Comparing NEWS2, TRISS, and RTS in predicting mortality rate in trauma patients based on prehospital data set: a diagnostic study.

BACKGROUND: In the recent years, National Early Warning Score2 (NEWS2) is utilized to predict early on, the worsening of clinical status in patients. To this date the predictive accuracy of National Early Warning Score (NEWS2), Revised Trauma Score (RTS), and Trauma and injury severity score (TRISS) regarding the trauma patients' mortality rate have not been compared. Therefore, the objective of this study is comparing NEWS2, TRISS, and RTS in predicting mortality rate in trauma patients based on prehospital data set. METHODS: This cross-sectional retrospective diagnostic study performed on 6905 trauma patients, of which 4191 were found eligible, referred to the largest trauma center in southern Iran, Shiraz, during 2022-2023 based on their prehospital data set in order to compare the prognostic power of NEWS2, RTS, and TRISS in predicting in-hospital mortality rate. Patients are divided into deceased and survived groups. Demographic data, vital signs, and GCS were obtained from the patients and scoring systems were calculated and compared between the two groups. TRISS and ISS are calculated with in-hospital data set; others are based on prehospital data set. RESULTS: A total of 129 patients have deceased. Age, cause of injury, length of hospital stay, SBP, RR, HR, temperature, SpO2, and GCS were associated with mortality (p-value < 0.001). TRISS and RTS had the highest sensitivity and specificity respectively (77.52, CI 95% [69.3-84.4] and 93.99, CI 95% [93.2-94.7]). TRISS had the highest area under the ROC curve (0.934) followed by NEWS2 (0.879), GCS (0.815), RTS (0.812), and ISS (0.774). TRISS and NEWS were superior to RTS, GCS, and ISS (p-value < 0.0001). CONCLUSION: This novel study compares the accuracy of NEWS2, TRISS, and RTS scoring systems in predicting mortality rate based on prehospital data. The findings suggest that all the scoring systems can predict mortality, with TRISS being the most accurate of them, followed by NEWS2. Considering the time consumption and ease of use, NEWS2 seems to be accurate and quick in predicting mortality based on prehospital data set.

Large congenital cervical mass in a neonate: prenatal diagnosis and postnatal management of teratoma: a case report.

INTRODUCTION: Cervical teratomas are rare congenital neoplasms that can cause neonatal airway obstruction if large. CASE PRESENTATION: The female Persian neonate displayed respiratory distress at birth, with a 7 cm × 8 cm cystic solid mass identified on the left side of the neck. Antenatal ultrasonography revealed polyhydramnios. Despite initial stabilization, the infant required intubation and mechanical ventilation due to persistent respiratory distress. Imaging confirmed a cystic mass compressing the trachea, ruling out cystic hygroma. Surgical resection on postnatal day 17 revealed a 10 cm × 10 cm solid cystic structure, histologically identified as an immature teratoma. CONCLUSION: Despite risks of poor fetal and postnatal outcome from large cervical teratomas, early surgical resection after airway stabilization can result in recovery. Proper multidisciplinary management of respiratory distress from such tumors is paramount.

Case Report: Gastrointestinal Basidiobolomycosis in a Young Girl with Cystic Fibrosis and Celiac Disease.

Basidiobolomycosis is an uncommon fungal infection that has been reported in the literature mainly as a cause of infection in the skin and subcutaneous tissue. Intraabdominal infections have been reported in tropical and subtropical areas in the Middle East, such as Iran and Saudi Arabia, and in the United States. Our patient was a 6-year-old girl with cystic fibrosis and celiac disease who was referred to our department with a history of chronic abdominal pain. In the imaging studies of the abdomen and pelvis, a large retroperitoneal mass was reported in the right upper part of the abdomen with involvement of the duodenum and the mesentery of the small and large intestines, as well as the superior mesenteric vessels, and was diagnosed as basidiobolomycosis through biopsy. Because of the large unresectable mass, the patient was first treated with antifungal drugs for 2 months and then surgical resection was performed. The main point in the management of these patients is a combination of antifungal therapy and surgical resection. In some patients, complex surgeries such as the Whipple procedure may be performed to appropriately manage intraabdominal infections.