Trend of minimally invasive and open surgery experience of general surgery residents: Accreditation Council for Graduate Medical Education general surgery case log in Thailand.

Purpose: Minimally invasive surgery (MIS) offers patients several benefits, such as smaller incisions, and fast recovery times. General surgery residents should be trained in both open and MIS. We aimed to examine the trends of minimally invasive and open procedures performed by general surgery residents in Thailand. Methods: A retrospective review of the Royal College of Surgeons of Thailand and Accreditation Council for Graduate Medical Education general surgery case logs from 2007 to 2018 was performed for common open and laparoscopic general surgery operations. The data were grouped by three time periods, which were 2007-2010, 2011-2014, and 2015-2018, and analyzed to explore changes in the operative trends. Results: For Thai residents, the mean number of laparoscopic operations per person per year increased from 5.97 to 9.36 (56.78% increase) and open increased from 20.02 to 27.16 (35.67% increase). There was a significant increase in the average number of minimally invasive procedures performed among cholecystectomy (5.83, 6.57, 8.10; p < 0.001) and inguinal hernia repair (0.33, 0.35, 0.66; p < 0.001). Compared to general surgery residents in the United States, Thai residents had more experience with open appendectomy, but significantly less experience with all other operations/procedures. Conclusion: The number of open and minimally invasive procedures performed or assisted by Thai general surgery residents has slowly increased, but generally lags behind residents in the United States. The Thai education program must be updated to improve residents' technical skills in open and laparoscopic surgery to remain competitive with their global partners.

Predictive MERRA-2 aerosol diagnostic model for oral, oropharyngeal and laryngeal cancer caused by air pollution in Thai population.

Introduction: Head and neck cancers were generally characterized with many possible causes. Exposure to outdoor particulate matter affected to multiple organ systems but it was unknown whether which species in PM was an association with cancer incidence. Objectives: The study aimed to examine the oral- oropharyngeal- laryngeal cancer incidence and accumulated air pollution-related cancers in the spatial patterns. Methods: Observational study was conducted, and the Poisson log-linear models were used which were analyzed on subgroups-specific incidence rates by national references of Thailand and NASA's database of aerosol diagnostics model (MERRA-2). Results: With a significant influence on increasing of 1 µg/m3 black carbon, organic carbon, Dust-PM2.5, and SO4 were associated with increased cancer risk in 1.433 times (95%CI: 1.215-1.690), 1.272 times (95%CI: 1.139-1.420), 3.640 times (95%CI: 2.011-6.589), and 1.704 times (95%CI: 1.334-2.177), respectively. Conclusion: This study indicated that oral-oropharyngeal-laryngeal cancer incidence could worsen because of adverse air pollution conditions. These issues should be addressed and the importance of the monitoring procedure for dust-PM2.5, sulfate, black carbon, and organic carbon should be emphasized.

Is Adjunctive Hyperbaric Oxygen Treatment Alone or with Surgery the Proper Management for Active and Persistent Osteoradionecrosis?

ABSTRACT: This study enrolled patients with stage 3 osteoradionecrosis. There were three treatment modalities: antibiotics, hyperbaric oxygen therapy (HBOT), and surgery. Complete healing was the primary outcome. Multiple logistic regression analysis demonstrated that surgery with HBOT improved wound healing better than HBOT alone.

Accumulated ambient air pollution and colon cancer incidence in Thailand.

This research examined the relationship between colon cancer risks and pollution in various areas of Thailand, using satellites to gather quantities of aerosols in the atmosphere. Bayesian hierarchical spatio-temporal model and the Poisson log-linear model were used to examine the incidence rates of colon cancer standardized by national references; from the database of the National Health Security Office, Ministry of Public Health of Thailand and NASA's database from aerosol diagnostics model. Modern-Era Retrospective Analysis for Research and Applications, Version 2 (MERRA-2) was used to explore disease-gender-specific spatio-temporal patterns of colon cancer incidences and accumulated air pollution-related cancers in Thailand between 2010 and 2016. A total of 59,605 patients were selected for the study. Due to concerns regarding statistical reliability between aerosol diagnostics model and colon cancer incidences, the posterior probabilities of risk appeared the most in dust PM2.5. It could be interpreted as relative risk in every increase of 10 µg/m3 in black carbon, organic carbon, and dust-PM2.5 levels were associated respectively with an increase of 4%, 4%, and 15% in the risks of colon cancer. A significant increase in the incidence of colon cancer with accumulated ambient air quality raised concerns regarding the prevention of air pollution. This study utilized data based on the incidences of colon cancer; the country's database and linked cancer data to pollution. According to the database from NASA's technology, this research has never been conducted in Thailand.

Factors Associated with Time Intervals for Diagnosis of Colorectal Cancer: A Hospital Based Study in Khon Kaen, Thailand.

BACKGROUND: Colorectal cancer (CRC) is among the five-leading cancers in Thailand. Delayed diagnosis is crucial for undermining the prognosis of the patients. This study aims to evaluate the factors associated with the time interval for diagnosis (TID). METHODS: A cross-sectional analytical study of 191 CRC patients with histological confirmation who were undergoing treatment in the tertiary hospital in Khon Kaen Province was conducted. The data were obtained by interview and retrieving from medical records. The time interval in each diagnostic process is reported in geometric mean. The geometric mean ratio (GMR) used to interpret the results from multiple linear regressions that analyze the relationship between factors and log-transformed TID. RESULTS: Most patients were males (61.78%) with  mean age of 61.28±10.2 years old. The geometric mean of TID was 263.48 days. Two factors were significantly associated with longer TID: first visit at a tertiary hospital (GMR=7.77 relative to secondary hospital; 95%CI=1.95 to 30.57) and distance to tertiary healthcare. Two factors were significantly associated with shorter TID: officer/ state enterprise (GMR=0.53 relative to agriculture; 95%CI=0.28 to 0.98) and cost of traveling to secondary healthcare. CONCLUSIONS: The results showed the occupation, first health care visit, distance and cost were factors associated with TID. Improving the facilities at the secondary healthcare units for diagnosing CRC would be likely to help to reduce the  wasted time in the  healthcare system.

A Prospective Randomized Double-blind study of silicone gel plus Herbal Extracts Versus Placebo in Pre-sternal hypertrophic scar prevention and amelioration.

OBJECTIVE: Post-surgical hypertrophic scar is more frequently reported in Asians. Many modalities can treat scars but there have not been any publications to define the efficacy of silicone gel plus herbal extracts for scar prevention or amelioration. DESIGN: 48 patients, who underwent median sternotomy were randomized and double-blinded to 2 groups to use topical silicone gel plus herbal extract gel or placebo for 6 months. Patients were treated either with topical silicone gel plus herbal extract gel or control using only placebo for 6 months. The scars were observed by experienced plastic surgeons using the Vancouver scar scale. SETTING: A single tertiary care center at Khon Kaen University. PATICIPANTS: 48 patients who underwent median sternotomy were enrolled in this study. All patients were aged over 18 years. All the wounds were sutured with polyglycolic 4/0 subcuticular suture material and did not receive other scar management before participating in this study. INTERVENTION: The silicone gel plus herbal extract gel (Bangkok Botanica, Bangkok, Thailand) in semi-liquid form was formulated from 15% Herbal extract (Allium Cepa extract, Centella Asiatica extract, Aloe Vera extract and Paper Mulberry extract), 50% polydemethysiloxane, 30% cyclopentasiloxane and 5% silica. The placebo gel was a composite of water, acrylate, C10-30 alkyl acrylate cross-polymer, polysorbate 20 and fragrance that was similar in color and consistency as that of the active gel and packed in the similar sealed packages. MAIN OUTCOME MEASURES: The scar was assessed using the Vancouver scar scale to determine pigmentation, vascularity, pliability and height. RESULTS: the study showed the silicone gel plus herbal extract gel could improve scar amelioration in height (p = 0.005) and pliability (p < 0.001) when compared to the placebo. The vascularity and pigmentation showed improvement using silicone gel plus herbal extracts but the improvement was not statistically significant. CONCLUSION: The silicone gel plus herbal extracts gel was effective for scar improvement in median sternotomy wounds.

Adding herbal extracts to silicone gel on post-sternotomy scar: a prospective randomised double-blind study.

OBJECTIVE: Silicone gel has been shown effective in improving healing post-sternotomy scars. It remains to be determined whether adding herbal extracts to the gel would augment the healing effect. METHOD: After median sternotomy, patients were randomised into two groups. Group 1: topical silicone gel plus herbal extract gel (Allium cepa, Centella Asiatica, Aloe vera and Paper Mulberry) and Group 2: silicone gel. Patients were treated for six months. The postoperative scars were assessed at three and six months by plastic surgeons using the Vancouver Scar Scale (VSS) and the patient assessment scar scale. RESULTS: Each group comprised 23 patients (n=46 in total). The VSS was significantly lower in Group 1 than in Group 2 (p=0.018 and p=0.051, respectively). In Group 1, the four differences from baseline were vascularity scores at three and six months (-0.391, p=0.025; -0.435, p=0.013, respectively), and pigmentation scores at three and six months (-0.391, p=0.019; -0.609, p=0.000, respectively). In Group 2, differences from baseline were the pigmentation and vascularity score at six months (-0.6609, p=0.000; -0.348, p=0.046, respectively). CONCLUSION: Our results suggest, post-sternotomy scars trend to have better vascularity and pigmentation when treated with silicone gel plus herbal extracts.

Construction of polluted aerosol in accumulation that affects the incidence of lung cancer.

BACKGROUND: This model demonstrated the correlation between lung cancer incidences and the parts of ambient air pollution according to the National Aeronautics and Space Administration (NASA)'s high resolution technology satellites. METHODS: Chemical type of aerosols was investigated by the Aerosol Diagnostics Model such as black carbon, mineral dust, organic carbon, sea-salt and SO4. The model investigated associations between the six year accumulation of each aerosol and lung cancer incidence by Bayesian hierarchical spatio-temporal model. Which also represented integrated geophysical parameters. RESULTS: In analyses of accumulated chemical aerosol component from 2010 - 2016, the incidence rate ratio (IRR) of patients in 2017 were estimated. We observed a significant increasing risk for organic carbon exposure (IRR 1.021, 95%CI 1.020-1.022), SO4, (IRR 1.026, 95% CI 1.025-1.028) and dust, (IRR 1.061, 95% CI 1.058-1.064). There was also suggestion of an increased risk with, every 1 ug/m3 increase in organic carbon compound is associated with 21% increased risk of lung cancer, whereas a 26% excess risk of cancer per 1 ug/m3 increase in mean SO4 and 61% increased risk of lung cancer for dust levels. The other variables were the negative IRR which did not increase the risk of the exposed group. CONCLUSION: With our results, this process can determine that organic carbon, SO4 and dust was significantly associated with the elevated risk of lung cancer.

Factors associated with patient satisfaction in laparoscopic adrenalectomy.

Laparoscopic adrenalectomy a treatment that is recommended for patients with adrenal adenoma and has been shown to lead to a 94% biochemical remission rate of aldosterone as well as improvements to quality of life in five domains of the SF-36. This method is also associated with high rates of patient satisfaction. However, there is little information available on the factors associated with patient satisfaction in cases of laparoscopic adrenalectomy. This study aimed to evaluate these factors in patients with Conn's syndrome who underwent laparoscopic adrenalectomy. This study was based on a survey and was conducted at Srinagarind Hospital at the Khon Kaen University Faculty of Medicine in Thailand. The inclusion criteria were that patients were between 15 and 60 years of age, had been diagnosed with adrenal gland tumors, and had undergone trnasperitoneal laparoscopic adrenalectomy. All eligible patients were asked to fill out a self-report questionnaire in which they rated their satisfaction (out of 10) and factors associated with their level of satisfaction in the areas of clinical treatment and scarring. There were 44 patients who participated in the study. The average (SD) age of all patients was 47.10 (10.90) years. The average overall satisfaction scores for the surgery and with regard to scarring post surgery were 9.47 (1.15) and 8.11 (2.21), respectively. Only the presence of headaches was an independent factor associated with the overall satisfaction, with a coefficient of -0.29 (p value 0.001). Only age was significantly predictive of overall satisfaction with regard to scarring with a coefficient of 0.05 and p value of 0.046. In conclusion, the presence of headaches was related to overall satisfaction and age was associated with satisfaction with regard to scarring in patients Conn's syndrome who underwent laparoscopic adrenalectomy.

Efficacy of Adjunctive Hyperbaric Oxygen Therapy in Osteoradionecrosis.

Osteoradionecrosis (ORN) is a common consequence resulting from radiation in patients with cancer. Presently, hyperbaric oxygen therapy (HBOT) is proposed to have a role in improving wound healing in ORN patients. There is no strong scientific evidence to confirm the benefits of HBOT for treatment of ORN as an adjunctive treatment. This study aimed to determine the benefits of adjunctive treatment of HBOT in ORN. A retrospective study was conducted at the Srinagarind Hospital, the Faculty of Medicine, Khon Kaen University, Thailand, between 2011 and 2017. The patients diagnosed with ORN, who received adjunctive HBOT before the operation, were enrolled. Complete healing of wounds was the primary outcome. There were 84 ORN patients with a mean age of 58.78 years; 54.76% were male and 45.24% were female. HBOT had a role significant in improving wound healing of ORN patients with stages 1 and 2. Poisson regression analysis showed that stage 3 of ORN negatively correlated with the number of HBOT dives (p = 0.001, incidence rates ratio = 0.85). In conclusion, HBOT improved wound healing of ORN patients with stages 1 and 2. In addition, stage 2 of ORN patients significantly required the highest number of HBOT dives compared to other types of ORN to promote wound healing, whereas stage 3 patients, who underwent bone debridement combined with HBOT, initiated to success of treatment process and required a smaller number of dives.

Preliminary Results: Colorectal Cancer Screening Using Fecal Immunochemical Test (FIT) in a Thai Population Aged 45-74 Years: A Population-Based Randomized Controlled Trial

Objective: The aim of this paper is to provide some details and the results to date of a colorectal cancer screening trial using a fecal immunochemical test (FIT). Methods: A population-based randomized controlled trial began in May, 2016. All people aged 45 to 74 years living in Nam Phong District, Khon Kaen Province, Thailand, and willing to participate are being recruited using an outreach method. Enrolled participants are randomly allocated by a computer-generated randomization program either to a study arm (receive sample kit for FIT) or to a control arm (no provision of kit). Positive FIT cases are subsequently confirmed by a colonoscopy examination, and negative FIT cases are re-tested with FIT every two years. The preliminary results to date were analysed using descriptive statistics. Results: A total of 1,060 enrolled participants provided a complete set of data. Of those randomly assigned to the study arm and tested by FIT, 92 (8.7%) were found to be positive, 39 (11.5%) males and 53 (7.4%) females. The f-Hb concentrations at the 75th, 90th and 95th percentiles for all age groups were higher in males than in females, and the distributions of f-Hb concentration varied with age, especially at the 95th percentile where f-Hb concentrations increased with age. Conclusion: The preliminary results of our screening trial have indicated that the prevalence of positive FIT cases is higher than in a similar recent and, at the time unique, previous study in Thailand. This finding is especially the case for males and those in the older age groups.

Joinpoint Analysis Trends in the Incidence of Colorectal Cancer in Khon Kaen, Thailand (1989 ­ 2012)

Objective: This study focused on recent changes in the incidence of colorectal cancer (CRC) in Khon Kaen, Thailand. Methods: Data for CRC over the period 1989 to 2012 from the population-based cancer registry of Khon Kaen province were employed. Age-standardized incidence rates (ASR) were calculated and classified into 4 age-groups for comparison. Joinpoint regression analysis was used to detect changes in trends among each line segment and an overall line was generated, whether increasing or decreasing, with annual percent change (APC) and average annual percent change (AAPC). Results: There were 3,364 CRC cases included in the analysis, 72.2% histological confirmed and 53.5% in men. Trends of ASRs generally demonstrated gradual increase over the period 1989 to 2012. For those aged under 45 or 50 years there was slight overall increase, with a somewhat zigzag pattern. From joinpoint analysis, the trends of all aged groups were found to be increasing among both men and women: aged 45 years and older group AAPC=3.40, 2.30 and 3.90, respectively); aged 50 years and older group AAPC=2.90, 2.20 and 3.40; aged under 45 years AAPC=6.30, 6.00 and 6.90; and aged under 50 years (AAPC=5.70, 3.20 and 5.70. Conclusions: ASRs for CRC have been gradually increasing in the northeast region of Thailand. Future studies should consider the subsite distribution.

Prognostic Factors for Large Symptomatic Gists: a Pragmatic Study of Experiences From a University Hospital Over 10 Years

Background: Gastrointestinal stromal tumors (GISTs), which are mesenchymal neoplasms in the gastrointestinal (GI) tract account for 0.2% of all GI tumors. Several factors have been reported (mostly from studies conducted in Western countries) to be associated with survival in GISTs cases such as tumor site, staging, and tumor size. We conducted a pragmatic study, looking at a 10-year period, aimed at understanding the prognostic factors related to GISTs in a university hospital. The study population consisted of patients with large symptomatic GISTs. Methods: This was a retrospective study conducted at the Department of Surgery in the Khon Kaen University Hospital (Thailand). All patients diagnosed with GISTs that were treated between 2006 and 2015 were consecutively enrolled. The diagnosis of GISTs was made by examining the pathological section and immunohistochemistry results. The outcome of this study was the rate of survival after surgical treatment. Prognostic factors were determined using Cox regression analysis. Results: There were 124 GISTs patients treated at the university hospital during the 10-year period of the study. The median age of all patients was 54 years (range 24-83 years). Of those, 119 (95.9%) were symptomatic. Rectosigmoid GISTs accounted for 20.2% of all tumors. The median tumor size was 8 cm. A total of 68 patients (54.8%) died. The median survival time for all patients was 7.18 years (1st -3rd quartile range 6.48-7.89). There were three significant factors associated with death including male gender, liver metastasis, and peritoneal metastasis. Conclusion: Male gender, liver metastasis, and peritoneal metastasis were prognostic factors for large symptomatic GISTs.

Laparoscopic Adrenalectomy: 6 Years Experience in Srinagarind Hospital.

BACKGROUND AND OBJECTIVE: Laparoscopic adrenalectomy has become the procedure of choice to treat benign functioning and non-functioning adrenal tumors. This study aims to present our single unit experience of laparoscopic adrenalectomy. MATERIAL AND METHOD: Review of all recorded clinical data was performed in patients who underwent laparoscopic adrenalectomy for adrenal neoplasm, between January 2008 and December 2013 in Srinagarind Hospital. Patients' demographic data, lesion size, operation time, blood loss, conversion rate, length of postoperative stay, morbidity and mortality were collected and analyzed. RESULTS: Forty-six adrenalectomy were done. 11 men and 35 women, with a mean age of 44 years (range 20-69) were enrolled. A right adrenal gland tumor in 14 cases (30.43%) and left adrenal gland tumor in 32 cases (69.57%). Overall mean operative time was 97 minutes and mean blood loss was 61.73 ml. Conversion to open surgery was necessary in 6 of 46 patients (13.04%). Mean length of post operative hospital stay of conversion to open surgery group (9.83 days) was longer than laparoscopic group (4.67 days) significantly p<0.05 (95% CI: -7.28 to -3.03). Tumor mean size was of 2.6 cm and most was cortical adenoma. Morbidity rate was 2.17% and no mortality. CONCLUSION: Laparoscopic adrenalectomy is the procedure of choice for benign adrenal gland tumor. Current review confirms that it has been a safe and feasible procedure associated with minimal morbidity. Surgical skill and laparoscopic experience are important factors to achieve consistently good outcomes.

Efficacy of metal and plastic stents in unresectable complex hilar cholangiocarcinoma: a randomized controlled trial.

BACKGROUND: Endoscopic biliary stent drainage is effective in the palliative treatment of patients with hilar cholangiocarcinoma (HCA). However, no randomized controlled trial comparing the efficacy of the self-expandable metal stent (SEMS) and the plastic stent (PS) in patients with unresectable complex HCA is available. OBJECTIVE: To compare the successful drainage rates of endoscopic SEMSs and PSs. DESIGN: A single-center, open-label randomized controlled trial. SETTING: University hospital in KhonKaen, Thailand. PATIENTS: One hundred eight patients with unresectable complex, Bismuth type II-IV HCA. INTERVENTIONS: Endoscopic retrograde cholangiography with unilateral SEMS or PS insertion. MAIN OUTCOME MEASUREMENTS: Successful drainage rate. LIMITATIONS: Diagnosis of HCA was made by clinical presentations, imaging studies, and clinical outcome during follow-up. RESULTS: One hundred eight patients were randomly allocated to the SEMS and PS groups. Intention-to-treat analysis revealed that the successful drainage rate in the SEMS group was higher than in the PS group (70.4% vs 46.3%, P = .011). The median survival times were 126 and 49 days, respectively, in the SEMS and PS groups. The overall survival rates of the patients in both groups were statistically different by log-rank test (P = .002). CONCLUSIONS: Endoscopic biliary drainage with the SEMS provides better adequacy of drainage and longer survival compared with the PS in patients with unresectable complex HCA.

Laparoscopic appendectomy: results of a new technique for stump management.

OBJECTIVE: The purpose of the present study was to review a new laparoscopic technique for treatment of appendicitis. An earlier pilot study indicated the safety of the technique in addition to saved time and cost. MATERIAL AND METHOD: The electronic records were analyzed on appendix surgeries performed at our hospital between January 1, 2007 and December 31, 2011. RESULTS: The 91 patients who had an appendiceal stump closure using clips (viz., the Hem-o-lock clip) had a significantly shorter surgery and hospitalization than those whose appendiceal stump was closed using the standard loop strap (Endo-loop). CONCLUSION: The complications between groups were not significantly different and were treated in both groups using conservative management.

Role of silicone derivative plus onion extract gel in presternal hypertrophic scar protection: a prospective randomized, double blinded, controlled trial.

Use of silicone derivative and onion extract had been reported in the prevention of hypertrophic scarring. Our experience showed the preventive use of silicone derivative plus onion extract gel on hypertrophic scars after median sternotomy. In a randomized, double blinded, placebo-controlled study, 60 patients after median sternotomy incisions were separated into two groups. All patients were treated either with silicone derivative plus onion extract gel (Cybele(®) scagel) or placebo gel twice daily for a total treatment period of 12 weeks. During each visit, pain and itching scores were graded by the patients and scar characteristics were observed by surgeons using the Vancouver scar scale. Pain and itch score values from patients' who applied silicone derivative plus onion extract gel was less than another group (P < 0·05). Pigmentation was significantly different between two groups (P < 0·05) and the reduction of scores on vascularity, pliability, height in treated group was not superior to the untreated group. No adverse events were reported by any of the patients. A silicone derivative plus onion extract gel is safe and effective for the preventing the hypertrophic scarring after median sternotomy.

Palliative surgical bypass versus percutaneous transhepatic biliary drainage on unresectable hilar cholangiocarcinoma.

OBJECTIVE: To compare the survival probability of unresectable hilar cholangiocarcinoma patients who have been managed by palliative surgical bypass versus percutaneous transhepatic biliary drainage (PTBD). MATERIAL AND METHOD: A historical (retrospective) cohort study was performed by retrospective and prospective data collection. From January 1, 2000 to December 31, 2002, all unresectable hilar cholangiocarcinoma patients who received only one type of palliative surgical bypass or PTBD in Srinagarind Hospital, Khon Kaen University were included in the present study. The patients were followed until December 31, 2004. Survival analysis was completed for all of the patients. STATISTIC ANALYSIS: Survival analysis was analyzed with the Kaplan-Meier method, Cox regression analysis, and Log-rank test. A p-value of less than 0.05 was considered significant. RESULTS: During the study period, 83 patients were included. Palliative surgical bypass was performed in 42 patients and PTBD was performed in 41 patients. Demographic data, peri-operative complication rate, and late complication rate were comparable. The median survival time of the palliative surgical bypass group was 160 days,(95% CI: 85.33, 234.67) and 82 days (95% CI: 29.76, 134.24)for PTBD group. Comparing survival experience by Log-rank test gave statistical significant diference (p = 0.0276). Hazard ratio was 0.599 (p = 0.03) CONCLUSION: Survival rate of the palliative surgical bypass group was higher than the PTBD group. The survival rate of both groups was comparable to previous reports.

Outcome of in-patient trauma cases: Accident and Emergency Unit, Khon Kaen University.

OBJECTIVES: To study and report the outcome of in-patient trauma cases based on the Trauma and Injury Severity Scoring (TRISS) method and compare the outcome with the registry data from the Major Trauma Outcome Study (MTOS). MATERIAL AND METHOD: A descriptive study was performed by retrospective data collection. From 1 January 2002 to 31 December 2002, all admitted trauma patients in the Accident and Emergency Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University were included in the present study. Survival analysis was completed for all of the patients. STATISTICAL ANALYSIS: TRISS method and W, M and Z-statistics (Z-score) on the basis of definitive outcome-based evaluation (DEF) method for comparing with MTOS data. RESULTS: The majorities of patients were men (76.85%) and mean age was 30.81 years. One hundred and ninety five patients (96.06%) sustained blunt trauma, the vast majority resulting from motor vehicle crashes. The observed survivors were 182, whereas the expected survivors were 183.582. The W, M and Z-statistics were -0.779, 0.843 and -0.493 respectively. CONCLUSION: Z-score -0.493 indicated no statistical difference between observed and expected survivors.