Showing papers on "Abbreviated Injury Scale published in 2006"

AIS 2005: A contemporary injury scale

Abstract: To determine and to quantify outcome from injury demands that multiple factors be universally applied so that there is uniform understanding that the same outcome is understood for the same injury. It is thus important to define the variables used in any outcome assessment. Critical to defining outcomes is the need for a universal language that defines individual injuries. The abbreviated injury scale (AIS) is the only dictionary specifically designed as a system to define the severity of injuries throughout the body. In addition to a universal injury language, it provides measures of injury severity that can be used to stratify and classify injury severity in all body regions. Its revision, AIS 2005 will be discussed here.

Depression in orthopaedic trauma patients : Prevalence and severity

Abstract: Background: There is a known connection between physical injury and disability and emotional distress. Several investigators have shown a relationship between trauma, depression, and poor outcomes. The literature on trauma and depression is limited with regard to clarifying the relationship between the degree of injury and depression and the relationship between physical function of patients with less severe injuries and depression. Methods: One hundred and sixty-one patients who presented to our orthopaedic trauma services were enrolled in the study and interviewed. We obtained information about patient demographics and administered several self-reported outcome measures: the Beck Depression Inventory (BDI), the Short Musculoskeletal Function Assessment (SMFA), and the Physical Function-10 (PF-10) subset of the Short Form-36 (SF-36). We documented the nature and severity of the injury or injuries and calculated correlations between the outcome measures and the BDI. Injury-specific factors such as the AO Fracture Classification, the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS), and the Gustilo and Anderson grade of open fractures were also examined. Results: Fifty-five percent of the patients had minimal depression, as measured with the BDI; 28% had moderate depression; 13% had moderate-to-severe depression; and 3.7% had severe depression. When the somatic elements of the BDI were removed, the prevalence of moderate, moderate-to-severe, or severe depression was 26%. The SMFA scores had a strong negative correlation with the BDI (–0.75; p < 0.001). Of the injury-specific factors, only open factures were found to have an impact on the presence of depression, with an odds ratio of 4.58 (95% confidence ratio, 1.57 to 12.35). Conclusions: The prevalence of clinically relevant depression approached 45% in a diverse cohort of orthopaedic trauma patients. Global disability is strongly correlated with depression. The presence of an open fracture may also increase the risk of depression. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

American Association for the Surgery of Trauma Organ Injury Scale for kidney injuries predicts nephrectomy, dialysis, and death in patients with blunt injury and nephrectomy for penetrating injuries

Abstract: Background:Despite broad clinical use of the American Association of the Surgery of Trauma (AAST) injury scale for kidney, it has only been found to predict the need for renal surgery in single institution series. We sought to validate this scheme for morbidity and mortality in a national cohort of

Head, face, and neck injuries during Operation Iraqi Freedom II: results from the US Navy-Marine Corps Combat Trauma Registry.

Abstract: BACKGROUND:: Head, face, and neck injuries (HFNIs) are an important source of combat mortality and morbidity. The objective of this study was to document the characteristics and causes of HFNIs during Operation Iraqi Freedom II. METHODS:: A retrospective review of HFNIs sustained by US military casualties between March 1, 2004 and September 30, 2004 was performed. Data were collected from the Navy-Marine Corps Combat Trauma Registry. RESULTS:: During the study period, 39% of all injury casualties in the registry had HFNIs. Of the 445 HFNI patients, one-third presented with multiple wounds to the head, face, and neck. Four percent of battle HFNI patients died from wounds, and nearly 40% of the surviving wounded were evacuated for treatment. Improvised explosive devices (IEDs) were the most frequent cause of battle HFNIs. Nonbattle HFNIs were most often the result of motor vehicle crashes. The majority (65%) of all HFNIs were to the face. Head injuries, overall, were more severe than face or neck wounds according to the Abbreviated Injury Scale. CONCLUSIONS:: The proportion of combat-related HFNIs is increasing and is primarily caused by IEDs. Improved protection for the vulnerable facial region is needed. Continued research on the changing nature of warfare and distribution of HFNIs is necessary to enhance the planning and delivery of combat casualty medical care. Language: en

Serious injury is associated with suboptimal restraint use in child motor vehicle occupants

Abstract: This article reports on a study undertaken to investigate the relationship between restraint usage (child seats, seat belts) and injury outcome in motor vehicle occupants aged 2–8 years (n = 152). The authors conducted a retrospective case review of all child occupants presenting at the Children's Hospital at Westmead (New South Wales, Australia) between July 2002 and January 2005 for injuries associated with a motor vehicle crash. Injury severity was assessed in terms of the Abbreviated Injury Scale (AIS), and organized by age and type of restraint. While nearly all of the children (94%) used some restraint, most (82%) used a suboptimal form of restraint. Injury severity between optimally-restrained children and suboptimally-restrained children differed significantly, with suboptimally-restrained children receiving a greater proportion of moderate to severe (AIS 2+) injuries. No optimally-restrained child sustained an AIS 2+ injury. The authors note that while the use of restraints designed for older children or adults, such as seat belts, fulfills legal obligations, this is suboptimal restraint use and results in more severe injuries. They conclude that there are significant benefits to be gained by encouraging children to use appropriate restraint for their size.

Injuries among elite snowboarders (FIS Snowboard World Cup)

Abstract: Background: Although snowboarding is already established as an Olympic sport, it is still a developing sport, with new disciplines, more demanding snow installations, and spectacular tricks. A recent study on subjects at Norwegian national elite level showed that injury risk is high and that injuries among competitive snowboarders differ from those seen in recreational snowboarders, with fewer wrist injuries and more knee and back injuries. Objective: To describe the incidence and type of injuries among female and male snowboarders at international elite level. Method: At the last race of the Federation Internationale de Ski Snowboard World Cup, acute injuries resulting in missed participation and overuse injuries influencing performance, were recorded during a retrospective interview (91% response rate). The registration period was from April 2002 (end of season) until March 2003. Exposure was recorded as the number of runs in all disciplines, and the incidence was calculated as number of injuries per 1000 runs. Results: The 258 athletes interviewed reported 3193 competition days (n = 46 879 runs) in all disciplines. In total, 135 acute injuries were recorded; 62 (46%) during competition in the official disciplines. Of the 135 acute injuries, the most common injury locations were knee (n = 24; 18%), shoulder (n = 18; 13%), back (n = 17; 13%), and wrist (n = 11; 8%). The overall incidence during competition was 1.3 (95% confidence interval 1.0 to 1.7) injuries per 1000 runs; 2.3 (0.9 to 3.8) for big air (n = 10), 1.9 (1.1 to 2.8) for halfpipe (n = 21), 2.1 (1.2 to 3.0) for snowboard cross (n = 20), 0.6 (0.2 to 1.0) for parallel giant slalom (n = 8), and 0.3 (0.0 to 0.7) for parallel slalom (n = 3). The severity of injuries was graded based on time loss (27% lost >21 days) and score on the Abbreviated Injury Scale (AIS) (38% AIS 1, 61% AIS 2 and 1% AIS 3). There were 122 overuse injuries, 38 (31%) of these to the knee. Conclusion: The injury risk for big air, snowboard cross, and halfpipe disciplines is high, while that for the snowboard slalom disciplines is lower. The injury pattern is different from recreational athletes, with a greater share of knee injuries and fewer wrist injuries. Compared with national level, the injury risk appears to be lower at World Cup level.

Which AIS based scoring system is the best predictor of outcome in orthopaedic blunt trauma patients

Abstract: Background: Abbreviated Injury Scale (AIS)-based systems-the Injury Severity Score (ISS), New Injury Severity Score (NISS), and AISmax-are used to assess trauma patients. The merits of each in predicting outcome are controversial. Methods: A large prospective database was used to assess their predictive capacity using receiver operator characteristic curves. Results: In all, 10,062 adult, blunt-trauma patients met the inclusion criteria. All systems were significant outcome predictors for sepsis, multiple organ failure (MOF), length of hospital stay, length of intensive care unit (ICU) admission and mortality (p < 0.0001). NISS was a significantly better predictor than the ISS for mortality (p < 0.0001). NISS was equivalent to the AISmax for mortality prediction and superior in patients with orthopaedic injuries. NISS was significantly better for sepsis, MOF, ICU stay, and total hospital stay (p < 0.0001). Conclusions: NISS is superior or equivalent to the ISS and AISmax for prediction of all investigated outcomes in a population of blunt trauma patients. As NISS is easier to calculate, its use is recommended to stratify patients for clinical and research purposes.

Use of the WHOQOL-BREF for Evaluating Persons with Traumatic Brain Injury

Abstract: This study examined psychometric properties of a brief version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) among persons with traumatic brain injury (TBI) and the relations of the WHOQOL-BREF domains, including physical capacity, psychological wellbeing, social relationships, and environment, to different indicators of TBI severity. Of the 354 eligible and available subjects from 22 hospitals in northern Taiwan over a 6-month period, 199 completed telephone interviews during data collection. Three indicators of TBI severity were used: the Glasgow Coma Scale, the presence of post-traumatic amnesia, and the abbreviated injury scale to the head. All domain scores of the WHOQOL-BREF had nearly symmetrical distributions: low percentages of ceiling and floor values (0 ∼ 3%), low missing rates (0 ∼ 0.5%) for all but one item (43.2%), and very good internal consistency (0.75 ∼ 0.89) and test-retest reliability (0.74 ∼ 0.95). The WHOQOL-BREF also exhibited excellent known-groups va...

Incorporating recent advances to make the TRISS approach universally available.

Abstract: Background: The Trauma and Injury Severity Score (TRISS), used to garner predictions of survival from the Injury Severity Score (ISS), the Revised Trauma Score (RTS, for physiologic reserve), and age is difficult for many trauma facilities to compute because it requires 8 to 10 variables and ISS depends on the specialized Abbreviated Injury Scale (AIS) scale rather than the International Classification of Diseases scale (ICD-9). It has been shown that metrics describing a patient's worst injury (WORSTSRR) are a powerful predictor of survival (regardless of coding type, AIS versus ICD-9) and that the Glasgow Coma Scale (GCS) motor component contains the majority of the information found in the full GCS score. This study hypothesized that the TRISS approach could be made more predictive and efficient with fewer variables by incorporating these advances. Methods: A total of 310,958 patients with nonmissing TRISS variables were subset from the National Trauma Data Bank (NTDB). Logistic regression was used to model mortality as a function of anatomic, physiologic and age variables. A traditional TRISS model was computed (with NTDB-derived coefficients) that uses ISS, RTS, age index, and mechanism to predict survival. Four smaller three- or four-variable models employed the ICD-9 WORSTSRR, the GCS motor component, and age (both continuously and dichotomously). Two of the four models also use mechanism. These models were compared using the concordance index (c-index, a measure of model discrimination) and the pseudo-R 2 statistic (estimates proportion of variance explained). Results: Each experimental model (two models with 3 variables and two models with 4 variables) have superior discrimination and explain more variance than the traditional TRISS model that employs 8-10 variables. Conclusions: Recent advances in anatomic and physiologic scoring markedly simplify TRISS-type models at no cost to prediction. This approach uses routinely available data, requires up to seven fewer terms, and predicts at least as well as the original TRISS. These findings could increase the availability of accurate trauma scoring tools to smaller trauma facilities.

Terror-related injuries: a comparison of gunshot wounds versus secondary-fragments-induced injuries from explosives.

Abstract: Background Terror-related injuries caused by secondary fragments (SF) from explosive devices show a distinctive pattern in severity, distribution, outcomes of assault, and health-system resource use as compared with terror-related penetrating injuries caused by gunshot wounds. Study design A case-comparison study conducted in a tertiary university hospital and the only Level I trauma center in the Jerusalem vicinity. During a period of 4 years, over 1,500 casualties of terror-related injuries were treated in one Level I trauma center. The study included 533 patients who were admitted for hospitalization. Excluded from the study were victims who were dead on arrival or who succumbed to their injuries within 30 minutes of arrival at the emergency department. Data were collected from trauma registry records. Results Gunshot-wound victims were mostly men, aged 19 to 30, and SF victims were more evenly distributed between the genders and across the age spectrum. Injury Severity Score (ISS) was considerably higher in SF victims, although critical mortality rates were higher in gunshot-wound victims. More than 40% of SF victims were injured in three or more body regions, as opposed to Conclusions Terror victims suffering from SF wounds have more complex, widespread, and severe injuries than victims suffering from gunshot wounds. They tend to involve multiple body regions and use more in-hospital resources. Attenuation of bus seats and protective vests can lead to a reduction in severity of these injuries.

Injury patterns and severity among hospitalized motorcyclists: a comparison of younger and older riders.

Abstract: Since 1997, there has been an increase in injuries and fatalities to motorcyclists. Data from the National Center for Statistics and Analysis of the National Highway Safety Administration (NHTSA) reveal that, as of 2004, fatalities had increased for the eighth year in a row. While there has also been an increase in motorcycle registrations during this period, the rate of increase in fatalities has been greater than that of registrations (NHTSA, 2005). Concomitant with these changes, there has been a significant change in the pattern of motorcyclist deaths, with a growing proportion of older riders. In 1991 this older group accounted for 15% of deaths, but had grown to 46% by 2004. Although fatalities increased in all age groups, the largest increase has been in the group of riders over the age of 49; thus, the mean age of fatally injured motorcyclists has increased from 29.3 in 1990 to 37.9 in 2002. At the same time there has been an increase in the average engine size of motorcycles, from a mean of 769 cc in 1990 to 999 cc in 2002. On a national level, this trend has been associated with an increasing number of states repealing or modifying motorcycle helmet use laws, as well as a decreasing helmet use rate among observed motorcyclists (Stutts, et al., 2004). Recommendations from NHTSA include the need for better data on the causes of crashes among older riders and the differences in the types of injuries sustained by older and younger riders (NHTSA, 2002). Previous research has reported both decreased crash rates and increased injury rates among older motorcyclists (Haworth, 2004; Mulvihill and Haworth, 2005). Stutts et al. (2004) examined trends in motorcyclist deaths, vehicle registrations, and crash rates from 1990–2002. They showed that, during this period the numbers of motorcyclists aged 16–24 declined, while those 35 and older increased. Significant differences were observed in the crash patterns of older and younger motorcyclists in North Carolina, with older motorcyclists crashing more often on high speed roadways and in rural areas, having fewer run-off-road events, being involved in fewer single-vehicle crashes, having more crashes at intersections, and having more alcohol/drug involvement. These differences may affect the patterns of injury experienced by motorcyclists in various age groups. Despite the burden of injury associated with motorcycle crashes, few comprehensive studies have been conducted to examine the types of injuries sustained by hospitalized motorcyclists; instead, the majority of studies have focused primarily on fatalities, comparing riders with and without helmets, and trends in head injury following repeal or passage of motorcycle helmet laws. In a study of fatally injured riders, Sarkar et al. (1995) noted that 36% of deaths among helmeted riders were due to the trunk, as compared to 19% among the non-helmeted. Similar findings were noted in a California study of fatalities before and after a mandatory helmet law (Kraus et al., 1994). Thus, among helmeted motorcyclists, a substantial proportion of fatalities that occur will involve serious chest and abdominal trauma. Several studies have also addressed the high rates of lower extremity, chest, and abdominal injuries following motorcycle crashes. Kraus et al. (2002), in a study of the incidence of thoracic and abdominal injuries among injured motorcyclists in California, reported that multiple intra-thoracic and intra-abdominal injuries were common, and that the number and bilaterality of rib fractures were strongly associated with serious injuries to the thoracic and abdominal organs. In a British study of injured motorcyclists, Ankarath et al. (2002) showed that thoracic and abdominal trauma, as well as pelvic ring fractures associated with long bone injuries, were the major contributors to reduced survival, following head injury. However, these studies did not address the role of the age of the motorcyclist. The purpose of this analysis is to compare the types of injuries sustained by older vs. younger motorcyclists hospitalized in the state of Maryland, and to examine the characteristics of their crashes, motorcycles, and helmet usage.

Injury risk in behind armor blunt thoracic trauma.

Abstract: First responders and military personnel are particularly susceptible to behind armor blunt thoracic trauma in occupational scenarios. The objective of this study was to develop an armored thorax injury risk criterion for short duration ballistic impacts. 9 cadavers and 2 anthropomorphic test dummies (AUSMAN and NIJ 0101.04 surrogate) were tested over a range of velocities encompassing low severity impacts, medium severity impacts, and high severity impacts based upon risk of sternal fracture. Thoracic injuries ranged from minor skin abrasions (abbreviated injury scale [AIS] 1) to severe sternal fractures (AIS 3+) and were well correlated with impact velocity and bone mineral density. 8 male cadavers were used in the injury risk criterion development. A 50% risk of AIS 3+ injury corresponded to a peak impact force of 24,900 +/- 1,400 N. The AUSMAN impact force correlated strongly with impact velocity. Recommendations to improve the biofidelity of the AUSMAN include implementing more realistic viscera and decreasing the skin thickness. Language: en

Speeding and maxillofacial injuries: impact of the introduction of penalty points for speeding offences.

Abstract: On 31 October 2002 the Irish Government introduced a point demerit scheme for road speeding offences. To evaluate the impact of the scheme, we made a comparative assessment of the number of maxillofacial operations necessitated by road crashes at two tertiary surgical centres in the year before and the year after the introduction of penalty points. There were no significant differences in the composition of the groups between the two study periods. There were 57 operations in the year before and 22 in the year after for injuries caused by collisions (a 61% reduction). No changes were seen in the distribution or severity of maxillofacial injuries or in the pattern or severity of other injuries. Severity was assessed using the Abbreviated Injury Scale (AIS) and Maximum Abbreviated Injury Severity Scale (MAIS), and bodily injuries by the Injury Severity Scale (ISS). The number of patients requiring intensive care and the duration of admission to the unit were unchanged, as was the total duration of hospital admission. There were no differences in the requirement for other specialist management.

Severe outcome of children following trauma resulting from road accidents.

Abstract: The aim of the study was to determine the risk factors of a severe outcome for children severely injured [killed or with an Injury Severity Score (ISS) ≥16] in a road accident. Casualties that occurred between 1996 and 2001 which involved children under 14 years of age were assessed in a population-based study based on data included in a French road trauma Registry. A severe traumatic brain injury (TBI) was defined as a head injury with an Abbreviated Injury Scale (AIS) severity score ≥3. A multivariate logistic regression was performed to quantify the risk of a “severe outcome” defined as death or an expected serious impairment 1 year later. The annual incidence of an ISS of 16+ was 7.7 per 100,000 children. Among the 126 severely injured children included in this study, 40 died (including 16 immediate deaths), and a severe outcome was expected for 54 of the 86 survivors. Children with an “isolated severe TBI” and those with “multiple injuries including TBI” were more likely to have a severe outcome than those who had an “isolated severe injury without TBI” (OR: 7.91; 95%CI: 1.43–43.77 and OR: 8.37; 95%CI: 1.52–46.13, respectively). Age was inversely linked to a severe outcome. The unprotected motor vehicle occupants (MVO) had an odds ratio of 7.56 (95%CI: 1.07–53.56) compared to the protected MVO. Only 30% of children who survived a severe TBI were admitted to rehabilitation. The mechanism of the injury, an injury pattern involving the head and a young age were associated with a severe outcome following a road accident. A majority of children severely injured were not referred to inpatient rehabilitation.

Incidence of thoracic and lumbar spine injuries for restrained occupants in frontal collisions

Abstract: The increased utilization of three-point restraint systems has greatly reduced the incidence of spinal injuries in motor vehicle accidents. Nevertheless, several studies which rely upon the National Automotive Sampling System (NASS) have documented lower thoracic and upper lumbar fractures in restrained occupants involved in frontal collisions of moderate severities. Although it has been postulated that the injury mechanism may be related to the occupant being out-of-position or sitting in an unusual posture, conclusions with regard to the precise mechanism of injury are difficult due to the lack of information contained in the NASS database. In addition, previous studies have not reported statistical significance of these injuries. In this study, we combined statistical analysis of frontal collisions in the NASS database with the analysis of data acquired from sled and crash tests, which utilized anthropomorphic test devices (ATDs), in order to evaluate the incidence and potential injury mechanisms underlying thoracic and lumbar spine fractures in moderate frontal impacts. In the first portion of the study, we performed a statistical analysis of the NASS database to estimate the incidence rate of spinal fracture. This was complemented with measurements and analysis of lumbar spine load data derived from frontal sled and crash tests. Analysis of the NASS database demonstrated that thoracolumbar spinal injuries are rare when an occupant is restrained by a lap and shoulder belt, and are often accompanied by abdominal injury. The spinal loads measured during frontal impacts with restrained and nominally positioned ATDs were found to be well below injury thresholds. Our results also suggest that the potential for isolated fracture is increased when the geometry of occupant-to-restraint interaction is compromised, as occurs when an occupant submarines the lap belt.

Timeline to operative intervention for solid organ injuries in children

Abstract: BACKGROUND: Nonoperative management of solid organ injuries (SOI) in children is now the standard of care. Little is know regarding the time to failure for those children requiring operative intervention. We sought to delineate this timeline to operative intervention for the subset of single solid organ injured patients requiring laparotomy. METHODS: The National Trauma Data Bank (NTDB) was queried for the period 1991 to 2003 for all children (age 2) were excluded. Data abstracted included age, organ injury and severity (ICD-9, AIS), and operative procedures. Survival analysis methods were used to evaluate equality of hazard rates (indicating rate of operative intervention by hour). RESULTS: For the period of review, the NTDB contained 2,013 children with a single SOI including 1,813 eligible for review. The mean age was 9.2 +/- 3.8 years with a mean Injury Severity Score (ISS) of 8.6 +/- 6.3. The study population included 224 (12.4%) kidney injuries, 488 (26.9%) liver injuries, and 1,101 (60.7%) splenic injuries. A total of 120 (6.6%) of the patients required an operation for their solid organ injury. The median time to operation was 2.4 hours with 61.7% undergoing surgery within 3 hours of arrival, 79.4% within 6 hours, and 89.7% within 24 hours. The operative intervention rate was greatest for splenic injuries (8.7%) followed by liver (3.5%) and kidney (3.1%) injuries. Hazard rates varied significantly by organ injured (p < 0.001) and peaked at 1.5 hours for liver, 2 hours for spleen, and 4.5 hours for kidney. Hazard rates varied significantly by injury severity (p < 0.001) with a peak time to surgery for all severity at 2 hours postadmission. CONCLUSION: Although the patterns for peak time to operative intervention varied for the specific organs injured and injury severity, the need for operative intervention for children with an SOI is established for the vast majority of children within 24 hours of admission.

Abdominal Injury Patterns in Real Frontal Crashes: Influence of Crash Conditions, Occupant Seat and Restraint Systems

Abstract: An in-depth study was conducted through the analysis of medical reports and crash data from real world accidents. The objective was to investigate the abdominal injury patterns among car occupants in frontal crashes. The influence of the type of restraint system, the occupant seat, the age and the crash severity was investigated. The results indicate that the risk of abdominal AIS 3+ injuries increased with crash severity and decreased with the introduction of belt retractors. Rear belted passengers were observed to be more likely injured than front belted occupants. The organs injured in frontal crashes for belted occupants were mainly hollow organs especially jejunum, ileum and mesentery.