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At least 19 recordsLinked to original sources
PubMed1983

An evaluation of multiple trauma severity indices created by different index development strategies.

Evaluation of the effectiveness of emergency trauma care systems is complicated by the need to adjust for the widely variable case mix found in trauma patient populations. Several strategies have been advanced to construct the severity indices that can control for these population differences. This article describes a validity and reliability comparison of trauma severity indices developed under three different approaches: 1) use of a multi-attribute utility (MAU) model; 2) an actuarial approach relying on empirical data bases; and 3) an "ad hoc" approach. Seven criteria were identified to serve as standards of comparison for four different indices. The study's findings indicate that the index developed using the MAU theory approach associates most closely with physician judgments of trauma severity. When correlated with a morbidity outcome measure, the MAU-based index shows higher levels of agreement than the other indices. The index development approach based on the principles of MAU theory has several advantages and it appears to be a powerful tool in the creation of effective severity indices.

Actuarial Analysis↗
PubMedDate not supplied

[Major resection in severe hepatic trauma. Technical indications and clinical considerations in a case of personal experience].

Before the Second World War overall mortality from liver injuries was 60%. The extraordinary progresses made in elective hepatic surgery, backed by an increasingly detailed physiopathological knowledge and by progress in anesthesia and reanimation techniques, have had a positive effect also on traumatological liver surgery bringing mortality rates dawn to between 10% and 20%. However, in spite of this reassuring success, mortality from liver injury still remains unacceptably high for the most severe lesions on the "Calne scale", in particular 50-60% for 4th degree lesions. A review of the literature regarding this group of patients indicates hemorrhagic shock as being the prime cause of mortality: extensive lobar disintegration associated with severe vascular disinsertion involving the suprahepatic-caval crossroads are responsible for the patient's death in 50% of cases. Associated intra- or extra-abdominal lesions, which are often commonplace, make a decisive contribution to raising the mortality rate for 4th degree lesions. Lastly, the high number of possible postoperative complications contributes to the severity of prognosis in this group of patients. The analysis of a case of severe hepatic injury (4th degree according to Calne's and Lenriot's classifications) with a favourable outcome prompts the author to make a number of clinical and surgical observations, and to conclude that emergency hepatic resection still continues to be a rare indication reserved for cases of absolute necessity for which there is no other possible therapy.

Adult↗
PubMed1980

Evaluation of burn blister fluid.

Although edema is evident immediately after a burn, the diffusion of nutrient chemical constituents of the body is not impaired. Blister fluid, not unlike plasma or serum, contained all substances found in the body, including parenterally administered penicillin. The elevation of potassium and the cation to anion imbalance is primarily due to the Na/K cellular pump malfunction, and the destruction of the permeability of the cell membrane is most likely a direct result of complement and other cellular enzymes, which include the prostaglandins and thromboxanes. The elevated SGOT, CPK, and LDH indicated severe trauma to the cells in the immediate area of burn and possibly to the skeletal muscle. The presence of immunoglobulins indicated that high-molecular-weight proteins diffuse equally well during this edematous phase (IgM, 900,000; IgG, 190,000). Evidence of this nature strongly suggests that the integrity of the burn blister by maintained.

Biological Assay↗
PubMed2000

Visual disorders after traumatic brain injury in developmental age.

Visual disorders secondary to TBI are common, often multiple, associated with complex clinical pictures; in developmental age they may particularly interfere with the development process, and compromise the rehabilitation and outcome processes. The aim of this study is to identify visual disorders in 56 post-traumatic children admitted to the Traumatic Brain Injury Unit. All patients underwent a complete clinical, neurological and neuroophthalmological assessment. Correlations were studied between visual disorders and clinical parameters of acute phase, age at trauma, neuroimaging data and outcome, in order to identify possible risk factors for their occurrence. A high incidence was found of complex visual disorders following head trauma: decreased visual acuity, together with a convergence oculo-motor deficit, is the most frequently detected deficit. Trauma severity, indicated by duration of coma, is associated with most of the visual disorders and appears to be the main risk factor conducive to their appearance.

Acute Disease↗
PubMed1999

[Injuries missed in diagnosing severely injured accident victims in the emergency room].

OBJECTIVE: To determine the incidence of injuries missed in the emergency room (ER) and the factors involved. DESIGN: Retrospective. METHOD: Of patients with an Hospital trauma index-injury severity score (HTI-ISS) > or = 14 who were treated in 1996 in the ER of the Academic Hospital Utrecht, the Netherlands, it was studied in the computerized database whether injuries had been missed. A missed injury was defined as an injury not identified during assessment in the Emergency department, but identified later in the hospital or rehabilitation centre. The groups of patients with and without missed injuries were compared with each other regarding possible risk factors for missing injuries. RESULTS: Of 376 severely injured patients in 1996, 329 patients had sufficient follow-up documentation. In 37 patients (11%) of these 329 patients 47 injuries were missed. Fractures were the injuries most frequently missed (n = 25), followed by nerve tissue injuries (n = 14). There were consequences for the treatment in 13 of these patients (35%). Patients with missed injuries had a higher HTI-ISS, were more often primarily referred to the ER and arrived more often at night compared with patients without missed injuries. The two patient groups did not differ at to experience of the physicians.

Adult↗
PubMed1993

Factors affecting morbidity and mortality from road traffic accidents: a Nigerian peri-urban study.

Road traffic census was taken along major roads linking Ilorin, Nigeria, with the north, east, south and north-west at different times on three randomly selected days per month during 16 months of 1982 and 1983. Road physical characteristics thought to affect safe and free traffic flow were also documented along the same roads. Trauma patients at the University of Ilorin Teaching Hospital were prospectively studied between 1983 and 1984. Of 715 road traffic accident (RTA) victims 78.6% were males, 48% suffered multiple injuries while 43.7% were managed non-operatively. Seventy-nine patients (11.0%) died. Of 10 variables analysed, outcome was significantly affected by non-operative management (P < 0.01) while patients' primary admission versus referral status was of borderline significance (P = 0.05). In addition to these indices of trauma severity, high truck-trailer traffic and high frequency of narrow bridges, bends and vehicle wrecks per kilometer of road were associated with high RTA rates.

Accidents, Traffic↗
PubMed1992

[Bronchoscopy for initial care following severe thoracic trauma--basically indicated?].

UNLABELLED: The study objective was to determine the usefulness of routine early (within 24 h after admission) and late (on the 3rd posttraumatic day) flexible fiberoptic bronchoscopy in patients with severe chest trauma. METHODS: By history, physical examination, and radiologic findings, we identified 15 consecutive patients, all of whom were anaesthetized, orally intubated, and mechanically ventilated. There was no change in ventilation, including FIO2, for bronchoscopy. The patients had continuous cardiovascular monitoring and peripheral pulse oximetry. The bronchoscope was inserted through a tight-fitting side port at the endotracheal tube connector. Pulse rate, mean arterial pressure, and arterial blood gases were recorded before, 1 min after, and 10 min after bronchoscopy, as were intracranial pressure (ICP) in 7 patients with an ICP probe (early bronchoscopy only) and the duration of the examination. Statistical significance was tested by means of the Wilcoxon test for correlating samples. Significance was assumed at P less than 0.05 in a two-sided test. RESULTS: Early bronchoscopy revealed two bronchial avulsions, two aspirations, and ruled out one suspected aspiration. Late bronchoscopy showed plugging of at least 3 segmental bronchi by clots in 4 patients, none of whom was able to expectorate effectively. In general, changes in the observed vital parameters were minimal. There was a significant but clinically irrelevant increase in mean pulse rate before and 1 min after early bronchoscopy. DISCUSSION: We conclude that bronchoscopy should always be considered in patients with severe chest trauma, the decision being based on typical radiological findings as well as clinical signs and symptoms. Given the proper indication, bronchoscopy supplies valuable information at minimal risk to the patient.

Adult↗
PubMed1990

[Triage. Initial diagnosis of life-threatening injuries based on functional state and mechanism of injury].

Functional status expressed as Trauma Score (TS) and mechanism of injury were evaluated as criteria for diagnosing severe trauma in 253 traffic accident victims. An Injury Severity Score (ISS) of greater than or equal to 16 was considered a severe, potentially life-threatening injury. In 67 patients with ISS greater than or equal to 16, either TS was less than or equal to 13 or the history suggested risk of high energy trauma in 72%. When one or both of these criteria were met, ISS was greater than or equal to 16 in 54%. In addition, five patients (3%) with ISS less than 16 had potentially life-threatening injuries in the abdomen or in the thorax. Of these, two had a history indicating high energy trauma. Identifying severely injured patients by assessment of function and mechanism of injury gave an overtriage of 46%, which is acceptable, and an undertriage of 12%. Caution should be exercised in excluding severe trauma on these criteria. Considered together, decreased TS and a history indicating high energy injury, gave high sensitivity (72%) and specificity (78%) for diagnosing severe trauma, ISS greater than or equal to 16.

Accidents, Traffic↗
PubMed1995

A five-year experience with severe injuries in elderly patients.

Recent reports of injury in elderly patients document that aggressive care is justified. Our experience indicates that geriatric injury differs from that of other trauma patients. All patients entered into a large urban trauma center registry over a five-year period were analyzed. Variables reviewed included demographics, trauma indices, mechanism of injury, mean number of hospital days, and morbidity and mortality for patients under 60 years old and for geriatric patients defined as those aged 60 and above. There were 3,064 patients in the reviewed group, of whom 243 qualified for geriatric analysis. Blunt injuries in males were the most typical scenario. Failure to use safety belts and alcohol intoxication persist into the geriatric age group (83% and 13%, respectively). Trauma indices including Injury Severity Score (ISS) were slightly greater in the geriatric group (27 versus 23) as compared to younger patients; plus geriatric patients tolerated head injury less well (GCS in those who died 6.7 versus 4.6, respectively; p < 0.001). Mortality in the geriatric group was 31% while being 17.1% in the younger group (p < 0.005). Days in the hospital were 20 for the geriatric compared to 13 for the younger group (p < 0.025). Infections and chest complications were twice as common in the elderly and dysrhythmias were five times more frequent. Elderly patients constitute 8% of the trauma population and suffer a magnitude of injury at least comparable to the general population. Their mortality is approximately 50% above the population as a whole and morbidity twice as common, accounting for the prolonged hospital stay.

Accidents, Traffic↗
PubMed1993

Prophylactic vena cava filter insertion in severely injured trauma patients: indications and preliminary results.

Pulmonary embolism (PE) remains a significant problem in trauma patients. A 5-year review at this institution revealed 25 PEs (seven fatal) in 2525 admitted trauma patients (1% incidence). Three groups of high-risk patients were identified: (1) those with severe head injury and coma; (2) those with spinal cord injuries with neurologic deficit; and (3) those with pelvic and long bone fractures. The relative risk of PE in these high-risk patients was 21 to 54 times that of the general trauma population. Beginning in July 1991, as prophylaxis against PE, vena cava filters (VCF) were inserted in patients whose injuries placed them in a high-risk group. Thirty-four patients had VCFs inserted percutaneously in the radiology suite without complications. On follow-up examination, 17.6% developed documented lower extremity deep vein thrombosis. There were no PEs. Overall, the incidence of PE in the general trauma population was significantly decreased from 1% to 0.25% (p < 0.05; chi 2). We conclude that insertion of VCFs in high-risk trauma patients is safe and efficacious in decreasing the incidence of PE.

Adult↗
PubMed1992

[The type of coma as prognostic indicator in severe cranial trauma in childhood].

Various methods are used by neurologists to evaluate posttraumatic brain damage. The most important and reliable are the length of posttraumatic amnesia and coma. In previous papers we have already described the value of the type of coma in the prognosis of serious head injury in childhood (Baracchini-Muratorio et al. 1985; Pruneti et al. 1985). In this study, 30 children (aged 6-12 years) with serious closed head injury and subsequent coma were evaluated. The children were divided into two groups according to the type of coma, using the Plum and Posner coma classification (1966) modified by Pagni et al. (1974). The children were followed up for at least two years (9 for five years) after the trauma by means of neurological, physical, EEG, CT scan and neuropsychological examinations. The neuropsychological test results confirm the hypothesis of a different evolution of sequelae in relation to the type of coma, independently of length of coma and site of brain damage.

Adolescent↗
PubMed1990

Blunt renal trauma in childhood. Features indicating severe injury.

The clinical presentation of children with blunt renal trauma may differ from that of adults. The clinical features at presentation of 50 consecutive children (20 severe injuries, no pedicle injuries) admitted over a period of almost 8 years were reviewed to determine if there were clinical clues to major renal trauma in childhood. Gross haematuria and low haematocrit were the most helpful factors at the time of presentation and correlated well with severe renal injury. Hypotension was seen in 4 patients and only 1 had severe renal trauma. Suspicion of a major renal injury should be high when there is gross haematuria or a low haematocrit. In this study only 1 of 20 patients with major renal injury demonstrated clinical signs of shock. Unlike adults, hypotension does not appear to be a reliable indicator of the severity of renal injury in children and diagnostic evaluation should not be reserved only for those in shock.

Adolescent↗
PubMed1985

[The PMN elastase plasma level, a biochemical parameter of the severity of trauma].

Polytrauma patients with defined severity of trauma showed a significant release of lysosomal enzymes as measured by PMN leucocyte elastase-alpha 1 proteinase inhibitor complex in plasma. A positive correlation was found between the amount of liberated elastase and the severity of trauma (- indicated by means of extent of tissue trauma and blood loss). The concentration of elastase complexed with alpha 1 proteinase inhibitor may serve as an indicator for the severity of trauma and as an objective parameter supplementing the scales and scores used until now, which all are based upon subjective judgement.

Adolescent↗
PubMedDate not supplied

Is it possible to predict limb viability in complex Gustilo IIIB and IIIC tibial fractures? A comparison of two predictive indices.

The patient with severe lower limb trauma presents a management dilemma; whether to amputate primarily or to attempt limb salvage. In recent years, many predictive indices have been published which purport to identify limbs which are non-viable. We retrospectively applied two recently described indices, the Mangled Extremity Severity Score (MESS) and the Limb Salvage Index (LSI), to 54 limbs in 50 patients with either Gustilo IIIB or IIIC complex tibial fractures. There were 22 amputations (40.7 per cent) in the series. The mean MESS score in the limb salvage group was 3.8 (range 2-10), and the mean MESS score in the amputation group was 7.7 (range 4-13) (P < 0.0001). The mean LSI score in the limb salvage group was 3.6 (range 3-8), and the mean LSI score in the amputation group was 6.9 (P < 0.01). However, in the group with MESS scores > 7 (which recommends amputation), there were three limbs which were salvaged with acceptable functional outcome. Similarly, in those with LSI scores > 6 (which recommends amputation), there were seven limbs successfully salvaged. A MESS > 7 offered a greater relative risk of amputation (9.2) than a LSI score > 6 (5.3). We found both indices of use in predicting limb salvage and functional outcome. However, neither is sufficiently accurate to be considered absolutely reliable in clinical practice.

Adolescent↗
PubMed2000

The effects of trauma among kidnap victims in Sardinia, Italy.

BACKGROUND: No study to date has investigated the effects of the trauma of being kidnapped for ransom. In the present study, we aimed to assess the general health status and the presence of post-traumatic stress disorder (PTSD) and major depression (MDD) in a sample of kidnap victims. We also focused attention on dissociative experiences and on the development of the Stockholm syndrome during captivity. METHODS: We investigated the traumatic experiences and reported general health status of 24 kidnap victims using a semistructured interview. The Structured Clinical Interview for DSM-IV was used to assess the presence of PTSD and MDD. The Dissociative Experiences Scale was also administered. RESULTS: The lifetime frequency of PTSD and MDD were 45.9% and 37.5% respectively. The Stockholm syndrome had been present in 50% of the sample during captivity. The presence of PTSD can be predicted by the number of violent experiences, whereas the number of humiliating or deprivation experiences predicts the development of the Stockholm syndrome. Subjects with both PTSD and the Stockholm syndrome reported a greater number of physical complaints at the interview. CONCLUSIONS: There is no significant connection between PTSD and the Stockholm syndrome. Both are indices of the severity of the trauma of being kidnapped, but they are associated with different aspects of the traumatic experience. The presence of both syndromes appears to have a detrimental effect on physical health.

Adult↗