The predictive value of the Kampala Trauma Score (KTS) in the outcome of multi-traumatic patients compared to the estimated Injury Severity Score (eISS).

PURPOSE: The classification of trauma patients in emergency settings is a constant challenge for physicians. However, the Injury Severity Score (ISS) is widely used in developed countries, it may be difficult to perform it in low- and middle-income countries (LMIC). As a result, the ISS was calculated using an estimated methodology that has been described and validated in a high-income country previously. In addition, a simple scoring tool called the Kampala Trauma Score (KTS) was developed recently. The aim of this study was to compare the diagnostic accuracy of KTS and estimated ISS (eISS) in order to achieve a valid and efficient scoring system in our resource-limited setting. METHODS: We conducted a cross-sectional study between December 2020 and March 2021 among the multi-trauma patients who presented at the emergency department of Imam Reza hospital, Tabriz, Iran. After obtaining informed consent, all data including age, sex, mechanism of injury, GCS, KTS, eISS, final outcome (including death, morbidity, or discharge), and length of hospital stay were collected and entered into SPSS version 27.0 and analyzed. RESULTS: 381 multi-trauma patients participated in the study. The area under the curve for prediction of mortality (AUC) for KTS was 0.923 (95%CI: 0.888-0.958) and for eISS was 0.910 (95% CI: 0.877-0.944). For the mortality, comparing the AUCs by the Delong test, the difference between areas was not statistically significant (p value = 0.356). The diagnostic odds ratio (DOR) for the prediction of mortality KTS and eISS were 28.27 and 32.00, respectively. CONCLUSION: In our study population, the KTS has similar accuracy in predicting the mortality of multi-trauma patients compared to the eISS.

Comparison of nine trauma scoring systems in prediction of inhospital outcomes of pediatric trauma patients: a multicenter study.

Hereby, we aimed to comprehensively compare different scoring systems for pediatric trauma and their ability to predict in-hospital mortality and intensive care unit (ICU) admission. The current registry-based multicenter study encompassed a comprehensive dataset of 6709 pediatric trauma patients aged ≤ 18 years from July 2016 to September 2023. To ascertain the predictive efficacy of the scoring systems, the area under the receiver operating characteristic curve (AUC) was calculated. A total of 720 individuals (10.7%) required admission to the ICU. The mortality rate was 1.1% (n = 72). The most predictive scoring system for in-hospital mortality was the adjusted trauma and injury severity score (aTRISS) (AUC = 0.982), followed by trauma and injury severity score (TRISS) (AUC = 0.980), new trauma and injury severity score (NTRISS) (AUC = 0.972), Glasgow coma scale (GCS) (AUC = 0.9546), revised trauma score (RTS) (AUC = 0.944), pre-hospital index (PHI) (AUC = 0.936), injury severity score (ISS) (AUC = 0.901), new injury severity score (NISS) (AUC = 0.900), and abbreviated injury scale (AIS) (AUC = 0.734). Given the predictive performance of the scoring systems for ICU admission, NTRISS had the highest predictive performance (AUC = 0.837), followed by aTRISS (AUC = 0.836), TRISS (AUC = 0.823), ISS (AUC = 0.807), NISS (AUC = 0.805), GCS (AUC = 0.735), RTS (AUC = 0.698), PHI (AUC = 0.662), and AIS (AUC = 0.651). In the present study, we concluded the superiority of the TRISS and its two derived counterparts, aTRISS and NTRISS, compared to other scoring systems, to efficiently discerning individuals who possess a heightened susceptibility to unfavorable consequences. The significance of these findings underscores the necessity of incorporating these metrics into the realm of clinical practice.

Automated stratification of trauma injury severity across multiple body regions using multi-modal, multi-class machine learning models.

OBJECTIVE: The timely stratification of trauma injury severity can enhance the quality of trauma care but it requires intense manual annotation from certified trauma coders. The objective of this study is to develop machine learning models for the stratification of trauma injury severity across various body regions using clinical text and structured electronic health records (EHRs) data. MATERIALS AND METHODS: Our study utilized clinical documents and structured EHR variables linked with the trauma registry data to create 2 machine learning models with different approaches to representing text. The first one fuses concept unique identifiers (CUIs) extracted from free text with structured EHR variables, while the second one integrates free text with structured EHR variables. Temporal validation was undertaken to ensure the models' temporal generalizability. Additionally, analyses to assess the variable importance were conducted. RESULTS: Both models demonstrated impressive performance in categorizing leg injuries, achieving high accuracy with macro-F1 scores of over 0.8. Additionally, they showed considerable accuracy, with macro-F1 scores exceeding or near 0.7, in assessing injuries in the areas of the chest and head. We showed in our variable importance analysis that the most important features in the model have strong face validity in determining clinically relevant trauma injuries. DISCUSSION: The CUI-based model achieves comparable performance, if not higher, compared to the free-text-based model, with reduced complexity. Furthermore, integrating structured EHR data improves performance, particularly when the text modalities are insufficiently indicative. CONCLUSIONS: Our multi-modal, multiclass models can provide accurate stratification of trauma injury severity and clinically relevant interpretations.

Use of Reverse Shock Index Multiplied by Simplified Motor Score in a Five-Level Triage System: Identifying Trauma in Adult Patients at a High Risk of Mortality.

Background and Objectives: The Taiwan Triage and Acuity Scale (TTAS) is reliable for triaging patients in emergency departments in Taiwan; however, most triage decisions are still based on chief complaints. The reverse-shock index (SI) multiplied by the simplified motor score (rSI-sMS) is a more comprehensive approach to triage that combines the SI and a modified consciousness assessment. We investigated the combination of the TTAS and rSI-sMS for triage compared with either parameter alone as well as the SI and modified SI. Materials and Methods: We analyzed 13,144 patients with trauma from the Taipei Tzu Chi Trauma Database. We investigated the prioritization performance of the TTAS, rSI-sMS, and their combination. A subgroup analysis was performed to evaluate the trends in all clinical outcomes for different rSI-sMS values. The sensitivity and specificity of rSI-sMS were investigated at a cutoff value of 4 (based on previous study and the highest score of the Youden Index) in predicting injury severity clinical outcomes under the TTAS system were also investigated. Results: Compared with patients in triage level III, those in triage levels I and II had higher odds ratios for major injury (as indicated by revised trauma score < 7 and injury severity score [ISS] ≥ 16), intensive care unit (ICU) admission, prolonged ICU stay (≥14 days), prolonged hospital stay (≥30 days), and mortality. In all three triage levels, the rSI-sMS < 4 group had severe injury and worse outcomes than the rSI-sMS ≥ 4 group. The TTAS and rSI-sMS had higher area under the receiver operating characteristic curves (AUROCs) for mortality, ICU admission, prolonged ICU stay, and prolonged hospital stay than the SI and modified SI. The combination of the TTAS and rSI-sMS had the highest AUROC for all clinical outcomes. The prediction performance of rSI-sMS < 4 for major injury (ISS ≥ 16) exhibited 81.49% specificity in triage levels I and II and 87.6% specificity in triage level III. The specificity for mortality was 79.2% in triage levels I and II and 87.4% in triage level III. Conclusions: The combination of rSI-sMS and the TTAS yielded superior prioritization performance to TTAS alone. The integration of rSI-sMS and TTAS effectively enhances the efficiency and accuracy of identifying trauma patients at a high risk of mortality.

Utilizing ultra-early continuous physiologic data to develop automated measures of clinical severity in a traumatic brain injury population.

Determination of prognosis in the triage process after traumatic brain injury (TBI) is difficult to achieve. Current severity measures like the Trauma and injury severity score (TRISS) and revised trauma score (RTS) rely on additional information from the Glasgow Coma Scale (GCS) and the Injury Severity Score (ISS) which may be inaccurate or delayed, limiting their usefulness in the rapid triage setting. We hypothesized that machine learning based estimations of GCS and ISS obtained through modeling of continuous vital sign features could be used to rapidly derive an automated RTS and TRISS. We derived variables from electrocardiograms (ECG), photoplethysmography (PPG), and blood pressure using continuous data obtained in the first 15 min of admission to build machine learning models of GCS and ISS (ML-GCS and ML-ISS). We compared the TRISS and RTS using ML-ISS and ML-GCS and its value using the actual ISS and GCS in predicting in-hospital mortality. Models were tested in TBI with systemic injury (head abbreviated injury scale (AIS) ≥ 1), and isolated TBI (head AIS ≥ 1 and other AIS ≤ 1). The area under the receiver operating characteristic curve (AUROC) was used to evaluate model performance. A total of 21,077 cases (2009-2015) were in the training set. 6057 cases from 2016 to 2017 were used for testing, with 472 (7.8%) severe TBI (GCS 3-8), 223 (3.7%) moderate TBI (GCS 9-12), and 5913 (88.5%) mild TBI (GCS 13-15). In the TBI with systemic injury group, ML-TRISS had similar AUROC (0.963) to TRISS (0.965) in predicting mortality. ML-RTS had AUROC (0.823) and RTS had AUROC 0.928. In the isolated TBI group, ML-TRISS had AUROC 0.977, and TRISS had AUROC 0.983. ML-RTS had AUROC 0.790 and RTS had AUROC 0.957. Estimation of ISS and GCS from machine learning based modeling of vital sign features can be utilized to provide accurate assessments of the RTS and TRISS in a population of TBI patients. Automation of these scores could be utilized to enhance triage and resource allocation during the ultra-early phase of resuscitation.

Evaluation of emergency department admissions of mass casualty patients using the revised trauma score, injury severity score, and trauma and injury severity score.

BACKGROUND: There is a need for studies evaluating prognostic scoring systems in mass trauma patients in conflict regions to predict patient prognosis for emergency surgical prioritization. In this study, we aimed to evaluate scoring systems such as the Revised Trauma Score (RTS), Injury Severity Score (ISS), and Trauma and Injury Severity Score (TRISS) in trauma patients admitted due to mass trauma in Northern Syria. METHODS: This study was a retrospective evaluation of patients admitted due to mass trauma to the emergency departments of hospitals in Northern Syria. The diagnostic efficiency of RTS, ISS, and TRISS scoring systems was evaluated in these admissions in the first half of 2021. RESULTS: The most common causes of mass trauma were bomb blast (67.3%), gunshot (28.8%), and 14 (3.9%) patients admitted with other causes. When the odds ratio (OR) was analyzed, a one-unit increase in the RTS score increased the odds of survival by a factor of 6.133, and a one-unit increase in the TRISS score increased the odds of survival by a factor of 1.057. Differently, it was found that each 1-unit increase in ISS decreased the patient's probability of survival by 0.856 units. When RTS, TRISS, and ISS scores were analyzed, the area under the ROC curve was statistically significant for all of them (p<0.001) and all of them had a diagnostic value for mortality with sensitivities of 99.0%, 94.8%, and 91.9%; specificities of 87.8%, 90.5%, and 88.6; AUC of 0.958, 0.975, and 0.958, respectively. CONCLUSION: The use of trauma scoring systems, especially TRISS, may be useful for prioritizing patients in mass casualty settings in the presence of overcapacity.

An investigation of heterogeneous impact, temporal stability, and aggregate shift in factors affecting the driver injury severity in single-vehicle rollover crashes.

Single-vehicle rollover crashes have been acknowledged as a predominant highway crash type resulting in serious casualties. To investigate the heterogeneous impact of factors determining different injury severity levels in single-vehicle rollover crashes, the random parameters logit model with unobserved heterogeneity in means and variances was employed in this paper. A five-year dataset on single-vehicle rollover crashes, gathered in California from January 1, 2013, to December 31, 2017, was utilized. Driver injury severities that were determined to be outcome variables include no injury, minor injury, and severe injury. Characteristics pertaining to the crash, driver, temporal, vehicle, roadway, and environment were acknowledged as potential determinants. The results showed that the gender indicator specified to minor injury was consistently identified as a significant random parameter in four years' models and the joint five-year model, excluding the 2016 crash model where the night indicator associated with no injury was observed to produce the random effect. Additionally, two series of likelihood ratio tests were conducted to assess the year-to-year and aggregate-to-component temporal stability of model estimation results. Marginal effects of explanatory variables were also calculated and compared to analyze the temporal stability and interpret the results. The findings revealed an overall temporal instability of model specifications across individual years, while there is no significant aggregate-to-component variation. Injury severities were observed to be stably affected by several variables, including improper turn indicator, under the influence of alcohol indicator, old driver indicator, seatbelt indicator, insurance indicator, and airbag indicator. Furthermore, the year-to-year and aggregate-to-component shift was quantified and characterized by calculating the differences in probabilities between within-sample observations and out-of-sample predictions. The overall results imply that continuing to expand and refine the model to incorporate more comprehensive datasets can result in more robust and stable injury severity prediction, thus benefiting in mitigating the associated driver injury severity.

Fall-related ocular trauma in patients over 90 years in tertiary ophthalmic center in Germany: 90-TOSG Report 1.

PURPOSE: To investigate the clinical characteristics of fall-related ocular trauma in patients over 90 years of age. METHODS: Retrospective, medical record reviews. Patients over the age of 90 years treated in a tertiary center with fall-related ocular trauma were included in the study. RESULTS: Fifty consecutive patients (fifty eyes) were analyzed. The mean age was 93.6 ± 1.8 years and 41 patients (82%) were female. The most common site of the injuries was orbital fracture (18 patients, 36%), accompanied with open globe rupture (OGR) in three patients, and globe contusion in two patients. Seventeen patients (34%) presented with OGR. Ocular trauma score in those patients was category 1 in 10 patients (58.8%) and category 2 in the others. Conjunctival hemorrhage and/or periocular contusion was seen in 14 patients (28%) and globe contusion in six patients (12%). At the presentation, the mean best corrected visual acuity (BCVA) was 2.82 ± 0.24 logMAR in patients with OGR and 1.98 ± 0.81 logMAR in six patients with globe contusion. Three of the patients with OGR had a final vision of 20/200 or better whereas the remaining patients had hand movements or less. The most common risk factors were female gender (82%) and use of antihypertensive drugs (46%). CONCLUSION: Patients with OGR had a poor visual outcome despite the early treatment. It is important to raise public awareness about of the poor prognosis of ocular injuries due to falls in the elderly population in order to establish preventive measures.

Evaluation of the predictive effects of trauma scoring systems in colorectal injuries.

INTRODUCTION: Colorectal injuries following traumas are significant causes of morbidity and mortality. This study aimed to evaluate the predictive effect of trauma scoring systems on mortality and morbidity in patients with post-traumatic colon injury. METHODS: The records of 145 patients with colon trauma treated at Seyhan State Hospital between January 1, 2010, and January 1, 2020, were retrospectively analyzed. Injury Seriousness Score (ISS), Revised Trauma Score (RTS), Trauma Injury Severity Score (TRISS), and Colon Injury Score (CIS) scores were calculated for all patients. The predictive effects of scoring systems on primary outcomes of surgical treatment, complication rates, mortality, and anastomotic leaks were evaluated. RESULTS: The mean age of the patients was 36.1 (SD ± 16.6), and the female/male ratio was 37/108. Anastomotic leakage occurred in 12 (8.2%) patients, and complications were observed in 57 (39.3%) patients. Seven (4.7%) patients died. A statistically significant relationship was observed between the increase in CIS and anastomotic leakage, morbidity, and mortality. Increases in ISS and decreases in RTS and TRISS were associated with increased morbidity and mortality, but these relationships were not statistically significant. CONCLUSION: A significant relationship was observed between the increase in CIS and anastomotic leakage, morbidity, and mortality. The study suggests the need for a specific scoring system for evaluating the prognostic status in colon traumas, as ISS, RTS, and TRISS scores were not found to be significantly predictive of outcomes in this patient population.

Reverse Shock Index multiplied by Glasgow Coma Scale score as a point-of-care severity assessment for initial trauma management: A nationwide cohort study.

BACKGROUND: Severe trauma patients often require emergent interventions, such as massive transfusion, resuscitative procedures, and surgical procedures, and consume considerable human and medical resources. However, few practical indices can be easily used for emergent interventions. In recent years, it has become clear that rSIG (Reverse Shock Index multiplied by Glasgow Coma Scale [GCS] score), which can be easily calculated from vital signs, is a promising predictor of mortality. However, it is unclear whether rSIG is useful for emergent interventions. METHODS: Data collected by the Japan Trauma Data Bank for adult patients admitted directly from the scene of trauma between April 2019 and December 2020 were analysed. The outcomes were massive transfusion, resuscitative procedures, surgical procedures and emergent interventions. Emergent interventions were defined as the composite outcome of massive transfusion, resuscitative procedures, and surgical procedures. The ability of rSIG to predict massive transfusion was compared with that of the ABC score and FASILA score by receiver-operating characteristic curve analysis. The ability of rSIG to predict resuscitative and surgical procedures was compared with that of the Shock Index (SI), GCS, Triage Revised Trauma score (T-RTS), and Previous Simple Prediction (PSP) score. The ability of rSIG to predict emergent interventions was compared with that of T-RTS, PSP, ABC, and FASILA. In addition to rSIG, rSIM (Reverse Shock Index multiplied by best motor response score) was also analysed as a supplement. RESULTS: The study included 32,201 patients, 6,371 of whom required emergent interventions. The area under the receiver-operating characteristic curve (AUROC) for massive transfusion was highest for rSIG (0.846 [95 % confidence interval 0.832-0.859]) and significantly higher for rSIG than for rSIM, ABC and FASILA (all p < 0.0001). AUROCs for resuscitative and surgical procedures were highest for rSIG (0.777 [0.769-0.785] and 0.731 [0.720-0.741], respectively) and significantly higher than those for rSIM, SI, GCS, T-RTS, and PSP (all p < 0.0001). The AUROC for emergent interventions was highest for rSIG (0.760 [0.753-0.768]) and significantly higher for rSIG than for rSIM, T-RTS, PSP, ABC, or FASILA (all p < 0.0001). CONCLUSIONS: rSIG is a simple and effective point-of-care predictor of emergent interventions during initial management of trauma.

Development and validation of a pediatric model predicting trauma-related mortality.

OBJECTIVES: To develop a prediction model of mortality in pediatric trauma-based injuries. Our secondary objective was to transform this model into a translational tool for clinical use. STUDY DESIGN: A retrospective cohort study of children ≤ 18 years was derived from the National Trauma Data Bank between the years of 2007 to 2015. The goal was to identify clinical or physiologic variables that would serve as predictors for pediatric death. Data was split into a development cohort (80%) to build the model and then tested in an internal validation cohort (20%) and a temporal cohort. The area under the receiver operating characteristic curve (AUC) was assessed for the new model. RESULTS: In 693,192 children, the mortality rate was 1.4% (n = 9,785). Most subjects were male (67%), White (65%), and incurred an unintentional injury (92%). The proposed model had an AUC of 96.4% (95% CI: 95.9%-96.9%). In contrast, the Injury Severity Score yielded an AUC of 92.9% (95% CI: 92.2%-93.6%), while the Revised Trauma Score resulted in an AUC of 95.0% (95% CI: 94.4%-95.6%). CONCLUSION: The TRAGIC + Model (Temperature, Race, Age, GCS, Injury Type, Cardiac-systolic blood pressure + Mechanism of Injury and Sex) is a new pediatric mortality prediction model that leverages variables easily obtained upon trauma admission.

Prognostic factors of open-globe injuries: A review.

Open-globe injuries (OGI) can lead to significant visual impairment. The Ocular Trauma Score (OTS) is the most widely recognized tool for predicting visual outcomes. This review aimed to identify prognostic factors and assess the effectiveness of the OTS in predicting visual outcomes. Twenty-one articles published on PubMed and Google Scholar were analyzed. Initial visual acuity and the zone of injury were found to be the most significant prognostic factors for OGI. Other significant prognostic factors include retinal detachment/involvement, relative afferent pupillary defect, vitreous hemorrhage, vitreous prolapse, type of injury, hyphema, lens involvement, and duration from incidence of OGI to vitrectomy. Of the 21 studies evaluated, 11 investigated the effectiveness of OTS. Four studies concluded that OTS was effective overall, while six studies suggested that it was only useful in certain OGI categories. Thus, there is a need for further research to develop an optimized ocular trauma prognosticating system.

The relationship between computed tomography findings and ocular trauma and pediatric ocular trauma scores in pediatric globe injuries: Does imaging have prognostic and diagnostic value?

BACKGROUND: The aim of this study is to assess the relationship between computed tomography (CT) findings in open globe injuries (OGIs) in pediatric patients and the pediatric ocular trauma score (POTS) and OTS in pediatric ocular trauma. METHODS: In 34 pediatric patients with OGI, CT findings were categorized into nine main categories: Scleral irregularity, lens dislocation, abnormal vitreous density, choroid-retinal layer thickening, preseptal thickness increase, intraocular foreign body and air, vitreous hemorrhage, retinal detachment, and perforation. The relationship between different types and numbers of CT findings and the POTS and OTS was evaluated. RESULTS: The mean age of trauma was 6.6±3.1. Of the patients, 9 (26.5%) were female and 25 (73.5%) were male. The most com-mon CT findings are scleral irregularity and increased preseptal thickness (47.1%). In univariate analysis, a P<0.05 was found between 16 patients with 1 or less CT findings (median POTS value 80 [71.25-90.0]) and 11 patients with 2 or 3 CT findings (median POTS value 60 [15-70]). A P<0.05 was found between 16 patients with 1 or less CT findings (median POTS value 80 [71.25-90.0]) and 7 patients with 4 or more CT findings (median POTS value 45 [25-80]). A P > 0.05 was found between 11 patients with 2 or 3 CT findings (median POTS value 60 [15-70]) and 7 patients with 4 or more CT findings (median POTS value 45 [25-80]). No significant difference was found between the number of CT findings and OTS stages. While POTS was significant (P<0.05) in patients with ab-normal vitreous density (median 45 [30-69.6]), OTS value was not significant (P>0.05). There was no significant difference between POTS and OTS in other CT findings. CONCLUSION: The number of CT findings may assist in predicting POTS and, consequently, estimating visual prognosis in pediatric patients with OGI. In emergency situations where, sufficient clinical data are unavailable, the objective findings from CT may help in assessing the severity of ocular trauma and potentially predicting long-term visual outcomes.

Orthodontic treatment in traumatized permanent teeth: a systematic review / Tratamento ortodôntico em dentes permanentes traumatizados: uma revisão sistemática

Objective: to analyze, through literature review, the available literature on orthodontic treatment in traumatized permanent teeth. Methods: A literature search was performed in electronic databases (PubMed and SciELO) using the descriptors [tooth injuries] OR [injuries, teeth] OR [injury, teeth] OR [teeth injury] OR [injuries, tooth] OR [injury, tooth] OR [tooth injury] OR [teeth injuries] AND [orthodontics]. Observational studies and clinical trials were included, narrative reviews, laboratory and in vitro studies, case reports and series as well as articles that presented abstracts written in languages other than Portuguese, English and Spanish were excluded from the study. Two reviewers considered the eligibility, the risk of bias of the analyzed data and the qualitative synthesis of the studies included. A total of 1,322 references were found and 4 articles met all inclusion criteria and were included in the qualitative analysis. Some consequences like pulp necrosis and root resorption have been highlighted and trauma severity should be considered when orthodontically intervening in previously traumatized teeth. Final considerations: The traumatized teeth can be orthodontically treated as long as the time of tissue reorganization is respected, and the pull and periodontal conditions are followed up.(AU)

Objetivos: analisar, por meio de revisão de literatura, a respeito do tratamento ortodôntico em dentes permanentes traumatizados. Metodologia: Uma pesquisa bibliográfica foi realizada em bancos de dados eletrônicos (PubMed e SciELO) usando os descritores [tooth injuries] ou [injuries, teeth] ou [injury, teeth] ou [teeth injury] ou [injuries, tooth] ou [injury, tooth] ou [tooth injury] ou [teeth injuries] e [orthodontics]. Foram incluídos estudos observacionais e ensaios clínicos, revisões narrativas, estudos laboratoriais e in vitro, relatos de casos e séries, bem como artigos que apresentassem resumos redigidos em idiomas diferentes do português, inglês e espanhol foram excluídos do estudo. Dois revisores consideraram a elegibilidade, o risco de viés dos dados analisados e a síntese qualitativa dos estudos incluídos. Foram encontradas 1.322 referências e 4 artigos atenderam a todos os critérios de inclusão e foram incluídos na análise qualitativa. Algumas consequências como necrose pulpar e reabsorção radicular têm sido destacadas e a gravidade do trauma deve ser considerada na intervenção ortodôntica em dentes previamente traumatizados. Considerações finais: Os estudos incluídos nesta revisão sugerem que dentes traumatizados podem ser tratados ortodônticamente desde que respeitado o tempo de reorganização tecidual e acompanhadas as condições pulpares e periodontais.(AU)

The Bidirectionality of Global Surgical Research: The Utility of the Malawi Trauma Score in the United States Trauma Population.

INTRODUCTION: Trauma scoring systems provide valuable risk stratification of injured patients. Trauma scoring systems developed in resource-limited settings, such as the Malawi Trauma Score (MTS), are based on readily available clinical information. This study sought to test the performance of the MTS in a United States trauma population. MATERIALS AND METHODS: We analyzed the United States National Trauma Data Bank during 2017-2020. MTS uses alertness score: alert, responds to verbal or painful stimuli, or unresponsive (AVPU), age, sex, presence of a radial pulse, and primary anatomic injury location. MTS and an age-adjusted version reflective of the US age distribution, was evaluated for its performance in predicting crude mortality in the National Trauma Data Bank using receiver operating characteristic analysis. We utilized logistic regression to model the odds ratio of death at a particular MTS cutoff. RESULTS: A total of 3,833,929 patients were included. The mean age was 49.3 y (sandard deviation 24.4), with a male preponderance (61.1%). Crude mortality was 3.4% (n = 131,452/3,833,929). The area under the curve for the MTS in predicting mortality was 0.87 (95% CI 0.87, 0.88). The area under the curve for a cutoff of 15 was 0.83 (95% CI 0.83, 0.83). An MTS of 15 higher had an odds ratio of death of 46.5 (95% CI 45.9, 47.1), compared to those with a score of 14 or lower. CONCLUSIONS: MTS has excellent performance as a predictor of mortality in a US trauma population. MTS is simple to calculate and can be estimated in the prehospital setting or the emergency department. Consequently, it may have utility as a triage tool in both high-income trauma systems and resource-limited settings.

Clinical evaluation and management of badminton-related eye injuries: a retrospective case series.

BACKGROUND: To describe the clinical features, visual outcomes, management, and complications of ocular injury in badminton and investigate risk factors associated with visual impairment. METHODS: Data on patients injured while playing badminton admitted to Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, Fudan University between January 2018 to December 2020.The relationship between visual acuity (VA) and demographic and clinical variables was also analyzed. Patients were managed medically or surgically as per their needs, followed up for at least 18 months. The visual outcomes were predicted using ocular trauma score (OTS), predicted outcomes were compared with actual outcomes using statistical tests. RESULTS: This study involved 102 patients (78 men, 24 women) with a mean age of 43.8 ± 16.1 years (7-71 years). Of these, 93 patients had closed-globe injuries and 9 had open-globe injuries. Vision-threatening findings included lens subluxation(31.4%),retinal detachment(13.7%),hyphema(12.7%). Open-globe injury had significantly lower presenting VA and final VA (P= 0.0164, 0.0053).Final VA was found to be correlated with presenting VA, maculopathy, retinal detachment, and OTS (P=0.0000, 0.0494, 0.0001, 0.0000 respectively), it was worse in patients who were under 20 years of age and were female. OTS prediction was not significantly different when compared with actual visual outcomes postoperatively in OTS3, OTS4, and OTS5 (P > 0.05),while the prognosis of patients with OTS1 and OTS2 was better than OTS study (P=0.001, 0.007, respectively). CONCLUSION: Badminton-related closed-globe injuries were more frequent; open-globe injuries were usually more serious. Younger and female patients have poorer visual recovery prognoses. OTS was found to be a reliable tool for predicting visual outcomes.

Wound size and location affect the prognosis of penetrating ocular injury.

BACKGROUND: Ocular trauma is a leading cause of vision loss. Penetrating ocular injury is a major type of open globe injury(OGI), while its epidemiology and clinical characteristics are still uncertain. The aim of this study is to reveal the prevalence and prognostic factors of penetrating ocular injury in the Shandong province. METHODS: A retrospective study of penetrating ocular injury was performed at the Second Hospital of Shandong University, from January 2010 to December 2019. Demographic information, injury causes, ocular trauma types, and initial and final visual acuity(VA) were analyzed. To obtain more precise characteristics of penetrating injury, the eye global was divided into three zones and analyzed. RESULTS: Among 210 OGI, there are 83 penetrating injuries which account for 39.5% of all. In addition, the final VA of 59 penetrating injuries recovered to 0.1 or better, which possesses the highest frequency among OGI. In order to research the relationship between the wound location and the final VA, we took 74 cases of penetrating injuries without retina or optic nerve damage for analysis. Results show that 62 were male and 12 were female. The average age was 36.01 ± 14.15. The most frequent occupation is the worker followed by the peasant. Statistics show that there is an obvious deviation in the Ocular trauma score (OTS) predicting the final VA and the actual final VA in the 45-65 score group (p < 0.05). Results suggest that the commonest penetrating injury zone is zone III (32 cases, 43.8%). Zone III, which is farthest from the center of the visual axis, has the largest improvement of the final VA (p = 0.0001). On the contrary, there is no statistical difference in the visual improvement in zone I and zone I + II that involves the injury of the central visual axis. CONCLUSION: This study describes the epidemiology and clinical characteristics of patients hospitalized for penetrating ocular injury without retina damage in Shandong province. It can be concluded that larger size and closer location to the visual axis of damage are accompanied by worse prognosis improvement. The study provides a better understanding of the disease and enlightenment for the prediction of visual prognosis.

Predicting the Future in Trauma: Trauma and Injury Severity Score Loses Accuracy and Validity for Late Deaths After Injury.

BACKGROUND: The Trauma and Injury Severity Score (TRISS) is widely used to predict mortality in trauma patients, but its performance metrics have not been analyzed for early vs later deaths. Therefore, we aimed to investigate the impact of time to death on the accuracy of TRISS. METHODS: Patients from 2013 to 2018 American College of Surgeons Trauma Quality Improvement Program database were included. We compared predicted survival by TRISS using the areas under receiver operating characteristic curves (AUCs) and calibration curves between different cut-off times and subgroups. We further compared early (≤72 hr) and late (>72 hr) deaths based on mechanisms and severity. RESULTS: Among the 1,180,745 patients, the total mortality rate was 6.4%, with 59% early deaths and 41% late deaths. The AUC of TRISS for all patients was .919 (95% CI: .918-.921) for ≤72 hr survival and .845 (95% CI: .843-.848) for >72 hr survival. Significant discrepancies in AUCs between the early and late death groups existed in all cohorts based on blunt/penetrating mechanisms and severity. TRISS predicted well in early survival of penetrating injury but was less reliable in late survival of penetrating injury and all blunt injury. TRISS tended to underestimate survival, particularly for patients with lower probability of survival, with increased discrepancies seen for predicting late deaths. CONCLUSIONS: The predictive ability of TRISS varies significantly based on the timing of deaths and key injury factors. TRISS may be best utilized in predicting early survival in penetrating injury, but its reliability and accuracy diminish when predicting late deaths for all kinds of injury.