[Epidemiological data on severely injured patients; a retrospective study of the period 1985-1989]. / Epidemiologische gegevens van ernstig gewonden; een retrospectief onderzoek over de periode 1985-1989.

OBJECTIVE: To describe the epidemiological data of a group of multiple injured patients. SETTING: University Hospital, Groningen. DESIGN: Retrospective, descriptive. PATIENTS AND METHODS: All multiple injured patients (HTI/ISS > 18), treated from 1985 to 1989 were analysed (932 cases). Age, sex, residence, type of accident, mortality, cause of death, ISS, length of hospital stay and destination after discharge are described. RESULTS: Generally speaking the multiple injured patients investigated were young and male. 75% of the injuries were caused by traffic accidents; occupants of cars run the highest risk of dying. Mortality (22%) is mainly determined by severe head injuries and increases with a higher ISS. The length of hospital stay averaged 22.5 days and compared with situations abroad is short. Half the patients could be discharged to their homes. Those who were transferred to a rehabilitation centre or a nursing home have a high ISS and mainly have severe injuries of the extremities. CONCLUSION: In view of the number of patients who could be discharged to their homes, the ultimate functional results look fair.

A Turbo Pascal program to convert ICD-9CM coded injury diagnoses into injury severity scores: ICDTOAIS.

Diagnoses of injuries as a result of trauma are commonly coded by means of the International Classification of Diseases (9th rev.) Clinical Modification (ICD-9CM). The Abbreviated Injury Scale (AIS) is frequently employed to assess the severity of injury per body region. The Injury Severity Score (ISS) is an over-all index or summary of the severity of injury. To compute one of these two types of scores the entire medical record of each patient must be examined. The program ICDTOAIS replaces the manual coding or translation between the two scores. The program converts the ICD-9CM coded diagnoses into AIS and ISS scores. The program also computes the maximum AIS (MAXAIS) per body region, enabling the researcher to assess the relative impact of the severity of trauma of different body regions in both morbidity and mortality studies. The program locates invalid ICD-9CM rubrics in the data file. ICDTOAIS may be employed as a program alone or as a procedure in database management systems (e.g., DBase III plus, DBase IV, or the different versions of FOXPRO). The program is written in Turbo Pascal, Version 6.

[Comparison of 2 scales in the assessment of injury severity in seriously injured patients]. / Vergelijking van twee schalen voor het meten van letselernst bij ernstig gewonde patiënten.

We compared the Abbreviated Injury Scale (AIS-85) and the Hospital Trauma Index (HTI) in seriously injured patients. The effect of these scales on the application of Injury Severity Scores (ISS) was investigated. Furthermore, the predictive value on mortality of the AIS/ISS and the HTI/ISS was determined. Subjects were 932 seriously injured patients (HTI/ISS score greater than or equal to 18) admitted to University Hospital Groningen between 1985 and 1990. A quantitative and a qualitative comparison were performed. Logistic regression was used to estimate the predictive value of the AIS/ISS and the HTI/ISS on mortality. The AIS/ISS and HTI/ISS differed quantitatively and qualitatively. The average HTI/ISS score was ten points higher than the average AIS/ISS. By combining specific regions of the scales the predictive value could be improved. The ISS scores were incomparable. Consequently in future studies the method used to calculate the ISS score should be mentioned.

Urinary tract injuries in multiply-injured patients: a rational guideline for the initial assessment.

In a retrospective study involving 866 multiply-injured patients we demonstrated urinary tract injuries in 72 patients (8.3 per cent), 17 (2 per cent) of which were serious. Haematuria was a frequent finding in multiply-injured patients. In patients with serious lesions of the urinary tract, more than 35 RBCs/HPF in the sediment or macroscopic haematuria were found. All major injuries were demonstrated by the emergency intravenous urogram. Ultrasonography demonstrated contusions of the kidney or bladder and ruptures of the kidneys, but was not reliable in diagnosing ruptures of the bladder. Of 155 patients with a pelvic fracture 13 (8 per cent) had lower urinary tract injuries. In all these patients the fracture was located in the pubic arch. If a retrograde urethrogram was performed in these patients all urethral lesions were detected. We propose a rational guideline, which guarantees diagnostic accuracy of serious injuries of the urinary tract after blunt trauma, while interfering as little as possible with the resuscitative and diagnostic procedures in severely injured patients.