Value of ocular trauma score and ocular structural parameters in the assessment of healing visual acuity from ocular trauma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the value of ocular trauma score(OTS), initial visual acuity, and ocular structural parameters in the assessment of healing visual acuity from ocular trauma.METHOD: A total of 302 cases(302 eyes)of ocular trauma were selected as subjects, which were accepted and issued clear appraisal opinions by the Academy of Forensic Science from June 2015 to June 2021. The subjects were grouped according to the healing best corrected visual acuity(BCVA)from ocular trauma. Group Ⅰ included 63 cases(63 eyes)with BCVA <3.7; Group Ⅱ included 70 cases(70 eyes)with 3.7≤ BCVA <4.5; Group Ⅲ included 78 cases(78 eyes)with 4.5≤ BCVA <4.9; Group Ⅳ included 91 cases(91 eyes)with BCVA≥4.9. In addition, 77 cases(77 healthy eyes)of ocular trauma were selected as the control group, namely Group Ⅴ. The healing BCVA and ocular structural parameters from ocular trauma and theirs correlation were analyzed, and the random forest(RF)and support vector machine(SVM)model of healing visual acuity was established by the IBM SPSS Modeler 18.0.RESULTS: The initial visual acuity, OTS, the grading of corneas, lenses, and fundus, and the thickness of the retinal never fiber layer of ocular trauma patients were correlated with the healing BCVA(P<0.01). There were significant differences in ocular structural parameters among groups, except the central subfield thickness(P<0.001). The SVM model had higher accuracy of predicting healing visual acuity than the RF model, and the accuracy rate was over 80% when the error was within 0.15.CONCLUSION:OTS and ocular structural examination can provide effective information for the clinical forensic medicine appraisal of visual dysfunction after ocular trauma, and they are valuable in discriminating camouflage of visual dysfunction.

New model for the prediction of visual outcomes in young children with mechanical ocular conditions and comparison with other models

Purpose: Herein, we compared the efficacy among the Ocular Trauma Score (OTS), Toddlers Ocular Trauma Score (TOTS), and Pediatric Ocular Trauma Score (POTS) for prognosis prediction in Indian children who had mechanical ocular conditions causing traumatic cataract. Methods: This prospective, interventional study recruited consecutive children undergoing operation for traumatic cataracts caused by mechanical eye injuries at Drashti Netralaya. The following details were obtained from their medical files: the circumstance and time of injuries, penetrating injury type, initial and final visual acuity (VA), time of operation, and associated eye diseases. Specific variables were employed to determine the OTS, TOTS, and POTS. For all patients, the final and predicted VA determined using all scores were compared using Fischer’s exact test. Accuracy, specificity, and sensitivity were evaluated for all the scores by using the area under receiver operating characteristic curve. Results: We enrolled 124 eyes. Patients’ mean value for age was 4.6 ± 1.29 years; 44 (35.41%) and 74 (64.5%) were female and male patients, respectively. Visual outcomes significantly improved after operation, and the outcomes did not differ between closed? and open?globe injuries (P = 0.162). The actual and predicted VA did not exhibit a statistically significant difference among the three scores. TOTS and POTS were more suitable for evaluating low?risk injuries, whereas the OTS could more efficiently examine high?risk cases. Conclusion: TOTS and POTS were more accurate than the OTS in VA prediction after operation in toddlers with traumatic cataracts caused by mechanical globe injury. TOTS and POTS were more suitable for evaluating low?risk injuries, whereas the OTS could more efficiently examine high?risk cases. All the examined scores can be helpful in estimating VA following treatment

Analysis of 74 Open Globe Injuries Requiring Vitreo-Retinal Intervention and Its Correlation with Ocular Trauma Score

Aim: Retrospective study of 74 eyes with open globe injuries requiring V-R Intervention & its correlation with ocular trauma score.Results: Commonest cause of injury: Hammer-chisel/stone in 32.43% (24) & Thorn/wooden stick 27% (20). Average age-30.5yrs. Average interval between trauma & intervention was -10.04days (4hrs – 52days).Discussion: Delay of presentation to ophthalmologist has lot of significance,high incidence of endophthalmitis & retinal detachment compared to other studies. Surgical outcome shows lower incidence of NO Light Perception & Significant reduction in number of cases with </=HM. Patients had better prognosis & visual outcome, higher incidence of 1/200- 20/50; 35.14% cases with >20/200. 60% of our cases had traumatic cataract, visual acuity may be underestimated in traumatic cataract. Faulty Projection of rays probably would be better criteria than RAPD. Extension of wound beyond pars plana, and aniridia (6.7%) are important risk factor.Conclusion: Modification of raw points is recommended in OTS criteria in Indian scenario.

Efectividad del Ocular Trauma Score en la predicción de los resultados visuales en pacientes con catarata traumática / Effectiveness of the Ocular Trauma Score to predict visual outcomes in traumatic cataract patients

Objetivo: Evaluar la efectividad del Ocular Trauma Score como factor pronóstico de la agudeza visual final en pacientes con diagnóstico de catarata traumática. Métodos: Se realizó un estudio descriptivo, longitudinal y de evaluación de un sistema pronóstico en una serie de 61 casos. Los pacientes fueron divididos en dos grupos de acuerdo con el mecanismo del trauma. Se estudió la relación entre la agudeza visual a los tres meses después de la cirugía de catarata y las variables demográficas y clínicas. El resultado visual se predijo mediante el Ocular Trauma Score y se comparó con el obtenido. Resultados: La mediana de la edad de los pacientes estudiados fue de 52,8 (RI: 44,0-63,0) años. Los pacientes con antecedentes de trauma abierto tendieron a ser más jóvenes: 50,5 (RI: 43,0-54,0) años de edad vs. 57,0 (RI: 45,5-65,5) años. Predominaron los pacientes del sexo masculino (85,2 por ciento) y de baja escolaridad (55,7 por ciento). Se observó mejoría de la agudeza visual mejor corregida después de la cirugía, en particular en los pacientes con trauma cerrado. El Ocular Trauma Score pronosticó adecuadamente para agudeza visual de 20/40 o más. Conclusiones: Se logran buenos resultados con el uso del Ocular Trauma Score como factor pronóstico de la agudeza visual en pacientes con diagnóstico de catarata traumática(AU)

Objective: Evaluate the effectiveness of the Ocular Trauma Score as a prognostic factor for final visual acuity in patients diagnosed with traumatic cataract. Methods: A descriptive longitudinal evaluative study was conducted of a prognostic system in a series of 61 cases. The patients were divided into two groups according to the trauma mechanism. An analysis was performed of the relationship between visual acuity three months after cataract surgery and clinical and demographic variables. Visual outcome was predicted with the Ocular Trauma Score and then compared with the result obtained. Results: Mean age of the patients studied was 52.8 (IR 44.0-63.0) years. Patients with a history of open trauma tended to be younger: 50.5 (IR: 43.0-54.0) years vs. 57.0 (IR: 45.5-65.5) years. A predominance was found of male sex (85.2 percent) and a low educational level (55.7percent. Best corrected visual acuity was found to improve after surgery, particularly in patients with closed trauma. The Ocular Trauma Score predicted appropriately for visual acuity values of 20/40 or higher. Conclusions: Good results are obtained with the use of the Ocular Trauma Score as a prognostic factor for visual acuity in patients diagnosed with traumatic cataract(AU)

Risk factors of hemothorax after rib fracture / 中华创伤杂志

Objective:To explore the risk factors of hemothorax after rib fracture and evaluate its predictive value for hemothorax.Methods:A retrospective case control study was made on the data of 449 patients with rib fracture admitted to Jiangsu Shengze Hospital affiliated to Nanjing Medical University from January 2018 to November 2019. There were 308 males and 141 females，with the age range of 19-97 years［（57.4±14.0）years］. The hemothorax was defined as pleural effusion on chest CT or X examination on admission or within one week after admission. There were 330 patients in hemothorax group and 119 patients in non-hemothorax group. Indices were compared between the two groups，including gender，age，occupation，weight，height，underlying diseases［diabetes，chronic obstructive pulmonary disease（COPD），hypertension，hyperlipidemia］，causes of injury，imaging findings［number of rib fracture，flail chest，bilateral rib fractures，locations of rib fracture and intramural injuries（pneumothorax，pulmonary contusion，mediastinal emphysema and myocardial contusion）］，thoracic cavity drainage，injury to admission time，vital signs（blood pressure and heart rate），routine blood［white blood cell，hemoglobin（Hb），platelet，hematocrit（Hct）］，blood type，urine routine（urinary occult blood，urinary protein，urinary ketone body），biochemical examination［total cholesterol（TCHO），triglyceride（TG），high density lipoprotein（HDL-C），low-density lipoprotein（LDL-C），albumin（ALB），total bilirubin（TBIL），glutamic oxalacetic transaminase（AST），alanine transaminase（ALT），urea nitrogen（BUN），creatinine（CRE），glycosylated hemoglobin（HbA1C）］，coagulation tests［prothrombin time（PT），fibrinogen（FIB），plasma D-dimer（D-D），thrombin time（TT）］after admission，trauma score［chest wall injury score（CIS），injury severity score（ISS），new injury severity score（NISS）］and length of hospital stay. The univariate analysis was used to observe the correlation between each factor and hemothorax after rib fracture and to screen the significant correlation factors，followed by multivariate logistic regression analysis to further identify the independent risk factors. The receiver operating characteristic（ROC）curve was used to analyze the predictive value of continuous variables in independent risk factors and to calcuate the optimal threshold.Results:The two groups showed no significant differences in gender，occupation，weight，height，diabetes，COPD，hyperlipidemia，injury to admission time，blood pressure，heart rate，platelet，urine protein，urine ketone body，TCHO，HDL-C，TBIL，ALT，CRE，HbA1C or PT（ P>0.05）. The hemothorax group showed significantly decreased Hb，Hct，TG，LDL-C and TT and significantly increased age，number of rib fracture，white blood cell count，AST，FIB，D-D，trauma score（CIS，ISS，NISS）and length of hospital stay when compared to non-hemothorax group（ P<0.05）. There were significant differences in hypertension，causes of injury，flail chest，bilateral rib fractures and locations of rib fracture and urinary occult blood between the two groups（ P<0.05）. The univariate analysis showed that age，hypertension，number of rib fractures，flail chest，bilateral rib fractures，locations of rib fracture（upper chest anterolateral segment，middle chest anterolateral segment，middle chest posterolateral segment，middle chest proximal spinal segment，lower chest posterolateral segment，lower chest proximal spinal segment），pneumothorax，pulmonary contusion，myocardial contusion，thoracic cavity drainage，white blood cell count，urinary occult blood，BUN，FIB，trauma score（CIS，ISS，NISS）and length of hospital stay were significantly associated with hemothorax（ P<0.05）. The multivariate Logistic regression analysis showed that locations of rib fracture（including middle chest posterolateral segment，middle chest proximal spinal segment，lower chest posterolateral segment and lower chest proximal spinal segment），pulmonary contusion，thoracic cavity drainage，BUN and trauma score（CIS，ISS，NISS）were significantly associated with hemothorax after rib fracture（ P<0.05）. The ROC curve analysis of continous variables in independent risk factors showed BUN area under the curve（AUC）of 0.587（95% CI 0.529-0.645），CIS AUC of 0.824（95% CI 0.779-0.870），ISS AUC of 0.789（95% CI 0.739-0.840）and NISS AUC of 0.876（95% CI 0.835-0.917）（ P<0.05），and the optimal thresholds for the above variables were 5.0 mmol/L，2.5 points，15 points and 21.5 points，respectively. Conclusion:Locations of rib fracture（including the middle chest posterolateral segment，middle chest proximal spinal segment，lower chest posterolateral segment，lower chest proximal spinal segment），pulmonary contusion，thoracic cavity drainage，BUN，trauma score（CIS，ISS，NISS）are independent risk factors for hemothorax after rib fracture. BUN>5.0 mmol/L and trauma score（CIS>2.5 points，ISS>15 points，NISS>21.5 points）have significant values in predicting hemothorax.

El trauma ocular en la infancia / Ocular trauma in childhood

RESUMEN Objetivo: Determinar los resultados de la aplicación del ocular trauma score como herramienta de pronóstico visual en traumatismos. Métodos: Se realizó un estudio descriptivo longitudinal retrospectivo en el Servicio de Oftalmología del Hospital Pediátrico Provincial Docente "Eduardo Agramonte Piña", desde enero del año 2011 a enero de 2016. El universo estuvo conformado por 438 pacientes quienes recibieron ingreso hospitalario, y la muestra quedó conformada por 357 ojos de 356 pacientes con el diagnóstico de trauma ocular. Se analizaron las siguientes variables: etiología al ingreso, edad, sexo, topografía y tipo de lesión, evento traumático, agente causal, agudeza visual inicial según tipo de lesión y el pronóstico visual según el ocular trauma score. Resultados: El 81,3 por ciento de los pacientes ingresados presentaron etiología traumática; 64,6 por ciento fueron varones, con predominio del grupo de edad entre 5 y 9 años. Hubo una preponderancia de los traumas cerrados. Los accidentes recreativos fueron los más predominantes; los palos y las piedras resultaron el agente causal más frecuente y la agudeza visual final fue superior a la inicial. Conclusiones: La etiología traumática constituye la primera causa de ingreso en el Servicio de Oftalmología, donde se observa predominio de los pacientes entre 5 y 9 años, fundamentalmente del sexo masculino. Los traumas del globo ocular cerrado predominan sobre los del globo ocular abierto. Estos últimos presentan mayor afectación de la agudeza visual. El accidente recreativo y doméstico es más frecuente, así como los palos y las piedras como agentes causales. La mejoría de la agudeza visual fue significativa en este estudio, lo que se correspondió con la predicción sugerida por el ocular trauma score(AU)

ABSTRACT Objective: To determine the results of the application of the ocular trauma score as a tool for visual prognosis in traumatisms. Methods: Descriptive, longitudinal and retrospective study was carried out. The universe consisted of 438 patients who received hospital admission and the sample consisted of 357 eyes of 356 patients with the diagnosis of ocular trauma at admission. Different variables were analyzed: etiology at admission, age, sex, topography and type of injury, traumatic event, causal agent, initial visual acuity according to type of injury and visual prognosis according to ocular trauma score. Results: 81,3 percent of the patients admitted had traumatic etiology, 64.6 percent were males with predominance of the group aged between 5 and 9 years. There was a preponderance of closed traumas. The sticks and stones were the most frequent causal agent and the final visual acuity was superior to the initial one. Conclusions: The traumatic etiology is the first cause of admission in the Ophthalmology Service, where predominance is observed between 5 to 9 years, mainly of the male sex. The traumas to closed ocular globe predominate over those of open ocular globe presenting these last greater affectation of the visual acuity. The recreational and domestic accident is more frequent, as well as the sticks and stones as causal agents. The improvement in visual acuity is significant, corresponding with the prediction suggested by ocular trauma score(AU)

Initial Prealbumin Level And Ability To Normalize Prealbumin Are Highly Predictive Of Increased Mortality And Morbidity In Elderly Trauma Patients

Prealbumin is a well characterized indicator of nutritional status more recently found to be an inverse inammatory marker. At our urban level 1 trauma center, we sought to study the relationship between malnutrition and outcomes in elderly trauma patients. Using prealbumin as a surrogate marker for nutritional status, we hypothesized that patients with reduced prealbumin on initial evaluation have worse outcomes, and in patients where initial prealbumin that was reduced, ability to correct is associated with improved outcomes. We performed a retrospective cohort study involving 200 consecutive patients over the age of 65 admitted to our trauma service. Based on initial prealbumin, patients were divided into 3 groups - below 5 mg/dL, 5-10 mg/dLand greater than 10 mg/dL. Prealbumin was then re-assessed 4 days after admission and patients were again divided into 2 groups based on ability to normalize prealbumin. Data obtained included age, gender, revised trauma score (RTS), injury severity score (ISS), days on a ventilator, ICU length of stay (ICU-LOS), hospital length of stay (HLOS), survival, initial prealbumin, and ability to correct prealbumin within 4 days after admission. Of the 200 patients enrolled, patients were divided into 3 groups using initial prealbumin - 71 patients below 5 mg/dL, 101 patients 5-10 mg/dL, and 28 patients greater than 10 mg/dL. There were 180 patients who were hospitalized for over a 4 day period. Normalization of prealbumin was achieved in 128 patients while 52 patients did not. Mean age was 79.2 years. RTS was found to be decreased in patients with initial prealbumin below 5 mg/dLin comparison to the other groups (11.3 vs. 11.8 vs. 11.8, p = 0.0002), with greater ISS (25.1 vs. 18.8 vs. 19.7, p < 0.0001), ICU LOS (days) (11.3 vs. 3.9 vs. 3.0, p < 0.0001), ventilator days (7.9 vs. 0.8 vs. 0.1, p < 0.0001), HLOS (days) (17.4 vs 7.8 vs. 7.1, p < 0.0001) and decreased survival (66% vs. 95% vs. 100%, p < 0.0001). Patients with prealbumin corrected within 4 days had lower ISS (19.9 vs. 29.2, p < 0.0001), as well as reduction in ventilator days (0.9 vs. 10.1, p < 0.0001), ICU LOS (days) (4.2 vs. 13.8, p < 0.0001), HLOS (days) (8.3 vs. 21.3, p < 0.0001) and improved survival (94% vs. 63%, p < 0.0001). Prealbumin is able to provide short term information regarding current nutritional status and response to therapy. Recent evidence suggest prealbumin may be a prognostic indicator for risk of malnutrition and inammation in critically ill trauma patients. In management of critically ill trauma patients, prealbumin can provide a valuable clinical indication of response to therapeutic intervention and potentially guide management strategy.

Pediatric traumatic scores / 中国小儿急救医学

Trauma is one of the leading causes of death and disability in children and adolescents. The children with multiple injuries have complicated and varied conditions. This article reviewed the traumatic scores of multiple trauma in pediatric patients. There are many kinds of trauma scores in children,each with advantages and disadvantages,but no trauma scores can meet all clinical and scientific requirements. The current injury severity score is the most widely used in-hospital scoring system. The child trauma score is the easiest pre-hospital scoring system. The BIG score is an emerging simple and easy scoring system. It is recommended that multiple assessments of multiple injuries in children should be repeated and combination of multiple scores are used.

Application of trauma scoring in thoracic trauma / 解放军医学杂志

[Abstract] It is the key to assess the severity of trauma early and accurately for the successful treatment of thoracic trauma. Thoracic trauma scoring is a method of using digital quantitative scoring to record the severity, characteristics, outcome and prognosis of thoracic trauma in a quantitative or semi-quantitative way. The purpose of scoring is to evaluate the severity of trauma, select the optimal treatment means, improve the prognosis and thereby improve the survival rate of patients. This article mainly introduces the methodology, application scope, clinical application status of seven civilian thoracic trauma scoring systems(thoracic organ injury scaling, blast lung injury severity score, penetrating thoracic trauma index, penetrating thoracic trauma course score, rib fracture scoring, rib score, thoracic trauma severity), and the present situation, characteristics and differences between the scores of modern war chest trauma and those of peacetime chest trauma, and puts forward the future exploration direction of thoracic trauma scoring on the battlefield.

Utilidad del puntaje del trauma ocular como herramienta de pronóstico visual en la cirugía de catarata traumática / Usefulness of the ocular trauma score as a visual prognostic tool in traumatic cataract surgery

Objetivo: determinar la utilidad y la aplicabilidad del puntaje de trauma ocular para predecir los resultados visuales en la cirugía de catarata. Métodos: se realizó un estudio descriptivo, longitudinal y retrospectivo en 124 pacientes con catarata traumática, operados en el Centro de Microcirugía Ocular en el período comprendido entre enero del año 2010 y diciembre de 2015, quienes fueron subdivididos en dos grupos según el tipo de trauma ocular previo. Se evaluó cada paciente inicialmente con el ocular trauma score y se analizó, como variable dependiente, la agudeza visual final tras 3 meses de seguimiento. Se comparó con su valor inicial categorizado y estratificado según el ocular trauma score. En todas las pruebas estadísticas inferenciales se empleó el nivel de significación 0,05, a excepción de las pruebas de Kolmogorov-Smirnov y Levene, donde p debía ser mayor de 0,05. El análisis estadístico se sustentó en tablas y gráficos. Resultados: la incidencia de las cirugías traumáticas fue de 12,0 operaciones x cada 1 000 operaciones de catarata. Predominaron los pacientes con antecedentes de un trauma ocular cerrado (61,3 por ciento) y del sexo masculino (73,4 por ciento) con un promedio de edad de 56,4/15,2 años. La agudeza visual fue de 20/40 o mejor en el 76,6 por ciento de los casos. Los factores predictores fueron: tipo de trauma, desprendimiento de retina, vitrectomía par plana y elevación de la presión intraocular. Conclusiones: El ocular trauma score muestra utilidad para identificar aquellos pacientes que alcanzan una agudeza visual de 20/60 o mayor

Objective: determine the usefulness and applicability of the ocular trauma score to predict visual results in cataract surgery. Methods: a retrospective longitudinal descriptive study was conducted of 124 traumatic cataract patients operated on at the Center for Ocular Microsurgery from January 2010 to December 2015. The patients were divided into two groups according to the type of previous ocular trauma. Each patient was initially evaluated with the ocular trauma score. The dependent variable was final visual acuity after three months of follow-up, which was compared with its initial value as categorized and stratified according to the ocular trauma score. All inferential statistical tests used a significance level of 0.05, except for Kolmogorov-Smirnov's and Levene's tests, where p should be above 0.05. The statistical analysis was supported by tables and charts. Results: the incidence of traumatic surgery was 12.0 operations per 1 000 cataract operations. A predominance was found of patients with a history of closed ocular trauma (61.3 percent) and male sex (73.4 percent). Mean age was 56.4/15.2 years. Visual acuity was 20/40 or better in 76.6 percent of the cases. The predictors were trauma type, retinal detachment, pars plana vitrectomy and intraocular pressure elevation. Conclusions: the ocular trauma score was found to be useful to identify patients who will have visual acuity values of 20/60 or higher(AU)

The Relationship between Visual Outcome and Ocular Trauma Score after Open Globe Injuries in Children

PURPOSE: We evaluated the prognostic factors of open globe injuries in children and adolescents, and compared the ocular trauma score (OTS) and pediatric penetrating ocular trauma score (POTS). METHODS: We performed a retrospective review of 77 children under 18 years of age who visited our clinic with open globe injuries between May 1993 and April 2014. We investigated the factors that may affect final visual acuity. We also compared the OTS and POTS using receiver operating characteristic curves as a method to predict final visual acuity. RESULTS: By univariate analysis, an initial visual acuity less than 20/200, globe rupture, wound size greater than 7.0 mm, retinal detachment, lens dislocation, and total number of operations contributed to worse visual outcomes (<20/200). Conversely, central corneal involvement, traumatic cataract, wound size less than 7.0 mm, and initial visual acuity greater than 20/200 were better prognostic indicators (≥20/32). Both OTS and POTS had diagnostic value as a predictor of final visual acuity, although there were no statistically significant differences between the two scoring systems. CONCLUSIONS: Initial visual acuity and wound size are important prognostic factors for the final visual acuity in children and adolescent, following open globe injuries. Both OTS and POTS are reliable prognostic models for open globe injuries in children and adolescents.

Effectiveness and prognosis of 23G vitrectomy for perforating ocular trauma caused by metallic foreign bodies / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To summarize the characteristics of ocular perforation caused by metallic foreign body, evaluate the effectiveness and safety of 23G vitrectomy, and analyze the factors that affect the final vision of patients with ocular trauma score. <p>METHODS: Continuous observation and analysis from July 1, 2014 to June 1, 2016, hospitalized in our hospital caused by metallic perforating ocular trauma for 23G vitrectomy in 38 cases(38 eyes). A prospective collection of patient included age, gender, eye, place of occurance of trauma, foreign body size, wound length, foreign body position, initial visual acuity and final visual acuity, macular etc.. The ocular trauma score(OTS)system was used to assess the effectiveness and prognosis of the patients. The follow-up time was over 6mo. <p>RESULTS: There were 38 eyes in 38 patients, including 37 males and 1 females, aged 16y-56y. Ocular trauma mainly occurred in the workplace, 33 cases accounted for 87%, followed by sports venues, 3 cases accounting for 8%. Corrected visual acuity more than 0.1 in eyes with intraocular foreign bodies underwent 23G vitrectomy were 21 cases, accounting for 55%. Preoperative retinal detachment, large foreign body(more than 5.0mm), damage of lens were important factors of poor prognosis. Foreign bodies were located in the vitreous body in 23 cases, accounting for 61%, located in the retina in 15 cases, accounting for 39%. When admitted to hospital, the patients suffered from retinal detachment in 21 cases(55%), endophthalmitis in 7 cases(18%), the size of intraocular foreign bodies(IFOB)was larger than 5.0mm in 7 cases(18%), severe postoperative proliferative vitreoretinopathy(PVR)was in 6 cases(16%), epiretinal membrance of macula in 5 cases(13%). Of the same OTS scores, visual acuity in 6mo was significantly better than preoperative; no matter preoperative vision or postoperative vision in 6mo, the higher the OTS scores, the better the visual acuity. <p>CONCLUSION: The ocular perforation caused by metallic foreign body mostly occurs in young men under 40y, and the main reason is injury in the workplace. No protective measures are adopted. The main factors affecting the final visual acuity are retinal detachment, foreign body greater than 5.0mm and postoperative PVR appearance after the injury, vitrectomy time has little effect. The 23G vitrectomy is safe, reliable and effective in the treatment of ocular penetrating injuries due to metallic foreign bodies. OTS score can be used effectively in patients with ocular perforation caused by metallic foreign bodies and make reasonable and useful postoperative visual acuity prediction.

Therapeutic effects of different doses of methylprednisolone on smoke inhalation-induced acute lung injury in rats / 中华危重病急救医学

Objective To investigate the therapeutic effect of different doses of methylprednisolone (MP) in smoke inhalation-induced acute lung injury (SI-ALI).Methods Adult male Sprague-Dawley (SD) rats were divided into control group (group A,n = 6), smoke inhalation group (group B, smoke inhalation 30 minutes,n = 30) and smoke+MP 40, 4, 0.4 mg/kg intervention group (groups C, D, E; intraperitoneal injection of MP at 1 hour before smoke inhalation, n = 30) according to random number table method. The survival status of rats in each group was observed at 24 hours, and murine smoke inhalation induced trauma score (MSITS) according to the symptoms and signs of rats at 3 hours after smoke inhalation were scored. The blood of abdominal aorta of rats was collected. Then the rats were sacrificed to harvest bronchoalveolar lavage fluid (BALF) and lung tissue. The levels of interleukin (IL-6, IL-17a) in plasma and BALF were detected by enzyme linked immunosorbent assay (ELISA); the total number of white blood cells and the proportion of leukocytes or macrophages in BALF were calculated; the histopathological changes of lung were observed and the lung injury score was given; the expression of myeloperoxidase (MPO) and high mobility group protein B1 (HMGB1) in lung tissue were detected by Western Blot.Results The 24-hour survival rate of group B rats was 33.67％. The survivalrate of groups C, D and E (65.73％, 85.17％, 60.07％) were significantly higher than that of group B (allP < 0.05), and the survival rate of group D was significantly higher than that of groups C and E. Diffuse inflammatory cell infiltration, intra-alveolar hemorrhage and a large amount of edema fluid were seen in the lung tissue of group B; and the lung injury score was significantly higher than that of group A. Compared with group B, the lung injury in different doses of MP group were decreased to different degrees, while the lung injury scores in groups C and D were significantly decreased (3.31±1.37, 2.62±0.98 vs. 5.52±0.97, bothP < 0.01); correlation analysis showed that MSITS score was significantly and positively correlated with lung injury score (r = 0.862,P < 0.001). The levels of plasma inflammatory factors and BALF protein, inflammatory cells and inflammatory factors, and the expression of MPO, HMGB1 in group B were significantly higher than those in group A. Compared with group B, the levels of inflammatory factors in plasma, and protein content, inflammatory cells and inflammatory factors in BALF in different doses of MP group were decreased to different degrees, with significant differences in groups C and D [plasma: IL-17a (pg/L): 49.28±27.12, 36.57±16.52 vs. 191.79±88.21; IL-6 (ng/L): 206.47±109.96, 197.52±113.86 vs. 669.00±299.60; BALF: protein content (mg/L):892.0±164.5, 566.1±120.9 vs. 1838.0±145.8; white blood cell count (×109/L): 5.40±1.67, 2.81±1.20 vs. 9.02± 2.06; neutrophil ratio: 0.315±0.081, 0.273±0.080 vs. 0.590±0.096; IL-17a (ng/L): 22.63±8.62, 18.92±8.43 vs. 43.31±19.17; IL-6 (ng/L): 156.49±46.94, 123.66±64.91 vs. 253.43±80.03; allP< 0.01]; in addition, the expression of MPO and HMGB1 protein in lung tissues of MP groups with different doses were significantly decreased, the expression of MPO in group D was significantly lower than that in group E [MPO/β-actin (fold increase from group A):2.14±0.97 vs. 4.35±0.87,P < 0.01], the expression of HMGB1 in groups C and D were significantly lower than that in group E [HMGB1/β-actin (fold increase from group A): 1.77±0.73, 1.23±0.67 vs. 3.65±1.08, bothP < 0.05]. Conclusions MP can significantly improve the survival rate of SI-ALI rats and reduce the acute pulmonary and systemic inflammatory response. The MP effect of 4 mg/kg was better than 40 mg/kg and 0.4 mg/kg.

Study on the use of antimicrobial agents in hospitalized trauma patients based on medical big data / 药学实践杂志

Objective To investigate the relationship between the trauma severity and the usage of antibacterial drugs and to provide reference for standard protocol of proper antibiotic use in wound care.Methods ICD-10 and AIS were used to set up the relationship and to analyze the use of antibiotics in patients with different trauma score.Results 25 035 trauma patients were enrolled in this study.Those patients were divided into five groups according to the AIS score with least severe as group 1 to most severe as group 5.The patient percentage in group 1 to 5 was 21.92％,67.73％,8.86％,0.97％ and 0.52％ respectively.The five most frequently used antibiotic classes are second generation cephalosporins,third generation cephalosporins,first generation cephalosporins,fluoroquinolones and penicillin/beta lactamase inhibitor combination, accounted for 29.69％,22.57％,20.33％,4.66％ and 4.47％ of total DDDs of antibacterial drugs.Individually, the top 10 antibiotics are cefuroxime (12.21％), cefazolin (8.31％), ceftriaxone (7.74％), cefathiamidine (7.34％), cefotiam (4.87％), ceftazidime (3.68％), amoxicillin/clavulanic acid (3.63％), levofloxacin (3.59％), cefoxitin (3.56％), flucloxacillin (3.52％);gentamicin (2.27％), ornidazole (2.00％) and cefoperazone/tazobactam (1.44％) were used most in their categories respectively.The variety and quantity of antibacterial drugs used for different trauma patients were different.Conclusion The trauma score based on ICD-AIS can reflect the severity of trauma.The use of antibiotics in patients with different trauma score can provide reference for the clinical applications of antibiotics in wound care.

Effect of trauma scoring system and combined score on the trauma response of acute trauma ;patients / 中国实用护理杂志

Objective To investigate the performance of Injury Severity Score (ISS), New Injury Severity Score (NISS), Revised Trauma Score (RTS), CRAMS (circulation, respiration, abdomen, motor, speech)score and combined score on the trauma response of trauma patients. Methods Data of acute trauma patients from March 2014 to February 2015 were chosen as the research object. The clinical information at admission was recorded, and the ISS, NISS, RTS, CRAMS and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) were calculated. The optimal cut-off values were looked for the comparability between the four scores and APACHE Ⅱ score were figured out by ROC curve. The joint diagnosis combined physiological score with anatomical score in overlap mode was used for comparing sensitivity and specificity. Results There was a total of 1 020 patients included in the study. APACHEⅡscore ≥20 was found 711 cases, and APACHEⅡ<20 was 309 patients, and there were significant statistic differences in ISS score (U=11.347, P<0.05),NISS score (U=11.969, P<0.05),CRAMS score (U=8.194, P < 0.05) and RTS score (U=8.357, P < 0.05) between two groups. It was showed by ROC curve analysis that the area under the ROC curve (AUC) of ISS, NISS, CRAMS and RTS was 0.907, 0.941, 0.768 and 0.803 (all P<0.05). Compared with the trauma score, combined scores could increase the sensitivity of the prompt assessment of trauma severity in trauma patients, but the combined scores may also reduce the specificity. Conclusions Of these four scoring systems, NISS has the best correlation with APACHEⅡ. Compared with the trauma score, combined scores can increase the sensitivity of the prompt assessment of trauma severity in trauma patients, but the combined scores may also reduce the specificity.

A comparative study of three maxillofacial trauma scoring systems in mandible fracture grading / 实用口腔医学杂志

Objective:To compare 3 maxillofacial trauma scoring systems in mandible fracture grading.Methods:Maxillofacial Injury Severity Score(MISS),Maxillofacial Injury Severity Score(MFISS),Mandible Injury Severity Score(S5)were used in the analysis of mandible fracture severity in 313 cases with mandible fractures.The results were statistically analyzed.Results:S5 score showed higher correlation with operation time,operation charge and hospitalization expenses than MFISS and MISS,and it could distinguish single and multiple mandible fractures effectively.It was also a significant factor affecting the cost of hospitalization.Conclusion:The Mandible Injury Severity Score was more suitable for the scoring of mandible fracture.

Application of the revised trauma score in patients with multiple trauma emergency / 现代临床护理

Objective To study the effect of revised trauma score (RTS) in the rescue of patients with multiple trauma emergency application. Methods According to the admission time, 56 multiple trauma patients were assigned into the control group, and another 58 into the observation group. The control group was treated with traditional pre-hospital and hospital emergency care. The observation group with pre-hospital emergency care and hospital based on the RTS results. The two groups were compared in terms of effective treatment time and complications. Result The effective rescue time of the observation group was significantly shorter than that of the control group (P<0.001) and the complication rate was significantly lower than that of the control group (P<0.05). Conclusion Based on the integrated emergency rescue measures on the basis of RTS scores, accurate condition judgment can be made in a short time so that consistent care can be given to the patients and the success rate can be improved , and the occurrence of complications can be reduced and the rescue success rate can be increased.

Value of modified early warning score and acute physiology and chronic health evaluation Ⅱ in evaluation of severity and prognosis of polytrauma patients in emergency department / 中华创伤杂志

Objective To access the effectiveness of modified early warning score (MEWS) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) in predicting the degree of injury and outcome for emergently admitted polytrauma patients.Methods In this single-center prospective study,266 polytrauma patients hospitalized from June 2012 to January 2013 were enrolled.MEWS and APACHE Ⅱ score were collected and compared for the rate of ICU admission,high dependency unit admission,outpatient therapy,death,and discharge within 30 days.Diagnostic and predictive performance of MEWS and APACHE Ⅱ were assessed by the receiver operating characteristic curve (ROC).Results A higher values in MEWS and APACHE Ⅱ were linked to much severe injury,increased likelihood of admission to the ICU or high dependency unit and high mortality.Patients with MEWS value ≥5 had increased risk of death as compared with those with MEWS value ＜ 5 (x2 =90.749,P ＜0.01).MEWS =5,for injury severity evaluation,showed a sensitivity of 85.7％ and specificity of 84.8％.MEWS value≥5 predicted ICU admission with a sensitivity of 80.0％ and specificity of 91.1％ and high dependency unit admission with a sensitivity of 67.9％ and specificity of 79.9％.APACHE Ⅱ score ≥ 21 was associated with increased rate of death,with significant difference from that among patients with APACHE Ⅱ score ＜ 21 (x2 =73.518,P ＜ 0.01).APACHE Ⅱ score =21,for injury severity evaluation,showed a sensitivity of 90.5％ and specificity of 79.5％.APACHE Ⅱ score ≥ 21 predicted ICU admission with a sensitivity of 95.0％ and specificity of 73.6％ and high dependency unit admission with a sensitivity of 88.2％ and specificity of 72.8％.In prediction of prognosis,ICU admission and high dependency unit admission,area under the ROC curve with 95％ CI for NEWS was 0.889 (0.830-0.948),0.937 (0.900-0.975) and 0.946 (0.916-0.977) respectively and for APACHE Ⅱ was 0.939 (0.898-0.979),0.761 (0.677-0.845) and 0.832 (0.782-0.883) respectively.MEWS and APACHE Ⅱ score in death group were (6.4 ± 2.7) points and (29.9 ± 6.4) points,but lowered to (3.0 ± 1.5) points and (16.8 ± 5.7) points respectively in survival group (P ＜ 0.01).Conclusions Both APACHE Ⅱ and MEWS have the ability to discriminate the severity of polytrauma patients and identify the potential of seriously ill patients.MEWS is more suitable for early identification of critically ill trauma patient due to its easy and quick operation as well as low cost,while APACHE Ⅱ is more suitable for evaluation of emergency observing patients and ICU patients.

The Availability of Modified Ocular Trauma Score in Korean Patients with Open Globe Injury

PURPOSE: To modify the ocular trauma score (OTS) model by analyzing the clinical characteristics of Korean patients with open globe injury and to determine the availability of the modified OTS in predicting the final visual acuity. METHODS: Among the prognostic factors in the original OTS, endophthalmitis and perforating injury were excluded, and wound location, vitreous hemorrhage, lens damage, and lid laceration were added to the modified OTS based on the data of 242 patients with open globe injury from January 2000 to September 2010. To determine the availability of the modified OTS, 29 patients from September 2010 to December 2011, not included in the previous data, were retrospectively reviewed, and the positive and negative predictive values for assessment of final visual acuity less than 0.02 were calculated by the original and modified OTS. RESULTS: The modified OTS was applied to the previous data, and the positive predictive value was 75.3% and negative predictive value was 90.8%. By using the original OTS, the positive predictive value was 70.1% and negative predictive value was 89.8%. The values of the modified OTS was higher than those of the original OTS, but it was not statistically significant (p = 0.5956, p = 0.9370). When the modified OTS was applied to the new 29 patients, the positive and negative predictive values were 75.0% and 90.5%, respectively. CONCLUSIONS: The prognostic factors of the original OTS were modified based on the previous data and the positive and negative predictive values of final visual acuity by modified OTS were similar to those by the original OTS. The modified OTS would be useful in analyzing the patients with open globe injuries and could be used as a prognostic model for Korean patients.

The Predictability of Ocular Trauma Score and Prognostic Factors of Open Globe Injury

PURPOSE: To determine the prognostic factors of visual outcome in open globe injury and to assess the possibility of an ocular trauma score (OTS) model of predictive value in open globe injuries in Koreans. METHODS: The medical records of 242 patients with open globe injury from 2000 to 2010 were retrospectively reviewed. Prognostic factors of visual outcome, positive predictive rate, and negative predictive rate were surveyed. RESULTS: In the multivariate analysis, old age, relative afferent pupillary defect, impaired initial visual acuity and retinal detachment were the worst predictive factors of vision survival. In OTS categories 1 and 2, worse final visual acuity was acquired, and positive predictive rate and negative predictive rate for assessment of final visual acuity less than 0.02 were 70.1% and 89.8%, respectively. CONCLUSIONS: The prognostic factors of open globe injury associated with impaired final visual acuity were old age, relative afferent pupillary defect, worse initial visual acuity, retinal detachment and OTS categories 1 and 2. The OTS may have prognostic value in open globe injuries in Korean patients. However, identified prognostic factors of the present study did not entirely coincide with those of other Koreans or previous studies. Therefore, additional studies on the modified open globe injury as a prognostic model in Korean patients are needed.