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Objective:To determine the accuracy of injury severity score(ISS)in the assessment of patients with severe trauma by the consistency analysis of the patients'ISS with severe trauma scored by three clinicians,and to guide the allocation of medical resource.Methods:Through retrospective analysis of 100 patients with serious or severe trauma admitted to Peking University People's Hospital since Sep-tember 2020 to December 2021(ISS ≥ 16 points),we conducted a consistency analysis of ISS within dif-ferent evaluators.The general information(gender,age),vital signs,physical examination,imaging,laboratory examination and other associated data of the patients after admission were retrospectively diag-nosed by 3 clinicians specializing in trauma surgery and ISS was determined.SPSS 22.0 software was used for statistical analysis,descriptive reports were made on the observed values of each set of data,and Fleiss kappa test was used for consistency analysis of the credibility of the ISS within three clinicians.Results:Through the consistency analysis of the ISS in 100 patients with severe trauma scored by 3 eva-luators,the total Fleiss kappa value was 0.581,and the overall consistency was medium.Consistency analysis of the different scores was conducted according to the calculation rules of ISS.Among the patients with single-site severe trauma,abbreviated injury scale(AIS)was 4 or 5 points,ISS was 16 or 25 points,and Fleiss kappa value was 0.756 and 0.712 within the three evaluators,showing a relatively high consistency.AIS of each part was more than 4 points,and total ISS was more than 41 points in the severe trauma patients,Fleiss kappa values are higher than 0.8 within the 3 evaluators,showing a high consistency.Conclusion:According to the consistency analysis of severe trauma patients ISS within the three evaluators,when the severe trauma patients with ISS≥16 points are treated or transported,there is a certain accuracy error when the score is used for inter-department communication or inter-hospital trans-portation,and the consistency of different evaluators for the same injury is moderate.It may lead to mis-judgment of the severity of trauma and misallocation of medical resources.However,for trauma patients with single or multiple site AIS ≥ 4 points,ISS is highly consistent among different evaluators,which can accurately indicate the severity of the patient's condition.
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Objective:To investigate the ability of doctors in different regions and levels of hospitals in assessing the severity of severe trauma in China.Methods:A total of 38 trauma centers of China Trauma Rescue & Treatment Association (19 tertiary hospitals and 19 secondary hospitals, including 20 eastern and 18 western hospitals) were selected from November 2018 to May 2020. Two junior, two middle, and two senior emergency surgeons were selected in each center. Injury severity score (ISS) was performed on 10 patients with severe trauma, and the qualified rate was analyzed.Results:The qualified rates of junior, middle, and senior doctors were 56.05%, 56.18%, and 56.71%, respectively ( P>0.05). The qualified rates of tertiary and secondary hospitals were 63.07% and 49.56%, respectively ( P<0.01). The qualified rates of eastern and western hospitals were 67.00% and 44.44%, respectively ( P<0.01). Conclusions:The overall level of injury assessment of severe trauma patients by doctors in China is satisfactory, while there are still differences in hospital levels and regions. In the future, attention should be paid to the training and system construction in primary hospitals. We should actively support the construction and development of hospitals in the western regions and realize the standardization of trauma treatment in China as soon as possible.
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Four qi theory is an important part of property theory of traditional Chinese medicine. Current researches mainly focus on two aspects of cold and heat properties, which are not only important elements of treating diseases, but also are factors of causing adverse reaction. In this article, through the study on the toxicity mechanism of cold and hot properties, authors put forward to the control measures of toxic and side effects of traditional Chinese medicine with cold and hot properties, and pointed out that the importance of controlling toxicity of traditional Chinese medicine with cold and hot properties lies in the modernization and internationalization of traditional Chinese medicine.
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<p><b>BACKGROUND</b>There are no unified theories as to the anatomical changes that occur with hallux valgus, we investigated the radiological characteristics and anatomical risk factors for hallux valgus deformity in Chinese adults.</p><p><b>METHODS</b>We reviewed 141 patients with hallux valgus (206 feet; 15 males, 126 females; mean age, 58.5 years). These patients attended Peking University People's Hospital from April 2008 to March 2014. All feet had intact radiological data, obtained using the Centricity RIS/PACS system. We measured hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), proximal articular set angle (PASA), distal articular set angle, hallux interphalangeal angle, metatarsocuneiform angle, size of the medial eminence of the distal first metatarsal, tibial sesamoid position, and joint congruity of the first metatarsophalangeal joint (MTPJ).</p><p><b>RESULTS</b>We found positive correlations between the HVA and IMA (r = 0.279, P < 0.01) and HVA and PASA (r = 0.358, P < 0.01), but not for IMA and PASA (P > 0.05). Feet were divided into three groups based on HVA severity. IMA (P < 0.05) and PASA (P < 0.05) in the mild group were significantly lower than that in the moderate and severe groups, with no significant difference determined for IMA or PASA between the moderate and severe groups (P > 0.05). Feet were then grouped based on the shape of the first metatarsal head. Using this grouping, HVA was significant higher in the rounded shape (19.92°) than in a flat shape (17.66°). The size of the medial eminence of the distal first metatarsal was positively correlated with HVA (r = 0.185, P < 0.01). The medial eminence in the moderate and severe groups was significantly larger than that in the mild group; moderate and severe groups were not significantly different.</p><p><b>CONCLUSIONS</b>PASA enlargement is an adaptive change during early hallux valgus formation, and decompensation leads to subdislocation in the first MTPJ. A rounded first metatarsal head would thus predispose a foot to hallux valgus. Furthermore, bone proliferation at the medial eminence may also lead to early hallux valgus development.</p>