http://www.thelancet.com/article/S0140673621027963/pdf

Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21

Objectives:To update the Society of Critical Care Medicine’s guidelines for ICU admission, discharge, and triage, providing a framework for clinical practice, the development of institutional policies, and further research.Design:An appointed Task Force followed a standard, systematic, and evidence-

ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research.

Commuting by bicycle has advantages over other modes of transport,both for the commuter and for society.Although cycling is an option for many commuters,a considerable number of them choose to use other forms of trans-port.In order to underpin policies that promote commuting by bicy-cle,this paper investigates the de-terminants for commuting to work.As many bicycle commuters do notcycle every day,we also examine people’s daily choices,in terms of frequency.We conducted a survey of the current literature in order to identify the determinants for com-muting by bicycle.We found many determinants,not all of which are addressed by conventional mode choice studies and models.This suggests that predicting and influ-encing bicycle use needs to be grounded in other kinds of knowl-edge than those currently available for motorized forms of transport.

Commuting by Bicycle:An Overview of the Literature

Recent trends in burn epidemiology worldwide: A systematic review

Background: Burns are a major public health problem, with long hospitalization stay in both intensive care units and general wards. In Israel about 5% of all hospitalized injuries are burn injuries. There are no long-term epidemiological studies on burn injuries in adults in Israel. Objectives: To identify risk factors for burn injuries and provide a starting point for the establishment of an effective prevention plan. Methods: We analyzed the demographic, etiologic and clinical data of 5000 burn patients admitted to the five major hospitals with burn units in Israel during a 7 year period (1997–2003). Data were obtained from the records of the Israeli National Trauma Registry. The differences between various groups were evaluated using the chi-square test. Results: Male gender was twice as frequent as female gender in burn patients (68.0% vs. 31.9%), and non-Jewish ethnicity was more common when considering their proportion in the total population (62.3% vs. 36.8%). Second and third-degree burns with body surface areas less than 10% constituted the largest group (around 50%). The largest age group was 0–1 years, constituting 22.2% of the cases. Inhalation injury was uncommon (1.9%). The most common etiologies were hot liquids (45.8%) and open fire (27.5%). Children less than 10 years old were burnt mainly by hot liquids while the main cause of burns for adults > 20 years old was an open flame. The majority of burns occurred at home (58%); around 15% were work related. The mean duration of hospitalization was 13.7 days (SD 17.7); 15.5% were in an intensive care unit with a mean duration of 12.1 days (SD 17.1). Surgical procedures became more common during the period of the study (from 13.4% in 1998 to 26.59% in 2002, average 19.8%). The mortality rate was 4.4%. We found a strong correlation between burn degree and total body surface area and mortality (0.25% mortality for 2nd to 3rd-degree burns with less than 10% TBSA, 5.4% for 2nd to 3rd-degree burns with 20–39% TBSA, and 96.6% for burns > 90% TBSA). The worst prognosis was for those over the age of 70 (mortality rate 35.3%) and the best prognosis was for the 0–1 year group (survival rate 99.6%). Conclusions: The groups at highest risk were children 0–1 years old, males and non-Jews (the incidence rate among non-Jews was 1.5 times higher than their share in the general population). Those with the highest mortality rate were victims of burns > 90% TBSA and patients older than 70. Most burns occurred at home.

Burns in Israel: demographic, etiologic and clinical trends, 1997-2003.

Background: TBI may be defined by different methods. Some may be most useful for immediate clinical purposes, however less optimal for epidemiologic research. Other methods, such as the Abbreviated Injury Score (AIS), may prove more beneficial for this task, if the cut-off-points for their categories are defined correctly.Objective: To reveal the optimal cut-off-points for AIS in definition of severity of TBI in order to ensure uniformity between future studies of TBI.Results: Mortality of patients with TBI AIS 3, 4 was 1.9% and 2.9% respectively, comparing with 31.1% among TBI AIS 5+. Predictive discrimination ability of the model with cut-off-points of 5+ for TBI AIS (in comparison with other cut-off-points) was better. Patients with missing Glasgow Coma Scale (GCS) in the ED had an in-hospital mortality rate of 11.5%. In this group, 25% had critical TBI according to AIS. Normal GCS didn’t indicate an absence of head injury, as, among patients with GCS 15 in the ED, 26% had serious/critical TBI ...

Traumatic brain injury: It is all about definition.

BACKGROUND: Rib fractures are considered a marker of exposure to significant traumatic energy. In children, because of high elasticity of the chest wall, higher energy levels are necessary for ribs to fracture. The purpose of this study was to analyze patterns of associated injuries in children as compared with adults, all of whom presented with rib fractures. METHODS: A retrospective cohort study involving blunt trauma patients with rib fractures registered in the National Trauma Registry was conducted. RESULTS: Of 6,995 trauma victims who were found to suffer from rib fractures, 328 were children and 6,627 were adults. Isolated rib fractures without associated injuries occurred in 19 children (5.8%) and 731 adults (11%). More adults had 4 or more fractured ribs compared with children (P CONCLUSIONS: The incidence of associated head, thoracic, and abdominal solid organ injuries in children was significantly higher than in adults suffering from rib fractures. In spite of a higher Injury Severity Score and incidence of associated injuries, mortality rate was similar. Mortality of rib fracture patients was mostly affected by the presence of extrathoracic injuries. Language: en

Rib fractures: comparison of associated injuries between pediatric and adult population.

Incidence and Severity of Maxillofacial Injuries During the Second Lebanon War Among Israeli Soldiers and Civilians

Background Despite ISS being a widely accepted tool for measuring injury severity, many researchers and practitioners use different partition of ISS into severity groups. The lack of uniformity in ISS use inhibits proper comparisons between different studies. Creation of ISS group boundaries based on single AIS value squares and their sums was proposed in 1988 during Major Trauma Study (MTOS) in the USA, but was not validated by analysis of large databases. Methods A validation study analysing 316 944 patients in the Israeli National Trauma registry (INTR) and 249 150 patients in the American National Trauma Data Bases (NTDB). A binary algorithm (Classification and Regression Trees (CART)) was used to detect the most significantly different ISS groups and was also applied to original MTOS data. Results The division of ISS into groups by the CART algorithm was identical in both Trauma Registries and very similar to original division in the MTOS. For most samples, the recommended groups are 1–8, 9–14, 16–24 and 25–75, while in very large samples or in studies specifically targeting critical patients there is a possibility to divide the last group into 25–48 and 50–75 groups, with an option for further division into 50–66 and 75 groups. Conclusions Using a statistical analysis of two very large databases of trauma patients, we have found that partitioning of ISS into groups based on their association with patient mortality enables us to establish clear cut-off points for these groups. We propose that the suggested partition of ISS into severity groups would be adopted as a standard in order to have a common language when discussing injury severity.

https://injuryprevention.bmj.com/content/injuryprev/early/2014/02/23/injuryprev-2013-041042.full.pdf

Adi Givon

Papers

Burns in Israel: demographic, etiologic and clinical trends, 1997-2003.

Traumatic brain injury: It is all about definition.

Rib fractures: comparison of associated injuries between pediatric and adult population.

Incidence and Severity of Maxillofacial Injuries During the Second Lebanon War Among Israeli Soldiers and Civilians

ISS groups: Are we speaking the same language?