Injury severity score as a predictor of mortality in adult trauma patients by injury mechanism types in the United States: A retrospective observational study.

Injury severity score (ISS) is commonly used in trauma registries to describe injury severity and to predict outcomes in trauma patients regardless of injury mechanism. This study examined the correlation between ISS and mortality in adult trauma patients presenting to emergency departments in the United States with different mechanisms of injury. A retrospective observational study was conducted using the 2014 Nationwide Emergency Department Sample. Patients' characteristics were stratified by mortality. Receiver operating characteristic (ROC) curves were generated for death against ISS for each mechanism of injury. A logistic regression model was conducted for each mechanism of injury to determine whether ISS (≥16 vs <16) is a predictor of mortality. The study sample consisted of 16,147,058 weighted adult trauma patients. Median age was 46 years. Slightly over half were females (51.9%). Falls, motor vehicle accidents and being struck by or against, were the most commonly reported mechanisms of injury (44.6%, 18.1%, and 15.3%, respectively). The overall mortality in the study population was 0.4%. The area under the ROC curve was highest in injuries sustained in accidents involving machinery (0.947; 95% confidence intervals [CI], 0.896-0.998), followed by motor vehicle traffic (MVA) (0.788; 95% CI, 0.775-0.801) and cutting or piercing (0.746; 95% CI, 0.701-0.791). Deceased patients were accurately identified by ISS 65.2% in injury by machinery, 47.7% in injury involving MVA, 39.7% in injury by firearm and 31.4% in injury by assault. After adjusting for confounders, the multivariate models in which ISS was the main independent factor performed best in predicting mortality from firearm and machinery mechanism of injuries. Although the ROC curve analysis demonstrated a moderate or high discriminatory ability to identify deceased patients in 6 out of twelve mechanisms, and the multivariate analysis revealed that ISS was a significant predictor of mortality in 9 out of 12 injury mechanisms, the sensitivities of all logistic regression models were poor. The ISS ≥ 16 threshold alone therefore should not be used to identify patients with high-mortality risk. The mortality risk assessment should be done individually and be based on clinical evaluation.

Seasonal variation in incidence and outcomes of out of hospital cardiac arrest: A retrospective national observational study in the United States.

ABSTRACT: Out of hospital cardiac arrest (OHCA) remains a leading cause of mortality among adults in the United States. Environmental impact on incidence and outcomes of OHCA has not been fully investigated in recent years. Previous studies showed a possible increase in incidence and mortality in winter season and during seasons with temperature extremes. This study examines seasonal variation in incidence and outcomes of OHCA in the United States.Retrospective study of adult OHCA using the Nationwide Emergency Department Sample was carried out. Monthly incidence rate per 100,000 ED presentations was calculated. Survival rates for each month of admission were examined by hospital region. Multivariate analyses were conducted to determine the effect of the season and month of admission on survival.A total of 122,870 adult OHCA cases presented to emergency departments (EDs) in 2014 and were included. Average incidence of OHCA cases was 147 per 100,000 ED presentations. Overall survival rate in the study population was 5.6% (95% confidence intervals [CI] = 5.4%-5.9%). Patients had an average age of 65.5 (95% CI: 65.3-65.7) years and were mainly men (61.8%). Rates of OHCA presentations were highest during December and January (9.9% and 10.0%) while survival rates were lowest during December (4.6%) and highest in June (6.9%). Regional variation in OHCA outcomes was also noted with highest average survival rate in West (7.8%) and lowest in South (4.3%). After adjusting for confounders including region of hospital, Summer season (Ref: all other seasons), and more specifically month of June (Ref: all other months) were found to be positively associated with survival (OR 1.27, 95% CI [1.07-1.52], P-value = .008) and (OR 1.43, 95% CI [1.08-1.89], P-value = .012 respectively).Incidence and outcomes of out of hospital cardiac arrest presentations to the emergency departments in the United States have seasonal variation. Both incidence and mortality of OHCA increase during colder months, and survival is significantly higher in summer season or in June. Exploring how to use this variation to improve outcomes through refresher training of medical providers or through other mitigation plans is needed.

Fall related injuries in elderly patients in a tertiary care centre in Beirut, Lebanon.

CONTEXT: Falls cause significant morbidity and mortality, constituting 38.9% of trauma visits to the emergency department (ED) in Lebanon. Elderly have increased risk of falls due to co-morbidities. Injury-related deaths are most common in developing countries, and few studies have examined falls internationally. AIMS: Describe characteristics, injury patterns, and outcomes of elderly treated for fall injuries at a tertiary care center in Lebanon. SETTINGS AND DESIGN: Retrospective observational chart review of elderly presenting after a fall to the ED. SUBJECTS AND METHODS: Retrospective observational study of elderly (≥65 years) patients who presented to the ED at a tertiary care center in Lebanon with the chief complaint of "fall" over a 6-year period. STATISTICAL ANALYSIS USED: Descriptive analysis. RESULTS: Two hundred and thirty-five patients were included; mean age was 78.1 (±7.2) years with female predominance (60.5%). Falls occurred at home (99.2%) and from ground level (96.4%). Patients presented by private transport (85.8%). The initial impact was to the head in 31.2% of patients with 47.8% on antiplatelet/anticoagulation therapy. Imaging includes extremity X-ray (46.6%) and head/cervical spine computed tomography (39.5%). Dispositions included home (58.9%), regular floor (23.3%), operating room (7.9%), and intensive care unit (5.9%). Pelvic/hip repair was the most common surgical procedure. Most injuries were nonlife-threatening. Overall mortality was 2%. CONCLUSIONS: Falls have a high impact on the elderly population in Lebanon, with most occurring at home, resulting in pelvic/hip injuries and a mortality of 2%. There is a need to implement multifaceted fall prevention programs to mitigate such injuries and improve patient safety and outcomes.