elderly Mortality After Trauma (EMAT), and Geriatric Trauma Mortality Score (GERtality)-were reviewed. GTOS, GERtality and EMAT have 3, 5 and 26 parameters, respectively. EMAT contains almost every aspect of clinical scenarios, such as demographic data, comorbidities, injury type, and abnormal physiologic markers, and seems to be more reliable than the other 2. GTOS contains only age, severity of injury and the need for blood transfusion. GERtality covers age, comorbidities, severity of craniocerebral injury, severity of injury, and hemorrhage. However, EMAT calculation is complex, while GERtality and GTOS are user friendly. Our review shows that each of 3 scores has limitations and lacks further validation. GERtality contains more "fragile" information than GTOS and is more user friendly than EMAT. It might be more practical clinically. More research is needed in geriatric trauma evaluation.

Emergency medicine practice in low-resource settings: challenges in research and implementation

2025-06-20

Prithvishree Ravindra , Giles N. Cattermole , Vijaya Arun Kumar | European Journal of Emergency Medicine

Die neue britische Leitlinie zur Rettung von Personen nach Verkehrsunfällen – Vorstellung und Diskussion

2025-06-20

Maximilian Laun , Lukas Breimeir , Stefan Foerch +1 more | Notfall + Rettungsmedizin

Zusammenfassung Verkehrsunfälle mit Kraftfahrzeugen stellen weltweit eine der häufigsten Todesursachen dar. Trotz notfallmedizinischer und feuerwehrtechnischer Fortschritte blieb der Prozess der Rettung von Traumapatient:innen aus verunfallten Fahrzeugen in den letzten Jahrzehnten … Zusammenfassung Verkehrsunfälle mit Kraftfahrzeugen stellen weltweit eine der häufigsten Todesursachen dar. Trotz notfallmedizinischer und feuerwehrtechnischer Fortschritte blieb der Prozess der Rettung von Traumapatient:innen aus verunfallten Fahrzeugen in den letzten Jahrzehnten weitestgehend unverändert. Das rettungstechnische Vorgehen nach dem Prinzip einer „absoluten Bewegungsminimierung der Wirbelsäule“ wird jedoch zunehmend infrage gestellt. Der Nutzen einer potenziellen Verzögerung zeitkritischer Interventionen zugunsten der Vermeidung sekundärer Rückenmarksverletzungen konnte bisher nicht nachgewiesen werden. Die vorliegende Arbeit stellt die im November 2024 veröffentlichten Empfehlungen des Consensus-Statements zu „Extrication following a Motor Vehicle Collision“ der Faculty of Pre-Hospital Care (FPHC) des Royal College of Surgeons of Edinburgh vor und vergleicht sie mit den aktuellen Leitlinien und Empfehlungen aus Deutschland und Dänemark. Im Zuge dessen werden relevante Aussagen für die Praxis hervorgehoben. Hierzu zählen die Durchführung einer (assistierten) Selbstbefreiung, die situationsangepasste Kommunikation mit Betroffenen sowie die Anwendung von Hilfsmitteln zur Unterstützung von Ersthelfenden und Einsatzkräften bei der Auswahl einer effizienten Befreiungsmethode.

Utilising artificial intelligence in prehospital emergency care systems in low- and middle-income countries: a scoping review

2025-06-20

Odhran Mallon , Freddy Lippert , Willem Stassen +4 more | Frontiers in Public Health

Introduction Improvements in prehospital emergency care have the potential to transform patient outcomes globally, but particularly within low-and middle-income countries. Whilst artificial intelligence is being implemented in many healthcare settings, … Introduction Improvements in prehospital emergency care have the potential to transform patient outcomes globally, but particularly within low-and middle-income countries. Whilst artificial intelligence is being implemented in many healthcare settings, little is known about its use in prehospital emergency care systems. This scoping review aims to uncover how artificial intelligence is currently being used within the prehospital emergency medical services of low-and middle-income countries and assess the implications for future development. Methods A review of peer-reviewed articles using any artificial intelligence models in prehospital emergency care in low-and middle-income countries was carried out. Medline, Global Health, Embase, CINAHL and Web of Science were searched for studies published between January 2014 and July 2024. Data were extracted, collated and presented in table format and as a narrative synthesis. This scoping review is reported using the PRISMA-ScR guidelines. Results Sixteen articles were included in the study. Most studies were conducted in China and deep learning models were used in half of the studies. Articles assessing dispatch forecasting were the most common, although artificial intelligence tools are also utilised in classification and disease prediction. There was significant variation in sample sizes throughout the selected studies. Overall, machine learning algorithms outperformed other comparator methods when they were used in all but two studies. Discussion Limitations included only analysing articles published in English. Additionally, studies that did not identify the model as an artificial intelligence tool, or did not explicitly mention a LMIC in the title or abstract may have been inadvertently excluded. Whilst artificial intelligence can significantly benefit patient care in out-of-hospital settings, the continued development of this technology requires proper consideration for the local sociocultural contexts and challenges in these countries, along with using complete, population-specific datasets. Further research is needed to support advancements in this field and promote the realisation of universal health coverage. Systematic review registration https://doi.org/10.17605/OSF.IO/9VS2M , osf.io/9vs2m.

American Board of Emergency Medicine Report on Residency and Fellowship Training Information (2024-2025)

2025-06-19

Yvette Calderon , Barry Knapp , Lynne Holden +7 more | Annals of Emergency Medicine

Abstracts from international emergency medicine journals

2025-06-19

EMJ Production | Emergency Medicine Journal

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will … Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.

Road Accidents in India: The Golden Hour & Resuscitative Hour

2025-06-19

B. V. N. Jayasri , B. Sravani | International Journal of Contemporary Medicine

Background *According to the Ministry of Road Transport and Highways (MoRTH),1,68,491 people were killed, and 4,43,366 injured in 4,61,312 road crashes in India in 2022.On average, India witnessed 1,263 road … Background *According to the Ministry of Road Transport and Highways (MoRTH),1,68,491 people were killed, and 4,43,366 injured in 4,61,312 road crashes in India in 2022.On average, India witnessed 1,263 road crashes and 461 deaths every day or 53 crashes and 19 deaths every hour. Methods *1. Airway Obstruction - Management2. CPR: Cardiopulmonary Resuscitation3. Transportation & Emergency care4. Revascularization & Vascular Rehabilitation5. Surgical Intervention6. Avoiding Road accidents by following Traffic Guidelines Results *1. In an accident, the Golden hour is crucial because it represents the window of time where medical care has the greatest impact on the outcome of the injuries. Within this 60-minute period, emergency services can stabilize the injured person, stop any bleeding, treat serious injuries, and transport the casualty to a specialized hospital, where they will receive the care necessary to survive and recover.2. The Golden hour is vital not only in terms of saving lives but also for reducing the risk of complications and long-term consequences. Conclusion *It is essential that both drivers and pedestrians understand the significance of the golden hour and know how to respond in emergency situations. Responsibility does not rest solely with emergency services; every individual plays a crucial role in ensuring that the golden hour remains effective.

Spectrum Of Spinal Trauma At The National Orthopaedic Hospital, Lagos, Nigeria

2025-06-19

Blessing S Ibe , Akpama E Egwu , Akwa E Erim +1 more | Global Journal of Pure and Applied Sciences

Background: Spinal trauma is a leading cause of morbidity and mortality, particularly in young adults. Despite advances in prevention and treatment, spinal trauma continues to pose a major public health … Background: Spinal trauma is a leading cause of morbidity and mortality, particularly in young adults. Despite advances in prevention and treatment, spinal trauma continues to pose a major public health challenge. This study aims to assess the Incidence and Spectrum of Spinal Trauma at the National Orthopaedic Hospital Igbobi, Lagos, Nigeria from the year 2019 to 2022. The study assessed the trends in the incidence of spinal trauma overtime and examined the demographic distribution and clinical diagnosis of spinal traumas. Methods: Data was collected retrospectively from the Magnetic Resonance Imaging (MRI) medical records of 86 patients who had been diagnosed with spinal trauma. Data obtained from the study was analyzed using the Statistical Package for Social Sciences (SPSS) version 25.0. Results: The results showed that patients ages were between 8 to 87 years (Mean±SD = 36.67+15.06). The frequency of spinal trauma in males 53(61.6%) and females 33(38.4%). A high incidence of spinal trauma 26(29.55%) was found within the age bracket of 21-33 years, followed by 34-46 years which accounted for 21(23.86%). The most common level of injury was found in the cervical spine 38(44.19%), followed closely by lumbosacral spine 31(36.05). The most frequent causes of spinal trauma were RTA 30(34.88), followed by fall 17(19.77%). The highest frequency of clinical diagnosis was found in fractures (26.74%), followed by spondylosis 14(16.28%). Conclusion: The study revealed a higher proportion of spinal trauma in males than their female counterpart, and mostly in younger individuals in their second decade of life.

Outcomes in REBOA by Sex: Results From the American Association of Surgery for Trauma (AAST) Aortic Occlusion and Resuscitation for Trauma and Acute Care Surgery (AORTA) Trial

2025-06-19

Joanna Shaw , Kosuke Kawai , Nikhil Chervu +1 more | The American Surgeon

Background: Female patients have smaller diameter femoral vessels than men and higher rates of procedural complications for elective vascular surgeries. We investigated sex differences in REBOA outcomes including vascular access … Background: Female patients have smaller diameter femoral vessels than men and higher rates of procedural complications for elective vascular surgeries. We investigated sex differences in REBOA outcomes including vascular access complications. Methods: Retrospective data query from the AORTA database for 779 patients who underwent REBOA from 2013 to 2023. Demographics, physiology, and outcomes were examined. Univariable and multivariate analyses were performed. Results: Among 779 patients who received REBOA, 22.6% (n=176) were female, and the mean age was 43.0 (+/-18.0) years. The mean Injury Severity Score (ISS) was 34.0 (±15.0). The mean admission Glasgow Coma Scale (GCS) was 8.2 (±5.3) and systolic blood pressure (SBP) at the time of aortic occlusion (AO) was 66.0 (±33.7) mmHg. Female patients were more likely to sustain blunt trauma (91.1% vs. 74.9%; p<0.001) and had marginally higher ISS (36.5 [±15.7] vs. 33.3 [±14.7]; p=0.06). Female patients had lower GCS at admission (7.3 [±5.1] vs. 8.4 [±5.3]; p=0.019). There were no significant differences in vascular complications including pseudoaneurysm, hematoma, traumatic AV fistula, or distal embolism. Acute kidney injury was more common among males (29.4% vs. 13.6%; p<0.001). Hospital length of stay did not differ significantly (15.6 [±18.3] vs. 18.7 [±24.6] days; p=0.43). There was no difference in hospital mortality (52.3% vs. 47.1%) after accounting for clinical factors in the multivariable regression model (adjusted OR 1.07; 95% CI 0.66-1.73; p=0.78). Discussion: Patients who receive REBOA are critically ill. Female patients who receive REBOA do not have significantly more access-related complications than male patients.

Vulnerability of the border area: analysis of the Traffic Accident Analysis System in Korea

2025-06-19

D. Kim , Hang Joo Cho , Sung Yub Jeong +1 more | Journal of Trauma and Injury

This study assessed patient vulnerability following traffic accidents (TAs) in Korea's border area (BA). The BA includes cities and counties directly adjacent to the demilitarized zone with North Korea. The … This study assessed patient vulnerability following traffic accidents (TAs) in Korea's border area (BA). The BA includes cities and counties directly adjacent to the demilitarized zone with North Korea. The rear area (RA) is defined as the area immediately adjacent to the BA. TA data from 2017 to 2021 were obtained from the Traffic Accident Analysis System in Korea. Information on road length, population, number of TAs, injured patients, and fatalities was collected. The number of TAs and fatalities per 1 km of road length and per 100,000 people was calculated. Severity (number of fatalities per 100 TA cases) and lethality (number of fatalities divided by the sum of fatalities and injured patients) were used to assess the vulnerability of each area. A total of 55,463 TAs were analyzed. Although the RA exhibited higher numbers of TAs and deceased patients per 1 km of road length and per 100,000 people, the BA showed significantly higher fatalities per 100,000 people as well as increased severity and lethality. The BA is more likely to be associated with death following TAs, despite a lower overall TA incidence compared to the RA. Further analysis is needed to address and mitigate this vulnerability.

Comparison of Trauma Scoring Systems for Predicting Mortality in Emergency Department Patients with Traffic-Related Multiple Trauma

2025-06-19

Murtaza Kaya , Harun Yıldırım , Mehmet Toprak +1 more | Diagnostics

Background/Objectives: Trauma scoring systems are essential tools for predicting clinical outcomes in patients with multiple injuries. This study aimed to compare the performance of various anatomical and physiological scoring systems … Background/Objectives: Trauma scoring systems are essential tools for predicting clinical outcomes in patients with multiple injuries. This study aimed to compare the performance of various anatomical and physiological scoring systems in predicting mortality among patients admitted to the emergency department following traffic accidents. Methods: In this prospective observational study, trauma patients presenting with traffic-related injuries were evaluated using seven scoring systems: ISS, NISS, AIS, GCS, RTS, TRISS, and APACHE II. Demographic data, clinical findings, and laboratory values were recorded. The prognostic performance of each score was assessed using ROC curve analysis, and diagnostic metrics including sensitivity, specificity, and likelihood ratios were calculated. Results: Among 554 patients included in the study, the overall mortality rate was 2%. The TRISS and GCS scores demonstrated the highest predictive performance, each with an AUC of 0.98, sensitivity of 100%, and specificity exceeding 93%. APACHE II followed closely with an AUC of 0.97, also achieving 100% sensitivity. NISS (AUC = 0.92) and ISS (AUC = 0.91) were effective anatomical scores, while RTS showed moderate predictive value (AUC = 0.90). Strong correlations were noted between ISS, NISS, and AIS (Rho > 0.85), while RTS was negatively correlated with these anatomical scores. All scoring systems showed statistically significant associations with mortality. Conclusions: TRISS, GCS, and APACHE II were the most effective trauma scoring systems in predicting mortality among emergency department patients. While complex models offer higher accuracy, simpler scores such as RTS and GCS remain valuable for rapid triage. The integration of both anatomical and physiological parameters may enhance early risk stratification and support timely decision-making in trauma care.

Systems of Neurotrauma HealthCare

2025-06-19

Berje Shammassian , Anthony M. DiGiorgio , Geoffrey T. Manley | Neurosurgery Clinics of North America

Task switching: Hospitalist superpower or source of safety concern during interhospital transfers?

2025-06-18

Evan Michael Shannon | Journal of Hospital Medicine

Injury Severity Scoring in the Resuscitation Room—Is Preliminary Injury Severity Score Accurate?

2025-06-18

S. M. King , Jacob Steinmetz , Søren Steemann Rudolph +2 more | Acta Anaesthesiologica Scandinavica

ABSTRACT Background The Injury Severity Score (ISS) is a commonly used trauma assessment tool. An accurately calculated ISS is fundamental when used for the classification of the injury severity of … ABSTRACT Background The Injury Severity Score (ISS) is a commonly used trauma assessment tool. An accurately calculated ISS is fundamental when used for the classification of the injury severity of trauma patients and subsequent evaluation of a trauma center's performance. This study aimed to analyze the accuracy of a preliminary ISS of trauma patients in the resuscitation room. Methods A preliminary ISS assessed by clinicians during the primary assessment of trauma patients at the Trauma Center of Rigshospitalet, Denmark in the time period January 2019–May 2024 was recorded in a trauma database and compared with definitive ISS assessed by certified Abbreviated Injury Scale (AIS) coders. Clinicians were not AIS‐certified. All trauma patients were clinically assessed by a trauma team. The primary outcome of the study was the interrater agreement of the preliminary and definitive ISS, evaluated using Cohen's Kappa and a Bland–Altman plot for visual representation. Cases with missing or invalid data were excluded. Results In total, 3623 trauma patients with preliminary and definitive ISS were registered. The majority of trauma patients were adult 2858 (79%), and male 2433 (67%). Penetrating trauma was sustained by 588 (16%) patients while 3032 (84%) suffered blunt trauma. The Cohen's Kappa between the preliminary and the definitive ISS value was 0.51 (95% CI 0.50–0.53), suggesting a moderate overall agreement. The lowest agreement was found in the subgroup of seriously (ISS 15–24) injured patients, 0.31 (95% CI 0.27–0.35). The Bland–Altman plot showed acceptable agreement, although it seemed there was an increasing difference in ISS with increasing mean ISS. No indication of other bias or systematic mistakes was identified. Conclusion This study found a moderate but overall acceptable level of agreement between preliminary and definitive ISS in trauma patients. In the most severe cases, the preliminary ISS showed a tendency to underestimate injury severity. These findings suggest that the accuracy of preliminary ISS diminishes in cases of severe trauma, highlighting the need for cautious interpretation in critically injured patients. Preliminary ISS remains a valuable tool in clinical settings for trauma severity classification.

Predicting outcomes after moderate and severe traumatic brain injury using artificial intelligence: a systematic review

2025-06-18

Armaan K. Malhotra , Husain Shakil , Christopher W. Smith +7 more | npj Digital Medicine

Methodological standards of existing clinical AI research remain poorly characterized and may partially explain the implementation gap between model development and meaningful clinical translation. This systematic review aims to identify … Methodological standards of existing clinical AI research remain poorly characterized and may partially explain the implementation gap between model development and meaningful clinical translation. This systematic review aims to identify AI-based methods to predict outcomes after moderate to severe traumatic brain injury (TBI), where prognostic uncertainty is highest. The APPRAISE-AI quantitative appraisal tool was used to evaluate methodological quality. We identified 39 studies comprising 592,323 patients with moderate to severe TBI. The weakest domains were methodological conduct (median score 35%), robustness of results (20%), and reproducibility (35%). Higher journal impact factor, larger sample size, more recent publication year and use of data collected in high-income countries were associated with higher APPRAISE-AI scores. Most models were trained or validated using patient populations from high-income countries, underscoring the lack of diverse development datasets and possible generalizability concerns applying models outside these settings. Given its recent development, the APPRAISE-AI tool requires ongoing measurement property assessment.

Socioeconomic correlates of decompressive craniectomy outcomes for pediatric traumatic brain injury: a meta-epidemiological study

2025-06-17

César E. Ramírez , Ankitha Iyer , Barbara A. Hoglund +7 more | Journal of Clinical Neuroscience

Cleared to land? A nationwide analysis of emergency care hospital and HEMS infrastructure in Germany

2025-06-17

Justus Wolff , Christian Hohenstein , Christian Karagiannidis +5 more | Scandinavian Journal of Trauma Resuscitation and Emergency Medicine

Abstract Background Healthcare systems are increasingly shifting toward specialization and centralization. As a result, distances are growing between emergency patients and suitable emergency hospitals, as well as in between hospitals … Abstract Background Healthcare systems are increasingly shifting toward specialization and centralization. As a result, distances are growing between emergency patients and suitable emergency hospitals, as well as in between hospitals for interhospital transfers. Helicopter Emergency Medical Services (HEMS) are essential in maintaining equitable access to emergency care, particularly in rural regions. However, the availability and quality of HEMS landing infrastructure at hospitals remains largely unexamined. This study provides the first nationwide integrated mapping and analysis of emergency care hospital and HEMS landing facility distribution. Methods We conducted a nationwide cross-sectional analysis of all German hospitals classified under the Emergency Care Level system (ECL I–III). Using data from hospital quality reports, government registries, and satellite imagery, we assessed the availability and type of HEMS landing facilities, categorized as certified helipads or Public Interest Sites (PIS). The study aimed to map and characterize the emergency care hospital and HEMS infrastructure, identify associated hospital and regional factors, and assess spatial access and data completeness through targeted analyses. Results Of 1,037 emergency care hospitals, 69.6% have a designated landing facility, with 44.0% of these featuring a certified helipad and 56.0% relying on PIS. A substantial proportion of hospitals (30.4%) lack any HEMS landing facility, especially in urban areas. Certified helipads are more prevalent at higher-tier emergency hospitals (ECL II and III) but no landing facility is available at 18.3% of these facilities, particularly in metropolitan regions. Hospitals in rural areas are more likely to have a HEMS landing facility. Conclusions Despite the crucial role of HEMS in emergency medical care, nearly one-third of Germany’s emergency care hospitals lack designated landing facilities, with PIS still outnumbering certified helipads. This reflects structural and regulatory shortcomings that may compromise timely access to specialized care. Enhancing national oversight, modernizing infrastructure, and adopting harmonized European standards are key measures to ensure reliable aeromedical access – and to improve patient outcomes across borders.

Intent Vs Execution

2025-06-17

Jan‐Michael Van Gent , Thomas W. Clements , Jeremy W. Cannon +5 more | Annals of Surgery

Objective(s): Evaluate the adherence to balanced resuscitation in the first 4-hours, and how whole blood (WB) affected the achievement of these ratios. Summary Background Data: In 2014, TQIP Best Practices … Objective(s): Evaluate the adherence to balanced resuscitation in the first 4-hours, and how whole blood (WB) affected the achievement of these ratios. Summary Background Data: In 2014, TQIP Best Practices recommended balanced resuscitation in a 1:1:1 (RBC:FFP:PLT) ratio. A subsequent randomized trial demonstrated a reduction in mortality with 1:1:1 in hemorrhaging trauma patients. Adoption of these recommendations and study findings have yet to be evaluated. Methods: A prospective, multicenter, observational cohort study was performed at seven academic level-1 trauma centers. Injured patients who required both blood transfusion and hemorrhage control procedures were enrolled. Primary outcome was 4-hour ratios of RBC:FFP and RBC:PLT. Patients dying in the first 60 minutes were excluded. Results: Of 1047 eligible patients, 1034 met inclusion. Overall, at 4-hours, 1:1 ratios for RBC:FFP and RBC:PLT were only achieved in 40% and 23%, respectively. Patients who achieved 1:1 for RBC:FFP (9 vs. 22%) and RBC:PLT (13 vs. 18%) at 4-hours had lower 28-day mortality rates; both P <0.05. Multivariate regression confirmed an associated reduction in mortality with achievement of 1:1 ratios of RBC:FFP (OR 0.42, 95% C.I. 0.25-0.68; P <0.001) and RBC:PLT (0.61, 95% C.I. 0.37-0.98; P =0.044). Additionally, WB was associated with an increased likelihood of achieving both RBC:FFP (OR 2.8, 95% C.I 2.14-3.62) and RBC:PLT (OR 3.4, 95% C.I. 2.55-4.62) of 1:1; both P <0.001. Conclusions: In this prospective multi-institutional study, <50% of patients were resuscitated in a balanced fashion. The use of WB was associated with increased likelihood of achieving balanced ratios. Unbalanced resuscitation was associated with decreased survival.

Comparative Analysis of Trauma Scoring Systems Across Body Regions in Polytraumatized Patients: Outcomes from Tanta University Hospitals

2025-06-17

Hédi Ben Mansour , Radwa Muhammad Ashour , Hydar Ali | Research Square (Research Square)

<title>Abstract</title> <bold>Background:</bold> Trauma remains a leading cause of morbidity and mortality, necessitating the use of trauma scoring systems to assess injury severity, guide clinical management, and predict patient outcomes. Various … <title>Abstract</title> <bold>Background:</bold> Trauma remains a leading cause of morbidity and mortality, necessitating the use of trauma scoring systems to assess injury severity, guide clinical management, and predict patient outcomes. Various trauma scoring models exist, but their accuracy in predicting mortality among polytraumatized patients remains debated. This study aimed to evaluate and compare the predictive accuracy of different trauma scoring systems in polytraumatized patients with injuries across multiple anatomical regions admitted to Tanta University Hospitals. The study further explored the correlation between trauma scores and patient outcomes, including survival and mortality. <bold>Methods:</bold> A prospective study was conducted on 300 polytrauma patients admitted between December 2024 and May 2025. Patients were evaluated using multiple trauma scoring systems, including the Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), Revised Trauma Score (RTS), Trauma and Injury Severity Score (TRISS), and Kampala Trauma Score (KTS). Physiological parameters such as heart rate, respiratory rate, blood pressure, and capillary refill time were recorded. The predictive performance of these scoring systems was assessed using regression analysis and Receiver Operating Characteristic (ROC) curve analysis. <bold>Results:</bold> The majority of the study population (79.67%) were male, with a mean age of 32.87 ± 12.06 years. Falls from heights (24%) and road traffic collisions (23%) were the leading causes of polytrauma. Among the trauma scores, TRISS (AUC = 0.99), RTS (AUC = 0.99), and Glasgow Coma Scale (GCS) (AUC = 0.99) demonstrated the highest predictive accuracy for mortality, while ISS showed poor performance (AUC = 0.18). Regression analysis confirmed that TRISS had the strongest predictive value for survival, followed by RTS and GCS, whereas ISS and KTS were less reliable predictors. <bold>Conclusion:</bold> TRISS, RTS, and GCS demonstrated the highest predictive accuracy for mortality (AUC = 0.99), whereas ISS showed limited predictive ability (AUC = 0.18). Our findings highlight the critical role of integrating physiological parameters in trauma scoring for improved clinical decision-making.

D-dimer levels at the time of admission to hospital as a predictor of outcome in trauma patients: A prospective observational study

2025-06-16

Amarjyoti Hazarika , Mandeep Kumar , Jasmina Ahluwalia +5 more | Saudi Journal of Anaesthesia

Background: Trauma causes a state of hypercoagulability, and its presence is common early in the injury course. D-dimer (DD), considered a good screening tool for coagulation activation and higher plasma … Background: Trauma causes a state of hypercoagulability, and its presence is common early in the injury course. D-dimer (DD), considered a good screening tool for coagulation activation and higher plasma levels, has been associated with unfavorable outcomes. Hence, in trauma, measuring DD levels may help provide useful prognostic information. The aim of the study was to find whether DD levels at the time of admission can predict the outcome of patients. Methods: This prospective observational studied 205 adult patients of age group 18–60 years, presenting to trauma emergency within 24 h of injury and blood samples collected within this period. The primary outcome was to assess whether DD levels at admission predicted outcome. Association of DD levels with injury severity score, with blunt or penetrating trauma, time from injury to admission, and to hospital stay were secondary outcomes. A value of DD >250 ng/ml was considered elevated. Results: The DD levels were significantly higher in patients who died than those who were discharged [2316.28 (384.5,3331.18) vs 498.03 (140,693), P = 0.001]. On receiver operating characteristic analysis, a cutoff value of 1793.35 ng/ml for serum DD was obtained with sensitivity and specificity values of 72.7% and 60.8%, respectively. The odds of death in patients were 5.87 [95% CI 1.67 to 20.51] times more when DD >1793.35 ng/ml ( P = 0.002). Conclusion: Our study demonstrates that DD levels at admission were high among nonsurvivors compared to survivors. A cutoff value of more than 1793.35 ng/ml is associated with an unfavorable outcome.

Is level 1 trauma care necessary for all severely injured older patients? Evaluating undertriage and feasibility of care in major and non-major trauma centres in the Netherlands

2025-06-16

Sara van Ameijden , Pieter Boele van Hensbroek , Doeke Boersma +3 more | European Journal of Trauma and Emergency Surgery

Abstract Purpose Undertriage remains a challenge within the severely injured older patients. The survival benefit in major trauma centres (MTCs) compared to non-major trauma centres (nMTCs) has been disputed. This … Abstract Purpose Undertriage remains a challenge within the severely injured older patients. The survival benefit in major trauma centres (MTCs) compared to non-major trauma centres (nMTCs) has been disputed. This study aimed to assess the differences in patient characteristics of severely injured older patients treated in MTCs and nMTCs and to regard whether these characteristics could be related to pre-hospital triage decisions and influence clinical outcomes in MTCs and nMTCs. Methods A retrospective cohort study was conducted, using the Dutch National Trauma Registry to identify all patients of 70 and above with an ISS ≥ 16 during 2016–2022. Patient characteristics and outcomes between MTCs, nMTCs and directly transferred patients were compared. Backward logistic regression analyses were performed to identify factors predicting mortality. Results A total of 10,899 patients were included. Patients in nMTCs harboured more octo- and nonagenarians than MTCs (44.6% vs. 37.2% and 15.1% vs. 6.7% resp., p < 0.001). The ISS was significantly lower in nMTCs (median 19 [IQR 17–25] vs. 22 [17–27], p < 0.001), with severe head injury and a low GCS being more prevalent in MTCs. High energy falls were more often observed in MTCs (15.6% vs. 7.7%, p < 0.001). Mortality was significantly lower in nMTCs (OR 0.59, 95%-CI 0.54–0.65), with a GCS 3–8 strongly associated with an increased risk for mortality in both nMTCs and MTCs (OR 19.93, p < 0.001 and OR 7.87, p < 0.001 resp.). Conclusion The differences in patients presented in MTCs and nMTCs indicate factors contributing to undertriage; severely injured older patients with recognizable injuries and trauma mechanisms are more likely to be presented in a MTC. Whether feasible care for severely injured older patients should be provided in MTCs or nMTCs should not only be dependent on ISS and mortality rates; patient-centred care goals harbouring broader perspectives as frailty and health- and quality-of-life benefit of aggressive injury treatment should also contribute in triage- and treatment decision-making. Level of evidence and study type Level III, prognostic/epidemiological.

C-reactive Protein Levels and Survival Outcomes in Traumatic Injuries: A Prospective Observational Study in Chennai, India

2025-06-16

N Natarajan , Ramakrishnan Trichur Venkatakrishnan , Ramya Ramakrishnan +3 more | Research Square (Research Square)

<title>Abstract</title> <bold>Background</bold> Traumatic injuries significantly affect the morbidity and mortality rates worldwide. This study investigated trauma severity, outcomes, and inflammatory responses at a tertiary care center in Chennai, India.<bold>Objective</bold> To … <title>Abstract</title> <bold>Background</bold> Traumatic injuries significantly affect the morbidity and mortality rates worldwide. This study investigated trauma severity, outcomes, and inflammatory responses at a tertiary care center in Chennai, India.<bold>Objective</bold> To assess the relationship between C-reactive protein (CRP) levels, trauma type, treatment, and survival outcomes, considering sex-related differences.<bold>Methods</bold> A prospective observational study of 701 patients with trauma was conducted at Sri Ramachandra Institute's Department of Emergency Medicine from July 2021 to January 2024. Demographics, CRP levels, trauma types, treatments, and outcomes were analyzed using chi-square tests and Receiver Operating Characteristic (ROC) analysis.<bold>Results</bold> The cohort included 571 males (81.5%) and 130 females (18.5%) with a mean age of 43 ± 15 years for survivors and 43 ± 13 years for non-survivors. CRP levels were significantly associated with survival outcomes across the sexes (p = 0.000). In the 0–40 mg/L CRP range, non-survivors were 50.3% male and 16% were female, while survivors were 27.8% male and 5.9% were female (p < 0.001). ROC analysis showed an Area Under the Curve (AUC) of 0.708 (95% confidence interval [CI]: 0.670–0.746, p < 0.001) for predicting survival. Better survival rates were observed with combined head, chest, and abdominal trauma, with worse outcomes in Subarachnoid Hemorrhage, Subdural Hematoma, and bone fractures. No significant sex differences were observed between the conservative and surgical treatments (p = 0.394).<bold>Conclusion</bold> This study showed the prognostic value of CRP and the impact of trauma type on survival outcomes, emphasizing the importance of comprehensive trauma assessment. Further research is needed to improve trauma care protocols.

Determinants of Code Status in Older Trauma Patients Readmitted to an ICU

2025-06-15

M Wang , Joanna Liao , Jesse P. Maupin +1 more | American Journal of Hospice and Palliative Medicine®

Context: The number of older adults experiencing traumatic injuries admitted to intensive care units is growing. Injured older adults are more likely to experience complications and unplanned ICU readmissions. There … Context: The number of older adults experiencing traumatic injuries admitted to intensive care units is growing. Injured older adults are more likely to experience complications and unplanned ICU readmissions. There is limited knowledge about the drivers of code status decisions in older adults experiencing unplanned ICU readmissions. Objectives: To examine the determinants of code status designation in older trauma patients readmitted to an ICU. Methods: This was a retrospective study of patients aged 65 and older readmitted to a Level I trauma center ICU between 2018 and 2020. Code status was examined before and after the first unplanned ICU readmission. A thematic framework was developed to classify reasons for code status designation. Results: 105 patients admitted to a trauma ICU had unplanned ICU readmission. 52.3% of patients remained full code after ICU readmission while 25.7% changed code status to DNR. The most common reason for changing code status from full code to DNR was reaching an understanding of severity of illness (55.6%). Conclusion: Over a quarter of patients changed their code status from full code to DNR after an unplanned ICU readmission. Frail older adults (Clinical Frailty Scale > 4) and patients aged 80 and older were more likely to change their code status from full code to DNR after an unplanned ICU readmission. The results highlight the importance of communication of illness severity, particularly in frail older adults aged 80 and older to guide decision making in the ICU.

Airway management in trauma patients with active hemorrhage: Does intubation location matter? A nationwide retrospective cohort study

2025-06-14

Danny Epstein , Sharon Goldman , Irina Radomislensky +6 more | The American Journal of Emergency Medicine

Uso do protocolo ABCDE para manejo de pacientes politraumatizados

2025-06-13

Amanda Martins Fagundes , Gabrielle de Jesus Paiano , Paula Camila Torres e Silva +4 more | Journal of Medical and Biosciences Research.

O trauma, resultante de forças externas intensas, é uma das principais causas de mortalidade e invalidez no mundo. Quando há lesões simultâneas em múltiplas regiões corporais, configura-se o politraumatismo, um … O trauma, resultante de forças externas intensas, é uma das principais causas de mortalidade e invalidez no mundo. Quando há lesões simultâneas em múltiplas regiões corporais, configura-se o politraumatismo, um quadro crítico que exige abordagem rápida e eficaz. As principais causas de óbito incluem hemorragias, lesões cranioencefálicas e traumas torácicos. Diante disso, o protocolo ATLS (Advanced Trauma Life Support), baseado na sequência ABCDE, orienta o atendimento sistemático a pacientes politraumatizados.O estudo utilizou revisão bibliográfica em bases científicas e obras especializadas, abordando o manejo inicial no trauma. A avaliação começa com a estabilização da coluna cervical e vias aéreas (A), seguida pela análise respiratória (B), circulação e controle de hemorragias (C), avaliação neurológica com a Escala de Coma de Glasgow (D) e, por fim, exposição completa do paciente para identificação de lesões ocultas (E), sempre com atenção ao controle térmico ambiental. A aplicação rigorosa e simultânea dessas etapas por equipes treinadas é essencial para reduzir complicações e óbitos. Conclui-se que o domínio do protocolo ATLS por profissionais de saúde, tanto no ambiente pré-hospitalar quanto intra-hospitalar, é fundamental para garantir um atendimento seguro, eficaz e capaz de salvar vidas em situações de politraumatismo.

Trauma center performance and outcome disparities in severe childhood traumatic brain injury: A Trauma Quality Improvement Program study including a causal mediation analysis

2025-06-13

Joseph H. Piatt | Journal of Trauma and Acute Care Surgery

BACKGROUND That Black children die at higher rates from traumatic injuries has been recognized for years, but race as a social construct cannot itself be a cause of death. The … BACKGROUND That Black children die at higher rates from traumatic injuries has been recognized for years, but race as a social construct cannot itself be a cause of death. The effect of race must be mediated. METHODS This observational, cross-sectional study was based on data from the Trauma Quality Improvement Program of the American College of Surgeons for the years 2014 through 2022. Severe traumatic brain injury was defined as an Abbreviated Injury Scale head score of 4 or greater. Exclusion criteria were age older than 18 years, transfer to another acute care facility, and discharge from a facility that treated 10 or fewer cases. The outcome was mortality. A probability of mortality was assigned to each case as a metric of injury severity. A ratio of observed to expected deaths was calculated as a metric of trauma center (TC) performance. Causal mediation analyses were performed to estimate the contributions of injury severity and TC performance to mortality disparities between Black and White children and between Hispanic and non-Hispanic White children. RESULTS There were 51,025 cases in the study sample. Raw mortality rates were 30.4% and 16.1% for Black and White children, respectively ( p < 0.0001), and 16.9% and 15.9% for Hispanic and non-Hispanic White children, respectively ( p = 0.0366). Injury severity mediated a 10.8% increment in the risk of mortality for Black children, and TC performance mediated another 0.4% increment. For Hispanic children, injury severity mediated a 1.2% increment in risk of mortality, and TC performance mediated a 0.4% protective effect. CONCLUSION Trauma center performance accounts for a small but highly significant increment to the mortality disparity between Black and White children with severe traumatic brain injury, but as in past work, injury severity makes a much greater contribution. LEVEL OF EVIDENCE Epidemiological; Level III.

Prognosis, risk factors, and scoring model of patients resuscitated from traumatic cardiac arrest: A multicenter observational study in Japan

2025-06-13

Narong Kulvatunyou , Natasha Keric | Journal of Trauma and Acute Care Surgery

Letter to the editor: Trauma care and its financing around the world

2025-06-13

Shailvi Gupta , Amila Ratnayake , Ian Civil | Journal of Trauma and Acute Care Surgery

Health-Related Quality of Life and Unmet Healthcare Needs in the First Year Following Moderate-to-Severe Traumatic Injuries—An Observational Study

2025-06-13

Joanna Nordhagen Selj , Paul B. Perrin , Solveig L. Hauger +7 more | Journal of Clinical Medicine

Background: Traumatic injuries often lead to long-lasting impairments and complex rehabilitation needs. Trauma patients report lower health-related quality of life (HRQoL) and increased needs for healthcare and social support. This … Background: Traumatic injuries often lead to long-lasting impairments and complex rehabilitation needs. Trauma patients report lower health-related quality of life (HRQoL) and increased needs for healthcare and social support. This study aimed to describe HRQoL trajectories in a Norwegian cohort with moderate-to-severe trauma over 12 months and assess the relationship between unmet needs and HRQoL. Methods: A multicenter prospective cohort study with follow-up at six and twelve months post-injury included adults aged 18+ with a New Injury Severity Score (NISS) > 9 and a minimum hospital stay of two days. HRQoL was assessed using the EQ-5D-5L. Needs and unmet needs were evaluated using the Needs and Provision Complexity Scale. Hierarchical linear modeling (HLM) examined predictors of HRQoL trajectories. Results: Of 538 participants, 83% were followed up at six and/or twelve months. Mean age was 52 years, falls were the most common cause of injury (44%), and 76% had a severe injury (NISS > 15). HRQoL remained stable, except for improvements in usual activities and anxiety-depression domains. HLM showed that older age (b = −2.698), longer hospital stay (b = −4.108), and unmet healthcare (b = −1.094) and social support needs (b = −3.132) were associated with worse HRQoL over time. Unmet personal care needs were linked to improved HRQoL (b = 2.654). The only significant predictor*time interaction was between unmet healthcare needs and overall HRQoL. Conclusions: HRQoL largely remained stable, with improvements in some domains. Unmet healthcare needs predicted a decline in HRQoL, highlighting the importance of timely support and targeted interventions from health professionals.

Loss of Non-Tangible Resources and Posttraumatic Growth among Survivors of the Solai Dam Disaster, Nakuru County, Kenya

2025-06-12

George Manono ARERI , Rose Otieno , Billiah Gisore | Kabarak journal of research and innovation.

Kenya frequently experiences disasters that are often accompanied by profound mental health impacts. Existing literature primarily focuses on the negative psychological outcomes of such events, with limited attention to the … Kenya frequently experiences disasters that are often accompanied by profound mental health impacts. Existing literature primarily focuses on the negative psychological outcomes of such events, with limited attention to the potential for posttraumatic growth (PTG) among survivors. This study investigated PTG among survivors of the Solai dam disaster in Nakuru County, Kenya, aiming to establish the relationship between demographic characteristics, the loss of non-tangible resources, and the extent of PTG. The study targeted adult survivors from the 223 most affected households, with a purposive sample of 80 respondents. A mixed-methods approach was employed. Quantitative data were collected using the Posttraumatic Growth Inventory–Expanded (PTGI-X) and the Loss of Resources (LOR) scale, while qualitative data were obtained through interviews. Quantitative data were analyzed using SPSS, with descriptive and inferential statistics, including chi-square analysis. Thematic analysis was used for qualitative data. Findings revealed that a majority of participants (83.8%) reported experiencing high levels of PTG. There was a statistically significant association between the extent of loss of non-tangible resources and the level of PTG (χ² = 31.441, p = 0.000), indicating that loss of such resources was positively associated with growth outcomes. These results underscore the importance of not only addressing trauma but also recognizing and supporting growth potential in disaster recovery. The study highlights the need for sustained mental health interventions and proposes the integration of PTG-focused strategies into psychosocial support programs for disaster survivors in Kenya.

In-hospital complications among trauma admissions in a health region of New Zealand

2025-06-12

Sheena Moosa , Alastair D. Smith , Ishani Soysa +1 more | Trauma

Introduction Trauma patients are at higher risk of complication than general acute admissions. Understanding the complications associated with trauma care can provide insights into avoidable morbidity and guide quality improvement … Introduction Trauma patients are at higher risk of complication than general acute admissions. Understanding the complications associated with trauma care can provide insights into avoidable morbidity and guide quality improvement activities. This study aims to quantify the volume and prevalence of complications affecting trauma admissions in one of the four health regions of New Zealand (NZ). Methods A retrospective, observational study utilised data from the Te Manawa Taki Trauma Registry (TMTTR) to identify individuals who were hospitalised in the region due to injuries from 2015 to 2023. Data from the TMTTR was linked with the New Zealand National Minimum Dataset (NMDS) that contains in-hospital complications records mapping across multiple fields, including the patient's unique identifier, facility name and admission and complication episode date field elements. This investigation focuses on the epidemiological parameters of complications in trauma admissions. Results During 2015–2023, a total of 3294 trauma admissions of all severities to Te Manawa Taki facilities involved one or more hospital-acquired complications, representing 6.2% of the total 52,899 admissions. The volume of complications in non-major trauma patients is 2.3 times that of major trauma. Complications were associated with increasing age, female gender and non-Māori ethnicity ( p < 0.01). Acute kidney failure, urinary tract infections and pneumonia are the top three complication irrespective of severity. Admissions with complications have a significantly higher mean hospital Length Of Stay (LOS) 13.6 days compared to 3.8 days for those without complications ( t = 76.6, p < 0.001). Conclusion Analysis of complications in trauma admissions has shown important variation in demographic characteristics and types of complications that may be amenable to mitigation and reduction of the impact on patients and the health system. This study has set the scene for further investigation into the clinical, in-hospital, socio-demographic and pre-existing health status factors that increase the risk of complications in trauma admissions.

Comparison of machine learning and human prediction to identify trauma patients in need of hemorrhage control resuscitation (ShockMatrix study): a prospective observational study

2025-06-12

Tobias Gauss , Arthur James , Clélia Colas +7 more | The Lancet Regional Health - Europe

Shock index combined with age and the Glasgow Coma Scale during the initial care of polytraumatized patients as a predictor of mortality.

2021-12-01

Victoria Juárez San Juan , Paula Juárez San Juan , Sara Castillo Acosta +3 more

To study whether combining age and the Glasgow Coma Scale (GCS) with the shock index (SI) - SIA/G - during the initial care of polytraumatized patients can improve the ability … To study whether combining age and the Glasgow Coma Scale (GCS) with the shock index (SI) - SIA/G - during the initial care of polytraumatized patients can improve the ability of the SI alone to predict mortality. To compare the predictive performance of the SIA/G combination to other prognostic scales: the addition of points for the GCS, age and systolic blood pressure (GAP); the Revised Trauma Score (RTS); and the Injury Severity Score (ISS).Observational cohort study of patients with severe trauma admitted to the intensive care unit of a tertiary care hospital between 2015 and 2020. We calculated the SI (heart rate/systolic blood pressure), the SI/G ratio, the product of the SI and age SIA, and the combined index: SIA/G. The areas under the receiver operating characteristic curves (AUROCs) for hospital mortality and 24-hour mortality were calculated for the SIA/G combination and compared to the AUROCs for the GAP, the RTS, and the ISS.We analyzed data for 433 patients, 47 of whom (10.9%) died. All the prognostic indexes were significantly related to mortality but the SIA/G was the best predictor of both hospital and 24-hour mortality, with AUROCs of 0.879 (95% CI, 0.83-0.93) and 0.875 (95% CI, 0.82-0.93), respectively. A score of 3.3 for the SIA/G showed 82% sensitivity and 80% specificity for hospital mortality (86% and 78%, respectively, for 24-hour mortality). The AUROCs for the GAP, RTS, and ISS indexes were lower for hospital mortality.The combined SIA/G score is a better predictor in hospital of mortality in patients with multiple injuries than the SI or the traditional GAP, RTS, and ISS indexes.Estudiar si la edad y la puntuación Glasgow Coma Score (GCS) incrementan la predicción de mortalidad del Shock Index (SI) en la atención inicial del paciente politraumatizado y compararlo con las escalas pronósticas, GAP (Glasgow Coma Score-Age-Systolic Blood Pressure), RTS (Revised Trauma Score) e ISS (Injury Severity Score).Estudio observacional sobre una cohorte de pacientes de la unidad de cuidados críticos de un hospital de tercer nivel con diagnóstico de trauma grave entre 2015 y 2020. Se recogió el SI (FC/TAS) y el SI asociado al GCS (SI/G), a la edad (SIA) y a ambos (SIA/G). Se calculó el área bajo la curva (ABC) de la característica operativa del receptor (COR) para cada uno de ellos para la mortalidad hospitalaria (MH) y en las primeras 24 horas (M24). También se comparó el ABC COR del SIA/G con las de las escalas GAP, RTS e ISS.Se analizaron 433 pacientes de los cuales fallecieron 47 (10,9%). Todos los SI se relacionaron significativamente con la mortalidad, pero el SIA/G presentó la mayor ABC COR para MH (0,879, IC 95% 0,83-0,93) y para M24 (0,875, IC 95% 0,82-0,93). El valor SIA/G de 3,3 puntos mostró una sensibilidad del 82% y especificidad del 80% para MH y del 86% y 78% para M24. El ABC COR del SIA/G para la MH fue superior a las de las escalas GAP, RTS e ISS.SIA/G es superior al SI y a las escalas clásicas GAP, RTS e ISS como predictor de MH del paciente politraumatizado.