The RIGHT Scoring System for the Medicolegal Classification of Head Injury.

Background: In India, in case of an allegation of assault, the medical officer is required to classify the nature of injury into simple, grievous, and dangerous based upon the Indian Penal Code, which is outdated and has numerous gray areas. Objective: The aim of this study is twofold: first, to formulate an objective scoring system for the medicolegal classification of head injuries and Second to validate the proposed scoring system on patients with head injury. Methods and Material: A panel of experts consisting of neurosurgeons, radiologists, and forensic specialists came up with an objective scoring system, coined as the RIGHT (radiological-intervention-Glasgow Coma Scale (GCS)-based head trauma) scoring system consisting of three parameters, namely, the motor subscore of the GCS, computerized tomography image findings, and management of the patient. This was used to classify head injuries-into simple, grievous, and dangerous. A single-centre pilot study was planned-including patients with head trauma reporting to the emergency department. Medicolegal nature of the head injury was classified according to the proposed RIGHT score. A 6-month follow-up was performed using the Glasgow Outcome Score (GOS). Results: In total, 130 patients with head injury reported to the emergency department. There was a significant correlation between the RIGHT score assigned upon admission and the GOS at 6 months (P < 0.001). Conclusions: As the scoring system could be applied objectively and a significant correlation between nature of injury given by RIGHT score and 6-month outcome was present; therefore, the RIGHT scoring system proved to be an effective method in unambiguously classifying the nature of head injury for medicolegal opinions.

Differences in Health Care Resource Utilization After Surgery for Metastatic Spinal Column Tumors in Patients with a Concurrent Affective Disorder in the United States.

BACKGROUND: Affective disorders, such as depression and anxiety, are exceedingly common among patients with metastatic cancer. The aim of this study was to investigate the relationship between affective disorders and health care resource utilization in patients undergoing surgery for a spinal column metastasis. METHODS: A retrospective cohort study was performed using the 2016-2018 National Inpatient Sample database. All adult patients (≥18 years) undergoing surgery for a metastatic spinal tumor were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification coding systems. Patients were categorized into 2 cohorts: no affective disorder (No-AD) and affective disorder (AD). Patient demographics, comorbidities, hospital characteristics, intraoperative variables, postoperative adverse events (AEs), length of stay (LOS), discharge disposition, and total cost of hospital admission were assessed. A multivariate logistic regression analysis was used to identify independent predictors of increased cost, nonroutine discharge, and prolonged LOS. RESULTS: Of the 8360 patients identified, 1710 (20.5%) had a diagnosis of AD. Although no difference was observed in the rates of postoperative AEs between the cohorts (P = 0.912), the AD cohort had a significantly longer mean LOS (No-AD, 10.1 ± 8.3 days vs. AD, 11.6 ± 9.8 days; P = 0.012) and greater total cost (No-AD, $53,165 ± 35,512 vs. AD, $59,282 ± 36,917; P = 0.011). No significant differences in nonroutine discharge were observed between the cohorts (P = 0.265). On multivariate regression analysis, having an affective disorder was a significant predictor of increased costs (odds ratio, 1.45; confidence interval, 1.03-2.05; P = 0.034) and nonroutine discharge (odds ratio, 1.40; confidence interval, 1.06-1.85; P = 0.017), but not prolonged LOS (P = 0.067). CONCLUSIONS: Our study found that affective disorders were significantly associated with greater hospital expenditures and nonroutine discharge, but not prolonged LOS, for patients undergoing surgery for spinal metastases.

Racial Disparities in Health Care Resource Utilization After Pediatric Cervical and/or Thoracic Spinal Injuries.

OBJECTIVE: This study aimed to investigate the impact of race on hospital length of stay (LOS) and hospital complications among pediatric patients with cervical/thoracic injury. METHODS: A retrospective cohort was performed using the 2017 admission year from 753 facilities utilizing the National Trauma Data Bank. All pediatric patients with cervical/thoracic spine injuries were identified using the ICD-10-CM diagnosis coding system. These patients were segregated by their race, non-Hispanic white (NHW), non-Hispanic black (NHB), non-Hispanic Asian (NHA), and Hispanic (H). Demographic, hospital variable, hospital complications, and LOS data were collected. A linear and logistic multivariate regression analysis was performed to determine the risk ratio for hospital LOS as well as complication rate, respectively. RESULTS: A total of 4,125 pediatric patients were identified. NHB cohort had a greater prevalence of cervical-only injuries (NHW: 37.39% vs. NHB: 49.93% vs. NHA: 34.29% vs. H: 38.71%, P < 0.001). While transport accident was most common injury etiology for both cohorts, NHB cohort had a greater prevalence of assault (NHW: 1.53% vs. NHB: 17.40% vs. NHA: 2.86% vs. H: 6.58%, P < 0.001) than the other cohorts. Overall complication rates were significantly higher among NHB patients (NHW: 9.39% vs. NHB: 15.12% vs. NHA: 14.29% vs. H: 13.60%, P < 0.001). Compared with the NHW cohort, NHB, NHA, and H had significantly longer hospital LOS (NHW: 6.15 ± 9.03 days vs. NHB: 9.24 ± 20.78 days vs. NHA: 9.09 ± 13.28 days vs. H: 8.05 ± 11.45 days, P < 0.001). NHB race was identified as a significant predictor of increased LOS on multivariate regression analysis (risk ratio: 1.14, 95% confidence interval: 0.46, 1.82; P = 0.001) but not hospital complications (P = 0.345). CONCLUSIONS: Race may significantly impact health care resource utilization following pediatric cervical/thoracic spinal trauma.