Showing papers on "Abbreviated Injury Scale published in 2001"
TL;DR: Extent of contusion volumes measured using three-dimensional reconstruction allows identification of patients at high risk of pulmonary dysfunction as characterized by development of ARDS.
Abstract: Background: The pathophysiology of pulmonary contusion (PC) is poorly understood, and only minimal advances have been made in management of this entity over the past 20 years. Improvement in understanding of PC has been hindered by the fact that there has been no accurate way to quantitate the amount of pulmonary injury. With this project, we examine a method of accurately measuring degree of PC by quantifying contusion volume relative to pulmonary function and outcome. Methods: Patients with PC from isolated chest trauma who had admission chest computed tomographic scan were identified from the registry of a Level I trauma center over a 1.5-year period. Subsequently, prospective data on all patients admitted to the intensive care unit with PC during a 5-month period were collected and added to the retrospective database. Using computer-generated three-dimensional reconstruction from admission chest computed tomographic scan, contusion volume was measured and expressed as a percentage of total lung volume. Admission pulmonary function variables (Pao 2 /FiO 2 , static compliance), injury descriptors (chest Abbreviated Injury Score, Injury Severity Score, injury distribution), and indicators of degree of shock (admission systolic blood pressure, admission base deficit) were documented. Outcomes included maximum positive end-expiratory pressure, ventilator days, pneumonia, and acute respiratory distress syndrome (ARDS). Results: Forty-nine patients with PC (35 bilateral) were identified. The average severity of contusion was 18% (range, 5-55%). Patients were classified using contusion volume as severe PC (≥20%, n = 17) and moderate PC (<20%, n = 32). Injury Severity Score was similar in the severe and moderate groups (23.3 vs. 26.5, p = 0.33), as were admission Glasgow Coma Scale score (12 vs. 13, p = 0.30), admission blood pressure (131 vs. 129 mm Hg, p = 0.90), and admission Pao 2 /FIo 2 (197 vs. 255, p = 0.14). However, there was a much higher rate of ARDS in the severe group as compared with the moderate group (82% vs. 22%, p < 0.001). There was a trend toward higher pneumonia rate in the severe group, with 50% of patients in the severe group developing pneumonia as compared with 28% in the moderate group (p = 0.20). Conclusion: Extent of contusion volumes measured using three-dimensional reconstruction allows identification of patients at high risk of pulmonary dysfunction as characterized by development of ARDS. This method of measurement may provide a useful tool for the further study of PC as well as for the identification of patients at high risk of complications at whom future advances in therapy may be directed.
275 citations
TL;DR: This study shows a decrease in severe TBI incidence when results are compared with another study conducted 10 years earlier in the same region, however, this results in an increase in the proportion of falls in elderly patients and an increases in the median age in patients, which influences the mortality rate.
Abstract: BACKGROUND: The aim of this prospective study was to estimate annual incidences of hospitalization for severe traumatic brain injury (TBI) (maximum Abbreviated Injury Score in the head region [HAIS] 4 or 5) in a defined population of 2.8 million. METHODS: Severe TBI patients were included in the emergency departments in the 19 hospitals of the region. A prospective data form was completed with initial neurologic state, computed tomographic scan lesions, associated injuries, length of unconsciousness, and length of stay in acute care centers. Outcome at the time the patient left acute hospitalization was retrospectively assessed from medical notes. RESULTS: During the 1-year period (1996), 497 residents fulfilled the inclusion criteria, leading to an annual incidence rate of 17.3 per 100,000 population; 58.1% were HAIS5. Mortality rate was 5.2 per 100,000. Men accounted for 71.4% of cases. Median age was 44 years, with a quarter of patients more than 70 years old. Traffic accidents were the most frequent causes (48.3%), but falls accounted for 41.8% of all patients. Age and severity were different according to the major categories of external causes. In HAIS5 patients, 86.5% were considered as comatose (coma lasting more than 24 hours or leading to immediate death) but only 60.9% had an initial Glasgow Coma Scale score
255 citations
TL;DR: Early fixation was associated with a lower incidence of pneumonia, a shorter intensive care unit stay, fewer ventilator days, and lower charges, and high-risk patients had lower pneumonia rates and less hospital resource utilization with early fixation.
Abstract: Objective To evaluate the effect of timing of spine fracture fixation on outcome in multiply injured patients Background Data There is little consensus regarding the optimal timing of spine fracture fixation after blunt trauma Potential advantages of early fixation include earlier patient mobilization and fewer septic complications; disadvantages include compounded complications from associated injuries and inconvenience of surgical scheduling Methods Patients with spine fractures from blunt trauma admitted to an urban level 1 trauma center during a 42-month period who required surgical spine fracture fixation were identified from the registry Patients were analyzed according to timing of fixation, level of spine injury, and impact of associated injuries (measured by injury severity score) Early fixation was defined as within 3 days of injury, and late fixation was after 3 days Outcomes analyzed were intensive care unit and hospital stay, ventilator days, pneumonia, survival, and hospital charges Results Two hundred ninety-one patients had spine fracture fixation, 142 (49%) early and 149 (51 %) late Patients were clinically similar relative to age, admission blood pressure, injury severity score, and chest abbreviated injury scale score The intensive care unit stay was shorter for patients with early fixation The incidence of pneumonia was lower for patients with early fixation Charges were lower for patients with early fixation Patients were stratified by level of spine injury There were 163 cervical (83 early, 80 late), 79 thoracic (30 early, 49 late), and 49 lumbar fractures (29 early, 20 late) There were no differences in injury severity between early and late groups for each fracture site The most striking differences occurred in the thoracic fracture group Early fixation was associated with a lower incidence of pneumonia, a shorter intensive care unit stay, fewer ventilator days, and lower charges High-risk patients had lower pneumonia rates and less hospital resource utilization with early fixation Conclusions Early spine fracture fixation is safely performed in multiply injured patients Early fixation is preferred in patients with thoracic spine fractures because it allows earlier mobilization and reduces the incidence of pneumonia Although delaying fixation in the less severely injured may be convenient for scheduling, it increases hospital resource utilization and patient complications
144 citations
TL;DR: While "minor" resections, if feasible, are associated with improved outcome, trauma surgeons should be facile in a wide range of technical procedures for the management of lung injuries.
Abstract: Background: Improved outcomes following lung injury have been reported using lung sparing techniques. Methods: A retrospective multicenter 4-year review of patients who underwent lung resection following injury was performed. Resections were categorized as minor (suture, wedge resection, tractotomy) or major (lobectomy or pneumonectomy). Injury severity, Abbreviated Injury Scale (AIS) score, and outcome were recorded. Results: One hundred forty-three patients (28 blunt, 115 penetrating) underwent lung resection after sustaining an injury. Minor resections were used in 75% of cases, in patients with less severe thoracic injury (chest AIS scores minor 3.8 ± 0.9 vs. major 4.3 ± 0.7, p = 0.02). Mortality increased with each step of increasing complexity of the surgical technique (RR, 1.8; CI, 1.4-2.2): suture alone, 9% mortality; tractotomy, 13%; wedge resection, 30%; lobectomy, 43%; and pneumonectomy, 50%. Regression analysis demonstrated that blunt mechanism, lower blood pressure at thoracotomy, and increasing amount of the lung resection were each independently associated with mortality. Conclusion: Blunt traumatic lung injury has higher mortality primarily due to associated extrathoracic injuries. Major resections are required more commonly than previously reported. While minor resections, if feasible, are associated with improved outcome, trauma surgeons should be facile in a wide range of technical procedures for the management of lung injuries.
142 citations
TL;DR: In patients with severe head injury who have targeted management including intracranial pressure- and cerebral perfusion pressure-guided therapy and delayed surgery for extracranial lesions, the occurrence of secondary insults in the intensive care unit and long-term neurological outcome were comparable and independent of the presence of extracanial lesions.
Abstract: Objectives: To study the occurrence of secondary insults and the influence of extracranial injuries on cerebral oxygenation and outcome in patients with closed severe head injury (Glasgow Coma Scale score ≤8). Design: Two-year prospective, clinical study. Setting: Two intensive care units in a level III trauma center. Patients: We studied 119 patients. Eighty patients had severe head injury and were divided into two categories: isolated severe head injury patients (n = 36, Injury Severity Score 29). Thirty-nine patients with extracranial injuries and no head injury served as the control group. Interventions: After patients were admitted to the intensive care unit, we began continuous multimodal cerebral monitoring of intracranial pressure, mean arterial blood pressure, cerebral perfusion pressure, end-tidal Co 2 , brain tissue Po 2 (Licox), jugular bulb oxyhemoglobin saturation in severe head injury patients, and mean arterial blood pressure in the control group. Targets of management included intracranial pressure 60 mm Hg, Paco 2 > 30 mm Hg, control of cerebral oxygenation, and delayed surgery for non-life-threatening extracranial lesions. Measurements and Main Results: Data were analyzed for critical thresholds. The occurrence of secondary insults (intracranial pressure >20 mm Hg, mean arterial blood pressure <70 mm Hg, cerebral perfusion pressure <60 mm Hg, end-tidal Co 2 <30 torr, brain tissue Po 2 <10 torr, jugular bulb oxyhemoglobin saturation <50%) was comparable in patients with isolated severe head injury and those with severe head injury with associated extracranial lesions (Abbreviated Injury Scale score ≤5). The duration of intracranial hypertension and arterial hypotension significantly correlated with an unfavorable outcome, independent of the Injury Severity Score. In patients with severe head injury, 1-yr outcome was 29% dead or vegetative, 17% severely disabled, and 54% moderate or good outcome. This was similar to patients with severe head injury and extracranial injuries (31% dead or vegetative, 14% severely disabled, and 56% moderate or good outcome) and was independent of the Injury Severity Score. Patients with no head injury had less secondary insults (mean arterial blood pressure <70 mm Hg, p <.01) and a better outcome compared with both severe head injury groups (p <.044). Conclusions: In patients with severe head injury who have targeted management including intracranial pressure- and cerebral perfusion pressure-guided therapy and delayed surgery for extracranial lesions, the occurrence of secondary insults in the intensive care unit and long-term neurological outcome were comparable and independent of the presence of extracranial lesions (Abbreviated Injury Severity level ≤5). A severe head injury is still a major contributor predicting an unfavorable outcome in multiply injured patients.
122 citations
TL;DR: The technical accident analysis allows prediction of the severity of injury and the clinical course and may serve as a tool for development of more sophisticated injury prevention strategies and may improve passive car safety.
Abstract: BACKGROUND: The crash mechanisms and clinical course of car occupants with thoracic injury were analyzed to determine prognostic factors and to create a basis for injury prophylaxis. METHODS: A technical and medical investigation of car occupants with a thoracic injury (Abbreviated Injury Scale-thorax [AIS(THORAX)] > or = 1) at the scene of the crash and the primary admitting hospital was performed. RESULTS: Between 1985 and 1998, 581 car occupants sustained a thoracic injury. Mean parameter values were as follows: AIS(THORAX), 2.5; Hannover Polytrauma Score (PTS), 21.4; Injury Severity Score (ISS), 24.2; Delta-v, 49.6 km/h (30.8 mph); and extent of passenger compartment deformation (DEF) (scale, 1--9), 4.0. In 19% (n = 112) of patients involved, the clinical course was evaluated: AIS(THORAX), 2.5; PTS, 20.0; ISS, 19.3; Delta-v, 50.1 km/h (31.1 mph); DEF, 3.9; intensive care unit time, 8.3 days; ventilation time, 5.7 days; and hospital stay, 15.3 days. In the groups with higher AIS(THORAX), ISS, PTS, and intensive care unit and ventilation time, higher Delta-v and DEF occurred. In patients with longer hospital stay, higher Delta-v, but no difference in DEF occurred. CONCLUSION: The injury severity and the clinical course demonstrated a positive correlation with the crash severity. Therefore, our technical accident analysis allows prediction of the severity of injury and the clinical course. It may consequently serve as a tool for development of more sophisticated injury prevention strategies and may improve passive car safety.
80 citations
TL;DR: Significant decreases in injury severity, penetrating violence, and operations have occurred over 15 years and will have profound effects on the practice of trauma surgeons and on surgical education.
Abstract: BACKGROUND: Safer cars, decreased violence, and nonoperative management have changed the trauma patient's nature. We evaluated changes in a Level I trauma center over 15 years and considered their effect on trauma surgeons. METHODS: From January 1985 through August 1999, 16,799 trauma registry patients were analyzed for mechanism of injury, Injury Severity Score, and procedures. RESULTS: Mean Injury Severity Score decreased from 15.9 to 10.7 and length of stay fell from 8.0 days to 5.9 days. There were significant decreases in penetrating trauma admissions and percentage of patients with Abbreviated Injury Scale score > 3 for head, chest, and abdomen. Frequency of craniotomy, thoracotomy, and laparotomy dropped dramatically. CONCLUSION: Significant decreases in injury severity, penetrating violence, and operations have occurred over 15 years. These changes will have profound effects on the practice of trauma surgeons and on surgical education. Language: en
73 citations
TL;DR: This study was conceived to emphasize the supposed advantages of the combined helicopter, physician, and advanced life-support rescue and found no increased benefit compared with the simpler rescue group could be demonstrated.
Abstract: Hypothesis A pattern of prehospital care combining advanced life support, physician staffing, and helicopter transport improves the outcome of patients with severe brain injuries, compared with combined expanded basic life support, nurse staffing, and ground transport. Design Inception cohort from the data set of a population-based, prospective study on major trauma. Setting Prehospital and hospital trauma systems of an Italian region. Patients All patients with major trauma (Injury Severity Score, ≥16) and severe head injury (Abbreviated Injury Scale score for the head, ≥4) rescued alive from March 1, 1998, to February 28, 1999, who received either form of care. Patients with self-inflicted injuries were excluded. The 184 patients who met the entry criteria were divided equally between care groups. Interventions None. Main Outcome Measures Mortality at 30 days and Glasgow Outcome Scale score of survivors. Results After verifying the comparability of the cohorts, no survival or disability benefit could be demonstrated (95% confidence interval [CI] of the odds ratio for mortality [helicopter/ambulance] [95% CI 1], 0.72 to 2.67; 95% CI of the difference in Glasgow Outcome Scale score medians between helicopter and ambulance groups [95% CI 2], 0.0 to 0.0). Similar results were derived from analyses restricted to the subgroups identified by low (≤90 mm Hg) roadside systolic blood pressure (95% CI 1, 0.58 to 7.17; 95% CI 2, −1 to 2) and by need for urgent neurosurgical intervention (95% CI 1, 0.16 to 2.60; 95% CI 2, 0 to 2). Exclusion from the ambulance group of victims rescued in urban areas did not change the results (95% CI 1, 0.80 to 3.24; 95% CI 2, 0.0 to 0.0). Stratification by age, Injury Severity Score, and Glasgow Coma Scale score demonstrated a small survival benefit (95% CI 1, 1.12 to 2.12) in the ambulance subgroup with Glasgow Coma Scale score from 10 to 12. Multiple logistic regression analysis confirmed that the group did not affect mortality. Conclusion This study was conceived to emphasize the supposed advantages of the combined helicopter, physician, and advanced life-support rescue. No increased benefit compared with the simpler rescue group could be demonstrated.
73 citations
TL;DR: In a prospective population-based study, all open hand, wrist, and forearm injuries that were treated at hospitals and emergency wards in three Norwegian cities with 225,000 inhabitants, were registered and injury severity was graded using the abbreviated injury scale (AIS).
70 citations
TL;DR: The performance of the ICD/AIS MAP in assessing severity of pediatric injuries was equal to or better than previous assessments of its performance on primarily adult patients.
Abstract: Objective —To determine the performance of the ICD/AIS MAP (© E J MacKenzie et al ) as a method of classifying injury severity for children. Methods —Data on all children less than 16 years of age admitted to all designated trauma centers in Pennsylvania from January 1994 through October 1996 were obtained from the state trauma registry. The ICD/AIS MAP was used to convert all injury related ICD-9-CM diagnosis codes into abbreviated injury scale (AIS) score and injury severity score (ISS). Agreement between trauma registry AIS and ISS scores and MAP generated scores was assessed using the weighted κ (κ w ) coefficient for ordered data and the intraclass correlation coefficient for continuous data. Results —Agreement in ISS scores was excellent, both overall (intraclass correlation coefficient = 0.86, 95% confidence interval (CI) 0.84 to 0.89)), and when grouped into three levels of severity (κ w = 0.86, 95% CI 0.85 to 0.87). Agreement in AIS scores across all body regions and ages was also excellent, (κ w = 0.86 (95% CI 0.83 to 0.87). Agreement increased with age (κ w = 0.78 for children w = 0.86 for older children) and varied by body region, though was excellent across all regions. Conclusions —The performance of the ICD/AIS MAP in assessing severity of pediatric injuries was equal to or better than previous assessments of its performance on primarily adult patients. Its performance was excellent across the pediatric age range and across nearly all body regions of injury.
56 citations
TL;DR: Although there were significant differences in mean NISS and ISS values for each hospital, differences in the predictive abilities of the two scoring systems were insignificant, even when analysis was restricted to the subgroup of patients with severe or penetrating injuries.
Abstract: Background: To compare the effectiveness of the Injury Severity Score (ISS) and New Injury Severity Score (NISS) in predicting mortality in pediatric trauma patients. Methods: NISS, the sum of the squares of a patient's three highest Abbreviated Injury Scale scores (regardless of body region), were calculated for 9,151 patients treated at four regional pediatric trauma centers and compared with previously calculated ISS values. The power of the two scoring systems to predict mortality was gauged through comparison of misclassification rates, receiver operating characteristic curves, and Hosmer-Lemeshow goodness-of-fit statistics. Results: Although there were significant differences in mean NISS and ISS values for each hospital, differences in the predictive abilities of the two scoring systems were insignificant, even when analysis was restricted to the subgroup of patients with severe or penetrating injuries. Conclusion: The significant differences in the predictive abilities of the ISS and NISS reported in studies of adult trauma patients were not seen in this review of pediatric trauma patients.
04 Jun 2001
TL;DR: Modifications to the URGENCY algorithm to include predictors for these three factors significantly improved accuracy of the MAIS 3+ injury predictions.
Abstract: The URGENCY algorithm uses data from on-board crash recorders to assist in identifying crashes that are most likely to have time critical (compelling) injuries. The injury risks projected by using the National Automotive Sampling System/Crashworthiness Data System data are the basis for the URGENCY algorithm. This study applied the algorithm retrospectively to a population of injured occupants in the database from the University of Miami School of Medicine, William Lehman Injury Research Center. The population selected was adult occupants in frontal crashes that were protected by three point belts plus an air bag. For the cases with greater than 50% predicted Maximum Abbreviated Injury Scale (MAIS) 3+ injury probability, 96% of the occupants in the study had MAIS 3+ injuries. For the cases with less than 10% predicted MAIS 3+ injury probability, 63% did not have MAIS 3+ injuries. Most of the MAIS 3+ injuries not predicted involved injuries in multiple impact crashes, pole crashes or close-in occupants injured by air bag deployment. Modifications to the URGENCY algorithm to include predictors for these three factors significantly improved accuracy of the MAIS 3+ injury predictions.
TL;DR: The cases revealed that serious injuries occur even in minor crashes, and head (39%), extremity (22%), and abdominal injuries (17%) were the most common significant injuries.
Abstract: BACKGROUND: Side impact collisions pose a great risk to children in crashes, but information about the injury mechanisms is limited. METHODS: This study involves a case series of children in side impact collisions who were identified through Partners for Child Passenger Safety, a large, child-focused crash surveillance system. The aim of the current study was to use in-depth crash investigations to identify injury mechanisms to children in side impact collisions. RESULTS: Ninety-three children in 55 side impact crashes were studied. Twenty-three percent (n = 22) of the children received an Abbreviated Injury Scale (AIS) score > or = 2 (clinically significant) injury. In these 22 children, head (40%), extremity (23%), and abdominal injuries (21%) were the most common significant injuries. Cases that illustrate body region-specific injury mechanisms are discussed. CONCLUSION: The cases revealed that serious injuries, particularly head injuries, occur even in minor crashes, and efforts should be made to make the interiors of vehicles more child occupant friendly. Lower extremity and abdominal injuries occurred because of contact with the intruding door. Design of vehicles to minimize crush should mitigate the occurrence and severity of these injuries.
Journal Article•
TL;DR: There was no difference in the nonoperative failure rate between patients with normal mental status and those with mild to moderate or severe head injuries, and no differences were noted in the rates of delayed laparotomy or survival between normal, mild to moderately head-injured, and severely head-Injured patients.
Abstract: The role of nonoperative management of solid abdominal organ injury from blunt trauma in neurologically impaired patients has been questioned. A statewide trauma registry was reviewed from January 1993 through December 1995 for all adult (age >12 years) patients with blunt trauma and an abdominal solid organ injury (kidney, liver, or spleen) of Abbreviated Injury Scale score > or =2. Patients with initial hypotension (systolic blood pressure <90 mm Hg) were excluded. Patients were stratified by Glasgow Coma Score (GCS) into normal (GCS 15), mild to moderate (GCS 8-14), and severe (GCS < or =7) impairment groups. Management was either operative or nonoperative; failure of nonoperative management was defined as requiring laparotomy for intraabdominal injury more than 24 hours after admission. In the 3-year period 2327 patients sustained solid viscus injuries; 1561 of these patients were managed nonoperatively (66 per cent). The nonoperative approach was initiated less frequently in those patients with greater impairment in mental status: GCS 15, 71 per cent; GCS 8 to 14, 62 per cent; and GCS < or =7, 50 per cent. Mortality, hospital length of stay, and intensive care unit days were greater in operatively managed GCS 15 and 8 to 14 groups but were not different on the basis of management in the GCS < or =7 group. Failure of nonoperative management occurred in 94 patients (6%). There was no difference in the nonoperative failure rate between patients with normal mental status and those with mild to moderate or severe head injuries. Nonoperative management of neurologically impaired hemodynamically stable patients with blunt injuries of liver, spleen, or kidney is commonly practiced and is successful in more than 90 per cent of cases. No differences were noted in the rates of delayed laparotomy or survival between normal, mild to moderately head-injured, and severely head-injured patients.
Journal Article•
TL;DR: It is concluded that NISS also performed the mortality prediction in trauma patients better than ISS and confirmed the results of the previous studies.
Abstract: Previously published investigations have suggested that the Injury Severity Score (ISS) can be replaced by the New Injury Severity Score (NISS) which takes into account the three most severe injuries regardless of body region. This study was conducted to evaluate whether NISS can also give a better mortality prediction than ISS in a different setting. The objective of this study was to compare the accuracy between ISS and NISS in predicting mortality of trauma patients. The study population consisted of trauma patients admitted to a 650-bed university hospital in Thailand from June 1996 to May 1999. Data of patients admitted to the hospital were prospectively collected to identify the injuries and outcomes of treatment. Each injury was reviewed and coded according to the Abbreviated Injury Scale 1990 revision (AIS-90) and computed for ISS and NISS. Areas under receiver operating characteristic (ROC) curves were employed to compare the abilities of the ISS and the NISS in predicting patients' mortality. The results of the study showed that 2,044 trauma patients were admitted to the hospital during the three-year study period and 114 patients died in the hospital. The median scores of the ISS and the NISS of the survivors were 4 and 8 respectively. The median scores of the ISS and the NISS of the non-survivors were 25 and 38 respectively. The area under ROC curve derived from the ISS (0.966; 95%C.I = 0.965 - 0.967) was significantly (p < 0.05) less than the NISS (0.974; 95%C.I = 0.973 - 0.975). We concluded, under our setting, that NISS also performed the mortality prediction in trauma patients better than ISS and confirmed the results of the previous studies.
TL;DR: The aim of the present paper was to assess the incidence of, and identify factors associated with road crash (RC)‐related fatal head injuries in rural and metropolitan Western Australia.
Abstract: BACKGROUND: The aim of the present paper was to assess the incidence of, and identify factors associated with road crash (RC)-related fatal head injuries in rural and metropolitan Western Australia. METHODS: Examination of demographics, driving behaviour and RC characteristics for RC fatalities involving a head injury (Abbreviated Injury Scale (AIS) > or = 2) between 1 January 1998 and 31 December 1999 was carried out using the State Coronial Database. RESULTS: There were 328 deaths. The median age was 28 years and 74.1% of cases were male. Seventy per cent died at the scene. Of scene survivors, 89% were transferred to a metropolitan hospital before dying. Sixty per cent of total RC and 65% of at-scene deaths occurred in rural areas. Single-vehicle crashes comprised 45% of total crashes, of which 72.8% occurred in rural locations. Poor driver behaviour was identified in 53% of deaths. Ethanol was implicated in 29.8% of deaths, other intoxicating drugs were implicated in 19.2%, speeding was implicated in 19.5%, and lack of safety restraints/devices was implicated in 22%. Poor driver behaviour was identified in 72% of single-vehicle deaths, compared with 38% of multivehicle crashes (P Language: en
TL;DR: An evidence based prevention programme based on local safety rules and educational programmes can reduce the burden of injuries related to physical exercise in a community and need to be adjusted to benefit all age groups.
Abstract: Objective —To evaluate a community based programme for evidence based prevention of injuries during physical exercise. Design —Quasi-experimental evaluation using an intervention population and a non-random control population. Participants —Study municipality (population 41 000) and control municipality (population 26 000) in Sweden. Main outcome measures —Morbidity rate for sports related injuries treated in the health care system; severity classification according to the abbreviated injury scale (AIS). Results —The total morbidity rate for sports related injuries in the study area decreased by 14% from 21 to 18 injuries per 1000 population years (odds ratio 0.87; 95% confidence interval (CI) 0.79 to 0.96). No tendency towards a decrease was observed in people over 40. The rate of moderately severe injury (AIS 2) decreased to almost half (odds ratio 0.58; 95% CI 0.50 to 0.68), whereas the rate of minor injuries (AIS 1) increased (odds ratio 1.22; 95% CI 1.06 to 1.40). The risk of severe injuries (AIS 3–6) remained constant. The rate of total sports injury in the control area did not change (odds ratio 0.93; 95% CI 0.81 to 1.07), and the trends in the study and control areas were not statistically significantly different. Conclusion —An evidence based prevention programme based on local safety rules and educational programmes can reduce the burden of injuries related to physical exercise in a community. Future studies need to look at adjusting the programme to benefit all age groups.
TL;DR: Children have an especially high risk of injury if they are involved in accidents as pedestrians, bicyclists and unrestrained car occupants and the use of adjusted restraining systems and bicycle helmets is likely to prevent from severe injuries.
Abstract: HYPOTHESIS Analysis of the current injury situation in road users not exceeding 14 years of age involved in road traffic accidents to allow conclusions regarding future prophylaxis. METHODS Traffic accident reports and medical records from children (< 15 years of age) were analyzed for the following parameters: Type, location and mechanism of injury, Abbreviated Injury Scale (AIS), Maximum AIS (MAIS), Injury Severity Score (ISS), Delta-v, collision speed, type and duration of treatment. RESULTS In 12,309 traffic accidents occurring in the area of Hannover, Germany between 1985 and 1998, 7.5% (n = 2,317) of the involved persons and 10.5% (n = 1,734) of the injured road users were children and adolescents. 70% sustained MAIS 1 injuries, 28% MAIS 2-4 and 1.5% MAIS 5/6 injuries. The mean ISS was 3.38. 30.3% of the injured children were car occupants, 32.1% bicyclists, 33.3% pedestrians. 30.3% of the children were unrestrained car occupants, 42.1% used safety belts designed for adults, 36% used special devices. Half of the children in cars remained uninjured, whereas only 8% of the bicyclists and 2% of the pedestrians were not injured. Severe injuries occurred in 20% of bicyclists and pedestrians at a collision speed less than 30 km/h and in 80% at more than 50 km/h. Half of those crashes could have been avoided, if the colliding vehicle would had driven about 15 km/h slower. CONCLUSION Children have an especially high risk of injury if they are involved in accidents as pedestrians, bicyclists and unrestrained car occupants. Besides of improvements of the inner and outer car design, the use of adjusted restraining systems and bicycle helmets is likely to prevent from severe injuries. Speed reduction is a considerable factor. According to our data, the injury severity for bicyclists and pedestrians increases progressively when the collision speed exceeds 50 km/h.
TL;DR: Femur fractures in the head-injured pediatric patient can be adequately addressed with early or late fixation with similar long-term outcomes, and early femur fracture fixation may decrease the length of hospital stay and the number of nonorthopaedic, nonneurologic complications.
Abstract: The purpose of this study was to analyze retrospectively pediatric femur fracture patients with concomitant head injury to determine whether time to fracture fixation affects central nervous system, orthopaedic, or additional complications. Twenty-five patients with a Head Abbreviated Injury Scale score of > or =3 and a femoral shaft fracture were reviewed. Patients were divided by time to treatment for their femur fracture. Average stay was 10.5 days for the early group and 18.5 days for the late group, the only statistically significant finding. Orthopaedic and central nervous system complications were similar between the two groups. Sixteen additional complications were found in the late group versus three for the early group. Femur fractures in the head-injured pediatric patient can be adequately addressed with early or late fixation with similar long-term outcomes. Early femur fracture fixation may decrease the length of hospital stay and the number of nonorthopaedic, nonneurologic complications.
04 Jun 2001
TL;DR: In this article, the authors identified specific occupant characteristics for which active-adaptive restraint systems might confer the most significant injury reductions in frontal and side automobile collisions, and discussed the effect of each occupant characteristic on injury severity.
Abstract: "Smart" restraint systems are being researched and developed. However, whilst technology can ultimately be produced that will give rise to adaptive restraint systems, injury research is necessary in order to identify and quantify the most important occupant characteristics. This is necessary to ensure that future adaptive restraint systems are optimised. 12,605 car occupant records from phases 4 and 5 of the UK Co-operative Crash Injury Study (CCIS) were analysed to establish the injury potential for front seat occupants in both frontal and side impacts. Casualties were grouped by gender, seating position and injury severity, with the latter measured in relation to the Maximum Abbreviated Injury Scale (MAIS). Data from a further 4,758 accidents contained within a Fatals database was also incorporated into the analysis. Cumulative frequency graphs for occupant characteristics such as age, weight, height and Body Mass Index (BMI) were produced against accident parameters, such as injury severity (MAIS) for each occupant grouping. The aim was to identify specific occupant characteristics for which active-adaptive restraint systems might confer the most significant injury reductions. This paper describes and discusses the analysis and identifies casualty groups who are at above average risk in frontal and side impacts. For example, in frontal impacts male drivers with a high BMI were shown to be at an increased risk of serious injury, compared with male drivers with an 'average' BMI. The effect of each occupant characteristic on injury severity in frontal and side automobile collisions are described and discussed and their implications for active-adaptive restraint systems emphasised. (A) For the covering abstract see ITRD E111577.
01 Jan 2001
TL;DR: The study shows the potential in using real-life data to establish injury risk functions to be used as guidelines in the design of a crashworthy road transport system and showed variations in the ability of explaining risk of injury depending on the crash severity parameter used.
Abstract: The aim of this paper was to present injury risk functions based on real-life frontal crashes where crash severity was measured with on-board crash pulse recorders (CPR). Results from 178 frontal collisions with an overlap of more than 25% and with an angle within +/- 30 degrees from straight frontal have been analysed. A mix of 18 car models of 4 different makes was included. The study shows the potential in using real-life data to establish injury risk functions to be used as guidelines in the design of a crashworthy road transport system. The results showed variations in the ability of explaining risk of injury depending on the crash severity parameter used. Acceleration seemed to better describe injury risk than velocity change of (delta V) in frontal impacts. In order to have lower than 25% risk of an Abbreviated Injury Scale (AIS) 2+ injury, mean acceleration should be kept below 8 g and peak acceleration below 26 g. At every crash severity interval, women had a higher injury risk of AIS1 injuries than men. Also the risk of AIS2+ injuries was higher for women than for men at a crash severity above 25 km/h or 7 g. At every crash severity, older drivers above 50 years of age had higher risk of AIS2+ injuries than drivers below 50 years of age. Drivers had higher AIS2+ injury risk than front seat passengers at mean acceleration above 8 g. At crash severities where the airbags are likely to be deployed, a large reduction in the risk of AIS1 and AIS2+ injuries was found. For the covering abstract of the conference see ITRD E206514.
Journal Article•
TL;DR: Boys in upper elementary grades and high school were at greater risk of being wounded by fragments of left over explosive devices than younger boys or girls and the most severe wounds were to the head/neck and the abdomen and inflicted during the shelling or bombing.
Abstract: The aim was to analyze clinical course of war-related injuries in children treated at the Split University Hospital during the wars in Croatia (1991-1995) and Bosnia and Herzegovina (1992-1995). Medical records of 94 treated children were analyzed. The severity of wounds was scored according to the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) evaluation systems. Most children were wounded during shelling/bombing (n = 28 10 boys and 18 girls) and by leftover explosive devices (n = 26). Children injured by leftover explosive devices were predominantly boys (23/26 children) aged 10 to 16 years (19/26 children). Extremities were the most frequently wounded body regions (43% of all wounded regions). The wounds to the head/neck (median AIS = 5.0 range 1-6) and abdomen (median AIS = 4.5 range 3-5) were the most severe. Abdominal wounds required surgical procedures (p < 0.001) and antibiotic treatment (p < 0.05) most frequently as well as patients with greater AIS and ISS scores (p < 0.05). According to the treatment outcome more patients wounded to the abdomen and extremities showed improvement than no change or complete recovery (p < 0.05). Permanent disability remained in 37 (39.4%) children and three (3.3%) children died. Boys in upper elementary grades and high school were at greater risk of being wounded by fragments of leftover explosive devices than younger boys or girls. The most severe wounds were to the head/neck and the abdomen and inflicted during the shelling or bombing. This should be taken into account in organization of surgical care for the children with war-related injuries. (authors)
TL;DR: A series of 131 patients aged 15 years or older with nonoccupational fall injuries from ladders admitted to Odense University Hospital, Denmark were studied, and males most frequently fell from straight tilting ladders outdoors when performing activities such as repairing, painting, or cleaning up gutters.
TL;DR: It is found that ankle/foot injuries were the most common injury location, but have decreased over time, and the severity of these injuries has also decreased.
Abstract: This study evaluated telemark injuries in a Swedish ski area in terms of injury ratio, location, and causes over time. During the seasons of 1989–2000 all injured telemark skiers (n=94) who attended the medical center in Tarnaby, Sweden, within 48 h after the accident were registered and asked to fill in an injury form. A control group of noninjured telemark skiers were interviewed in the season of 1999–2000. The most common cause of injury was fall (70%) and the injury ratio was 1.2. There was a higher proportion of beginners in the injured population, and they had a fall/run ratio of 0.7, compared with 0.3 for average and advanced skiers. Ankle/foot injuries were most common (28% of injuries) followed by knee (20%) and head/neck (17%). The ankle/foot injuries decreased from 35% to 22% in the seasons 1989–1995 to 1995–2000. Beginners had more ankle/foot injuries than skilled participants. The severity of ankle/foot injuries classified as the Abbreviated Injury Scale group 2 or higher decreased from 33% to 21% during the study period. Twenty-seven percent used plastic and 73% leather boots. We found no association between boot material and ankle/foot injuries. The proportion of high boots with two or more buckles was 51%. High boots appeared to be protective against ankle/foot injuries. The proportion of high boots increased from 24% to 67% during the study period. Thus ankle/foot injuries were the most common injury location, but have decreased over time. The severity of these injuries has also decreased. A possible explanation could be the increased use of high boots.
Journal Article•
TL;DR: The correlation degree between outliving period and trauma severity in persons fatally injured in traffic accidents is established and according to this finding to point out the ISS value of critical injury is pointed out.
Abstract: INTRODUCTION: In forensic pathology, only trauma systems based on disintegration of anatomic structure of organs and tissues, could be used for objectivization, comparison and establishing of severity of injuries. Trauma systems based on pathophysiological values are useless. The Abbreviated Injury Scale (AIS) and its derivate Injury Severity Score (ISS) are the most common. AIS coded injuries are divided into six body regions and injuries are assigned a six-digit score in relation to their severity. ISS results the sum of the squares of the highest AIS values from the three most severely injured body regions. In this way, the ISS values are discontinued and vary from 0 (absence of injuries) to 75 (incompatible-with-life injury). PURPOSE: The purpose of this paper is to establish the correlation degree between outliving period and trauma severity in persons fatally injured in traffic accidents, and according to this finding to point out the ISS value of critical injury. MATERIAL AND METHOD: A retrospective autopsy study was performed; it included the material of the Institute of Forensic Medicine in Belgrade of 1998. The autopsy reports and accessible clinical medical data were analyzed for persons over the age of 18, fatally injured in traffic accidents who survived trauma less than 15 days. The sample was statistically prepared (chi 2-test, t-test, correlation coefficient, regression line). RESULTS AND DISCUSSION: The sample included 272 persons: 193 males and 79 females. The proportion of men was more significant (chi 2 = 4.76; 0.01 Language: sr
01 Apr 2001
TL;DR: The original purpose of the Abbreviated Injury Scale (AIS) was to fill a need for a standardized system for categorizing the type and severity of injuries arising from vehicular crashes as discussed by the authors.
Abstract: The original purpose of the Abbreviated Injury Scale (AIS) was to fill a need for a standardized system for categorizing the type and severity of injuries arising from vehicular crashes. Over the years the Committee on Injury Scaling of the Association for the Advancement of Automotive Medicine (formerly the American Association for Automotive Medicine), the parent body of the AIS, has modified the AIS to remain in touch with contemporary issues. Following a discussion of the origins of today's AIS, this paper discusses the philosophical basis for the AIS and addresses future challenges to the AIS. The specific tasks of the 2000 revision to the AIS are listed.
01 Jan 2001
TL;DR: It is concluded that there appears to be a "Master Curve" of AIS versus mean delta V for car occupants, implying that the amount of power for a given injury level is a constant, irrespective of injury type.
Abstract: All injuries require an expenditure of energy. Here it is postulated that injury severity is proportional to Peak Virtual Power (PVP). PVP is compared to AIS scores for frontal impact with belted drivers, for all types of injuries and all body regions, from the Co-operative Crash Injury Study (CCIS) and NASS-CDS databases. The excellent correlations obtained show that the AIS score is linearly proportional to Peak Virtual Power, which is proportional to delta V3 for restrained occupants, and delta V2 for unrestrained occupants. Therefore, although phenomenological, AIS appears to measure a physical quantity. It is concluded that there appears to be a "Master Curve" of AIS versus mean delta V for car occupants, implying that the amount of power for a given injury level is a constant, irrespective of injury type. There appear to be significant differences between the AIS scores for abdominal injuries between CCIS and NASS-CDS, and detailed case studies should be conducted to resolve the differences.
TL;DR: Although pedestrians appeared to be responsible for the collisions, the results suggest it may be more feasible and effective to direct injury prevention measures towards lorry drivers.
Abstract: Pedestrian fatalities following collisions with heavy goods vehicles ('lorries') in south-east Scotland were studied between 1992 and 1998. Data sources included police and ambulance reports, forensic medicine records, hospital casenotes and the Scottish Trauma Audit Group database. All injuries were scored according to the Abbreviated Injury Scale, yielding Injury Severity Scores (ISS). Sixteen pedestrians (mean age 60.2 years) died after being hit by a lorry. Actions of pedestrians were implicated in causing all the collisions--four of which appeared to be suicides. Four of the apparently accidental deaths involved pedestrians with significant blood alcohol levels. Thirteen pedestrians were dead when found. Ten pedestrians had an ISS of 75, having a total of 13 injuries acknowledged to be unsurvivable (Abbreviated Injury Scale = 6), largely to the head and chest. The unsurvivable injuries reflect huge forces, explaining why only a small proportion of the pedestrians survived to hospital. There is little potential to reduce the number of deaths by improving hospital treatment, rather the focus needs to be directed towards injury prevention. Although pedestrians appeared to be responsible for the collisions, the results suggest it may be more feasible and effective to direct injury prevention measures towards lorry drivers.
04 Jun 2001
TL;DR: In this article, the authors developed a series of lateral impact Injury Assessment Functions (IAFs) from the analysis of cadaver test data, which were used to predict the risk of injury, in AIS (abbreviated injury scale), for each of the major body regions of the occupant.
Abstract: The objective of the ISIP Project has been to develop a methodology to allow vehicle designers to optimize safety systems of vehicles in side impacts. This optimization was based on the minimization of the cost of injury or Harm. To form the link between the safety system protective capability in a crash and the cost of injury to the occupant required the development of a series of lateral impact Injury Assessment Functions (IAFs). These IAFs had to be able to predict the risk of injury, in AIS (abbreviated injury scale), for each of the major body regions of the occupant. The injury predictions were used to derive Harm for the crash and were based on the responses of a human surrogate, the BioSID. This paper describes the development of these lateral injury IAFs from the analysis of cadaver test data.
Journal Article•
TL;DR: Blunt and penetrating diaphragm injuries have different clinical characteristics and should be dealt with differently to reduce the incidence of complication and improve prognosis.
Abstract: Objective: To explore a way of guiding diagnosis and treatment of blunt and penetrating diaphragm injuries. Methods: According to injury violence, 46 chest trauma patients with diaphragm rupture were divided into two groups: a blunt injury group and a penetrating injury group. The injury condition and trauma scores between the two groups were compared and analyzed. Results: The incidence of blunt diaphragm injuries was lower than that of penetrating injuries ( 1.78 % vs 8.53 %, P 0.05 ). In the blunt injury group most patients had multiple injuries. Penetrating injuries developed more quickly than blunt injuries, and resulted in hemorrhagic shock in the early period. Trauma scores showed that there was no significant difference in the Revised Trauma Score (RTS), the Injury Severity Score (ISS) and thoracic Abbreviated Injury Scale (AIS) between the two groups (P 0.05 ), but the blunt injury group had lower Glasgow Coma Scale (GCS) and abdominal AIS than the penetrating group (P 0.05 ). Conclusions: Blunt and penetrating diaphragm injuries have different clinical characteristics. So they should be dealt with differently to reduce the incidence of complication and improve prognosis.