Manejo cirúrgico de ferimento auto-infligido por arma de fogo em região maxilofacial / Surgical management of self-inflicted injury by gun in the maxillofacial region

INTRODUÇÃO: O manejo dos pacientes vítimas de PAF possui vertentes divergentes a respeito do tratamento cirúrgico, que pode ser realizado de forma imedata ou tardia. Em lesões auto-infligidas, a distância entre a arma e a região acometida é menor, causando consequências estéticas e funcionais mais devastadoras. Aliado ao fato desse tipo de trauma criar uma ferida suja devido à comunicação com a cavidade oral e seios paranasais, o manejo das lesões representam um desafio mesmo à cirurgiões experientes. OBJETIVO: Estre trabalho relata o manejo cirúrgico de uma ferida auto-infligida por arma de fogo que resultou em avulsão dos tecidos moles na região maxilofacial. DESCRIÇÃO DO CASO: Paciente do sexo masculino, 35 anos, vítima de projétil de arma de fogo auto-infligido em região maxilofacial, cursando com extenso ferimento em região de língua e mento. Clinicamente, o paciente não apresentava sinais de fratura em ossos da face. Ambos os ferimentos apresentavam secreção purulenta e o paciente manifestava disfonia devido a grande destruição tecidual. CONSIDERAÇÕES FINAIS: O tratamento de ferimentos por arma de fogo não só é um grande desafio para o cirurgião, como para toda a equipe multidisciplinar requerida para tais casos, visto que não há protocolos bem definidos para o tratamento dessas lesões(AU)

INTRODUCTION: The management of patients who are victims of FAP has divergent aspects regarding surgical treatment, which can be performed immediately or late. In self-inflicted injuries, the distance between the weapon and the affected region is smaller, causing more devastating aesthetic and functional consequences. Allied to the fact that this type of trauma creates a dirty wound due to the communication with the oral cavity and paranasal sinuses, the management of injuries represents a challenge even for experienced surgeons. OBJECTIVE: This paper reports the surgical management of a self-inflicted gunshot wound that resulted in soft tissue avulsion in the maxillofacial region. CASE DESCRIPTION: Male patient, 35 years old, victim of a self-inflicted firearm projectile in the maxillofacial region, coursing with extensive injury in the region of the tongue and chin. Clinically, the patient did not show signs of facial bone fractures. Both wounds had purulent secretion and the patient had dysphonia due to extensive tissue destruction. FINAL CONSIDERATIONS: The treatment of gunshot wounds is not only a great challenge for the surgeon, but also for the entire multidisciplinary team required for such cases, since there are no well-defined protocols for the treatment of these injuries(AU)

Public health framing of firearm violence on local television news in Philadelphia, PA, USA: a quantitative content analysis.

BACKGROUND: Firearm violence is an intensifying public health problem in the United States. News reports shape the way the public and policy makers understand and respond to health threats, including firearm violence. To better understand how firearm violence is communicated to the public, we aimed to determine the extent to which firearm violence is framed as a public health problem on television news and to measure harmful news content as identified by firearm-injured people. METHODS: This is a quantitative content analysis of Philadelphia local television news stories about firearm violence using a database of 7,497 clips. We compiled a stratified sample of clips aired on two randomly selected days/month from January-June 2021 from the database (n = 192 clips). We created a codebook to measure public health frame elements and to assign a harmful content score for each story and then coded the clips. Characteristics of stories containing episodic frames that focus on single shooting events were compared to clips with thematic frames that include broader social context for violence. RESULTS: Most clips employed episodic frames (79.2%), presented law enforcement officials as primary narrators (50.5%), and included police imagery (79.2%). A total of 433 firearm-injured people were mentioned, with a mean of 2.8 individuals shot included in each story. Most of the firearm-injured people featured in the clips (67.4%) had no personal information presented apart from age and/or gender. The majority of clips (84.4%) contained at least one harmful content element. The mean harmful content score/clip was 2.6. Public health frame elements, including epidemiologic context, root causes, public health narrators and visuals, and solutions were missing from most clips. Thematic stories contained significantly more public health frame elements and less harmful content compared to episodic stories. CONCLUSIONS: Local television news produces limited public health coverage of firearm violence, and harmful content is common. This reporting likely compounds trauma experienced by firearm-injured people and could impede support for effective public health responses to firearm violence. Journalists should work to minimize harmful news content and adopt a public health approach to reporting on firearm violence.

A higher education approach to active shooter incidents: Evidence from 40 United States university campuses.

In a post-9/11 environment with an increased United States (US) federal government emphasis on active shooter preparedness, this study seeks to understand how higher educational institutions have adapted to this changing policy environment. Furthermore, between 2000 and 2017, there were 15 active shooter incidents at US higher education institutions. This study provides data on how public and private higher education campuses are preparing for this increased active shooter threat. Interviews were conducted with higher education employees familiar with campus security policies from 40 higher education institutions across 18 states in the US. These colleges/universities also represented a range of institution type: community colleges (5), public institutions (9), and private institutions (26). Interviews were conducted with 18 Chief/Director of Campus Safety/Security, 14 members of campus police or security, seven Chiefs of Police, and one staff member familiar with campus security policies.

Unusual trajectory of a bullet from the shoulder to the brain: an emergency department perspective on finding a missing bullet.

Terminal ballistics continues to struggle with bullet trajectory reconstruction and interpretation. This is a case of a young man presented with a very unusual trajectory of a bullet from the left shoulder to the brain parenchyma. The single wound and altered mentation prompted a CT head and neck scan, which revealed a retained bullet in the brain parenchyma, traversing from the left shoulder, across the neck and into the brain without causing significant damage to vital organs. We managed the patient conservatively. Emergency physicians dealing with gunshot injuries should thoroughly search for the bullet in cases where only a single wound is present and the bullet is missing, and they should have a basic understanding of the ballistics to understand the mechanism and injury pattern sustained by the bullet. This atypical ballistic trajectory scenario emphasises the need to exercise vigilance in accurately predicting the trajectory when the ballistic route is unknown.

Receptivity of providing firearm safety storage devices to parents along with firearms safety education.

Background: In the United States, 33% of households with children contain firearms, however only one-third reportedly store firearms securely. It's estimated that 31% of unintentional firearm injury deaths can be prevented with safety devices. Our objective was to distribute safe storage devices, provide safe storage education, evaluate receptivity, and assess impact of intervention at follow-up. Method: At five independent, community safety events, parents received a safe storage device after completing a survey that assessed firearms storage methods and parental comfort with discussions regarding firearm safety. Follow-up surveys collected 4 weeks later. Data were evaluated using descriptive analysis. Result: 320 participants completed the surveys, and 288 participants were gunowners living with children. Most participants were comfortable discussing safe storage with healthcare providers and were willing to talk with friends about firearm safety. 54% reported inquiring about firearm storage in homes their children visit, 39% stored all their firearms locked-up and unloaded, 32% stored firearms/ammunition separately. 121 (37%0.8) of participants completed the follow-up survey, 84% reported using the distributed safety device and 23% had purchased additional locks for other firearms. Conclusion: Participants were receptive to firearm safe storage education by a healthcare provider and distribution of a safe storage device. Our follow up survey results showed that pairing firearm safety education with device distribution increased overall use of safe storage devices which in turn has the potential to reduce the incidence of unintentional and intentional self-inflicted firearm injuries. Providing messaging to promote utilization of safe storage will impact a firearm safety culture change.

Vesicocutaneous fistula at site of closed suprapubic tube tract as the first presenting sign of giant bladder stone.

Bladder stones represent approximately 5% of all cases of urolithiasis and are typically identified and managed long before causing irreversible renal injury. We present a case of a man in his 40s with a prior history of a gunshot wound to the abdomen who presented with leakage from a previously healed suprapubic tube tract and was found to have a giant bladder stone with a resulting renal injury. He subsequently underwent a combined open cystolithotomy and vesicocutaneous fistulotomy during his hospitalisation, which helped to improve his renal function. In addition to there being few reported cases of bladder stones >10 cm, this represents the first report in the literature of an associated decompressive 'pop-off' mechanism through a fistulised tract.

Demographic analysis of the suicide method by gender and age of the deceased between 2001 and 2010. / Analiza demograficzna metody samobójstwa z uwzglednieniem plci oraz wieku zmarlych w latach 2001-2010.

Aim: AAnalysis of the choice of suicide method by gender and age of the deceased. Material and methods: The study presented here was based on a retrospective analysis of autopsy reports from the years 2001-2010 in the Department of Forensic Medicine of the Jagiellonian University Collegium Medicum in Kraków. The basis of the research work conducted was the collection and extensive analysis of cases of suicide deaths. Subsequently, a preference analysis of the choice of suicide method was conducted, taking into account the age and gender of the deceased. The statistical analysis performed used logistic regression in Excel's XLSTAT as an analysis tool. Results: A total of 2,073 suicide cases were collected from the time frame under discussion. The predominant method of suicide was hanging (1524 cases, 1329 men and 195 women), the second most common method was jumping from the roof or window of a high floor of a building (jumping from heights; 171 cases, 100 men, 71 women). A statistically significant correlation of suicide method with gender was found for: hanging [odds ratio (OR) male (M) vs. female (F) = 3. 4; confidence interval (CI) = 2.7-4.3; p0.001]; drowning [OR: M/F =4.1; CI = 2.6-6.4; p0.001]; jumping from heights [OR: M/F=4.1; CI=2.9-5.7; p0.001] and poisoning [OR: M/F=3.2; CI = 2.1-4.9]. Suicide with the use of firearms occurred exclusively in the case of men (40 cases). The age of the victims correlated with the method of committing suicide by jumping from heights [0R=0.98; CI=0.97-0.99; p0.001] and rail suicide [OR=0.98; CI=0.96-0.99; p0.001]. Conclusions: The study revealed that both age and gender have a significant impact on the choice of suicide method. According to available epidemiological data and the authors' predictions, a predominance of male over female sex was observed in the case of hanging, while jumping from heights was relatively more often chosen by women. The elderly were less likely to choose jumping from heights and rail suicide.

Application of OFA-based ERAS for video-assisted thoracoscopic surgery in elderly patients with airway stenosis: A case report.

BACKGROUND: Thoracic surgery without general anesthesia can be traced back to the First World War, and thoracic epidural block was used to complete the operation due to a large number of patients with gunshot wounds who needed emergency thoracic surgery. By reducing the intraoperative opioid dose, intraoperative and postoperative opioid-related adverse events such as respiratory depression, nausea and vomiting, delirium, hyperalgesia, and other side effects can be reduced to the benefit of patients. METHODS: A 72-year-old male patient was admitted to the hospital with a 5-day history of multifocal pain throughout the body caused by a fall. The injury was not treated at that time, and the pain gradually increased, accompanied by cough with difficulty expelling sputum. DIAGNOSES: Left lung contusion; traumatic pneumonia; multiple left rib fractures; left fluid pneumothorax; thyroid tumor of unknown nature, possibly malignant. Grade I tracheal stenosis; Sequelae of cerebral infarction. Because of goiter and severe tracheal compression, the patient was not intubated and received deopiated general anesthesia combined with epidural anesthesia to preserve spontaneous breathing. OUTCOMES: At the end of the video-assisted thoracoscopic exploration, the patient was immediately conscious and returned directly to the ward 6 min later. The patient was able to move freely after surgery and eat normally within 6 h of surgery. The postoperative visual analog scale score was 2 points, and there were no anesthetic complications during the follow-up. CONCLUSION: The opioid-free anesthesia strategy of tubeless general anesthesia, allowing spontaneous breathing combined with epidural anesthesia in elderly patients with tracheal stenosis undergoing video-assisted thoracoscopic surgery can not only avoid accidents and injuries caused by tracheal intubation and mechanical ventilation, but can also significantly reduce postoperative respiratory complications, optimize postoperative analgesia, and help achieve enhanced recovery after surgery.

Addressing Systemic Racism and Racialized Violence to Reduce Firearm Injury and Mortality Inequities.

This JAMA Forum discusses systemic racism and racialized violence, promising approaches to address inequities in firearm violence, and ways to treat the trauma of gun violence.

Navigating the complexity of spinal cord injuries with retained foreign bodies and the diagnostic challenge of lead toxicity-a case reportaaa.

INTRODUCTION: Retained shrapnel from gunshots is a common occurrence; however, retained shrapnel within the spinal canal is exceedingly uncommon. Guidelines for removal and treatment of these cases are a difficult topic, as surgical removal is not necessarily without consequence, and retention can lead to possible further injury or a secondary disease process of plumbism, which can be difficult to diagnose in this population. CASE PRESENTATION: This case report provides a unique example of a young patient with retained shrapnel from a gunshot. This patient suffered an initial spinal cord injury due to a gunshot and secondarily presented with abdominal pain, fatigue, elevated blood lead levels, and was diagnosed with plumbism. This was addressed with operative removal of shrapnel and posterior instrumented spinal fusion, resulting in decreased lead levels and symptom resolution postoperatively. DISCUSSION: Lead toxicity risk in patients with retained shrapnel, particularly in the spine, warrants vigilant monitoring. While management guidelines lack consensus, symptomatic lead toxicity may necessitate intervention. Residual neurological deficits complicate evaluation, emphasizing individualized management decisions.

Pancreaticoureteric fistula following penetrating abdominal trauma: A Case Report.

Pancreaticoureteric Fistula (PUF) is a very rare complication secondary to penetrating abdominal trauma involving the ureter and pancreatic parenchyma. Pancreatic injuries carry h igh morbidity due to the involvem ent of surrounding structures and are d ifficult to diagnose due to thei r retroperitoneal location. A case of a patient is reported at Civil Hospital, Hyderabad who presented with a history of firearm injury and missed pancreatic duct involvement on initial exploration that eventually led to the development of Pan creaticoureteric Fistula. He was managed v ia p erc ut aneous nep hrostomy ( PCN ) for the right ureteric injury and pancreatic duct (PD) stenting was done for distal main pancreatic duct injury (MPD).

Trends in pediatric firearm-related injuries and disparities in acute outcomes.

Background: Firearm-related injuries (FRI) are an increasing cause of death and injury in children. The etiology for this rise is multifactorial and includes socioeconomic factors. Despite its prevalence and documented increase over COVID-19, there is a paucity of research on disparities and the influence of social determinants of health (SDH) in pediatric FRI. This study aims to explore the epidemiology of this vulnerable population in Atlanta, trends over time and relevant dates such as COVID-19 and a state firearm law, and disparities in clinical outcomes. Methods: Retrospective cohort of patients with FRI (0-20 years-old, x̄=9.8, Median = 11) presenting to our hospital EDs from January 2014 to April 2023 (N = 701) and eligible for the Trauma Registry. This period includes two major events, namely the COVID-19 pandemic (March 2020), and passage of state law Constitutional Carry Act (SB 319) (April 2022), allowing for permit-less concealed firearm carry. Single series interrupted time series (ITS) models were run and clinical outcome differences between race and insurance groups were calculated unadjusted and adjusted for confounders using inverse propensity treatment weights (IPTW). The primary outcome was mortality; secondary are admission and discharge. Results: Majority of FRI involved patients who were male (76.7%), Black (74.9%), publicly insured (82.6%), ≤12 years-old (61.8%), and injured by unintentional shootings (45.6%) or assault (43.7%). During COVID-19, there was a sustained increase in FRI rate by 0.42 patients per 1,000 trauma visits per month (95% CI 0.02-0.82, p = 0.042); post-SB 319 it was 2.3 patients per 1,000 trauma visits per month (95% CI 0.23-4.31, p = 0.029). Publicly insured patients had 58% lower odds of mortality than privately insured patients (OR 0.42, 95% CI 0.18-0.99, p = 0.047). When controlled for race and mechanism of injury, among other confounding factors, this association was not significant (p = 0.652). Conclusion: Pediatric FRI are increasing over time, with disproportionate burdens on Black patients, at our hospitals. Disparities in mortality based on insurance necessitate further study. As social and economic repercussions of COVID-19 are still present, and state firearm law SB 319 is still in effect, assessment of ongoing trends is warranted to inform preventative strategies.

Firearm injury and the Deloyers procedure: case report and literature review.

Following extended colon resections, it may not always be possible to perform colorectal anastomosis. The Deloyers procedure, which involves the transposition of the right colon, has been identified as a viable solution. This report aims to discuss the circumstances under which the Deloyers procedure was performed, as well as to evaluate the early and late postoperative outcomes, by reviewing cases conducted between 2010 and 2023. In a 22-year-old female patient who suffered major organ and tissue loss (with injuries to the sigmoid colon, descending colon, transverse colon, and mesentery) due to a firearm injury, the Deloyers procedure was applied during restorative surgery following initial damage control surgery. The procedure involved mobilizing the cecum and right colon, performing a cranio-caudal rotation over the ileocolic artery pedicle, followed by an appendectomy, and creating a colorectal anastomosis using circular staplers. There were no complications during the postoperative follow-ups. By the 14th postoperative day, the patient was discharged and experienced bowel movements four times a day, managed with 2.5 mg of diphenoxylate hydrochloride and 0.025 mg of atropine sulfate. At the 6-month follow-up, the frequency of bowel movements had decreased to twice daily without the need for medical treatment. Given the functional outcomes in patients after extended left colectomies, the Deloyers procedure, with its low associated morbidity, stands out as a viable option.

EMS injury cause codes more accurate than emergency department visit ICD-10-CM codes for firearm injury intent in North Carolina.

BACKGROUND: The timeliness, accuracy, and completeness of data for firearm injury surveillance is crucial for public health surveillance efforts and informing injury prevention measures. While emergency department (ED) visit data can provide near real-time information on firearms injuries, there are concerns surrounding the accuracy of intent coding in these data. We examined whether emergency medical service (EMS) data provide more accurate firearm injury intent coding in comparison to ED data. METHODS: We applied a firearm injury definition to EMS encounter data in NC's statewide syndromic surveillance system (NC DETECT), from January 1, 2021, through December 31, 2022. We manually reviewed each record to determine intent, and the corresponding manual classifications were compared to the injury cause codes entered in the EMS data and to ED visit records where EMS-ED record linkage was possible. We then calculated the sensitivity, specificity, positive and negative predictive values for each intent classification in SAS 9.4 using the manually reviewed intent classifications as the gold standard. RESULTS: We identified 9557 EMS encounters from January 1, 2021, through December 31, 2022 meeting our firearm injury definition. After removing false positives and duplicates, 8584 records were available for manual injury classification. Overall, our analysis demonstrated that manual and EMS injury cause code classifications were comparable. However, for the 3401 EMS encounters that could be linked to an ED visit record, sensitivity of the ED ICD-10-CM codes was low for assault and intentional self-harm encounters at 18.2% (CI 16.5-19.9%) and 22.2% (CI 16-28.5%), respectively. This demonstrates a marked difference in the reliability of the intent coding in the two data sources. CONCLUSIONS: This study illustrates both the value of examining EMS encounters for firearm injury intent, and the challenges of accurate intent coding in the ED setting. EMS coding has the potential for more accurate intent coding than ED coding within the context of existing hospital-based coding guidance. This may have implications for future firearm injury research, especially for nonfatal firearm injuries.

The burden and outcomes of firearm injuries at two district-level emergency centres in Cape Town, South Africa: A descriptive analysis.

BACKGROUND: In South Africa (SA), injuries are the second leading cause of years of healthy life lost, and interpersonal violence dominates the SA injury profile. Half of all injury-related deaths in SA are intentional, and firearms contribute to a quarter of these deaths. Injury surveillance systems are essential to develop, implement and monitor strategies that reduce preventable trauma. OBJECTIVES: To describe the burden of patients with firearm injuries and their outcomes at district-level emergency centres in the Western Cape. METHODS: This study was a retrospective analysis of a prospectively collected database. All patients who presented to two district-level emergency centres with a firearm injury over a 12-month period (1 January 2019 - 31 December 2019) were eligible for inclusion. RESULTS: Firearm injuries represented 5.7% of the trauma burden at the two district emergency centres. Of the 776 patients with firearm injuries who were included, the median age was 27 years, and 91% were male. A total of 520 (67%) patients self-presented, and there were 18 (2.3%) deaths in the emergency centre and a further 23 (3%) as inpatients. Of the total where wound location was determined (n=595), 30.4% sustained more than one firearm injury, and 112 out of the 167 admitted to Mitchells Plain Hospital required at least one visit to theatre. This accounted for 413 theatre hours and 1 376 inpatient bed days at Mitchells Plain Hospital. A significant proportion of patients (n=219, 29%) were transferred from the emergency centres to a tertiary service for further care. CONCLUSION: Firearm injuries represent a substantial proportion of the trauma burden at district emergency centres in the Western Cape Province. Managing patients with firearm injuries is resource intensive, as evident by their high acuity, the need for operative care, the long length of stay, the high burden on emergency medical services with interfacility transfers and the high demand for tertiary care. Data from this study aid our understanding of the prevalence and burden of firearm injuries at district level emergency centres, and multisectoral action, supported by evidence-based primary and secondary preventive strategies, is required to reduce the burden of firearm injuries, and mitigate their effects.

Fatal Police Shootings of Victims with Mental Health Crises: A Descriptive Analysis of Data from the 2014-2015 National Violent Death Reporting System.

One in five fatal police shooting victims may have been experiencing a mental health crisis (MHC) at the time of their death [1]. We use data on fatal police shootings from the National Violent Death Reporting System (2014-2015) to (a) identify incidents where the victim is reported to have experienced an MHC at the time of their death, (b) describe the characteristics of these incidents, and (c) compare the characteristics of MHC to fatal police shootings where the victim was not experiencing an MHC at the time of their death. We systematically coded 633 fatal police shootings from 27 states. Descriptive statistics characterized fatal police shootings, including victim characteristics; their mental health status; and contextual information regarding the police encounter (e.g., reason for police call). Overall, 203 of 633 fatal police encounters (32%) involved victims who showed signs of an MHC at the time of their death. Victims were predominantly white, male, and in possession of a firearm. In 3 of 4 cases, the MHC manifested as suicidal ideation despite any relevant documented history among most victims. Among half of suicidal victims, suicidal ideation was expressed verbally and in-person to a family member/intimate partner who subsequently called the police. Dispatch was aware of the MHC in 1 of 4 of total police calls. Overall, fatal police encounters involving those experiencing an MHC accounted for 1 in 3 of our caseloads. Approximately, 3 of 4 mental health calls involved a suicidal person who mainly expressed intent to a loved one in-person.

Situational and Victim Correlates of Increased Case Fatality Rates in Los Angeles Shootings, 2005-2021.

The gun assault case fatality rate measures the fraction of shooting victims who die from their wounds. Considerable debate has surrounded whether gun assault case fatality rates have changed over time and what factors may be involved. We use crime event data from Los Angeles to examine the victim and situational correlates of gun assault case fatality rates over time. We estimated log binomial regression models for the probability of death in each year from 2005 to 2021, conditioned on situational and victim characteristics of the crime. Case fatality rates increased by around 1.3% per year between 2005 and 2021 from around 15.9 to 19.7%. Baseline case fatality rates differed systematically by most situational and victim but followed similar temporal trends. Only victim age significantly covaried with the temporal trend in case fatality rates. An individual shot in Los Angeles in 2021 was 23.7% more likely to die than the equivalent victim in 2005. The steady increase in case fatality rates suggests that there were around 394 excess fatalities over what would have occurred if case fatality rates remained at the 2005 level. Increases in the average age of victims over time may contribute to the general temporal trend. We hypothesize that older victims are more likely to be shot indoors where lethal close-range wounds are more likely.

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.