Comparison of modified Kampala trauma score with trauma mortality prediction model and trauma-injury severity score: A National Trauma Data Bank Study.

BACKGROUND: Mortality prediction of trauma patients relies on anatomical, physiological or combined scores. The purpose of this study is to compare the diagnostic accuracy of the modified Kampala Trauma Score (M-KTS) with the Trauma Mortality Prediction Model (TMPM), and Trauma-Injury Severity Score (TRISS) using data from a large dataset from a developed registry, the National Trauma Data Bank (NTDB). METHODS: Using 2011 and 2012 data from NTDB, patient based trauma scores (M-KTS, TMPM, and TRISS) were calculated and predictive ability of M-KTS for mortality was compared with other trauma scores using receiver operating characteristics (ROC) curves. RESULTS: A total of 841089 patients were included in the study. TRISS outperformed other scores (AUC=0.922, %95 CI 0.920-0.924) with M-KTS as the second best score (AUC=0.901, %95 CI 0.899-0.903) followed by TMPM (AUC=0.887, 95% CI 0.844-0.889). For blunt trauma, TRISS (AUC=0.917, 95% CI 0.915-0.919) performed better than M-KTS (AUC=0.891, %95 CI 0.889-0.893) and TMPM (AUC=0.874, 95% CI 0.871-0.877). For penetrating trauma, M-KTS (AUC=0.956, 95% CI 0.954-0.959) and TMPM (AUC=0.955, 95% CI 0.951-0.958) had similar performance after TRISS (AUC=0.969, 95% CI 0.967-0.971). CONCLUSION: M-KTS performed worse than TRISS although its' main advantage is simple use in resource-limited settings.

Comparison of two intraosseous devices in adult patients in the emergency setting: a pilot study.

OBJECTIVE: To compare two intraosseous (IO) insertion devices in terms of safety and ease of use in patients who need urgent vascular access in the emergency setting following failed attempts for intravenous lines. METHODS: This prospective, randomized clinical study compared two different IO access devices in adults (≥16 years of age or weighing>40 kg) admitted to our emergency department with difficult peripheral venous access and in need of urgent intervention. The findings were compared in terms of the rates of successful insertion of spring-loaded impact-driven adult BIG and the battery-driven EZ-IO devices on the first attempt, difficulty of use, time taken to complete the insertion, and complication rates. RESULTS: A total of 52 patients were enrolled and randomized for the study. IO access was performed in 26 patients using the BIG device and in 26 patients using the EZ-IO device. The rates of successful insertion of BIG and EZ-IO devices on the first attempt were 92.3 and 84.6%, respectively (P=0.668). The time taken to complete the procedure was significantly greater in the EZ-IO group (5.2±2.2 s) compared with the BIG group (2.8±1.2 s) (P<0.001). Difficulty of use was scored using the visual analogue scale, which yielded the mean visual analogue scale for EZ-IO and BIG (25.4±12.6 and 8.6±6.4 mm, respectively) (P<0.001). No mechanical problems or technique-related complications were encountered in any of the groups. CONCLUSION: Both EZ-IO and BIG are shown to be reliable and safe methods for insertion of intravascular access in emergency conditions.

Development of a cutaneous fistula following hepatic cystic echinococcosis.

Hydatid cyst is an infectious disease characterized by cysts formed primarly within the gastrointestinal tract by echinococci. Hepatic hydatid disease, which is the most common form, remains asymptomatic until complications occur. In this report, we present an 80 years old patient who presented with a hepatic hydatid cyst which fistulized to the abdominal skin into the Emergency Department. Computed tomography of the abdomen showed inactive grade 5 cyst. Drainage without removal of the cyst failed to reveal active disease but the microbiological examination showed Klebsiella pneumonia that was sensitive to ampicillin-sulbactam as the causative agent. The treatment of the cyst with a combination of surgical and medical treatment was the successful treatment of Hepatic Hydatid Disease presenting with a cutaneous fistula.

Traumatic pneumorrhachis in a child: case report.

Traumatic pneumorrhachis (air within the spinal canal) is a very rare entity and rarer in the pediatric population. We report a 7-year-old polytrauma patient with subarachnoid pneumorrhachis and discuss the causes, mechanism, and implications of this condition.