No abstract available.
Accidents, Traffic* ; Emergencies* ; Emergency Service, Hospital* ; Injury Severity Score*

PURPOSE: Alcohol intake is commonly found in injured patients, and alcohol affects base deficit independently with trauma. The purpose of this study was to evaluate the effect of alcohol on base deficit in trauma patients. METHODS: Data was retrospectively collected from trauma patients over 18 years of age who were admitted at the emergency center between October 2005 and July 2006. Blood sampling for alcohol level, base deficit evaluation were done within first hour for all patients. Patients were divided according to the serum alcohol level into an alcohol group(serum alcohol level> or =10 mg/dl) and a non-alcohol group. The patients were also stratified into minor (ISS< or =15) and major (ISS> or =16) injury groups according to their injury severity score (ISS). RESULTS: The study enrolled 63 patients of whom 37 fell into the alcohol group and 26 into the non-alcohol group. The mean alcohol level within the alcohol group was 210+/-85 mg/dl. Base deficit and serum lactate were not found to be significantly different in minor and major injuries, and ISS, base deficit were not significantly different with serum alcohol level. Base deficit was somewhat higher on average but not statistically significant in the non-alcohol group than in the alcohol group (-3.0+/-4.5 vs. -1.8+/-6.7 mmol/L, p=0.444). The base deficit was higher for the major injury-alcohol group than for the major injury-non-alcohol group, but this difference also did not achieve statistical significance (-4.6 +/-5.8 vs -2.4+/-8.1 mmol/L, p=0.117) CONCLUSION: In the severely injured patients, base deficit appears to be increased with alcohol but we found no statistically significant differences in base deficit and ISS between alcohol group and non-alcohol group of injured patients.
Emergencies ; Humans ; Injury Severity Score ; Lactic Acid ; Retrospective Studies

PURPOSE: To study the clinical results of AO type C pelvic ring injuries and identify the prognostic factors. MATERIALS AND METHODS: 25 patients were treated for C type pelvic ring fractures between January 1995 and August 2002. The injury mechanism, associated injuries, time from injury to surgery, ICU care, Injury Severity Score, fracture site of posterior ring, displacement, surgical method, and complications were analyzed. Radiological and clinical evaluations of the results were conducted using the Majeed's score. Of the 25 patients, 16 were male, 9 were female, with an average age of 41.6 years. All except one patient had associated injuries and 12 patients had neurological complications. There were 17, 7 and 1 case of C1, C2 and C3 type injuries respectively. Twenty three cases underwent surgical treatment. RESULTS: The average Majeed's score was 66.6 points, and 15 patients (60%) had good or excellent results. The complications included 3 cases of non-union and 1 case of SI joint infection were complications. The clinical results were worse in those patients with neurological symptoms. CONCLUSION: Satisfactory results were obtained after surgical treatment of C type pelvic ring injuries. Neurological injuries affected the clinical outcome and appropriate fixation of the anterior ring was needed for stable fixation of C type pelvic ring injuries.
Female ; Humans ; Injury Severity Score ; Joints ; Male ; Pelvis

The TRISS (Revised Trauma Score and Injury Severity Score) method of trauma care evaluation was applied to 476 consecutive trauma patients admitted to our medical center over a 6-month period. Male to female ratio was 8:1, with a mean age of 24.7 years. Penetrating injury was the most common mechanism of injury (62%), with the chest as the most common region injured (36%). Mean probability of survival of 476 patients was 0.9802 and a predicted mortality of 9.4 patients. The overall mortality was 5.4 per cent with 26 actual deaths. As 93 per cent of patients had injuries to isolated anatomic regions, using the TRISS method, assigning numerical values to noninjured anatomic regions mathematically increased their probability of survival, even though the isolated injury was life-threatening. Consideration should be taken before adapting the TRISS method as the gold standard in evaluating trauma care in the local setting

Chemical and Drug Induced Liver Injury ; pathology ; Humans ; Injury Severity Score ; Liver ; pathology

PURPOSE: To estimate the incidence and risk of significant renal injury quantitatively in the admitted patients with abdominal trauma. MATERIALS AND METHODS: From January 1992 to July 1997, 511 patients who admitted to departments of urology and general surgery due to major abdominal trauma with and without renal injury were included in this study. The risk of renal injury was defined as the percentage of square of Abbreviated Injury Scale of kidney in the Injury Severity Score(ISS) per each patient. The patients were classified to 5 groups according to the causes of trauma as traffic accident, falls, assault, other blunt and stab Injury, then compared the incidence and risk of renal injury each other. RESULTS: The overall incidence of significant renal injury was 14.9%, and the incidence according to the causes was 27.0%,20.8%, 16.1%, 14.3% and 10.7% in falls, assault, stab injury, other blunt and traffic accident, respectively. The overall risk of significant renal injury estimated by ISS was 15.7% and the risk according to the causes was 26.7%,24.9%, 11.9%,9.9% and 4.9% in assault, falls, traffic accident, other blunt and stab injury, respectively Mean ISS in the patients with renal injury was markedly higher than that of the patients without renal injury(27.5 vs 13.6)(p < 0.01). CONCLUSIONS: Our study shows that both the incidence and risk of significant renal injury in the admitted patients with abdominal trauma can be expected in the probability of 15% or so, and according to the causes, those in the traumatized patients by the assault and falls mark high.
Abbreviated Injury Scale ; Accidents, Traffic ; Humans ; Incidence* ; Injury Severity Score ; Kidney ; Urology

OBJECTIVE: To compare the predictive power of International Classification of Diseases 10th Edition(ICD-10) based International Classification of Diseases based Injury Severity Score(ICISS) with Trauma and Injury Severity Score(TRISS) and International Classification of Diseases 9th Edition Clinical Modification(ICD-9CM) based ICISS in the injury severity measure. METHODS: ICD-10 version of Survival Risk Ratios(SRRs) was derived from 47,750 trauma patients from 35 Emergency Centers for 1 year. The predictive power of TRISS, the ICD-9CM based ICISS and ICD-10 based ICISS were compared in a group of 367 severely injured patients admitted to two university hospitals. The predictive power was compared by using the measures of discrimination(disparity, sensitivity, specificity, misclassification rates, and ROC curve analysis) and calibration(Hosmer-Lemeshow goodness-of-fit statistics), all calculated by logistic regression procedure. RESULTS: ICD-10 based ICISS showed a lower performance than TRISS and ICD-9CM based ICISS. When age and Revised Trauma Score(RTS) were incorporated into the survival probability model, however, ICD-10 based ICISS full model showed a similar predictive power compared with TRISS and ICD-9CM based ICISS full model. ICD-10 based ICISS had some disadvantages in predicting outcomes among patients with intracranial injuries. However, such weakness was largely compensated by incorporating age and RTS in the model. CONCLUSIONS: The ICISS methodology can be extended to ICD-10 horizon as a standard injury severity measure in the place of TRISS, especially when age and RTS were incorporated in the model. In patients with intracranial injuries, the predictive power of ICD-10 based ICISS was relatively low because of differences in the classifying system between ICD-10 and ICD-9CM.
Emergencies ; Hospitals, University ; Humans ; Injury Severity Score ; International Classification of Diseases* ; Logistic Models ; ROC Curve ; Sensitivity and Specificity

PURPOSE: This study was conducted in order to evaluate the epidemiological characteristics of children with fall-down injuries according to age groups and to analyze the major trauma groups that were treated at the emergency room (ER). METHODS: Among 1,222 children under age 6 who were treated at the ER from January 2008 to December 2009, a retrospective study was conducted through examination of medical records. The children were classified by age into 3 groups: infant, toddler, and pre-schooler. In each group, the differences between the causative factors that led to the fall-down injuries were analyzed. Also, ISS (Injury Severity Score) score above 4 was classified as major trauma, and an ISS score 0-1 was classified as a minor trauma. The relationship between major trauma and age group was also analyzed. RESULTS: Through an analysis of child fall-down injuries, men (56.6%), toddler (47.3%), head-related symptoms (72.9%), furniture-related traumas (80.2%), and falls from less than a 1-m height (69.9%) were found to be common factors. Furthermore, in radiological studies, fractures and brain hemorrhages accounted for 16.9% of major traumas, and simple skull fractures were the most common (21.4%). Distributed according to age group, the factors relevant to fall injuries were fall height and head-related symptoms for infants, accident site, fall height and head-related symptoms for toddlers, and accident site for pre-schoolers (p<0.05). Also, head-related symptoms and fall height were independent factors of major trauma in all age groups. However, major traumas (17.3%) were related to dumped trauma, fall height and accident site (p<0.05). CONCLUSION: This study was mainly about head-related injuries, and toddler were most common victims. The relevant factors for the major trauma were falling height for infants, accident site and falling height for toddlers, and accident site, falling height for pre-schoolers.
Child ; Emergencies ; Humans ; Infant ; Injury Severity Score ; Intracranial Hemorrhages ; Male ; Medical Records ; Retrospective Studies ; Skull Fractures

PURPOSE: The Trauma Scoring System is used for triage and treatment decision-making of injured patients. An ideal scoring system should have predictive validity, correlate with outcome, be easily applicable, and be reliably applied among observations. The purpose of this study was to analysis the trauma scoring system to predict motor vehicle accident (MVA) survival and mortality. METHODS: The registry data of MVA trauma patients admitted to W hospital between October 2008 and December 2009 were retrospectively reviewed. The dependent variable of interest was patient survival (coded as live or die). The independent variables used in the study included the full term for ISS (ISS) derived using Abbreviated Injury Score (AIS) and body system maximum AIS scores, full term (ICISS) score, full term (RTS) and full term (TRISS). Survival predictability in each scoring system (ISS, RTS TRISS, ICISS and ICISS full model) was compared. RESULTS: Trauma severity scores of the 1,843 patients [1,163 males (63.1%), 680 females (36.9%); mean age 41.7+/-20.9 years] were: RTS 7.36+/-3.23 (median: 7.84), ISS 6.42+/-8.42 (median: 4), TRISS 0.952+/-0.153 (median: 0.994), ICISS 0.970+/-0.055 (median: 0.990), and ICISS full model 0.982+/-0.104 (median: 0.998). To analyze the predictive validity of the receiver operation characteristic (ROC) curve analysis, ISS 0.956, ICISS 0.522, ICISS full model 0.398, RTS 0.095, and TRISS 0.368 appeared to predict the validity of the widest area of the ROC curve area, with ISS being most reliable. CONCLUSION: ISS is the best predictor of survival than the other derived other scoring systems for MVA patients.
Female ; Humans ; Injury Severity Score ; Male ; Motor Vehicles ; Retrospective Studies ; ROC Curve ; Triage

PURPOSE: A missed fracture is a very common occurrence in the Emergency Department (ED) and can have serious results because of delays in treatment, resulting in long-term disability. It is also one of the most common causes leading to medical legal issues. We analyzed the causes of missed fractures by using a bone scan which is known to be an effective tool for diagnosing bony lesions. METHODS: We reviewed the medical records of trauma patients who underwent a bone scan after being discharged the ED from September 2006 to March 2008. Cases of missed fractures were identified by using electronic medical records to review each diagnosis. Definition of missed fracture was read after bone scan by radiologist. We decided that there was no fracture if we read 'trauma-related lesion' or 'cannot rule out fracture' on a bone scan read by a radiologist. Enrolled patients were analyzed by age, sex, time until bone scan and Injury Severity Score (ISS). Patients were divided into two groups, alert mentality and not-alert mentality, so there were split between a diagnosis group and a missed fracture group. ISS was also used in determining the severity of the patient's injury upon discharge from the ED. RESULTS: A total of 532 patients were enrolled in this study. Of those, 487 patients were in the diagnosis group, and 45 patients (8.4%) were discovered to have had a fracture. Of the 45 missed fracture patients, 34 patients (6.4%) had one-site fractures, 8 patients (1.5%) had two-site fractures, and 3 patients (0.6%) had threesite fractures. The most commonly missed fracture was multiple rib fractures (18 patients, 30.5%), followed by lumbosacral (LS) spine fractures (10 patients, 16.9%), thoracic spine fractures (8 patients, 13.6%), and clavicle fractures (6 patients, 10.2%). Mean age was 50.12+/-18.54 years in the diagnosis group and 57.38+/-16.88 years in the missed fracture group. For the diagnosis group, the mean ISS was 9.03+/-8.26, but in the missed fracture group it was 17.53+/-9.69. Missed fractures were much more frequent in the not-alert mentality (p<0.01) and in the high ISS (ISS> or =16) group (p<0.01). CONCLUSION: Missed fractures occur most frequent in patients of old age, not-alert mentality, and high ISS. Multiple rib and spine fractures were found to be the most frequent missed fractures, regardless of trauma severity. This study also shows a high possibility of clavicle and scapula fractures in patients with severe trauma.
Clavicle ; Electronic Health Records ; Emergencies ; Humans ; Injury Severity Score ; Medical Records ; Rib Fractures ; Ribs ; Scapula ; Spine