Correction: Nursing Workload in Intensive Care Unit Trauma Patients: Analysis of Associated Factors.

[This corrects the article DOI: 10.1371/journal.pone.0112125.].

Clinical Signs of Basilar Skull Fracture and Their Predictive Value in Diagnosis of This Injury.

Although clinical signs for the diagnosis of basilar skull fracture (BSF) are ambiguous, they are widely used to make decisions on initial interventions involving trauma patients. We aimed to assess the performance of early and late (within 48 hr posttrauma) signs for BSF diagnosis and to verify the correlation between the presence of these signs and head injury severity. We conducted a prospectively designed follow-up study at a referral hospital for trauma care in Sao Paulo, Brazil, and performed structured observations for 48 hr post-blunt head injury in patients aged 12 years or older. The following signs of BSF were considered: raccoon eyes, Battle's sign, otorrhea, and rhinorrhea. Among the 136 enrolled patients (85.3% male; mean age 40 ± 21.4 years), 28 patients (20.6%) had BSF. The clinical signs for the early or late detection of BSF had low accuracy (55.9% vs. 43.4%), specificity (52.8% vs. 30.5%), and positive predictive value (25.7% vs. 27.1%). However, the presence of these signs was correlated to head injury severity, indicated by the Glasgow Coma Scale (p = .041) and Maximum Abbreviated Injury Scale-Head region (p = .002). In view of the low accuracy of these signs, resulting low clinical value of their presence, and their high sensitivity in the late stage, the study results contraindicate the value of BSF signs for making decisions about using the nasal route for the introduction of catheters and tubes in initial trauma care.

New Trauma and Injury Severity Score (TRISS) adjustments for survival prediction.

Background: The objective of this study is to propose three new adjustments to the Trauma and Injury Severity Score (TRISS) equation and compare their performances with the original TRISS as well as this index with coefficients adjusted for the study population. Methods: This multicenter, retrospective study evaluated trauma victims admitted to two hospitals in São Paulo-Brazil and San Diego-EUA between January 1st, 2006, and December 31st, 2010. The proposed models included a New Trauma and Injury Severity Score (NTRISS)-like model that included Best Motor Response (BMR), systolic blood pressure (SBP), New Injury Severity Score (NISS), and age variables; a TRISS peripheral oxygen saturation (SpO2) model that included Glasgow Coma Scale (GCS), SBP, SpO2, Injury Severity Score, and age variables; and a NTRISS-like SpO2 model that included BMR, SBP, SpO2, NISS, and age variables. All equations were adjusted for blunt and penetrating trauma coefficients. The model coefficients were established by logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of the models. Results: The original TRISS (area under the curve (AUC) = 0.90), TRISS with adjusted coefficients (AUC = 0.89), and the new proposals (NTRISS-like, TRISS SpO2, and NTRISS-like SpO2) showed no difference in performance (AUC = 0.89, 0.89, and 0.90, respectively). Conclusions: The new models demonstrated good accuracy and similar performance to the original TRISS and TRISS adjusted for coefficients in the study population; therefore, the new proposals may be useful for the assessments of quality of care in trauma patients using variables that are routinely measured and recorded.

Performance of new adjustments to the TRISS equation model in developed and developing countries.

BACKGROUND: The Trauma and Injury Severity Score (TRISS) has been criticized for being based on data from the USA and Canada-high-income countries-and therefore, it may not be applicable to low-income and middle-income countries. The present study evaluated the accuracy of three adjustments to the TRISS equation model (NTRISS-like; TRISS SpO2; NTRISS-like SpO2) in a high-income and a middle-income country to compare their performance when derived and applied to different groups. METHODS: This was a retrospective study of trauma patients admitted to two institutions: a university medical center in São Paulo, Brazil (a middle-income country), and a level 1 university trauma center in San Diego, USA (a high-income country). Patients were admitted between January 1, 2006, and December 31, 2010. The subjects were 2416 patients from Brazil and 8172 patients from the USA. All equations had adjusted coefficients for São Paulo and San Diego and for blunt and penetrating trauma. Receiver operating characteristic (ROC) curves were used to evaluate performance of the models. RESULTS: Regardless of the population where the equation was generated, it performed better when applied to patients in the USA (AUC from 0.911 to 0.982) compared to patients in Brazil (AUC from 0.840 to 0.852). When the severity was considered and homogenized, the performance of equations were similar to both application in the USA and Brazil. CONCLUSIONS: Survival probability models showed better performance when applied in data collected in the high-income countries (HIC) regardless the country they were derived. The severity is an important factor to consider when using non-adjusted survival probability models for the local population. Adjusted models for severely traumatized patients better predict survival probability in less severely traumatized populations. Other factors besides physiological and anatomical data may impact final outcomes and should be identified in each environment if they are to be used in the development of the trauma care performance improvement process in middle-income countries.

Desempenho dos ajustes do Trauma and Injury Severity Score (TRISS): revisão integrativa / Rendimiento de los ajustes de Trauma and Injury Severity Score (TRISS): revisión integrativa / Performance of Trauma and Injury Severity Score(TRISS) adjustments: an integrative review

RESUMO Objetivo identificar estudos que realizaram ajustes na equação do Trauma and InjurySeverity Score (TRISS) e compararam a capacidade discriminatória da equação modificada com a original. Método Revisão integrativa de pesquisas publicadas entre 1990 e 2014 nas bases de dados LILACS, MEDLINE, PubMed e SciELO utilizando-se a palavra TRISS. Resultados foram incluídos 32 estudos na revisão. Dos 67 ajustes de equações do TRISS identificados, 35 (52,2%) resultaram em melhora na acurácia do índice para predizer a probabilidade de sobrevida de vítimas de trauma. Ajustes dos coeficientes do TRISS à população de estudo foram frequentes, mas nem sempre melhoraram a capacidade preditiva dos modelos analisados. A substituição de variáveis fisiológicas do Revised Trauma Score (RTS) e modificações do Injury Severity Score (ISS) na equação original tiveram desempenho variado. A mudança na forma de inclusão da idade na equação, assim como a inserção do gênero, comorbidades e mecanismo do trauma apresentaram tendência de melhora do desempenho do TRISS. Conclusão Diferentes propostas de ajustes no TRISS foram identificadas nesta revisão e indicaram, principalmente, fragilidades do RTS no modelo original e necessidade de alteração da forma de inclusão da idade na equação para melhora da capacidade preditiva do índice.

RESUMEN Objetivo Identificar los estudios que se ajuste a La ecuación de Trauma and Injury Severity Score (TRISS) y comparar con la capacidad discriminatoria de la ecuación modificado con el original. Método revisión de estudios publicados entre 1990 y 2014 en las bases de datos LILACS, MEDLINE, PubMed y SciELO utilizando la palabra clave TRISS. Resultados Se incluyeron 32 estudios. De los 67 TRISS ecuaciones ajustes identificados, 35 (52,2%) resulto en una mejora en la precisión del índice para predecir la probabilidad de supervivencia de las víctimas de trauma. Ajustes coeficientes TRISS a la población del estudio eran frecuentes, pero no siempre mejoran la capacidad predictiva de los modelos analizados. La sustitución de variables fisiológicas revisadas Trauma Score (RTS) y modificaciones Del Injury Severity Score (ISS) en La ecuación tenía variada rendimiento. El cambio en la forma de inclusión de la edad, así como La inserción de género, las comorbilidades y mecanismo de la lesión mostro tendencia de mejora del rendimiento TRISS. Conclusión diferentes propuestas de ajustes a la TRISS fueron identificados en esta revisión y señalaron principalmente RTS debilidades en el modelo original y la necesidad de cambiar la forma de inclusión de la edad en la ecuación para mejorar la capacidad predictiva del índice.

ABSTRACT Objective Identify studies that made adjustments to the equation of Trauma and Injury Severity Score (TRISS) and compared the discriminatory ability of both modified and original equations. Method An integrative review of studies published between 1990 and 2014 using the following databases: LILACS, MEDLINE, PubMed and SciELO, based on searches using the term “TRISS”. Results 32 studies were included in this review. Of 67 adjustments to TRISS equations identified, 35 (52.2%) resulted in improved accuracy of this index in the prediction of survival probability for trauma patients. Adjustments of TRISS coefficients to study population were frequent, but did not always improve the predictive ability of the analyzed models. Replacement of physiological variables of the Revised Trauma Score (RTS) and changes in the Injury Severity Score (ISS) in the original equation presented varied performance. An alteration to the method of age inclusion in the equation, and the insertion of gender, comorbidities and trauma mechanism, presented a tendency towards improved performance of the TRISS. Conclusion Different proposals of adjustments to the TRISS were identified in this review and indicated, in particular, RTS fragilities in the original model and the need to change the method of age inclusion in the equation to improve the predictive ability of this index.

Performance of Trauma and Injury Severity Score(TRISS) adjustments: an integrative review. / Desempenho dos ajustes do Trauma and Injury Severity Score (TRISS): revisão integrativa.

Objective Identify studies that made adjustments to the equation of Trauma and Injury Severity Score (TRISS) and compared the discriminatory ability of both modified and original equations. Method An integrative review of studies published between 1990 and 2014 using the following databases: LILACS, MEDLINE, PubMed and SciELO, based on searches using the term "TRISS". Results 32 studies were included in this review. Of 67 adjustments to TRISS equations identified, 35 (52.2%) resulted in improved accuracy of this index in the prediction of survival probability for trauma patients. Adjustments of TRISS coefficients to study population were frequent, but did not always improve the predictive ability of the analyzed models. Replacement of physiological variables of the Revised Trauma Score (RTS) and changes in the Injury Severity Score (ISS) in the original equation presented varied performance. An alteration to the method of age inclusion in the equation, and the insertion of gender, comorbidities and trauma mechanism, presented a tendency towards improved performance of the TRISS. Conclusion Different proposals of adjustments to the TRISS were identified in this review and indicated, in particular, RTS fragilities in the original model and the need to change the method of age inclusion in the equation to improve the predictive ability of this index.

Nursing workload in intensive care unit trauma patients: analysis of associated factors.

BACKGROUND: From the perspective of nurses, trauma patients in the Intensive Care Unit (ICU) demand a high degree of nursing workload due to hemodynamic instability and the severity of trauma injuries. This study aims to identify the factors related to the high nursing workload required for trauma victims admitted to the ICU. METHODS: This is a prospective, cross-sectional study using descriptive and correlation analyses, conducted with 200 trauma patients admitted to an ICU in the city of São Paulo, Brazil. The nursing workload was measured using the Nursing Activities Score (NAS). The distribution of the NAS values into tertiles led to the identification of two research groups: medium/low workload and high workload. The Chi-square, Fisher's exact, Mann-Whitney and multiple logistic regression tests were utilized for the analyses. FINDINGS: The majority of patients were male (82.0%) and suffered blunt trauma (94.5%), with traffic accidents (57.5%) and falls (31.0%) being prevalent. The mean age was 40.7 years (± 18.6) and the mean NAS was 71.3% (± 16.9). Patient gender, the presence of pulmonary failure, the number of injured body regions and the risk of death according to the Simplified Acute Physiology Score II were factors associated with a high degree of nursing workload in the first 24 hours following admission to the ICU. CONCLUSION: Workload demand was higher in male patients with physiological instability and multiple severe trauma injuries who developed pulmonary failure.

Trauma and injury severity score: análise de novos ajustes no índice / Trauma and injury severity score: analysis of new adjustments in the index

Introdução: O Trauma and Injury Severity Score (TRISS) é considerado padrão ouro na análise de probabilidade de sobrevida do doente traumatizado, apesar de suas limitações. Vários têm sido os esforços na tentativa de torná-lo mais acurado, tendo em vista seu importante papel nos Programas de Melhoria de Qualidade em Trauma. Objetivos: Propor três novos ajustes à equação do TRISS e comparar suas performances com o TRISS e o TRISS-like originais e com esses índices e o NTRISS com coeficientes ajustados à população do estudo; identificar se a técnica de imputação múltipla aumenta a acurácia das equações derivadas de bancos de dados com perdas e comparar o desempenho dos novos modelos quando derivados e aplicados em diferentes grupos de vítimas traumatizadas. Método: Trata-se de um estudo multicêntrico, retrospectivo, com vítimas de trauma internadas no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC FMUSP) e no Centro de Trauma da Universidade da Califórnia San Diego Medical Center (UCSD MC), no período de 1º de janeiro de 2006 a 31 de dezembro de 2010. As informações dos doentes foram agrupadas em Bancos de Dados Derivação e Teste, sendo o primeiro utilizado para derivar as equações e o segundo para validar as equações geradas. Os coeficientes dos modelos foram estabelecidos pela análise de regressão logística. A curva Receiver Operating Characteristics (ROC) foi utilizada para avaliar a performance dos modelos e o algoritmo de DeLonge et al. para comparar as áreas sob as curvas (AUC). Resultados: A casuística foi composta de 2.416 doentes do HC FMUSP (São Paulo, Brasil) e 8.172 participantes do UCSD MC (San Diego, EUA). Os novos modelos propostos foram o NTRISS-like, que incluiu as variáveis Melhor Resposta Motora (MRM),Pressão Artéria Sistólica (PAS), New Injury Severity Score (NISS) e idade; o TRISS SpO2, com as variáveis Escala de Coma de Glasgow, PAS, saturação periférica de oxigênio (SpO2), Injury Severity Score, além da idade e o NTRISSlike SpO2 (MRM + PAS + SpO2 + NISS + idade). Todas as equações tiveram coeficientes ajustados para trauma contuso e penetrante. A técnica de imputação múltipla aplicada à derivação das equações não melhorou a acurácia dos modelos. Os modelos TRISS original, TRISS, TRISS-like e NTRISS com coeficientes ajustados e as novas propostas não apresentaram diferença estatisticamente significativa em sua performance. As novas equações ajustadas aos dados de São Paulo e as geradas com informações de San Diego apresentaram diferentes AUC ao serem aplicadas nos dois grupos de doentes dessas localidades. A acurácia sempre foi maior quando as equações foram aplicadas na população de San Diego. Conclusões: Os novos modelos apresentaram boa acurácia (cerca de 89,5%) e desempenho similar a outros ajustes do índice TRISS anteriormente publicados; portanto, podem ser utilizados nas avaliações de qualidade da assistência ao traumatizado. Os ajustes dos índices de probabilidade de sobrevida à realidade local de sua aplicação não melhoraram seu desempenho, resultado que reforça a incerteza sobre a necessidade desses ajustes, conforme o local de aplicação do índice.

Introduction: Trauma and Injury Severity Score (TRISS) is considered the "gold standard" in the analysis of survival probability of trauma patients, despite its limitations. There have been several efforts to make it more accurate because of its important role in Trauma Quality Improvement Programmes. Objectives: To propose three new adjustments to the TRISS equation and compare their performances with the TRISS and TRISS-like originals and these indices and NTRISS with coefficients adjusted to the study population; identify if the multiple imputation technique increases the accuracy of the equations derived from databases with missing; and to compare the performance of the new models when derivatives and applied to different groups of trauma patients. Methods: This is a multicenter, retrospective study with trauma victims admitted to the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC FMUSP) and the Trauma Center at the University of California San Diego Medical Center (UCSD MC) for the period between January 1st, 2006 and December 31st, 2010. The information of patients were grouped into two different databases: derivation and testing; the first one served to derive the equations and the second was used to validate the equations generated. The model coefficients were established by logistic regression analysis. Receiver Operating Characteristic curve (ROC) was used to evaluate the performance of the models and De Long et al. algorithm to compare the areas under the curves (AUC). Results: The casuistic consisted of 2,416 patients from HC FMUSP (São Paulo, Brazil) and 8,172 participants from UCSD MC (San Diego, USA). The new models proposed were NTRISS-like which included the variables Best Motor Response (BMR), Systolic Blood Pressure (SBP),New Injury Severity Score (NISS) and age; TRISS SpO2 that included the variables Glasgow Coma Scale, SBP, saturation of peripheral oxygen (SpO2), Injury Severity Score and age; and NTRISS-like SpO2 (BMR + SBP + SpO2 + NISS + age). All equations had adjusted coefficients for blunt and penetrating trauma. The multiple imputation technique applied in the derivation of the equations did not improve the accuracy of the models. The original TRISS, and TRISS, TRISS-like and NTRISS with adjusted coefficients and the new proposals showed no statistically significant difference in performance. The new equations fitted to the São Paulo data and generated with information from San Diego showed different AUC when applied in the two patient groups in these localities. The accuracy was always higher when the equations were applied to the population of San Diego. Conclusions: The new models demonstrated good accuracy (about 89.5%) and similar performance to other TRISS adjustments previously published, and may be used in assessments of quality of care for traumatized. The survival probability scores adjustments to the local reality of its application did not improve its performance, a result that reinforces the uncertainty about the need for such adjustments, as the application site index.

Mortes evitáveis em vítimas com traumatismos / Preventable trauma deaths / Muertes evitables en víctimas con traumatismos

OBJETIVO: Descrever métodos e estimativas de mortalidade proporcional por mortes evitáveis e tipos de não conformidades do atendimento relacionadas a esses eventos. MÉTODOS: Revisão sistemática de publicações sobre mortes evitáveis em vítimas com traumatismos entre 2000 e 2009. Foi realizada pesquisa nas bases de dados Lilacs, SciELO e Medline utilizando-se a estratégia de busca com as palavras-chave "trauma", "avoidable", "preventable", "interventions" e "complications", e os descritores em ciências da saúde "death", "cause of death" e "hospitals". RESULTADOS: Identificaram-se 29 artigos publicados no período, com predomínio de estudos retrospectivos (96,5 por cento). Os métodos mais comumente utilizados para definir a evitabilidade do óbito foram painel de especialistas ou pontuação de índices de gravidade, tendo sido empregadas as seguintes categorias: evitável, potencialmente evitável e não evitável. A média da mortalidade proporcional por mortes evitáveis dos estudos foi de 10,7 por cento (dp 11,5 por cento). As não conformidades mais comumente relatadas nas publicações foram sistema inadequado de atendimento ao traumatizado e erro na avaliação e tratamento. CONCLUSÕES: Observaram-se falhas na uniformização dos termos empregados para categorizar as mortes e as não conformidadades encontradas. Portanto, sugere-se a padronização da taxonomia da classificação das mortes e dos tipos de não conformidades observadas.

OBJECTIVE: To describe methods of estimation and assess preventable deaths and types of errors related to health care. METHODS: A systematic review of articles on preventable trauma deaths published between 2000 and 2009 was conducted. Lilacs, SciELO and Medline databases were searched using the keywords "trauma," "avoidable," "preventable," "interventions" and "complications" and the health sciences descriptors "death," "cause of death," and "hospitals." RESULTS: A total of 29 articles published during the study period were selected. Most were retrospective studies (96.5 percent). The most common methods used to define avoidability of death were expert panel and injury severity scores. Deaths were categorized as follows: preventable; potentially preventable; and not preventable. The mean preventable death rate was 10.7 percent (SD 11.5 percent). The most commonly reported errors were inadequate care management of injured patients and evaluation and treatment errors. CONCLUSIONS: Inconsistent terms were used to categorize deaths and related noncompliances. It is suggested to standardize the terminology for the classification of deaths and types of errors.

OBJETIVO: Describir métodos y estimativas de mortalidad proporcional por muertes evitables y tipos de no concordancias de la atención relacionadas con tales eventos. MÉTODOS: Revisión sistemática de publicaciones sobre muertes evitables en víctimas con traumatismos entre 2000 y 2009. Se realizó investigación en las bases de datos Lilacs, SciELO y Medline utilizándose la estrategia de búsqueda con las palabras clave "trauma", "avoidable", "preventable", "interventions" y "complications" y los descriptores en ciencias de la salud "death", "cause of death" y "hospitals". RESULTADOS: Se identificaron 29 artículos publicados en el período, con predominio de estudios retrospectivos (96,5 por ciento). Los métodos más comúnmente utilizados para definir la prevención del óbito fueron grupo de especialistas o puntuación de índices de gravedad, y empleadas las siguientes categorías: evitable, potencialmente evitable, y no evitable. El promedio de la mortalidad proporcional por muertes evitables de los estudios fue de 10,7 por ciento (de 11,5 por ciento). Las no concordancias más comúnmente relatadas en las publicaciones fueron sistema inadecuado de atención al traumatizado y error en la evaluación y tratamiento. CONCLUSIONES: Se observó fallas en la uniformización de los términos empleados para categorizar las muertes y las no concordancias encontradas. Por lo tanto, se sugiere la estandarización de la taxonomía de la clasificación de las muertes y de los tipos de no concordancias observadas.

Preventable trauma deaths.

OBJECTIVE: To describe methods of estimation and assess preventable deaths and types of errors related to health care. METHODS: A systematic review of articles on preventable trauma deaths published between 2000 and 2009 was conducted. Lilacs, SciELO and Medline databases were searched using the keywords "trauma," "avoidable," "preventable," "interventions" and "complications" and the health sciences descriptors "death," "cause of death," and "hospitals." RESULTS: A total of 29 articles published during the study period were selected. Most were retrospective studies (96.5%). The most common methods used to define avoidability of death were expert panel and injury severity scores. Deaths were categorized as follows: preventable; potentially preventable; and not preventable. The mean preventable death rate was 10.7% (SD 11.5%). The most commonly reported errors were inadequate care management of injured patients and evaluation and treatment errors. CONCLUSIONS: Inconsistent terms were used to categorize deaths and related noncompliances. It is suggested to standardize the terminology for the classification of deaths and types of errors.

The role of the New Trauma and Injury Severity Score (NTRISS) for survival prediction / O papel do New Trauma and Injury Severity Score (NTRISS) para predição de sobrevida / El papel del New Trauma and Injury Severity Score (NTRISS) para predicción de sobrevida

The objective of this study was to verify if replacing the Injury Severity Score (ISS) by the New Injury Severity Score (NISS) in the original Trauma and Injury Severity Score (TRISS) form would improve the survival rate estimation. This retrospective study was performed in a level I trauma center during one year. ROC curve was used to identify the best indicator (TRISS or NTRISS) for survival probability prediction. Participants were 533 victims, with a mean age of 38±16 years. There was predominance of motor vehicle accidents (61.9 percent). External injuries were more frequent (63.0 percent), followed by head/neck injuries (55.5 percent). Survival rate was 76.9 percent. There is predominance of ISS scores ranging from 9-15 (40.0 percent), and NISS scores ranging from 16-24 (25.5 percent). Survival probability equal to or greater than 75.0 percent was obtained for 83.4 percent of the victims according to TRISS, and for 78.4 percent according to NTRISS. The new version (NTRISS) is better than TRISS for survival prediction in trauma patients.

O objetivo deste estudo foi verificar se a substituição do Injury Severity Score (ISS) pelo New Injury Severity Score (NISS), na fórmula original do Trauma and Injury Severity Score (TRISS), melhora sua estimativa da taxa de sobrevida. Estudo retrospectivo realizado num centro de trauma nível I, durante um ano. A curva ROC foi utilizada para identificar o melhor indicador (TRISS ou NTRISS) para predição da probabilidade de sobrevida. O estudo incluiu 533 traumatizados, com idade média de 38±16 anos. Houve predomínio de acidentes de transporte (61,9 por cento). Lesões externas foram mais frequentes (63,0 por cento), seguidas por trauma craniencefálico/cervical (55,5 por cento). A taxa de sobrevida foi de 76,9 por cento. Houve predomínio dos valores do ISS variando de 9-15 (40,0 por cento) e, do NISS, de 16-24 (25,5 por cento). Probabilidade de sobrevida igual ou superior a 75,0 por cento foi obtida para 83,4 por cento das vítimas de acordo com o TRISS e por 78,4 por cento de acordo com NTRISS. A nova versão apresentou melhor desempenho que o TRISS na predição de sobrevida dos doentes traumatizados estudados.

El estudio objetivó verificar si la substitución del Injury Severity Score (ISS) por el New Injury Severity Score (NISS) en la fórmula original del Trauma and Injury Severity Score (TRISS) mejora su estimación de tasa de sobrevida. Estudio retrospectivo realizado en centro de trauma nivel I durante un año. Se usó curva ROC para identificar el mejor indicador (TRISS o NTRISS) para predicción de probabilidad de sobrevida. El estudio incluyó 533 traumatizados, edad media 38±16 años. Predominaron accidentes de transporte (61,9 por ciento). Prevalecieron las lesiones externas (63 por ciento), seguidas de trauma cráneo-encefálico/cervical (55,5 por ciento). Tasa de sobrevida: 76,9 por ciento. Predominaron valores de ISS variando de 9-15 (40,0 por ciento) y de NISS, de 16-24 (25,5 por ciento). Se obtuvo probabilidad de sobrevida igual o mayor a 75 por ciento para 83,4 por ciento de víctimas según TRISS y para 78,4 por ciento según NTRISS. La nueva versión (NTRISS) presentó mejor desempeño que TRISS en predicción de sobrevida en los pacientes traumatizados estudiados.

The role of the New Trauma and Injury Severity Score (NTRISS) for survival prediction.

The objective of this study was to verify if replacing the Injury Severity Score (ISS) by the New Injury Severity Score (NISS) in the original Trauma and Injury Severity Score (TRISS) form would improve the survival rate estimation. This retrospective study was performed in a level I trauma center during one year. ROC curve was used to identify the best indicator (TRISS or NTRISS) for survival probability prediction. Participants were 533 victims, with a mean age of 38±16 years. There was predominance of motor vehicle accidents (61.9%). External injuries were more frequent (63.0%), followed by head/neck injuries (55.5%). Survival rate was 76.9%. There is predominance of ISS scores ranging from 9-15 (40.0%), and NISS scores ranging from 16-24 (25.5%). Survival probability equal to or greater than 75.0% was obtained for 83.4% of the victims according to TRISS, and for 78.4% according to NTRISS. The new version (NTRISS) is better than TRISS for survival prediction in trauma patients.

Severity of trauma victims admitted in intensive care units: comparative study among different indexes / Gravedad de las víctimas de trauma, admitidas en unidades de terapia intensiva: estudio comparativo entre diferentes índices / Gravidade das vítimas de trauma, admitidas em unidades de terapia intensiva: estudo comparativo entre diferentes índices

This study compared the performance of the Injury Severity Score (ISS) with the New Injury Severity Score (NISS) and also the Simplified Acute Physiology Score II (SAPS II) with the Logistic Organ Dysfunction System (LODS) in trauma victims, in order to predict mortality and length of stay in Intensive Care Units (ICU), besides identifying which indexes have been the most effective to estimate these results. A retrospective analysis was done in the records of 185 victims admitted in ICU between June and December 2006. None of the four indexes properly discriminated the patients according to length of stay at the ICU. The ISS and the NISS did not show a good discriminating capacity in case of death, but the SAPS II and the LODS presented good performance to estimate mortality at the ICU. Results pointed towards the use of SAPS II and LODS when trauma victims are admitted in an ICU.

Este estudio tuvo por objetivo comparar en víctimas de trauma el desempeño del Injury Severity Score (IS), con el New Injury Severity Score (NIS) y, también, del Simplified Acute Physiology Score II (SAPS II), con el Logistic Organ Dysfunction System (LODS) para predecir la mortalidad y el tiempo de permanencia en unidades de terapia intensiva (UTI), y también para identificar cuales índices fueron los más efectivos para estimar esos resultados. Fue realizado un análisis retrospectivo de las fichas de 185 víctimas, admitidas en una UTI, entre junio y diciembre de 2006. Los cuatro índices no discriminaron adecuadamente a los pacientes según el tiempo de permanencia en la UTI. El IS y el NIS no mostraron una buena capacidad discriminatoria para la ocurrencia de muerte, diferente del SAPS II y del LODS que presentaron un mejor desempeño para estimar la mortalidad en UTI. Los resultados apuntaron para el uso del SAPS II y del LODS cuando víctimas de trauma son internadas en una UTI.

Este estudo objetivou comparar em vítimas de trauma o desempenho do Injury Severity Score (ISS), perante o New Injury Severity Score (NISS) e, também, do Simplified Acute Physiology Score II (SAPS II), perante o Logistic Organ Dysfunction System (LODS) para predizer a mortalidade e o tempo de permanência em unidades de terapia intensiva (UTI), além de identificar quais índices foram os mais efetivos para estimar esses desfechos. Foi realizada análise retrospectiva dos prontuários de 185 vítimas, admitidas em UTI, entre junho e dezembro de 2006. Os quatro índices não descriminaram adequadamente os pacientes segundo tempo de permanência na UTI. ISS e NISS não mostraram boa capacidade discriminatória para ocorrência de óbito, diferente do SAPS II e LODS que apresentaram melhor performance para estimar a mortalidade em UTI. Resultados apontaram para o uso do SAPS II e do LODS quando vítimas de trauma são internadas em UTI.

Mapping injuries in traffic accident victims: a literature review.

The objective of this study was to identify the body regions most affected in traffic accident victims and to map the trauma and severity of the lesions. A systematic literature review using key words related to traffic accidents, transportation accidents, wounds and injuries found a total of 248 articles. The electronic bases LILACS, MEDLINE, and PAHO were surveyed between the years 1990 and December 2006. This review emphasized a series of conclusive studies about the most frequent body regions involved and the major injuries occurring in these situations. It also indicated information gaps in the Brazilian literature. We believe that these findings are valuable for pre-hospital and intra-hospital teams and point the way to new investigations.

Mapping injuries in traffic accident victims: a literature review / Identificación de lesiones en víctimas de accidentes de tránsito: revisión sistemática de la literatura / Mapeamento das lesões em vítimas de acidentes de trânsito: revisão sistemática da literatura

The objective of this study was to identify the body regions most affected in traffic accident victims and to map the trauma and severity of the lesions. A systematic literature review using key words related to traffic accidents, transportation accidents, wounds and injuries found a total of 248 articles. The electronic bases LILACS, MEDLINE, and PAHO were surveyed between the years 1990 and December 2006. This review emphasized a series of conclusive studies about the most frequent body regions involved and the major injuries occurring in these situations. It also indicated information gaps in the Brazilian literature. We believe that these findings are valuable for pre-hospital and intra-hospital teams and point the way to new investigations.

El objetivo del estudio fue identificar las regiones corpóreas más afectadas en víctimas de accidentes de transporte e identificar la gravedad de las lesiones y del trauma. Fue realizada una revisión sistemática de la literatura, utilizándose descriptores relacionados a los accidentes de tránsito, accidentes de transporte, heridas y lesiones, totalizando 248 artículos. Las bases electrónicas investigadas fueron LILACS, MEDLINE y PAHO, entre 1990 y diciembre de 2006. Esta revisión destacó una serie de estudios conclusivos sobre las regiones corpóreas más frecuentes y aquellas de mayor gravedad afectadas en esos eventos y apuntó lagunas de conocimiento en la literatura nacional. Pensamos que lo encontrado puede ser de gran importancia para los equipos en los escenarios de prehospitalario e intrahospitalario y apuntan caminos en dirección de nuevas investigaciones.

O objetivo do estudo foi identificar as regiões corpóreas mais atingidas em vítimas de acidentes de transporte e mapear a gravidade das lesões e do trauma. Foi realizada revisão sistemática da literatura, utilizando-se descritores relacionados aos acidentes de trânsito, acidentes de transporte, ferimentos e lesões, totalizando 248 artigos. As bases eletrônicas pesquisadas foram LILACS, MEDLINE e PAHO, entre 1990 e dezembro de 2006. Essa revisão destacou uma série de estudos conclusivos sobre as regiões corpóreas mais freqüentes e aquelas de maior gravidade atingidas nesses eventos e apontou lacunas de conhecimento na literatura nacional. Acredita-se que esses achados possam ser de grande valia para as equipes nos cenários de pré-hospitalar e intra-hospitalar e apontem caminhos na direção de novas pesquisas.

Severity of trauma victims admitted in intensive care units: comparative study among different indexes.

This study compared the performance of the Injury Severity Score (ISS) with the New Injury Severity Score (NISS) and also the Simplified Acute Physiology Score II (SAPS II) with the Logistic Organ Dysfunction System (LODS) in trauma victims, in order to predict mortality and length of stay in Intensive Care Units (ICU), besides identifying which indexes have been the most effective to estimate these results. A retrospective analysis was done in the records of 185 victims admitted in ICU between June and December 2006. None of the four indexes properly discriminated the patients according to length of stay at the ICU. The ISS and the NISS did not show a good discriminating capacity in case of death, but the SAPS II and the LODS presented good performance to estimate mortality at the ICU. Results pointed towards the use of SAPS II and LODS when trauma victims are admitted in an ICU.

Ten years of new injury severity score (NISS): is it a possible change?

The article is a bibliographic review which intends to present the actual range of researches comparing the Injury Severity Score (ISS) and the New Injury Severity Score (NISS). Databases were searched using the keyword NISS, with 42 articles, 23 of which didn't compare the two indexes. Most part of the 19 selected articles showed that NISS has been more accurate in predicting the outcomes (dependent variables) than ISS, moreover in severe and specific trauma. Studies with populations between 1,000 and 10,000 resulted in NISS-favorable results, whereas studies with populations larger than 10,000 or smaller than 1,000 showed either NISS-favorable results or no difference between the two groups. However, there were no studies showing ISS-favorable results. These results and the easier calculation of NISS lead to a future replacement of ISS by NISS.

Ten years of new injury severity score (NISS): is it a possible change? / Diez años del new injury severity score (NISS): ¿Cambio posible? / Dez anos de new injury severity score (NISS): possível mudança?

The article is a bibliographic review which intends to present the actual range of researches comparing the Injury Severity Score (ISS) and the New Injury Severity Score (NISS). Databases were searched using the keyword NISS, with 42 articles, 23 of which didn't compare the two indexes. Most part of the 19 selected articles showed that NISS has been more accurate in predicting the outcomes (dependent variables) than ISS, moreover in severe and specific trauma. Studies with populations between 1,000 and 10,000 resulted in NISS-favorable results, whereas studies with populations larger than 10,000 or smaller than 1,000 showed either NISS-favorable results or no difference between the two groups. However, there were no studies showing ISS-favorable results. These results and the easier calculation of NISS lead to a future replacement of ISS by NISS.

Estudio de revisión bibliográfica cuyo objetivo es presentar el panorama sobre investigaciones que utilizan el Injury Severity Score (ISS) en comparación con el New Injury Severity Score (NISS). Las búsquedas fueron realizadas en las bases de datos, utilizando el término NISS. Encontrados 42 artículos, 23 de los cuales no realizaron la comparación de los índices en cuestión. Gran parte de los 19 artículos seleccionados, encontraron que el NISS al ser comparado, mostró una mejor relación con los resultados del ISS, principalmente en lesiones graves y específicas. Para estudios cuyas muestras variaron entre 1.000 y 10.000 casos, se observaron resultados favorables para el NISS. Muestras superiores a 10.000 e inferiores a 1.000 mostraron tanto preferencia como igualdad para el NISS. En ningún estudio el ISS superó al NISS, para el caso del diagnósticos de situaciones analizadas. Estas observaciones y un mejor cálculo del NISS frente al ISS, parecen indicar la futura substitución del ISS por el NISS.

Trata-se de revisão bibliográfica, cujo objetivo é apresentar o panorama das pesquisas que utilizam o New Injury Severity Score (NISS) e que o comparam com o Injury Severity Score (ISS). Foram realizadas buscas em bases de dados utilizando-se o termo NISS. Foram localizados 42 artigos, 23 não comparavam os índices em questão. A maioria dos 19 artigos selecionados afirmou que NISS se relacionou melhor com os resultados do que o ISS, principalmente em ferimentos graves e específicos. Em estudos, cuja amostra variou de 1.000 a 10.000 casos, observou-se resultado favorável ao NISS; amostras maiores que 10.000 e menores que 1.000 indicaram ora preferência ao NISS, ora igualdade. Em nenhum estudo o ISS superou o NISS para prever os eventos analisados. Essas observações e maior facilidade do cálculo do NISS em relação ao ISS direcionam a futura substituição do ISS pelo NISS.

Probabilidade de sobrevida: comparação dos resultados do trauma and injury severity score (TRISS) com sua nova versão (NTRISS) / Survival probability: comparison of the results of trauma and injury severity score (TRISS) and its new version (NTRISS)

Trauma and Injury Severity Score (TRISS) é um índice que permite calcular probabilidade de sobrevida de pacientes traumatizados. Para seu cálculo são necessárias as informações: idade; tipo de trauma - penetrante ou contuso; valor do Revised Trauma Score (RTS); e pontuação do Injury Severity Score (ISS). Em 1997 foi realizada uma revisão do ISS com o intuito de melhorar sua acurácia na determinação da gravidade do trauma. Essa revisão resultou em mudança no cálculo desse índice e, consequentemente, em uma nova versão, o New Injury Severity Score (NISS). Resultados de estudos têm indicado que o NISS se iguala ou supera o ISS na previsão de mortalidade. Procurou-se neste estudo verificar se a substituição do ISS pelo NISS, na fórmula original do TRISS, melhora sua estimação de sobrevida. Trata-se de pesquisa retrospectiva realizada no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A população foi constituída por 533 pacientes traumatizados atendidos e internados no Pronto-Socorro deste hospital pelo período de um ano. Foi realizada análise descritiva das características das vítimas e calculadas as medidas de posição para as variáveis contínuas. Para verificar qual o melhor indicador (TRISS ou NTRISS) para probabilidade de sobrevida e o melhor ponto de corte, foi utilizada a curva ROC. Os resultados foram confrontados com as mortes e sobrevidas observadas com o intuito de se identificar a fórmula mais acurada para cálculo daprobabilidade de sobrevida. Fizeram parte do estudo pacientes traumatizados entre 18 e 95 anos, sendo a maioria jovens (61,9%), do sexo masculino (80,5%). Os acidentes de transporte foram as causas externas mais frequentes (61,9%), e, consequentemente, houve predomínio de trauma contuso (87,1%). Do total de pacientes, 82,9% foram atendidos por unidades sistematizadas de atendimento pré-hospitalar. A região mais ) freqüentemente traumatizada foi a superfície externa (63,0%), seguida por cabeça e pescoço (55,5%). Os pacientes estiveram internados por uma média de 11,0 dias (+ 18,0). Dos 533 pacientes, 42,2% necessitaram de internação em Unidade de Terapia Intensiva. A taxa de sobrevida foi de 76,9%. A maioria dos indivíduos (54,5%) apresentou valor de RTS de 7 a 7,84. O escore do ISS e do NISS variou de 0 a 75, com predomínio do escore de 9 a 15 (40,0%) para o ISS e de 16 a 24 (25,5%) para o NISS. O valor do TRISS e do NTRISS variou de 0 a 100,0%; probabilidade de sobrevida maior ou igual a 75,0% foi apresentada por 83,4% dos pacientes segundo o TRISS e por 78,4% dos pacientes de acordo com o NTRISS. O TRISS superestimou a probabilidade de sobrevida dos pacientes traumatizados. Houve diferença estatisticamente significativa entre a previsão de sobrevida dada pelo TRISS e NTRISS, e o NTRISS foi mais assertivo que o TRISS para prever sobrevida dos pacientes atendidos neste centro de trauma.

The Trauma and Injury Severity Score (TRISS) is an index that permits the calculation of survival probability in trauma victims. The following information is necessary to perform this calculation: age, trauma type -penetrating or contusion; value from the Revised Trauma Score (RTS); and the scores from the Injury Severity Score (ISS). In 1997, a revision was done to the ISS to improve its accuracy for determining the severity of traumas, thus resulting in a new version called the New Injury Severity Score (NISS). Studies have shown that this NISS is equal to or greater than the ISS in the prediction of mortality. The objective of this study was to verify if substituting the ISS with the NISS, in the original TRISS form, improved the survival rate estimate. This retrospective study included 533 trauma victims who were attended and interned in the emergency room during a period of 1 year, in \"Hospital das Clínicas\" of the Medical School of the University of Sao Paulo. A descriptive analysis of the characteristics of the victims was performed and the position measurements for the continuous variables were calculated. An ROC curve was used to verify which would be the best indicator (TRISS or NTRISS) for calculating the survival probability. The results were compared with the deaths and survivors in order to indentify the most accurate formula for calculating survival probability. Included in this study were trauma victims, between the ages of 18 to 95, with themajority being youths (61.9%) and of the male gender (80.5%). Contributing causes were predominantly from motor vehicle accidents (61.9%), and predominantly with contusions (87.1%). Of the total victims, 82.9% were treated in first aid clinics. The most frequent trauma regions were superficial (63%) followed by the head and neck (55.5%) The victims were interned on an average of 11 days. ( +18.0). Of the 533 victims 42.2% were interned in the Intensive Care Unit (ICU) and the survival rate was 76.9%. The majority of individuals (54.5%) had RTS scores between 7 and 7.84. The ISS and NISS score varied from 0 to 75, with the average ISS score ranging from 9-15 (40.0%) and the NISS score from 16-24 (25.5%). The TRISS and NTRISS scores varied between 0 and 100 %; probability of survival equal to or greater than 75.0% was presented for 83.4% of the victims according to TRISS and 78.4% according to NTRISS thus, the TRISS overestimated the probability of survival in trauma victims. There was a statistically significant difference in the estimate of survivability data between the TRISS and NTRISS with the latter being the more accurate scale for predicting survivability among the victims treated in this trauma center.