Evolution of and controversy on definition of multiple trauma / 中华创伤杂志

Multiple trauma is complex and difficult to treat. The trauma at each site may obscure or delay the manifestation of each other. The severity of injury also exceeds the simple superposition of each injured site. There are numerous definitions of multiple trauma worldwide, with most regarding multiple trauma as major trauma. The definition of multiple trauma in China has evolved several times; however, it is currently still controversial, especially on whether the definition should be based on the nine body regions of the Abbreviated Injury Scale (AIS) or the six body regions of the Injury Severity Score (ISS). The absence of uniform anatomic region criteria in the definition of multiple trauma can lead to discrepancies in multiple trauma patients, causing the clinical application of the definition to be problematic. In this study, the authors elaborate the development and application status of the defination of multiple trauma at home and abroad, discuss the existed problems or controversies and put forward feasible suggestions on the definition of multiple trauma to further normalize the diagnosis and treatment of multiple trauma.

Evaluating mechanism and severity of injuries among trauma patients admitted to Sina Hospital, the National Trauma Registry of Iran / 中华创伤杂志(英文版)

PURPOSE@#Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries.@*METHODS@#The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset.@*RESULTS@#The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0% vs. 43.5%, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8% vs. 12.9%, p = 0.003).@*CONCLUSION@#Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.

Research progress and error analysis of abbreviated injury scale/injury severity score / 中华创伤杂志

Trauma score, trauma registry and construction of trauma database are the cornerstones for the quality improvement of trauma centers. Abbreviated injury scale (AIS)/injury severity score (ISS) has been used as the basis for evaluation of trauma centers in lots of countries since 2008, and has now developed into a globally recognized trauma scoring system. The authors introduce the changes in the number of codes and the setting of scores in the nine versions of AIS released since 1971, as well as the application effects of the AIS/ISS scoring system in recent years. Combined with the actual clinical cases, the errors in the current clinical application of AIS/ISS are analyzed. The construction of trauma registry and database in China has just started. The current focus is not to propose new trauma scores, but to correctly and accurately apply AIS/ISS scores first.

Evaluación del programa de computación educativo para la aplicación de escalas ISS y AIS en el servicio de urgencias para residentes de ortopedia de la Secretaría de Salud de la Ciudad de México / Evaluation of educational computer program for applying ISS and AIS scales in the emergency room for Orthopedic Residents of the Secretary of Health from Mexico City

Resumen: Introducción: Se creó el programa HAISS (Herramienta de Aprendizaje ISS) para mejorar la factibilidad y aprendizaje de las escalas de gravedad en trauma AIS (Abbreviated Injury Score) e ISS (Injury Severity Score). Objetivo: Obtener una herramienta de computación que promueva el aprendizaje y facilite el uso adecuado de las escalas AIS e ISS. Material y métodos: Se toma una muestra de 40 residentes de primero a cuarto grado de ortopedia de cuatro hospitales de la Secretaría de Salud. Se realizó un estudio longitudinal prospectivo con estadística analítica. Se entregaron 10 casos clínicos para obtención de ISS mediante la escala AIS, se utilizó el manual AIS 2005 actualización 2008, se plantearon dos preguntas para evaluar facilidad de uso y factibilidad, se midió el tiempo de realización. Se repitió el proceso al mes con el programa HAISS. Resultados: Con ayuda del programa HAISS se redujo el tiempo para resolver los 10 casos en más de 50%, la aceptación por parte del usuario de la escala AIS también mejoró. La fiabilidad de obtener la codificación de las lesiones con AIS no mejoró, pero no se ve afectada la obtención del ISS. Conclusiones: El programa HAISS mostró aceptación en un grupo de residentes de ortopedia, mejoró en forma subjetiva su uso y además ocupa poco tiempo.

Abstract: Introduction: The HAISS (Herramienta de Aprendizaje ISS) program was created to enhance the feasibility and learning of trauma severity scores AIS (Abbreviated Injury Score) and ISS (Injury Severity Score). Objective: Get a computer tool that promotes learning and facilitate proper use of AIS and ISS. Material and methods: A sample of 40 orthopedic residents from 1st to 4th grade from 4 hospitals of the Ministry of Health was taken. A prospective longitudinal study was conducted with analytical statistics. 10 clinical cases for obtaining ISS by AIS score were delivered, this was done with the AIS Manual 2005 update 2008, two questions were conducted to evaluate the feasibility and ease of use, the time to perform was measured. The process was repeated a month later with the HAISS program. Results: Using the HAISS program reduced the time to resolve the 10 cases by more than 50%, acceptance by the user of the AIS scale also improved. Reliability to obtain the codification of lesions with AIS did not improve, but it did not affected ISS. Conclusions: The HAISS computer program is useful for orthopedic residents to accept the AIS score and ISS score mainly because it improved the ease of use and makes it more user-friendly, it also takes less time to use it.

Risk factors for mortality of severe trauma based on 3 years' data at a single Korean institution

PURPOSE: This study aimed to determine the mortality rate in patients with severe trauma and the risk factors for trauma mortality based on 3 years' data in a regional trauma center in Korea. METHODS: We reviewed the medical records of severe trauma patients admitted to Ajou University Hospital with an Injury Severity Score (ISS) > 15 between January 2010 and December 2012. Pearson chi-square tests and Student t-tests were conducted to examine the differences between the survived and deceased groups. To identify factors associated with mortality after severe trauma, multivariate logistic regression was performed. RESULTS: There were 915 (743 survived and 172 deceased) enrolled patients with overall mortality of 18.8%. Age, blunt trauma, systolic blood pressure (SBP) at admission, Glasgow Coma Scale (GCS) at admission, head or neck Abbreviated Injury Scale (AIS) score, and ISS were significantly different between the groups. Age by point increase (odds ratio [OR], 1.016; P = 0.001), SBP or = 4 (OR, 1.912; P = 0.003), and ISS by point increase (OR, 1.042; P < 0.001) were significant risk factors. CONCLUSION: In severe trauma patients, age, initial SBP, GCS score, head or neck AIS score, and ISS were associated with mortality.

Measuring trauma severity using the 1998 and 2005 revisions of the Abbreviated Injury Scale / La medición de la gravedad del trauma con las versiones de la abbreviated injury scale de 1998 y 2005 / Mensuração da gravidade do trauma com as versões 1998 e 2005 da Abbreviated Injury Scale

Objetivo: Comparar a gravidade das lesões e do trauma mensurada pelas versões da Abbreviated Injury Scale 1998 e 2005 e verificar a mortalidade nos escores Injury Severity Score e New Injury Severity Score nas duas versões.Método: Estudo transversal e retrospectivo analisou lesões de pacientes de trauma, de três hospitais universitários do município de São Paulo, Brasil. Cada lesão foi codificada com Abbreviated Injury Scale 1998 e 2005. Os testes estatísticos aplicados foram Wilcoxon, McNemar-Bowker, Kappa e teste Z.Resultados: A comparação das duas versões resultou em discordância significante de escores em algumas regiões corpóreas. Com a versão 2005 os níveis de gravidade da lesão e do trauma foram significantemente reduzidos e a mortalidade foi mais elevada em escores mais baixos. Conclusão: Houve redução da gravidade da lesão e do trauma e alteração no percentual de mortalidade com o uso da Abbreviated Injury Scale 2005.



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Objetivo: Identificar los cuidados de enfermería prescritos para pacientes hospitalizados con riesgos de caídas y compararlos con las intervenciones de la Nursing Interventions Classifications (NIC). Método: Estudio transversal realizado en un hospital universitario del sur de Brasil. La recolección de datos fue retrospectiva en un sistema informatizado de registros de enfermería. La muestra se constituyó por 174 pacientes adultos internados en unidades clínicas y quirúrgicas con el Diagnóstico de Enfermería Riesgo de Caídas. Los cuidados prescritos fueron comparados con las intervenciones de la NIC por el método de mapeo cruzado. Resultados: Los cuidados más prevalentes fueron: mantener barandas en la cama, orientar al paciente y familia en relación a los riesgos y prevención de caídas, mantener el timbre al alcance del paciente y mantener las pertenencias cerca al paciente. Estos fueron mapeados en las intervenciones Control del Ambiente: Seguridad y Protección contra Caídas. Conclusión: Los cuidados prescritos en la práctica clínica fueron corroborados por el referencial de la NIC.

Objetivo: Comparar a gravidade das lesões e do trauma mensurada pelas versões da Abbreviated Injury Scale 1998 e 2005 e verificar a mortalidade nos escores Injury Severity Score e New Injury Severity Score nas duas versões. Método: Estudo transversal e retrospectivo analisou lesões de pacientes de trauma, de três hospitais universitários do município de São Paulo, Brasil. Cada lesão foi codificada com Abbreviated Injury Scale 1998 e 2005. Os testes estatísticos aplicados foram Wilcoxon, McNemar-Bowker, Kappa e teste Z. Resultados: A comparação das duas versões resultou em discordância significante de escores em algumas regiões corpóreas. Com a versão 2005 os níveis de gravidade da lesão e do trauma foram significantemente reduzidos e a mortalidade foi mais elevada em escores mais baixos. Conclusão: Houve redução da gravidade da lesão e do trauma e alteração no percentual de mortalidade com o uso da Abbreviated Injury Scale 2005.



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Effect of Alcohol Ingestion on the Severity and Outcome in Trauma Patients

PURPOSE: Although alcohol is frequently present in injury patients, whether it exacerbates injury and whether tolerance to alcohol changes such a relationship is less clear. We investigated alcohol's role in injury and the effect of alcohol on the severity of injury. METHODS: This prospective study was performed from July 20, 2004, to October 20, 2004, at five university hospital emergency departments (ED). We studied trauma patients, excluding pediatric patients (15 year old and under), alcohol consumption over the 6 hours prior to visiting the ED and continuous drinking after injury. Patients were screened by blood tests for the presence of alcohol and were classified into two groups by alcohol consumption. The injury severity was measured by using the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS). RESULTS: The study enrolled 361 injured patients, of whom 105 were intoxicated and 256 were not intoxicated. Alcohol consumption was significantly larger in males than in females and in cases involving violence. The injury severities were not correlated with alcohol consumption significantly between intoxicated patients and not intoxicated patients. were not significantly different. However, the number of days in the intensive care unit and the mortality correlated with alcohol consumption. In patients with severe injuries (ISS> or =15, AIS> or =3), alcohol consumption was correlated with severity of the injury. CONCLUSION: Alcohol intoxication is not associated with injury severity. But in patients with severe injuries (ISS> or =15, head AIS> or =3), alcohol consumption was correlated with injury severity.

Converting rules from international classification of disease codes of trauma to abbreviated injury scale values / 中华创伤杂志

Objective To develop converting rule from international classification of disease (ICD) codes of trauma to abbreviated injury scale (AIS) values so as to provide clues for a simple and convenient trauma scoring way. Methods The corresponding set relations were made for ICD-9CM codes and AIS-90 codes with similar code meanings in the trauma diseases. Based on medical theories and knowledge, 8 indeces closely associated with injury severity were worked out for each ICD-9CM code of trauma diseases by using the database of discharge abstracts of trauma patients. Discriminant analysis was used to set up corresponding relations of ICD-9CM codes with AIS values. Results Seven indices were selected for discriminant function. Corresponding relations of all ICD-9CM codes of trauma diseases with AIS values was made through nonparametric discriminant method. Under deliberation and revision by several clinical experts on traumatology, the converting rule was established eventually. Consistency analysis between the sample's international classification of disease injury severity score (ICISS) values and injury severity score (ISS) values showed that ICISS values were closely correlated with 2-ICISS (Y=Ln), with correlation coefficient of 0.831 1 ( P

The Injury Severity Score The Injury Severity Score of Mass Casualty (Train Accident at Kyungsan, May 14 th, 1981) / 대한정형외과학회잡지

Injuries are serious problem common to all societies. Yet even within a single community, groups of injured persons differ as to the nature and severity of their injuries. The difficulty of adjusting for such variations has hampered scientific study of injured persons. Neverthless it is essential to take differences in severity of injury into account when comparing the morhidity & mortality of various groups for the purpose of evaluating their emergency & subsequent care. In order to provide the guidelines of mass emergency care & transportation, the authors analysed the 206 injured patients of train accident at Kyungsan, May 14th, 1981 and compared mortality with severity and body system of the injuries. The results were obtained as follows: l. Of 206 injured patients, most were young people & the ratio of male & female was about equal. 2. Extremities were the most frequently injured parts of body system & single injury was more common. 3. According to most severe injury of AIS, 78% of injured persons belonged to below AIS grade 3 and none was dead. 4. Average ISS of survival groups was 6 and that of death groups was 34. None was dead below average ISS of 15. 5. Death rate was higher for patients above 50 years of age, than that for young patients and there was no age difference in mortality for ISS of 50 and higher. 6. Majority of death group were invclved in multiple injuries and major cause of death were chest and head injuries. 7. Average ISS and age of hospital death group were less than those of DOA group. 8. The authors thought that it was necessary to estahlish Emergency Service System including training and education of both professionals and the pulic, hospital categorization, communication and transportation system for the mass emergency care.