Injury severity in polytrauma patients is underestimated using the injury severity score: a single-center correlation study in air rescue

Schröter, Christian; Urbanek, F.; Frömke, Cornelia; Winkelmann, Marcel; Mommsen, Philipp; Krettek, Christian; Zeckey, Christian

doi:10.1007/s00068-017-0888-1

Cited by 10 publications

(7 citation statements)

References 19 publications

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“…Therefore, in this study, the ISS score could only differentiate between different grades of severity below the value of 25. This result is in agreement with a previous study, although only adult patients were included (24). Future studies with a larger study population are needed to further elucidate this topic.…”

Section: Discussionsupporting

confidence: 92%

Trauma Scores and Their Prognostic Value for the Outcome Following Pediatric Polytrauma

et al. 2021

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Purpose: The management and prognostic assessment of pediatric polytrauma patients can pose substantial challenges. Trauma scores developed for adults are not universally applicable in children. An accurate prediction of the severity of trauma and correct assessment of the necessity of surgical procedures are important for optimal treatment. Several trauma scores are currently available, but the advantages and drawbacks for use in pediatric patients are unclear. This study examines the value of the trauma scores Injury Severity Score (ISS), Pediatric Trauma Score (PTS), National Advisory Committee for Aeronautics (NACA), and Glasgow Coma Score (GCS) for the assessment of the polytraumatized child.Methods: In a retrospective study, 97 patients aged 0–17 years who presented with polytrauma and an ISS ≥16 in the trauma bay were included in the study. Patient records including radiological studies were analyzed. Pathological imaging findings and emergency surgery were assessed as outcome variables and the predictive value of the trauma scores were analyzed using receiver operator characteristic (ROC) curves. Statistical significance was set at an alpha level of P ≤ 0.05.Results: In this study, 35 of the 97 studied children had pathological cranial computed findings. These either underwent craniectomy or trepanation or a parenchymal catheter was placed for intracranial pressure monitoring. Abdominal trauma was present in 45 patients, 16 of which were treated surgically. Forty-three patients arrived with thoracic injuries, 10 of which received a thoracic drainage. One child underwent an emergency thoracotomy. Predictive accuracy for emergency surgery calculated using receiver-operator characteristic (ROC) curves was highest for ISS and NACA scores (0,732 and 0.683, respectively), and lower for GCS (0.246) and PTS (0.261).Conclusion: In our study cohort, initial ISS and NACA scores better predicted operative interventions and outcome than PTS or GCS for polytraumatized pediatric patients.

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Section: Discussionsupporting

confidence: 92%

Trauma Scores and Their Prognostic Value for the Outcome Following Pediatric Polytrauma

et al. 2021

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“…Fourth, although most characteristics were similar between the cohorts, the Before cohort had a significantly lower ISS than the After cohort. As reported previously, 30 the ISS in the Before cohort is more likely to have been underestimated because more patients died owing to exsanguination with no diagnosis in the Before cohort. Alternatively, the higher ISS in the After cohort may be partially attributable to improvements in the preadmission management of out-of-hospital impending cardiac arrests that enabled more individuals to survive long enough to be admitted to the hospital.…”

Section: Discussionmentioning

confidence: 52%

Impact of a streamlined trauma management approach and determinants of mortality among hemodynamically unstable patients with severe multiple injuries: a before-and-after retrospective cohort study

Otsuka

Uehata

Sakoda

et al. 2020

Trauma Surg Acute Care Open

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BackgroundTrauma management requires a multidisciplinary approach, but coordination of staff and procedures is challenging in patients with severe trauma. In October 2014, we implemented a streamlined trauma management system involving emergency physicians trained in severe trauma management, surgical techniques, and interventional radiology. We evaluated the impact of streamlined trauma management on patient management and outcomes (study 1) and evaluated determinants of mortality in patients with severe trauma (study 2).MethodsWe conducted a retrospective cohort study of 125 patients admitted between January 2011 and 2019 with severe trauma (Injury Severity Score ≥16) and persistent hypotension (≥2 systolic blood pressure measurements <90 mm Hg). Patients were divided into a Before cohort (January 2011 to September 2014) and an After cohort (October 2014 to January 2019) according to whether they were admitted before or after the new approach was implemented. The primary outcome was in-hospital mortality.ResultsCompared with the Before cohort (n=59), the After cohort (n=66) had a significantly lower in-hospital mortality (36.4% vs. 64.4%); required less time from hospital arrival to initiation of surgery/interventional radiology (median, 41.0 vs. 71.5 minutes); and was more likely to undergo resuscitative endovascular balloon occlusion of the aorta (24.2% vs. 6.8%). Plasma administration before initiating hemostasis (adjusted OR 1.49 (95% CI 1.04 to 2.14)), resuscitative endovascular balloon occlusion of the aorta (9.48 (95% CI 1.25 to 71.96)), and shorter time to initiation of surgery/interventional radiology (0.97 (95% CI 0.96 to 0.99)) were associated with significantly lower mortality.DiscussionImplementing a streamlined trauma management protocol improved outcomes among hemodynamically unstable patients with severe multiple trauma.Level of evidenceLevel III.

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“…Injury severity score (ISS) is based on the abbreviated injury scale (AIS),and is the most prevalence trauma score in clinical [15] .ISS is initially as a tool of comparison injury severity for multiple trauma patients.Over time,much of research demonstrated that the ISS is not only a tool for comparison of injury severity,but also a strongly correlation with mortality in multiple trauma patients [16] .Generally,patients with multiple trauma that de ned ISS ≥ 16 points associated with a mortality risk of 10%,which called as severe multiple trauma [17] .Additionally,A retrospective study showed injury severity score (ISS) was not only the one of independent risk factors of mortality,but also was the only one independent risk factor of complications and ICU length of stay [18] .ISS has been associated with mortality but the association between ISS and MODS is yet known.In our study,MODS group had a signi cantly higher ISS compared to non-MODS group(31.16±6.57 vs 23.72±7.20,P 0.001),and multivariate logistic regress analysis showed ISS could be as a predictor for MODS following multiple trauma.…”

Section: Discussionmentioning

confidence: 99%

A Nomogram Based on Clinical Characteristics for Predicting Multiple Organ Dysfunction Syndrome(MODS) Following Multiple Trauma Patients

Miao

Wei

Zhou

2020

Preprint

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BackgroundMultiple organ dysfunction syndrome (MODS) is the one of common complications,and the leading cause of late mortality in multiple trauma patients.The present study aims to develop and validate a nomogram based on clinical characteristics in order to identify the patients with multiple trauma who were at risk of developing MODS.MethodsAn retrospective cohort study was performed with data from January 2011 to December 2019,totally 770 patients with multiple trauma were enrolled in our study.They were randomly categorized into training set (n=514) and validation set (n=256).The univariate and multivariate logistic regression analyses were used to screen the predictors for multiple trauma patients who were at risk of developing MODS from training set data.Then we established a nomogram based on these above predictors.The discriminative capacity was assessed by receiver operating characteristic (ROC) curve area under the curve (AUC), and the predictive precision was depicted by calibration plot.The Hosmer-Lemeshow test was used to evaluate the the model’s goodness of fit.ResultsOur study showed that age,ISS,hemorrhagic shock,heart rate,blood glucose,D-dimer and APTT were independent risk factors for MODS in patients with multiple trauma by multivariate logistic regression analysis.A nomogram was established on basis of these above risk factors.The area under the curve (AUC) was 0.868 (95% confidence interval [CI]:0.829-0.908) in the training set and 0.884 (95% confidence interval [CI]:0.833-0.935) in the validation set.The Hosmer-Lemeshow test has a p value of 0.227 in training set and 0.554 in validation set respectively,which confirm the model’s goodness of fit.Calibration plot showed that the predicted and actual incidence of MODS probability were fitted well on both internal and external validations.ConclusionsThe present nomogram had a well predictive precision and discrimination capacity,which can facilitate improved screening and early identification of multiple trauma patients who were at high risk of developing MODS.

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Injury severity in polytrauma patients is underestimated using the injury severity score: a single-center correlation study in air rescue

Abstract: Multiple-trauma patients can be identified using the ISS. Anatomic scores might be used for transport decisions; however, an accurate estimation of the injury severity should also be based on other criteria such as patient status, mechanism of injury, and other triage criteria.

Cited by 10 publications

References 19 publications

Trauma Scores and Their Prognostic Value for the Outcome Following Pediatric Polytrauma

Trauma Scores and Their Prognostic Value for the Outcome Following Pediatric Polytrauma

Impact of a streamlined trauma management approach and determinants of mortality among hemodynamically unstable patients with severe multiple injuries: a before-and-after retrospective cohort study

A Nomogram Based on Clinical Characteristics for Predicting Multiple Organ Dysfunction Syndrome(MODS) Following Multiple Trauma Patients

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