Showing papers on "Abbreviated Injury Scale published in 1999"

Trauma care regionalization: a process-outcome evaluation.

Abstract: Background: Regionalization of trauma care services in our region was initiated in 1993 with the designation of four tertiary trauma centers. The process continued in 1995 with the implementation of patient triage and transfer protocols. Since 1995, the network of trauma care has been expanded with the designation of 33 secondary, 30 primary, and 32 stabilization trauma centers. In addition, during this period emergency medical personnel have been trained to assess and triage trauma victims within minimal prehospital time. The objective of the present study was to evaluate the impact of trauma care regionalization on the mortality of major trauma patients. Methods: This was a prospective study in which patients were entered at the time of injury and were followed to discharge from the acute-care hospital. The patients were identified from the Quebec Trauma Registry, a review of the records of acute-care hospitals that treat trauma, and records of the emergency medical services in the region. The study sample consisted of all patients fulfilling the criteria of a major trauma, defined as death, or Injury Severity Score (ISS) >12, or Pre-Hospital Index > 3, or two or more injuries with Abbreviated Injury Scale scores > 2, or hospital stay of more than 3 days. Data collection took place between April 1, 1993, and March 31, 1998. During this period, four distinct phases of trauma care regionalization were defined: pre-regionalization (phase 0), initiation (phase I), intermediate (phase II), and advanced (phase III). Results: A total of 12,208 patients were entered into the study cohort, and they were approximately evenly distributed over the 6 years of the study. During the study period, there was a decline in the mean age of patients from 54 to 46 years, whereas the male/female ratio remained constant at 2:1. There was also an increase in the mean ISS, from 25.5 to 27.5. The proportion of patients injured in motor vehicle collisions increased from less than 45% to more than 50% (p < 0.001). The mortality rate during the phases of regionalization were: phase 0, 52%; phase I, 32%; phase II, 19%; and phase III, 18%. These differences were clinically important and statistically significant (p < 0.0001). Stratified analysis showed a significant decline in mortality among patients with ISS between 12 and 49. The change in mortality for patients with fatal injuries (ISS ≥ 50) was not significant. During the study period, the mean prehospital time decreased significantly, from 62 to 44 minutes. The mean time to admission after arrival at the hospital decreased from 151 to 128 minutes (p < 0.001). The latter decrease was primarily attributable to changes at the tertiary centers. The proportion of patients with ISS between 12 and 24 and between 25 and 49 who were treated at tertiary centers increased from 56 to 82% and from 36 to 84%, respectively (p < 0.001). Compared with the secondary and primary centers, throughout the course of the study the mortality rate in the secondary and tertiary centers showed a consistent decline (p < 0.001). In addition, the mortality rate in the tertiary centers remained consistently lower (p < 0.001). The results of multivariate analyses showed that after adjusting for injury severity and patient age, the primary factors contributing to the reduced mortality were treatment at a tertiary center, reduced prehospital time, and direct transport from the scene to tertiary centers.

Relatively short diagnostic delays (<8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience.

Abstract: Objective: Blunt small bowel injury (SBI) is uncommon, and its timely diagnosis may be difficult. The impact of operative delays on morbidity and mortality has been unclear. The purpose of this study was to determine the relationship of diagnostic delays to morbidity and mortality in blunt SBI. Methods: Patients with blunt SBI with perforation were identified from the registries of eight trauma centers (1989-1997). Patients with duodenal injuries were excluded. Data were extracted by individual chart review. Patients were classified as multi-trauma (group 1) or near-isolated SBI (group 2 with Abbreviated Injury Scale score < 2 for other body areas). Time to operation and its impact on mortality and morbidity was determined for each patient. Results: A total of 198 patients met inclusion criteria: 66.2% were male, mean age was 35.2 years (range, 1-90 years) and mean Injury Severity Score was 16.7 (range, 9-47). 100 patients had multiple injuries (group 1). There were 21 deaths (10.6%) with 9 (4.5%) attributable to delay in operation for SBI. In patients with near-isolated SBI, the incidence of mortality increased with time to operative intervention (within 8 hours: 2%; 8-16 hours: 9.1%; 16-24 hours: 16.7%; greater than 24 hours: 30.8%, p = 0.009) as did the incidence of complications. Delays as short as 8 hours 5 minutes and 11 hours 15 minutes were associated with mortality attributable to SBI. The rates of delay in diagnosis were not significantly associated with age, gender, intoxication, transfer status, or presence of associated injuries. Conclusion: Delays in the diagnosis of SBI are directly responsible for almost half the deaths in this series. Even relatively brief delays (as little as 8 hours) result in morbidity and mortality directly attributable to missed SBI. Further investigation into the prompt diagnosis of this injury is needed.

Comparison of alternative methods for assessing injury severity based on anatomic descriptors.

Abstract: Background:There is mounting confusion as to which anatomic scoring systems can be used to adequately control for trauma case mix when predicting patient survival.Methods:Several Abbreviated Injury Scale (AIS) and International Classification of Disease Clinical (ICD-9CM) -based methods of scoring s

Abbreviated injury scale unification : The case for a unified injury system for global use

Abstract: Background: The Abbreviated Injury Scale (AIS), developed by the Association for the Advancement of Automotive Medicine is the most widely used anatomic injury severity scale in the world (Association for the Advancement of Automotive Medicine. The Abbreviated Injury Scale; 1985 and 1990 revisions. Des Plaines, IL: Association for the Advancement of Automotive Medicine). However, different user groups have modified the AIS system to fit their needs, and these modifications prevent ready comparison and trending of data collected in these systems in the United States and throughout the world. The United States currently has five AIS-based severity systems and two AIS-based impairment systems in use, with additional revisions forthcoming. Other modified AIS systems are known to be in use in the United Kingdom and Japan. The data collected in these systems cannot be accurately combined or compared without re-coding or the use of complex mapping methodologies. Furthermore, the expanding use of data linked from multiple databases to answer complex medical, engineering, or policy issues emphasizes the need for coordination between severity and other injury systems. Linkage of state-wide motor vehicle crash data with data from hospital injury classification systems, mortality files, trauma registry, and national crash databases brings into immediate focus the lack of well defined relationships between the severity coding systems and these other widely used injury systems (Mango N, Garthe E. SAE Congress, February, 1998; Johnson, S, Walker, J. NHTSA Technical Report. DOT HS 808 338, Washington, DC: NHTSA; January, 1996). With the expanding use of linked data in state and national policy decisions, it is vital that consistent standards for injury descriptions, severities, and impairments be available for clinical, engineering, and policy users. Methods: This paper compares five anatomic severity systems and two impairment systems in terms of purpose, code structure, and use and discusses the reasons for the differences between these systems. With global harmonization encouraging greater sharing of international data, the paper also presents the relationship of the severity and impairment systems to US morbidity and reimbursement and worldwide mortality classification systems. Results: To resolve compatibility issues resulting from multiple injury systems, the authors propose that a unified system for global use be developed, configured by inputs from major data owners, users, and analysts. The proposed unified system has six key attributes: backward compatibility with historical data through maps so no data are lost; scalability to allow a simple level of use for developing countries, a more complex level for crash research and a detailed level for clinical hospital use, all with data compatibility; the ability to satisfy the needs of the engineering community for injury location information and aspect, and also the clinical requirement for precise injury description; inherent integration with whole body severity scores to permit easy computation; compatibility with other injury data systems such as mortality, morbidity, and reimbursement systems; and a mechanism and process to maintain and upgrade the system into the 21st century. Conclusion: The authors believe that a unified injury system is a necessary and crucial advance from the currently fragmented injury system situation.

Abbreviated injury scale unification: the case for a unified injury system for global use.

Abstract: BackgroundThe Abbreviated Injury Scale (AIS), developed by the Association for the Advancement of Automotive Medicine is the most widely used anatomic injury severity scale in the world (Association for the Advancement of Automotive Medicine. The Abbreviated Injury Scale; 1985 and 1990 revisions. De

Unexpected contribution of moderate traumatic brain injury to death after major trauma.

Abstract: Background: The cardiovascular reflex responses to injury and simple hemorrhage are coordinated in the central nervous system. Coincidental brain injury, which is present in 64% of trauma patients who die, could impair these homeostatic responses. The occurrence of hemorrhagic shock in the patient with head injury is also known to increase mortality. Therefore, there is a potential bidirectional interaction between traumatic brain injury and peripheral injury, which would result in an increased mortality when these two injuries coexist. Our objective was to test the hypothesis that moderate traumatic brain injury is an independent predictor of outcome in patients with multisystem trauma. Methods: We carried out an analysis of the UK Trauma Audit and Research Network Database. Moderate traumatic brain injury was defined as an Abbreviated Injury Scale score of 3. The study population included 2,717 patients with multisystem injury: 378 patients had a moderate brain injury with peripheral injury, and 2,339 patients had extracranial injury alone. Mortality rates for both groups were compared at increasing injury severity. Results: Moderate brain injury alone was associated with a mortality rate of 4.2%. However, when combined with extracranial injury, the risk of death was double that attributable to extracranial injury alone (odds ratio, 2.08; 95% confidence interval, 1.57-2.77). Conclusion: This study confirms that the coexistence of moderate traumatic brain injury with extracranial injury is associated with a doubling of the predicted mortality rate throughout the injury severity ranges studied.

Severity and mechanism of head impacts in car to pedestrian accidents

Abstract: This study shows results of 762 car to pedestrian collisions, documented within in-depth investigations on the scene at the Medical University Hannover, Germany. Special attention is paid to the shape of the car front. The situation for the pedestrian injuries is described in relation to collision speed, and the following is found: (1) 70% of all accidents with pedestrians happened at an impact speed of up to 40 km/h, and 30% were higher; (2) Collision speed of more than 40 km/h had an injury severity risk of 31% Maximum Abbreviated Injury Scale (MAIS) 1, 65% MAIS 2-4, and 4% MAIS 5-6; and (3) 4.7% of the pedestrian heads colliding in the speed range of up to 40 km/h suffered injuries during an impact to the windscreen region, but 63.6% of the heads with speeds of more than 40 km/h suffered injuries from that region. The detailed head impact situation in the area of the windscreen was analyzed, and the deformation patterns of the glass and the frame were compared to the head injury pattern. Most of all windscreen impacts with the head occurred to the lower half part of the screen. The head injury severity is not significantly higher in the frame region than in the middle-part of the screen. Improvements for reducing the injury severity are postulated, and a proposal for an optimized test procedure is briefly described. For the covering abstract of the conference see ITRD E203643.

Candida infections in critically ill trauma patients: a retrospective case-control study.

Abstract: Hypothesis We sought to determine whether the usual risk factors for fungal infections are applied to trauma patients. Design Case-control study. Setting American College of Surgeons Committee on Trauma–certified Level I trauma center in a tertiary care community hospital. Patients Screening of medical records of a consecutive sample of 459 patients aged 16 years or older admitted to an intensive care unit for 4 days or more from 1993 through 1996 identified 20 patients infected with Candida species. Two case controls for each were selected from the remaining patients using sex, age within 5 years, mechanism of injury, and best fit of first 4 Abbreviated Injury Scale scores; the Injury Severity Score and intensive care unit length of stay were also used if needed. Interventions None. Results Univariate analyses by t and χ 2 tests showed significance ( P Conclusion Many of the classic risk factors for fungal infection in other populations are actually concomitants of injury severity and its requisite level of care in trauma patients. Hyperalimentation in persistently critically ill trauma patients significantly increases the risk of Candida infection.

Permanent sequelae in sports injuries: a population based study

Abstract: AIM To identify permanent sequelae after sports injuries in children and adolescents. METHODS In 1985, a prospective register was drawn up of all sports related injuries reported that year by the residents of Trieste, Italy aged 6–15 years. Moderate to severe injuries (scoring ⩾ 2 on the abbreviated injury scale (AIS)) were the object of a longitudinal clinical study. In 1988, 30.9% of the 220 subjects enrolled had sequelae. A further follow up was undertaken in 1997. RESULTS The follow up in 1997 involved 54 subjects (26 girls; average age 24.5 years). Subjective and objective sequelae, by now considered to be permanent, were found in 61.1%, corresponding to 15% of the AIS ⩾ 2 injuries recorded in 1985. The prevalence of sequelae was similar in the two sexes, in relation to the child’s age at time of injury, and in the different sports practised. It was higher in relation to the severity of the lesion (89% of AIS 3 injuries examined, 56% of AIS 2 injuries) and to the type of lesion and its location. With regard to AIS ⩾ 2 injuries, permanent sequelae were found in 50% of ankle fractures, 43% of elbow fractures, 33% of leg/foot fractures, 25% of knee sprains, and 23% of ankle sprains. CONCLUSIONS The frequency of sequelae in sports injuries in children and adolescents is high. The risk appears to be connected to certain anatomical and functional age characteristics. Prevention strategies should include specific assessment of physical fitness and adequate follow up after the accident, particularly rehabilitation.

Development and validation of the injury severity assessment survey/parent report: a new injury severity assessment survey.

Abstract: Objective To develop and pilot test a telephone-based survey instrument that enables parents to identify and characterize the body region and severity of childhood injuries using the Abbreviated Injury Scale (AIS) scoring system. Design A prospective cross-sectional survey. Setting The emergency department of an urban, tertiary care, pediatric trauma center. Participants One hundred forty-seven parents of children younger than 18 years and seen in the emergency department for acute treatment of an unintentional injury. Interventions None. Main Outcome Measure The degree of agreement, measured as sensitivity, specificity, and κ statistic, between medical record information and parents' responses to the telephone survey regarding the identification and characterization of clinically significant (AIS ≥2) injuries. Results The survey, known as the Injury Severity Assessment Survey/Parent Report, was developed via a systematic review of the AIS 1990 manual. Answers to questions were developed in a way that enabled automated coding of responses into AIS scores or ranges of scores. The sensitivity of the survey (its ability to detect injuries scoring 2 or more on the AIS that were documented in the medical record) varied somewhat by the body region of injury, ranging from 88% for head, face, neck, and spine injuries to 95% for extremity injuries. Intermediate sensitivity (92%) was noted for the detection of significant chest and abdomen injuries. The specificity of the survey (its ability to rule out the presence of a significant injury when one was not documented in the medical record) was more than 95% in each of the 3 body region groups. The κ statistics for the 3 body region groups ranged from 0.89 to 0.92. Conclusions A new telephone-based survey has been developed that enables parents to characterize their child's injuries by body region and to differentiate between minor injuries and more significant injuries using a well-established injury classification system. This survey has a significant advantage over previous telephone-based or written surveys of childhood injuries and may be particularly valuable in population-based (eg, random-digit dial surveys) or multi-institutional studies of pediatric injuries.

Fatal falls down stairs.

Abstract: Fatal falls down stairs in south-east Scotland were studied using prospectively collected data between 1992 and 1997. 51 individuals, comprising 27 men and 24 women with mean age 68.9 years, died following falls down stairs, 30 (59%) of which were unwitnessed. 43 (84%) individuals died following falls within their own homes. Overall, 27 (53%) fatal falls resulted in death at the scene of the accident. Analysis of injuries according to the Abbreviated Injury Scale yielded injury severity scores (ISS) of between 5 and 75, but only four individuals had injuries recognised to be unsurvivable (ISS = 75). Injury to the brain and/or spinal cord was responsible for the vast majority of most severe injuries. The results demonstrate that stairs represent a significant hazard for the elderly. Most of the deaths in the pre-hospital setting appeared to be more the result of the fact that the victim was alone and unable to summon assistance, rather than as a result of unsurvivable injuries. Consideration needs to be given to both how the safety of stairs can be improved and whether a particular elderly person can safely cope with stairs.

Plastic bullet injuries in Northern Ireland: experiences during a week of civil disturbance

Abstract: Background Plastic bullets were introduced to Northern Ireland for riot-control purposes in 1973. Their use has been controversial, with a number of fatalities. In the week beginning July 7, 1996, some 8,000 plastic bullets were fired during widespread rioting. Methods Details of injuries attributed to plastic bullets were obtained retrospectively from patient notes for the period July 8 to 14, 1996, in six hospitals. A total of 172 injuries in 155 patients were recorded. Results Nineteen percent of injuries were to the face/head/neck, 20% were to the chest or abdomen, and 61% were to the limbs. Abbreviated Injury Scale scores ranged from I to 3. Forty-two patients were admitted for hospitalization, three to intensive care units. No fatalities occurred. Conclusion Plastic bullet impact to the abdomen or above may cause life-threatening injuries. Below this site, major trauma is unlikely.

ABCs of scoring systems for pediatric trauma.

Abstract: This review presents an overview of scoring systems used in pediatric and adult trauma. Triage scoring systems, using readily available physical examination, physiologic, and/or mechanism of injury parameters, are used to determine appropriate prehospital referral patterns. The Trauma Score, Revised Trauma Score, Circulation/Respiration/Abdomen/Motor/Speech Scale, Prehospital Index, and Trauma Triage Rule were reviewed. Injury scoring systems based upon anatomic descriptions of all identified injuries, are retrospectively used to analyze trauma populations. The Abbreviated Injury Scale, Injury Severity Score, Modified Injury Severity Score, Organ Injury Scaling, and Anatomic Profile were discussed. The two trauma outcome analysis systems presented, TRISS and ASCOT, allow for reproducible quantification of trauma severity, and survival comparison between trauma populations. Many of these triage, injury severity, and outcome analysis systems were developed with patient survival as the major outcome variable. Although subsequent studies may have found them to have some predictive value for measures of trauma morbidity, these scoring systems do not specifically address long-term risk of impairment, and therefore overlook one of the most crucial elements of pediatric trauma care. The last 2 decades have seen considerable development of scoring systems and analysis methods applicable to the trauma patient. As presented, this trend includes both the elaboration of increasingly simple, field-oriented triage tools, and more complex mathematical techniques for trauma outcome analysis. Although not all systems were designed specifically with the pediatric patient in mind, validation or modification of these systems for the pediatric patient will likely occur in the future. It is anticipated that this field will continue to evolve with greater mathematical sophistication; a baseline familiarity of the early stages of this evolution may be of benefit to those caring for the pediatric trauma patient.

Trauma scoring systems explained

Abstract: Objective: To list, describe and classify the extant trauma scoring systems found in the English language literature from the vantage of utility to emergency medicine. Each system is illustrated by a table and a hypothetical case study. Data Sources: Medline citations provided the data. The systems are classified as physiological, anatomical and combined trauma scoring systems. Results: We reviewed the Glasgow Coma Scale, the Paediatric Glasgow Coma Scale, the Trauma Score and Revised Trauma Score, the Circulation, Respiration, Abdominal/Thoracic, Motor and Speech Scale, the Acute Physiology and Chronic Health Evaluation System, Abbreviated Injury Scale, the Injury Severity Score, the Anatomical Profile, A Severity Characterization of Trauma, Revised Trauma Score and Injury Severity Score and its revisions, the Paediatric Trauma Score and the Drug-Rock Injury Severity Score. Conclusions: This compendium should help emergency physicians become familiar with trauma scoring systems which evaluate the extent and severity of injuries, facilitate inter-institutional comparisons and facilitate trauma research.

Injuries of motorcyclists and bicyclists examined at autopsy.

Abstract: Few studies of autopsy findings of persons dying of head and neck injuries in cyclists have been published. We performed a retrospective analysis of injury severity and the relation between head and neck injuries and helmet use. Seventy-six bicyclists and motorcyclists were collected from among the forensic autopsy at the Jikei University School of Medicine. From autopsy findings and accident reports, the abbreviated injury scale (AIS) and the injury severity score (ISS) were calculated and analyzed epidemiologically. As a result, helmet use significantly decreased the severity of head and neck injuries but had no effect on overall injury severity or the severity of injuries to other body regions. Furthermore, helmets had little effect on injuries remote from the point of impact, injuries resulting from angular acceleration, or injuries at the junction of the head and neck. These findings may be useful for both forensic pathologists and clinicians evaluating injuries in bicyclists and motorcyclists.

Biomechanical predictor of commotio cordis in high-speed chest impact

Abstract: Background: Commotio cordis is a term used to describe cases of blunt thoracic impact causing fatality without gross structural damage of the heart and internal organs. Death is attributed to ventricular fibrillation or cardiac arrhythmia aggravated by traumatic apnea. The biomechanical response related to the risk of commotio cordis has not been determined. Methods: Reanalysis of previously published experimental data was performed to determine which biomechanical parameter predicts the occurrence of commotio cordis. Logistic regression was used to determine the risk for commotio cordis with the level of chest compression, rate of chest deformation, and viscous criterion. Results: By using only cases without serious tissue injury (Abbreviated Injury Scale score < 4), viscous criterion was the best predictor of commotio cordis or ventricular fibrillation (X 2 = 7.69, p = 0.006). It was also the best predictor of heart rupture (X 2 = 13.19,p = 0.0003) and severe cardiac injury with Abbreviated Injury Scale score ≥ 4 (X 2 = 25.03, p = 0.0001). Conclusion: Based on this in-depth analysis, the viscous criterion is the relevant biomechanical response to assess the risk of commotio cordis and more severe thoracic injury in high-speed blunt impact.

Fatal injury: characteristics and prevention of deaths at the scene.

Abstract: BACKGROUND: Almost half of all trauma deaths occur at the scene. It is important to determine if these deaths can be prevented. METHODS: Penetrating or blunt force trauma deaths were identified through the Office of the Medical Examiner during a 2-year period. Data were also obtained through review of these records. RESULTS: There were 312 deaths at the scene that received no medical care. Almost 60% were firearm-related. About 80% of the victims were men, and 55% of these deaths occurred in people between 20 and 49 years old. Suicide accounted for nearly half of these deaths. Eighty percent of these injured people had Abbreviated Injury Scale scores of 5 or 6. CONCLUSION: Almost 60% of deaths at the scene occurred at the same time as injury and reflect severe injury to vital regions of the body. These findings suggest that primary prevention of the initial event causing injury may be more important than definitive prehospital emergency medical care to prevent these deaths.

Motorcyclists head injuries: mechanisms identified from accident reconstruction and helmet damage replication

Abstract: Motorcycle accident data have been collected in Glasgow (Scotland), Hannover (Germany) and Munich (Germany) as part of a COST action, and the data have been used to create a database comprising 218 cases. The purpose of this study was to improve the knowledge of head and neck injury mechanisms. The criteria for inclusion was that a helmet was worn at the time of the accident and that a head impact, although not necessarily a head injury, had occurred. Sixty-seven percent sustained a head injury and 28.2% a neck injury. Also notable were the 53% with a thorax injury and 73% with leg injuries. It is not surprising that when the injuries were subdivided into Maximum Abbreviated Injury Scale (MAIS) that as the MAIS increased so did the proportion with a head injury, from 38% for MAIS 1 to 85% for MAIS 3 and greater. Eighteen cases were replicated with drop tests of a helmeted headform, and in 13 cases where the motorcyclist sustained a head injury the rotational acceleration was approximately 9,000 rad/s2 or greater. (A) For the covering abstract of the conference see ITRD E203643.

Injury severity and duration of hospital stay for urban road accidents in riyadh

Abstract: A sample of 1,831 victims of urban road accidents in Riyadh was analyzed. The analysis consisted of two parts. First, the injury severity of 1,006 subjects was measured by the abbreviated injury scale (AIS). More than half the subjects were scaled with severe injuries (AIS ⩾ 3). Association analysis between injury severity and accident characteristics (e.g., accident time, type, and location) was performed. Second, duration of stay at the hospital was examined for cases of injury as well as deaths. The probability density functions of the length of these time periods for cases of injury and death were found to be satisfactorily described by the γ distribution and by exponential distribution, respectively.

Nature and severity of injuries in traffic accident victims

Abstract: The objective of this retrospective study is to characterize the nature and severity of injuries of hospitalized traffic accident victims using the "Abbreviated Injury Scale" (AIS). Two-hundred and twenty such patients in a trauma reference hospital in Sao Paulo, Brazil were assessed. One-hundred and eleven of them were pedestrians, eighty-three vehicular passengers and twenty-six motorcyclists. The most common injuries were of the limbs, pelvic girdle and head/neck. Injury severity in all these patients was AIS = 3. Two-thirds of the forty-five victims who died were pedestrians.

Outcome after severe head injury treated by an integrated trauma system

Abstract: OBJECTIVES: To describe outcome after treatment of severe head injury within an integrated trauma system. METHODS: A retrospective analysis of all patients with severe head injury admitted to the Royal London Hospital by the Helicopter Emergency Medical Service (HEMS) between 1991 and 1994. Type of injury was defined on initial computed tomography of the head and outcomes assessed 12 months after injury using the Glasgow outcome score. RESULTS: 6.5% of HEMS patients had long term severe disability (severe disability or persistent vegetative state on the outcome score); 34.5% made a good recovery. CONCLUSIONS: The concern that a large number of severely disabled long term survivors might result as a consequence of this system of trauma management is not confirmed. The case mix of severity of extracranial injuries in these patients makes comparison with other published series difficult, but these data fit the hypothesis that pre-hospital correction of hypoxia and hypotension after head injury improves outcome.

Head injuries to motor vehicle occupants aged 0-5 years

Abstract: Data from the National Automotive Sampling System (NASS) indicate that while injuries to children younger than 5 years are infrequent, the injury distribution for these children is shifted towards more serious injuries and that head injuries are relatively more common. Among 236 children aged 0-4 years who sustained head injuries with Abbreviated Injury Scale values greater than or equal to 1 identified from the NASS database for the years 1993-1995, infants were at significantly higher risk of skull fracture (OR 3.7, 95% CI: 2,16, 6.4) and intracranial injury (OR 2.6 (95% CI:1,4, 4.8) compared to children aged 1-4 years. Unrestrained children of all ages also expereinced a higher risk of intracranial injury than their restrained counterparts. Even after adjusting for restraint use, the odds of skull fracture for infants was approximately 4 times greater than that for children aged 1-4 years. (A) For the covering abstract see IRRD E103621.

Geometrical effects on the mechanism of cervical spine injury due to head impact

Abstract: This study investigated the effects of spinal alignment on the biomechanics of the cervical spine. Spinal alignment was defined in terms of initial eccentricity. The attitude of occipital condyles with respect to the inferior end of the head-neck complex was characterized using the spinal alignment factor. Thirty human cadaver head-neck complexes were used in the study. Dynamic loading was applied to the cranium using an electrohydraulic testing device. The resulting pathology was assessed using pre and posttest radiography and computed tomography scans. Injuries were graded according to the Abbreviated Injury Scale (AIS) rating. They were classified into stable and unstable groups. In addition, the pathology was classified into fracture and non-fracture types. The resulting mechanisms of injury were divided into compression-flexion, compression-extension, vertical compression, and hyperflexion trauma. Results indicated that spinal alignment is a statistically significant factor that influences the mechanism of injury, AIS rating, and fracture/non-fracture classifications. However, this geometrical condition did not influence the spinal stability classification. For the covering abstract of the conference see ITRD E203643.

The effect of crash pulse shape on ais1 neck injuries in frontal impacts

Abstract: Crash data from real-life frontal car collisions, where the crash pulses have been measured with crash pulse recorders and where the influence of pulse shape on the risk of both short- and long-term disability from Abbreviated Injury Scale (AIS) 1 neck injuries, have been studied The risk of long-term consequences was especially influenced by the shape of the crash pulse To understand how the shape of the crash pulse affected occupant motion, a series of computer simulations of frontal impacts were conducted where the information from the crash pulse recorder data has been used in the simulations Several dummy response parameters, such as neck loads and accelerations, were compared with the injuries in 143 real-life collisions using the recorded crash pulses and the injury records The results showed that for a specific change of velocity (delta V) the pulse shape could significantly influence some of the dummy response parameters, such as angular head acceleration and neck bending moments It was also found that there was a correlation between these dummy response parameters and the long-term consequences The results may help to explain the injury mechanism of the AIS 1 neck injury in frontal impacts, and may have implications for the design of the seat belt system (A) For the covering abstract of the conference see ITRD E203643

Trauma Scoring Systems Explained

Abstract: Objective: To list, describe and classify the extant trauma scoring systems found in the English language literature from the vantage of utility to emergency medicine. Each system is illustrated by a table and a hypothetical case study. Data Sources: Medline citations provided the data. The systems are classified as physiological, anatomical and combined trauma scoring systems. Results: We reviewed the Glasgow Coma Scale, the Paediatric Glasgow Coma Scale, the Trauma Score and Revised Trauma Score, the Circulation, Respiration, Abdominal/Thoracic, Motor and Speech Scale, the Acute Physiology and Chronic Health Evaluation System, Abbreviated Injury Scale, the Injury Severity Score, the Anatomical Profile, A Severity Characterization of Trauma, Revised Trauma Score and Injury Severity Score and its revisions, the Paediatric Trauma Score and the Drug-Rock Injury Severity Score. Conclusions: This compendium should help emergency physicians become familiar with trauma scoring systems which evaluate the extent and severity of injuries, facilitate inter-institutional comparisons and facilitate trauma research.

Linkage of stats19 and scottish hospital in-patient data - analyses for 1980-1995

Abstract: The British national road accident reporting system (STATS19) uses three rather general categories of injury severity - Fatal, Serious and Slight. The value to researchers of enhancing STATS19 casualty records with clinical information has long been recognised. Since 1980, TRL has maintained a file of road accident casualty data for Scotland which has been enhanced with information such as length of stay in hospital and the overall Maximum Abbreviated Injury Scale code (MAIS) for each of the six body regions. This report analyses the enhanced casualty information for the years 1980-95. Its aim is to provide an overview of trends in the clinical data over these sixteen years, and to give some insight into the scope for more detailed analyses. Various clear trends are identified, and some clear differences in the distribution of the clinical details are reported. (A)