Risk Factors for ARDS in Hospitalized Burn Patients: An Analysis of the National Trauma Data Bank.

Acute Respiratory Distress Syndrome (ARDS) is a common complication among mechanically ventilated adult burn patients; however, the risk factors associated with its development are not well understood. Conflicting evidence also exists regarding ARDS as an independent predictor of poor hospital outcomes. The purpose of this study is to identify risk factors for ARDS in mechanically ventilated adult burn patients and characterize the impact of ARDS on hospital course. The National Trauma Data Bank (NTDB) was queried for patients >=18 years with International Classification of Diseases (ICD) codes corresponding to burn injury from 2007-2016. Hospitalized patients with at least 48 hours of mechanical ventilation were included. Multivariate logistic regression were used to identify risk factors for ARDS. Propensity score-matched analysis at a 1:3 ratio was used to determine the impact of ARDS on hospital course. This sample included 13928 patients, of which 1437 (10.3%) developed ARDS. Hypotension in the Emergency Department, alcohol use disorder, total body surface area (TBSA), Injury Severity Score (ISS), and inhalation injury were independently associated with ARDS. In the propensity score-matched cohort, ARDS patients had a significantly longer median (interquartile range) length of stay (31 [15-54] vs. 22 [9-43], p<0.001). In-hospital mortality was also significantly higher in the ARDS cohort (203 [35%] vs. 325 [24%], p<0.001). These findings highlight the impact of patient and injury characteristics on developing ARDS and support the consideration of ARDS when estimating mortality risk in burn patients.

Prediction of Mortality and Outcome of Various Trauma Scores in Polytrauma Patients.

Background In developing nations, the primary cause of death is trauma, and the prevalence of trauma is increasing as more vehicles are driven. Numerous trauma scoring systems have been created in order to predict the mortality rate and patients with trauma's prognosis. The purpose of the current study was to assess the prognostic ability of various trauma scoring systems for patients' mortality and morbidity in cases involving chest and abdominal injuries, as they are common in the surgery department. Methodology At Ranchi, Jharkhand's Rajendra Institute of Medical Sciences, a prospective observational study was conducted from June 2021 to September 2022. All patients who met the requirements for inclusion were older than 18 and reported chest and abdominal trauma totaling 204. Before any essential therapies, primary care and resuscitation, including airway maintenance, breathing, circulation, and hemorrhage control, were established. A comprehensive clinical evaluation was done based on each patient's needs. Radiological evaluation included chest X-ray and ultrasonography (USG) for chest trauma, whereas USG (FAST) and CT scans were for abdominal trauma. Trauma scores, such as the Revised Trauma Score (RTS), the Trauma Revised Injury Severity Score (TRISS), the New Injury Severity Score (NISS), and the Injury Severity Score (ISS), were computed and examined using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Results Of the 204 patients, 14.7% were female and 85.3% were male. The age range of 21-30 years old accounted for the largest percentage of cases (28%). 50 percent of injuries were caused by automobile accidents, while 25% were the result of assaults. At 83.8% versus 16.2%, blunt injuries were substantially more common than penetrating ones. In comparison to the chest, the abdomen was more frequently involved. The study's findings demonstrated that, while every trauma scoring was statistically significant in predicting mortality, the New Injury Severity Score (NISS), as well as the Trauma Revised Injury Severity Score (TRISS), became the most effective in predicting mortality (p < 0.0001). Conclusion According to the results, the most precise trauma grading method for chest and abdominal injuries is the Trauma Revised Injury Severity Score (TRISS), even though all other trauma scoring systems are useful in predicting patient outcomes. Surgeons using these metrics to predict outcomes and make well-informed treatment decisions can benefit greatly.

Associations of Age, Preinjury Morbidity, Injury Severity, and Cognitive Impairment With Mortality and Length of Stay in Trauma Consultation Patients: A Retrospective Study.

Background To the best of our knowledge, we have found no trauma consultation study investigating Injury Severity Score (ISS) ≥16, Glasgow Coma Scale score (GCS), intracranial hemorrhage (ICH), age, preexisting medical conditions (PEMC), and smoking as risk conditions for mortality. Objective We aimed to assess ISS ≥16 and other postinjury and preinjury conditions for associations with death and adverse outcomes (AO). Methodology Consecutive consultations of patients admitted to a trauma center over 18 months were investigated. Data were obtained from the trauma registry and the electronic medical record. AO were death, intensive care unit stay of two days or more, or hospital stay exceeding five days. Results Among 1,031 trauma consultations, 28 patients (2.7%) died and 258 (25.0%) had AO. The proportion of ISS ≥16 was greater with death (53.6% (15/28)) than with survival (20.2% (203/1,003); p<0.0001). Of 218 patients with ISS ≥16, 93.1% (n = 203) survived, whereas 46.4% (13/28) died with an ISS <16. The area under the receiver operating characteristic curve for ISS ≥16 and the death relationship was 0.7 (p<0.001). The proportion of GCS <15 was greater with death (42.9% (12/28)) than with survival (13.1% (131/1,003); p<0.0001). The incidence of ICH was greater with death (57.1% (16/28)) than with survival (32.5% (326/1,003); p=0.0063). The incidence of age ≥70 was greater with death (89.3% (25/28)) than with survival (48.2% (483/1,003); p<0.0001). The proportion of PEMC was greater with death (85.7% (24/28)) than with survival (50.8% (509/1,003); p=0.0002). The proportion of smoking history was similar with death (50.0% (14/28)) and survival (52.5% (527/1,003); p=0.7905). Death had independent associations with age (p=0.0019), GCS (p<0.0001), ISS ≥16 (p=0.0074), and PEMC (p=0.0137). AO had univariate associations with ISS ≥16 (p<0.0001), GCS <15 (p<0.0001), ICH (p=0.0004), and PEMC (p=0.0002). Area under the receiver operating characteristic curve for ISS ≥16 and the AO relationship was 0.6 (p<0.001). AO had independent associations with GCS (p<0.0001), ISS ≥16 (p<0.0001), and PEMC (p=0.0005). Conclusions ISS ≥16 alone is marginally accurate for classifying trauma consultation patients who died or had AO. Other postinjury and preinjury conditions, such as GCS, ICH, age, and PEMC, should also be considered when assessing one's risk of death and AO.

Serum Interleukin-6 as an Early Indicator of Trauma Complications.

BACKGROUND: Trauma is a major global health issue, associated with high mortality and complications like inapparent hypoxia, fat embolism syndrome (FES), sepsis, and multiple organ dysfunction syndrome (MODS). Early identification of high-risk patients is crucial but challenging. Serum interleukin-6 (IL-6), a key inflammatory cytokine, has shown potential as a biomarker for predicting adverse outcomes in trauma. IL-6 levels typically increase rapidly following trauma, peaking within 12 to 24 hours. Despite its potential role, there is limited research on the effectiveness of IL-6 as an early marker for trauma-related complications. This study aims to assess whether monitoring serum IL-6 levels at specific intervals after trauma can aid in early risk assessment and predict the development of these complications. MATERIALS AND METHODS: This prospective observational cohort study at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) included 119 trauma patients aged 19-65 years, admitted within 12 hours of injury. Venous blood samples (5 mL each) were collected at 12 and 24 hours for IL-6 and C-reactive protein (CRP) analysis. Injury severity score (ISS) was assessed for all the patients upon arrival to the emergency department at NEIGRIHMS and was categorized as mild, moderate, severe, and very severe. Inapparent hypoxia, FES, sepsis, and MODS were assessed using pulse oximetry, Gurd's criteria, quick sequential organ failure assessment (qSOFA) score, and Marshall's multiple organ dysfunction score, respectively. RESULTS: Among the participants, 21.85% developed complications; primarily inapparent hypoxia. Serum IL-6 levels were significantly elevated in individuals with complications at both 12 hours (p < 0.001) and 24 hours (p < 0.001) post-trauma. At the 12-hour mark, serum IL-6 demonstrated a sensitivity of 92.3% and a specificity of 78.5%, with a cut-off value of 37.26 pg/mL. By 24 hours, the sensitivity increased to 96.2% and the specificity to 87.1%, with a cut-off value of 55.08 pg/mL. Patients with MODS had the highest IL-6 levels, with medians of 270.87 pg/mL at 12 hours and 826.10 pg/mL at 24 hours. A strong correlation was observed between serum IL-6 at 24 hours and the ISS (rs = 0.725, p < 0.001). At 12 hours, there was a moderate correlation between serum IL-6 and CRP (rs = 0.488, p < 0.001). By 24 hours, this correlation strengthened to a strong level (rs = 0.749, p < 0.001). CONCLUSIONS: The significant association of serum IL-6 levels with both ISS and CRP highlights its potential role in assessing trauma severity. The high sensitivity and specificity of IL-6 at the 24-hour make it a valuable biomarker for the early detection of trauma-related complications.

Demographics, management and outcomes of major trauma in older patients at an Irish trauma unit.

BACKGROUND: Major trauma data in the developed world trends towards increased rates of lower energy mechanism in an older cohort. This study examines how the mechanism of trauma, injury pattern and outcomes differ between a younger and older cohorts in an Irish trauma unit. METHODS: In this retrospective study, all entries to the Trauma Audit and Research Network (TARN) database from Tallaght University Hospital, between January 1st 2016 and 31st December 2021, were interrogated. Differences between injury severity, 30-day mortality, and hospital length of stay in younger and older patients were also examined. RESULTS: Older patients (≥ 65 years) had a similar severity of injury to younger patients (< 65 years); however, they had longer stays in hospital (18.8 versus 9.5 days, p < 0.001). Older patients (≥ 65 years) were more likely to have head (16.1% versus 11.3%, p < 0.05) and cervical spine (21.4% versus 11.2%, p < 0.05) injuries as their primary injury compared with younger patients. Older patients (≥ 65 years) are less likely to have limb (33.3% versus 45.6%, p < 0.05). Fall from a height less than 2 m was more likely to be the mechanism of injury in the older cohort compared with the younger cohort (77.3% versus 36.3%, p < 0.05). CONCLUSION: This study highlights the increased mortality and morbidity experienced by older trauma patients compared with a younger cohort. The findings support the development of "silver trauma" care pathways and directing resources to meet the needs of older trauma patients and optimize clinical outcomes.

Epidemiology and Prevalence of Musculoskeletal Disabilities Following Motor Vehicle Accidents in Aljouf Region, Saudi Arabia.

Background and Objectives: Motor vehicle accidents (MVAs) are the leading cause of disability, particularly among young adults in Saudi Arabia. Persistent disabilities account for around 7% of all injuries attributed to MVAs in Saudi Arabia in the last twenty years. Limited studies on musculoskeletal disabilities following MVAs have been carried out in Saudi Arabia. This study aims to explore the epidemiology and prevalence of musculoskeletal disabilities in motor vehicle accident (MVA) patients in the Aljouf region, Saudi Arabia. Materials and Methods: This retrospective cross-sectional study evaluated all MVA victims treated in the Aljouf region, Saudi Arabia, from January 2020 to December 2022. A total of 3252 medical records were collected, with 731, 1197, and 1324 musculoskeletal injury cases per year, of which 88, 168, and 153 records from 2020, 2021, and 2022 were analysed, respectively. Results: The study found that patients aged 25-34 and 35-44 years were the most likely to experience disability following MVAs. The difference between age groups during a single year was statistically significant (p < 0.001). Most patients were male (89.8%, 82.7%, and 79.7%) during 2020, 2021, and 2022, respectively. The majority of injuries involved the upper extremities (38.6%, 36.9%, and 40.5%), followed by lower extremities (36.4%, 35.7%, and 34.6%), head and neck (21.6%, 26.2%, and 34.6%), thoracic region (20.5%, 24.4%, and 17%), and finally lumbosacral spine (6.8%, 5.4%, and 6.5%) during 2020, 2021, and 2022, respectively, with a significant difference for each year (p < 0.001). The study found a link between the likelihood of developing high disability grades and injury severity scores. The patients with very severe ISS ≥ 25 (OR: ∞ CI 95%: 39.81-∞; p < 0.001), severe ISS = 16-24 (OR: ∞ CI 95%: 20.90-∞; p < 0.001), and moderate ISS = 9-15 (OR: ∞ CI 95%: 1.2-∞; p = 0.02) were at greater risk of developing high grades of disability. Conclusions: This study highlighted the musculoskeletal disabilities in the Aljouf region following MVAs. Severe musculoskeletal disabilities were rare, but fractures were the most common following MVAs. More efforts should be directed towards education on early transportation and transfer to the nearest medical centres, seeking assistance immediately after MVAs for patient safety, and disability prevention.

High-energy blunt pelvic ring injuries and pre-hospital pelvic binder applications - A retrospective assessment based on a prospective registry.

INTRODUCTION: Application of a pelvic binder in the pre-hospital settings is a crucial step of high-energy blunt pelvic ring injury (PRI) management protocols. The aim of this retrospective cohort study was to evaluate the percentage of pre-hospital pelvic binder's applications in high-energy blunt type B or C PRI patients managed at a single level I trauma center, and to assess its impact on the medical resource requirements and patients' outcomes. METHODS: The institutional Severely Injured Patients' Registry was screened for patients meeting the following inclusion criteria: (1) high-energy blunt PRI; (2) admission between 2014.01.01 and 2022.12.31; (3) age ≥16 years; and (4) available computed tomography of the pelvis. Exclusion criteria were: (1) death before admission; (2) low-energy injury; (3) penetrating, blast and electrical injuries; and (4) secondary transfers. Study variables, including pre-hospital application of a pelvic binder and demographic, clinical, management and outcome data were extracted from the registry. Additionally, AO/OTA classifications were determined. RESULTS: A consecutive series of 262 patients was included into the final analysis. Of these, 58.8 % received a pre-hospital pelvic binder (PPB), increasing from type A (45.1 %) to type B (57.8 %) and type C (73.7 %). Pre-hospital hemodynamic instability was a major factor triggering the use of PPB in high-energy blunt type B PRI patients with PPB in 76.9 % of the cases with hemodynamic instability vs. 51.3 % of the cases without hemodynamic instability (p = 0.009). This difference was not statistically significant for high-energy blunt type C PRI patients (82.8 % vs. 64.3 %, p = 0.200). The presence of a physician on the trauma site contributed to the increased percentage of PRI managed with PPB from 43.5 % to 67.3 % in type B PRI (p = 0.011), and from 50 % to 77.1 % in type C PRI (p = 0.257). This study showed an increased need for packed red blood cells (PRBC) transfusions in subgroups treated with PPB and no statistically significant differences in term of intensive care unit (ICU) and total hospital length of stay and complications between high-energy blunt type B or C PRI patients with or without PPB. Comparison of mortality rates in patients with and without PPB showed a trend towards lower mortality rates with PPB in patients with AIS extremity participating in at least 50 % of the total ISS. CONCLUSION: In the ideal pre-hospital scenario, every high-energy blunt type B or C PRI patient should be managed with a PPB. Continuous pre-hospital team training and information is crucial to achieve this goal. The preparation of Emergency Department and ICU who admit a patient with PPB should include a sufficient number of PRBC ready for transfusion. Mortality rates did not seem to be affected by PPB, except for a trend towards lower mortality rates in patients in whom their PRI was the major component of the global severity of their injury. This might point out the critical and positive effect of PPB in high-energy blunt PRI patients.

Inferior vena cava collapsibility index and trauma severity in elderly fall injuries

SUMMARY OBJECTIVE: Falls are a serious cause of morbidity and mortality among older people. One of the underlying causes of falls is dehydration. Therefore, ultrasonography has become an essential tool for evaluating volume status in the emergency department. However, the effect of volume status on falls in older people has not been evaluated before. The aim of this study was to determine the relationship between the inferior vena cava collapsibility index and the injury severity score in older patients who presented with fall-related injuries to the emergency department. METHODS: A total of 66 patients were included in the study. The injury severity score was used as the trauma severity score, and the Edmonton Frail Scale was used as the frailty scale. Volume status was evaluated with inferior vena cava collapsibility index. The primary outcome measure was defined as the correlation between inferior vena cava collapsibility index and injury severity score. Secondary outcome measures were defined as the effect of inferior vena cava collapsibility index and injury severity score on hospitalization and mortality. RESULTS: There was no significant correlation between injury severity score and inferior vena cava collapsibility index (p=0.342). Neither inferior vena cava collapsibility index nor injury severity score was an indicator of the mortality of these patients. However, injury severity score was an indicator of hospitalization. The mean Edmonton Frail Scale score was an indicator of mortality among older people who experienced falls (p=0.002). CONCLUSION: Inferior vena cava collapsibility index cannot be used to predict trauma severity in older patients who have experienced falls admitted to the emergency department.

Monocyte derived large extracellular vesicles in polytrauma.

Despite significant progress in the medical field, there is still a pressing need for minimal-invasive tools to assist with decision-making, especially in cases of polytrauma. Our team explored the potential of serum-derived large extracellular vesicles, so called microparticles/microvesicles/ectosomes, to serve as a supportive tool in decision-making in polytrauma situations. We focused on whether monocyte derived large EVs may differentiate between polytrauma patients with internal organ injury (ISS > 15) and those without. Thus, we compared our EV data to soluble biomarkers such as tumour necrosis factor alpha (TNF alpha) and Interleukin-8 (IL-8). From the blood of 25 healthy and 26 patients with polytrauma large EVs were isolated, purified, and characterized. TNF alpha and IL-8 levels were quantified. We found that levels of these monocyte derived large EVs were significantly higher in polytrauma patients with internal organ damage and correlated with the ISS. Interestingly, we also observed a decline in AnnV+CD14+ large EVs during normal recovery after trauma. Thus, inflammatory serological markers as TNF alpha and as IL-8 demonstrated an inability to discriminate between polytrauma patients with or without internal organ damage, such as spleen, kidney, or liver lacerations/ruptures. However, TNF and IL-8 levels were elevated in polytrauma cases overall when contrasted with healthy non-traumatic controls. These findings suggest that delving deeper into the potential of AnnV+ large EVs derived from monocytes could highly beneficial in the managment of polytrauma, potentially surpassing the efficacy of commonly used serum markers.

A postmortem study of demographics and severity of thoracoabdominal injuries among patients attending a teaching hospital in northeast India.

Introduction: The global estimate reflects 4.4 million injury-related deaths every year and the thoracoabdominal region is frequently injured since it is a wide area. Methods: An autopsy-based cross-sectional study was conducted using a convenient sampling technique for three years. A Chi-square test was conducted for categorical variables. A P value of less than 0.01 was considered statistically significant. Results: Out of 80 cadavers, the male:female ratio was 1:0.31. The commonest age group was 20-29 years. Victims of road traffic accidents were 54 (67.5%) followed by falls from height 10 (12.5%). External thoracic injuries were commoner than internal and vice versa in abdominal injuries. Liver injuries were major in number. Combined thoracic-abdominal and associated injuries were observed in 67 (83.75%) victims. The commonest cause of death was craniocerebral injury combined with hemorrhagic shock (36.25%). Eighteen (22.5%) victims died on the spot having an Injury Severity Score (ISS) of 73.37 followed by a survival time of 1-7 days in 17 (21.25%) cases. A significant correlation was found between ISS and survival period. Conclusion: All thoracic and abdominal injuries represent a possible increase in morbidity and mortality; hence, working toward their prevention and timely intervention is necessary.

Added Value of Histological Evaluation of Muscle Biopsies in Porcine Vascularized Composite Allografts.

Background: Machine perfusion (MP) offers extended preservation of vascularized complex allografts (VCA), but the diagnostic value of histology using hematoxylin and eosin (H&E) in detecting ischemia-reperfusion injury (IRI) in muscle cells remains unclear. This study aims to document the application of the Histology Injury Severity Score (HISS) and to assess whether additional staining for nicotinamide adenine dinucleotide (NADH) and membrane attack complex (MAC) improves IRI detection in a porcine limb replantation model. Methods: The forelimbs of 16 Dutch Landrace pigs were amputated and preserved for 24 h using hypothermic MP (n = 8) with Histidine-Tryptophan-Ketoglutarate (HTK) or for 4 h with SCS (n = 8) before heterotopic replantation and 7 days of follow-up. Muscle damage was assessed via biochemical markers and light microscopy using H&E, NADH, and MAC at baseline, post-intervention, and post-operative day (POD) 1, 3, and 7 timepoints, using the HISS and a self-developed NADH and MAC score. Results: H&E effectively identified damaged muscle fibers and contributed to IRI assessment in porcine limbs (p < 0.05). The highest HISS was measured on POD 3 between MP (4.9) and SCS (3.5) (p = 0.029). NADH scores of both preservation groups varied over the 7-day follow-up and were statistically insignificant compared with baseline measurements (p > 0.05). MAC revealed no to minimal necrotic tissue across the different timepoints. Conclusions: This study documents the application of the HISS with H&E to detect IRI in muscle fibers. NADH and MAC showed no significant added diagnostic utility. The 24 h MP showed similar muscle alterations using the HISS compared to that of the 4 h SCS after a 7-day follow up.

A comparative analysis of the Trauma and Injury Severity Score and the Injury Severity Score in predicting high-value care outcomes in children with traumatic brain injury.

OBJECTIVE: Predicting high-value care outcomes is crucial in managing pediatric traumatic brain injuries (TBIs), where timely and accurate prognostication can significantly influence treatment decisions and resource allocation. This study aimed to enhance understanding of how well scoring systems such as the Trauma and Injury Severity Score (TRISS) can forecast high-value care outcomes. Furthermore, the authors compared the predictive power of TRISS with the routinely used Injury Severity Score (ISS). METHODS: The authors performed a retrospective review of their institutional database from June 2016 to June 2023 to identify cases of TBI based on a modified Centers for Disease Control and Prevention framework. Prolonged length of stay (LOS) was defined as a hospital stay falling into the upper quartile of the overall cohort. Discharge to an inpatient rehabilitation facility, acute care hospital, or foster care or death was defined as a nonroutine discharge disposition. Emergency department (ED) transfer to the intensive care unit (ICU) or operating room (OR) was defined as a proxy for severity of injuries. Multivariate logistic regression models were used to explore the association between ISS, TRISS, and high-value care outcomes. The DeLong test was used to assess the differences between the areas under the receiver operating characteristic curve (AUROCs). RESULTS: This study included 2705 patients with a mean age ± SD of 7.28 ± 5.46 years (63% male). In the overall cohort, 28% experienced prolonged LOS, 7% had a nonroutine discharge disposition from the hospital, and 23% were transferred to the ICU/OR from the ED. In multivariate regression models, both TRISS and ISS were correlated with higher odds of prolonged LOS, nonroutine discharge disposition, and transfer to the ICU/OR from the ED (all p < 0.001). TRISS had a significantly greater AUROC than ISS for nonroutine discharge disposition (0.883 vs 0.849, p < 0.001) and transfer to the ICU/OR (0.898 vs 0.887, p = 0.045), but this result was not significant for prolonged LOS (0.873 vs 0.880, p = 0.140). CONCLUSIONS: TRISS and ISS are effective tools for predicting high-value care outcomes in pediatric TBI. Utilizing these resources can assist healthcare providers in making informed, risk-adjusted predictions.

Circulating soluble CD163 is associated with reduced Glasgow Coma Scale Score and 1-year all-cause mortality in traumatized patients.

Soluble CD163 (sCD163) is a biomarker of macrophage activation, not previously investigated in the circulation of traumatized patients. A biobank of 398 adult trauma patients was analyzed. Patients with an Injury Severity Score (ISS) >8 served as trauma patients (n = 195) and those with ISS ≤8 as trauma controls (n = 203). Serum samples obtained upon admission, 15h and 72h after were analyzed for sCD163 using an in-house ELISA. Multiple linear regression was used to analyze the association between admission levels of sCD163 with, 1: overall trauma severity (ISS), and 2: severity of injury to specified organs using Abbreviated Injury Score (AIS) and Glasgow Coma Scale (GCS). The association between the peak level of sCD163 with 1-year all-cause mortality was analyzed by logistic regression analysis. Median admission levels of sCD163 were higher in trauma patients than trauma controls [2.32 (IQR 1.73 to 2.86) vs. 1.92 (IQR 1.41 to 2.51) mg/L, p < 0.01]. Worsening GCS score was associated with a 10.3% (95% CI: 17.0 to 3.1, p < 0.01) increase in sCD163. Increasing Head-AIS score was associated with a 5.1% (95% CI: -0.5 to 11.0, p = 0.07) increase in sCD163. The remaining AIS scores and ISS were not consistently associated with sCD163 admission levels. Each mg/L increase in sCD163 peak level had an odds ratio 1.34 (95%CI: 0.98 to 1.83), p = 0.06) after adjustment for age, sex, and GCS. Circulating sCD163 is increased in traumatized patients and associated with worsening GCS. Our findings suggest an association between circulating sCD163 levels with 1-year all-cause mortality.

Negative Factors Influencing Multiple-Trauma Patients.

BACKGROUND AND OBJECTIVES: This study aimed to assess the impact and predicted outcomes of patients with multiple trauma by identifying the prevalence of trauma sustained and associated complications. MATERIALS AND METHODS: This retrospective cohort study focused on individual characteristics of patients with multiple trauma admitted to our County Emergency Hospital. The final table centralized the characteristics of 352 subjects aged between 3 and 93 years who presented with multiple trauma from 2015 to 2021. Inclusion criteria for this study were the presence of multiple trauma, intervention times, mentioned subjects' ages, and types of multiple trauma. RESULTS: Patients with multiple trauma face an increased risk of mortality due to the underlying pathophysiological response. Factors that can influence the outcomes of multiple-trauma patients include the severity of the initial injury, the number of injuries sustained, and the location of injuries. CONCLUSION: The first 60 min after trauma, known as the "golden hour," is crucial in determining patient outcomes. Injuries to the head, neck, and spine are particularly serious and can result in life-threatening complications.

The injury pattern and outcomes among elephant attack survivors presenting to the emergency department: A retrospective observational study.

BACKGROUND: Human-elephant conflicts (HECs) are becoming a disturbing public health concern in eastern India. This study highlights the pattern of injuries, epidemiological factors, and outcomes among the victims who survived an elephant attack (EA). METHODS: This retrospective observational study was conducted in a tertiary care hospital. Data were retrieved from the medical records of EA victims who presented to the emergency department of the hospital over five years (January 2019-January 2024). Data regarding sociodemographic characteristics, injury mode, injury pattern, radiological findings, emergency procedures, and outcome variables (admission, length of intensive care unit and hospital stay, and death) were collected. RESULTS: In total, 45 EA victims were included in this study. The mean participant age was 45.8 ± 14.57 years. Of the total participants, 35 (78 %) were men. Most EAs [n = 18 (40 %)] occurred in the forest area and during the early morning hours between 4am and 8am [n = 18 (40 %)] of the winter season [n = 37 (82 %)] and were unprovoked [38 (84 %)]. Of the total injuries, 26 (67 %) injuries were due to the direct mode of EA and 13 (33 %) were due to the indirect mode. The most common mechanism of EA was using the trunk and foot [20 (51 %)], followed by the tusk [6 (15 %)]. The median ISS in victims was 20 (13-29). The median AIS score of chest injuries was 1 (0-3). Thirteen (29 %) patients were positive on e-FAST. Of the total EA victims, 12 (26 %) were admitted to the intensive care unit (ICU) and 17 were admitted to the wards. Severe chest injury (AIS score ≥ 3) (p = 0.003), direct mode of injury, and polytrauma (ISS > 16) were identified as significant factors contributing to ICU admission. The median ICU stay of the victims was 6 (3-8) days, and the median length of hospital stay was 7 (0.5-11) days. One inpatient mortality was noted. CONCLUSION: Middle-aged men were the most common victims of EA occurring during the early morning hours. Extremity and soft tissue injuries were most common, followed by chest and abdominal injuries. Severe chest injury resulted in ICU admission and extended hospitalization.

Traumatic Penile Injury: An Analysis of the Patient Age with Aetiological Type and Injury Severity in a Single Centre.

BACKGROUND: Penile trauma is associated with debilitating complications. Apart from its sparse literature, contextually relevant evidence on aetiology and standardized severity grading, and its stratification by legal age are needed. This study aimed to describe the frequency, aetiology and injury severity grade of patients, and explore the association of specific factors by legal age. SUBJECTS, MATERIALS AND METHODS: A single-centre retrospective cross-sectional study was conducted in our centre. Male patients with penile trauma managed by urologists were included. Data on age, year of presentation, aetiology, penile injury extent and co-existing genitourethral injuries were obtained. Descriptive and inferential statistics were undertaken using SPSS and MedCalc. Pvalue < 0.05 was considered significant. RESULTS: Forty-two patient records were analyzed. The median age and interquartile range for legal minors and legal adults were 9.5 (5.0-14.8) years and 31.0 (22.5-41.0) years, and they constituted 28.6% (n=12) and 71.4% (n=30) of the study population respectively. Penile trauma was isolated in 26.2% (n=11) of the total population.Its annual frequency was below the median volume between 2001 and 2008 but shifted to a rate above the average level between 2017 and 2021. The rate of conveyor belt-related aetiology and high-grade trauma was 41.7% and 75.0% in legal minors while it was 26.1% and 53.3% respectively in legal adults. CONCLUSIONS: Grade IV trauma was the most predominant while conveyor belt injury was the most common cause of the injury. Albeit limitations of statistical comparison, the rate of conveyor belt injury and high-grade trauma was numerically high in legal minors.

CONTEXTE: Les traumatismes du pénis sont associés à des complications débilitantes. Outre la rareté de la littérature, des preuves contextuel l ement per tinentes sur l ' étiol ogie et l a classification standardisée de la gravité, ainsi que leur stratification par âge légal, sont nécessaires. Cette étude visait à décrire la fréquence, l'étiologie et le degré de gravité des blessures des patients, et à explorer l'association de facteurs spécifiques par âge légal. SUJETS, MATÉRIELS ET MÉTHODES: Une étude rétrospective transversale monocentrique a été réalisée dans notre centre. Les patients masculins ayant subi un traumatisme pénien pris en charge par des urologues ont été inclus. Les données sur l'âge, l'année de présentation, l'étiologie, l'étendue de la blessure pénienne et les blessures génito-urétrales coexistantes ont été obtenues. Des statistiques descriptives et inférentielles ont été réalisées à l'aide de SPSS et MedCalc. Une valeur de p < 0,05 a été considérée comme significative. RÉSULTATS: Quarante-deux dossiers de patients ont été analysés. L'âge médian et l'intervalle interquartile pour les mineurs légaux et les adultes légaux étaient de 9,5 (5,0-14,8) ans et 31,0 (22,5-41,0) ans, représentant respectivement 28,6 % (n=12) et 71,4 % (n=30) de la population étudiée. Le traumatisme pénien était isolé chez 26,2 % (n=11) de la population totale. Sa fréquence annuelle était inférieure au volume médian entre 2001 et 2008, mais a dépassé le niveau moyen entre 2017 et 2021. Le taux d'étiologie liée aux tapis roulants et de traumatismes graves était de 41,7 % et 75,0 % chez les mineurs légaux, contre 26,1 % et 53,3 % respectivement chez les adultes légaux. CONCLUSIONS: Le traumatisme de grade IV était le plus prédominant, tandis que les blessures causées par les tapis roulants étaient la cause la plus courante de lésion. Bien que limitées par des comparaisons statistiques, les taux de blessures par tapis roulant et de traumatismes graves étaient numériquement élevés chez les mineurs légaux. MOTS-CLÉS: Facteurs d'âge, Étiologie, Score de gravité des blessures, Pénis.

Prognostic Association between Injury Severity Score and the Outcomes of Elderly Patients with Trauma in South Korea.

This study investigated the impact of the Injury Severity Score (ISS) on treatment approaches and survival outcomes in trauma patients, focusing on comparing elderly (≥65 years) with non-elderly patients. It analyzed adult trauma cases with abnormal Revised Trauma Scores from January to December 2019, categorizing patients into three severity groups based on ISS: mild (1-8), moderate (9-15), and severe (≥16). The study examined how ISS influenced therapeutic interventions and survival among elderly patients, comparing these outcomes to non-elderly patients using multivariable logistic regression analysis. In 16,336 adult trauma cases out of 52,262 patients, including 4886 elderly and 11,450 non-elderly patients, findings revealed that in the severe group, elderly patients had a lower, though not statistically significant, incidence of surgical or embolization interventions compared to the moderate group, differing from non-elderly patients. No significant differences were observed in the mild group between elderly and non-elderly patients. However, elderly patients had higher intervention rates in the moderate group and lower in the severe group, with significantly lower survival-to-discharge rates in the severe group. The ISS is insufficient for assessing trauma severity in elderly patients. Additional tools are needed for better evaluation and treatment decisions.

Prognostic Factors and Clinical Outcomes of Surgical Treatment of Major Thoracic Trauma.

BACKGROUND: Major thoracic trauma represents a life-threatening condition, requiring a prompt multidisciplinary approach and appropriate pathways for effective recovery. While acute morbidity and mortality are well-known outcomes in thoracic-traumatized patients, long-term quality of life in patients surviving surgical treatment has not been widely investigated before. METHODS: Between November 2016 and November 2023, thirty-two consecutive patients were operated on because of thoracic trauma. Age, sex, comorbidities, location and extent of thoracic trauma, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), Organ Injury Scale (OIS), intra and extrathoracic organ involvement, mechanism of injury, type of surgical procedure, postoperative complications, ICU and total length of stay, immediate clinical outcomes and long-term quality of life-by using the EQ-5D-3L scale and Numeric Rate Pain Score (NPRS)-were collected for each patient Results: Results indicated no significant difference in EQOL.5D3L among patients with thoracic trauma based on AIS (p = 0.55), but a significant difference was observed in relation to ISS (p = 0.000011). CONCLUSIONS: ISS is correlated with the EQOL.5D3L questionnaire on long-term quality of life, representing the best prognostic factor-in terms of long-term quality of life-in patients surviving major thoracic trauma surgical treatment.

Settlement Is at the End-Common Trauma Scores Require a Critical Reassessment Due to the Possible Dynamics of Traumatic Brain Injuries in Patients' Clinical Course.

Background: Scientific studies on severely injured patients commonly utilize the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) for injury assessment and to characterize trauma cohorts. However, due to potential deterioration (e.g., in the case of an increasing hemorrhage) during the clinical course, the assessment of injury severity in traumatic brain injury (TBI) can be challenging. Therefore, the aim of this study was to investigate whether and to what extent the worsening of TBI affects the AIS and ISS. Methods: We retrospectively evaluated 80 polytrauma patients admitted to the trauma room of our level I trauma center with computed-tomography-confirmed TBI. The initial AIS, ISS, and Trauma and Injury Severity Score (TRISS) values were reevaluated after follow-up imaging. Results: A total of 37.5% of the patients showed a significant increase in AIShead (3.7 vs. 4.1; p = 0.002) and the ISS (22.9 vs. 26.7, p = 0.0497). These changes resulted in an eight percent reduction in their TRISS-predicted survival probability (74.82% vs. 66.25%, p = 0.1835). Conclusions: The dynamic nature of intracranial hemorrhage complicates accurate injury severity assessment using the AIS and ISS, necessitating consideration in clinical studies and registries to prevent systematic bias in patient selection and subsequent data analysis.

Patients with Severe Trauma Having an Injury Severity Score of 24 and above Develop Nutritional Disorders.

In this single-center, retrospective, observational study, we aimed to assess the severity at which patients with trauma tend to develop metabolic disturbances that worsen their Controlling Nutritional Status (CONUT) scores. Participants were general adult patients with trauma hospitalized for at least one week. Injury Severity Scores (ISSs) at admission and CONUT scores one week later were calculated, and correlation coefficients were examined. The receiver operating characteristic (ROC) curve was used to calculate the ISS cutoff value for a CONUT score of 5 or more on day 7 of hospitalization. The ISS was assessed using multiple logistic regression analysis to determine whether it predicts worse nutritional status. Forty-nine patients were included. ISSs correlated with CONUT scores on day 7 (r = 0.373, p = 0.008). Using the ROC curve, the cutoff value for the ISS was 23.5. Multiple logistic regression analyses showed that a high ISS (odds ratio [OR], 1.158; 95% confidence interval [CI], 1.034-1.296; p = 0.011) and older age (OR, 1.094; 95% CI, 1.027-1.165; p = 0.005) were associated with a CONUT score 5 or more on day 7 of hospitalization. Patients with trauma with an ISS of 24 or higher have worsening CONUT scores during hospitalization; these patients require careful nutritional management.