Sample records for abbreviated injury score

  1. The natural logarithm transforms the abbreviated injury scale and improves accuracy scoring.

    PubMed

    Wang, Xu; Gu, Xiaoming; Zhang, Zhiliang; Qiu, Fang; Zhang, Keming

    2012-11-01

    The Injury Severity Score (ISS) and the New Injury Severity Score (NISS) are widely used for anatomic severity assessments, but they do not display a linear relation to mortality. The mortality rates are significantly different between pairs of the Abbreviated Injury Scale (AIS) triplets that generate the same ISS/NISS total. The Logarithm Injury Severity Score (LISS) is defined as a change in AIS values by raising each AIS severity score (1-6) by taking the natural logarithm to a power of 5.53 multiplied by 1.7987 and then adding the three most severe injuries (i.e. highest AIS), regardless of body region. LISS values were calculated for every patient in three large independent data sets: 3,784, 4,436, and 4,018 patients treated over a six-year period at Class A tertiary comprehensive hospitals in China. The power of LISS to predict morality was then compared with previously calculated NISS values for the same patients in each of the three data sets. We found that LISS is more predictive of survival as well (Hangzhou: receiver operating characteristic (ROC): NISS=0.931, LISS=0.949, p=0.006; Similarly, Zhejiang and Shenyang: ROC NISS vs. LISS, p<0.05). Moreover, LISS provides a better fit throughout its entire range of predicting (Hosmer-Lemeshow statistic for Hangzhou NISS=15.76, p=0.027; LISS=13.79, p=0.055; Similarly, for Zhejiang and Shenyang). LISS should be used as the standard summary measure of human trauma.

  2. Usefulness of the abbreviated injury score and the injury severity score in comparison to the Glasgow Coma Scale in predicting outcome after traumatic brain injury.

    PubMed

    Foreman, Brandon P; Caesar, R Ruth; Parks, Jennifer; Madden, Christopher; Gentilello, Larry M; Shafi, Shahid; Carlile, Mary C; Harper, Caryn R; Diaz-Arrastia, Ramon R

    2007-04-01

    Assessment of injury severity is important in the management of patients with brain trauma. We aimed to analyze the usefulness of the head abbreviated injury score (AIS), the injury severity score (ISS), and the Glasgow Coma Scale (GCS) as measures of injury severity and predictors of outcome after traumatic brain injury (TBI). Data were prospectively collected from 410 patients with TBI. AIS, ISS, and GCS were recorded at admission. Subjects' outcomes after TBI were measured using the Glasgow Outcome Scale (GOS-E) at 12 months postinjury. Uni- and multivariate analyses were performed. Outcome information was obtained from 270 patients (66%). ISS was the best predictor of GOS-E (rs = -0.341, p < 0.001), followed by GCS score (rs = 0.227, p < 0.001), and head AIS (rs = -0.222, p < 0.001). When considered in combination, GCS score and ISS modestly improved the correlation with GOS-E (R = 0.335, p < 0.001). The combination of GCS score and head AIS had a similar effect (R = 0.275, p < 0.001). Correlations were stronger from patients injuries (GCS injuries (GCS >8). GCS score, AIS, and ISS are weakly correlated with 12-month outcome. However, anatomic measures modestly outperform GCS as predictors of GOS-E. The combination of GCS and AIS/ISS correlate with outcome better than do any of the three measures alone. Results support the addition of anatomic measures such as AIS and ISS in clinical studies of TBI. Additionally, most of the variance in outcome is not accounted for by currently available measures of injury severity.

  3. Tangent function transformation of the Abbreviated Injury Scale improves accuracy and simplifies scoring.

    PubMed

    Wang, Muding; Qiu, Wusi; Qiu, Fang; Mo, Yinan; Fan, Wenhui

    2015-03-16

    The Injury Severity Score (ISS) and the New Injury Severity Score (NISS) are widely used for anatomic severity assessments after trauma. We present here the Tangent Injury Severity Score (TISS), which transforms the Abbreviated Injury Scale (AIS) as a predictor of mortality. The TISS is defined as the sum of the tangent function of AIS/6 to the power 3.04 multiplied by 18.67 of a patient's three most severe AIS injuries regardless of body regions. TISS values were calculated for every patient in two large independent data sets: 3,908 and 4,171 patients treated during a 6-year period at level-3 first-class comprehensive hospitals: the Affiliated Hospital of Hangzhou Normal University and Fengtian Hospital Affiliated to Shenyang Medical College, China. The power of TISS to predict mortality was compared with previously calculated NISS values for the same patients in each data set. The TISS is more predictive of survival than NISS (Hangzhou: receiver operating characteristic (ROC): NISS = 0.929, TISS = 0.949; p = 0.002; Shenyang: ROC: NISS = 0.924, TISS = 0.942; p = 0.008). Moreover, TISS provides a better fit throughout its entire range of prediction (Hosmer Lemeshow statistic for Hangzhou NISS = 29.71; p < 0.001, TISS = 19.59; p = 0.003; Hosmer Lemeshow statistic for Shenyang NISS = 33.49; p < 0.001, TISS = 21.19; p = 0.002). The TISS shows more accurate prediction of prognosis and a linear relation to mortality. The TISS might be a better injury scoring tool with simple computation.

  4. Using the abbreviated injury severity and Glasgow Coma Scale scores to predict 2-week mortality after traumatic brain injury.

    PubMed

    Timmons, Shelly D; Bee, Tiffany; Webb, Sharon; Diaz-Arrastia, Ramon R; Hesdorffer, Dale

    2011-11-01

    Prediction of outcome after traumatic brain injury (TBI) remains elusive. We tested the use of a single hospital Glasgow Coma Scale (GCS) Score, GCS Motor Score, and the Head component of the Abbreviated Injury Scale (AIS) Score to predict 2-week cumulative mortality in a large cohort of TBI patients admitted to the eight U.S. Level I trauma centers in the TBI Clinical Trials Network. Data on 2,808 TBI patients were entered into a centralized database. These TBI patients were categorized as severe (GCS score, 3-8), moderate (9-12), or complicated mild (13-15 with positive computed tomography findings). Intubation and chemical paralysis were recorded. The cumulative incidence of mortality in the first 2 weeks after head injury was calculated using Kaplan-Meier survival analysis. Cox proportional hazards regression was used to estimate the magnitude of the risk for 2-week mortality. Two-week cumulative mortality was independently predicted by GCS, GCS Motor Score, and Head AIS. GCS Severity Category and GCS Motor Score were stronger predictors of 2-week mortality than Head AIS. There was also an independent effect of age (<60 vs. ≥60) on mortality after controlling for both GCS and Head AIS Scores. Anatomic and physiologic scales are useful in the prediction of mortality after TBI. We did not demonstrate any added benefit to combining the total GCS or GCS Motor Scores with the Head AIS Score in the short-term prediction of death after TBI.

  5. The exponential function transforms the Abbreviated Injury Scale, which both improves accuracy and simplifies scoring.

    PubMed

    Wang, M D; Fan, W H; Qiu, W S; Zhang, Z L; Mo, Y N; Qiu, F

    2014-06-01

    We present here the exponential function which transforms the Abbreviated Injury Scale (AIS). It is called the Exponential Injury Severity Score (EISS), and significantly outperforms the venerable but dated New Injury Severity Score (NISS) and Injury Severity Score (ISS) as a predictor of mortality. The EISS is defined as a change of AIS values by raising each AIS severity score (1-6) by 3 taking a power of AIS minus 2 and then summing the three most severe injuries (i.e., highest AIS), regardless of body regions. EISS values were calculated for every patient in two large independent data sets: 3,911 and 4,129 patients treated during a 6-year period at the Class A tertiary hospitals in China. The power of the EISS to predict mortality was then compared with previously calculated NISS values for the same patients in each of the two data sets. We found that the EISS is more predictive of survival [Zhejiang: area under the receiver operating characteristic curve (AUC): NISS = 0.932, EISS = 0.949, P = 0.0115; Liaoning: AUC: NISS = 0.924, EISS = 0.942, P = 0.0139]. Moreover, the EISS provides a better fit throughout its entire range of prediction (Hosmer-Lemeshow statistic for Zhejiang: NISS = 21.86, P = 0.0027, EISS = 13.52, P = 0.0604; Liaoning: NISS = 23.27, P = 0.0015, EISS = 15.55, P = 0.0164). The EISS may be used as the standard summary measure of human trauma.

  6. Diagnostic accuracy of the Kampala Trauma Score using estimated Abbreviated Injury Scale scores and physician opinion.

    PubMed

    Gardner, Andrew; Forson, Paa Kobina; Oduro, George; Stewart, Barclay; Dike, Nkechi; Glover, Paul; Maio, Ronald F

    2017-01-01

    The Kampala Trauma Score (KTS) has been proposed as a triage tool for use in low- and middle-income countries (LMICs). This study aimed to examine the diagnostic accuracy of KTS in predicting emergency department outcomes using timely injury estimation with Abbreviated Injury Scale (AIS) score and physician opinion to calculate KTS scores. This was a diagnostic accuracy study of KTS among injured patients presenting to Komfo Anokye Teaching Hospital A&E, Ghana. South African Triage Scale (SATS); KTS component variables, including AIS scores and physician opinion for serious injury quantification; and ED disposition were collected. Agreement between estimated AIS score and physician opinion were analyzed with normal, linear weighted, and maximum kappa. Receiver operating characteristic (ROC) analysis of KTS-AIS and KTS-physician opinion was performed to evaluate each measure's ability to predict A&E mortality and need for hospital admission to the ward or theatre. A total of 1053 patients were sampled. There was moderate agreement between AIS criteria and physician opinion by normal (κ=0.41), weighted (κ lin =0.47), and maximum (κ max =0.53) kappa. A&E mortality ROC area for KTS-AIS was 0.93, KTS-physician opinion 0.89, and SATS 0.88 with overlapping 95% confidence intervals (95%CI). Hospital admission ROC area for KTS-AIS was 0.73, KTS-physician opinion 0.79, and SATS 0.71 with statistical similarity. When evaluating only patients with serious injuries, KTS-AIS (ROC 0.88) and KTS-physician opinion (ROC 0.88) performed similarly to SATS (ROC 0.78) in predicting A&E mortality. The ROC area for KTS-AIS (ROC 0.71; 95%CI 0.66-0.75) and KTS-physician opinion (ROC 0.74; 95%CI 0.69-0.79) was significantly greater than SATS (ROC 0.57; 0.53-0.60) with regard to need for admission. KTS predicted mortality and need for admission from the ED well when early estimation of the number of serious injuries was used, regardless of method (i.e. AIS criteria or physician opinion

  7. Diagnostic accuracy of the Kampala Trauma Score using estimated Abbreviated Injury Scale scores and physician opinion

    PubMed Central

    Gardner, Andrew; Forson, Paa Kobina; Oduro, George; Stewart, Barclay; Dike, Nkechi; Glover, Paul; Maio, Ronald F.

    2016-01-01

    Background The Kampala Trauma Score (KTS) has been proposed as a triage tool for use in low- and middle-income countries (LMICs). This study aimed to examine the diagnostic accuracy of KTS in predicting emergency department outcomes using timely injury estimation with Abbreviated Injury Scale (AIS) score and physician opinion to calculate KTS scores. Methods This was a diagnostic accuracy study of KTS among injured patients presenting to Komfo Anokye Teaching Hospital A&E, Ghana. South African Triage Scale (SATS); KTS component variables, including AIS scores and physician opinion for serious injury quantification; and ED disposition were collected. Agreement between estimated AIS score and physician opinion were analyzed with normal, linear weighted, and maximum kappa. Receiver operating characteristic (ROC) analysis of KTS-AIS and KTS-physician opinion was performed to evaluate each measure’s ability to predict A&E mortality and need for hospital admission to the ward or theatre. Results A total of 1,053 patients were sampled. There was moderate agreement between AIS criteria and physician opinion by normal (κ=0.41), weighted (κlin=0.47), and maximum (κmax=0.53) kappa. A&E mortality ROC area for KTS-AIS was 0.93, KTS-physician opinion 0.89, and SATS 0.88 with overlapping 95% confidence intervals (95%CI). Hospital admission ROC area for KTS-AIS was 0.73, KTS-physician opinion 0.79, and SATS 0.71 with statistical similarity. When evaluating only patients with serious injuries, KTS-AIS (ROC 0.88) and KTS-physician opinion (ROC 0.88) performed similarly to SATS (ROC 0.78) in predicting A&E mortality. The ROC area for KTS-AIS (ROC 0.71; 95%CI 0.66–0.75) and KTS-physician opinion (ROC 0.74; 95%CI 0.69–0.79) was significantly greater than SATS (ROC 0.57; 0.53–0.60) with regard to need for admission. Conclusions KTS predicted mortality and need for admission from the ED well when early estimation of the number of serious injuries was used, regardless of method

  8. Abbreviated injury scale scoring in traffic fatalities: comparison of computerized tomography and autopsy.

    PubMed

    Leth, Peter Mygind; Ibsen, Marlene

    2010-06-01

    The purpose of this investigation is to evaluate the value of postmortem computerized tomography (CT) for Abbreviated Injury Scale (AIS) scoring and Injury Severity Scoring (ISS) of traffic fatalities. This is a prospective investigation of a consecutive series of 52 traffic fatalities from Southern Denmark that were CT scanned and autopsied. The AIS and ISS scores based on CT and autopsy (AU) were registered in a computer database and compared. Kappa values for reproducibility of AIS-severity scores and ISS scores were calculated. On an average, there was a 94% agreement between AU and CT in detecting the presence or absence of lesions in the various anatomic regions, and the severity scores were the same in 90% of all cases (range, 75-100%). When different severity scoring was obtained, CT detected more lesions with a high severity score in the facial skeleton, pelvis, and extremities, whereas AU detected more lesions with high scores in the soft tissues (especially in the aorta), cranium, and ribs. The kappa value for reproducibility of AIS scores confirmed that the agreement between the two methods was good. The lowest kappa values (>0.6) were found for the facial skeleton, cerebellum, meninges, neck organs, lungs, kidneys, and gastrointestinal tract. In these areas, the kappa value provided moderate agreement between CT and AU. For all other areas, there was a substantial agreement between the two methods. The ISS scores obtained by CT and by AU were calculated and were found to be with no or moderate variation in 85%. Rupture of the aorta was often overlooked by CT, resulting in too low ISS scoring. The most precise postmortem AIS and ISS scorings of traffic fatalities was obtained by a combination of AU and CT. If it is not possible to perform an AU, then CT may be used as an acceptable alternative for AIS scoring. We have identified one important obstacle for postmortem ISS scoring, namely that aorta ruptures are not easily detected by post mortem CT.

  9. Mortality prediction of head Abbreviated Injury Score and Glasgow Coma Scale: analysis of 7,764 head injuries.

    PubMed

    Demetriades, Demetrios; Kuncir, Eric; Murray, James; Velmahos, George C; Rhee, Peter; Chan, Linda

    2004-08-01

    We assessed the prognostic value and limitations of Glasgow Coma Scale (GCS) and head Abbreviated Injury Score (AIS) and correlated head AIS with GCS. We studied 7,764 patients with head injuries. Bivariate analysis was performed to examine the relationship of GCS, head AIS, age, gender, and mechanism of injury with mortality. Stepwise logistic regression analysis was used to identify the independent risk factors associated with mortality. The overall mortality in the group of head injury patients with no other major extracranial injuries and no hypotension on admission was 9.3%. Logistic regression analysis identified head AIS, GCS, age, and mechanism of injury as significant independent risk factors of death. The prognostic value of GCS and head AIS was significantly affected by the mechanism of injury and the age of the patient. Patients with similar GCS or head AIS but different mechanisms of injury or ages had significantly different outcomes. The adjusted odds ratio of death in penetrating trauma was 5.2 (3.9, 7.0), p < 0.0001, and in the age group > or = 55 years the adjusted odds ratio was 3.4 (2.6, 4.6), p < 0.0001. There was no correlation between head AIS and GCS (correlation coefficient -0.31). Mechanism of injury and age have a major effect in the predictive value of GCS and head AIS. There is no good correlation between GCS and head AIS.

  10. The Value of Injury Severity Score and Abbreviated Injury Scale in the Management of Traumatic Injuries of Parenchymal Abdominal Organs.

    PubMed

    Grandić, Leo; Olić, Ivna; Pogorelić, Zenon; Mrklić, Ivana; Perko, Zdravko

    2017-09-01

    The aim of this study was to investigate the influence of etiology, types of injury, levels of consciousness and the Injury Severity Score (ISS) and Abbreviated Injury Scale (AIS) values on the selection of treatment modality and survival in patients with injuries of parenchymal abdominal organs. Case records of 224 patients treated for traumatic injury of parenchymal abdominal organs from January 2003 until December 2015 were reviewed. Th e values of ISS and AIS of injury severity were calculated and compared to the values obtained according to the etiology, state of consciousness and survival. Of the 224 patients, 172 (76.8%) were treated by surgical approach and 52 (23.2%) were treated conservatively. Th e mean patient age was 40.1}18.3 years. Th ere were 97 (43.3%) polytrauma cases. Of the 224 injured patients, 143 (63.8%) were treated with transfusions of blood products. Two hundred and six (92%) patients survived. Th e mean AIS and ISS values were significantly lower in patients that survived (AIS=3; ISS=28) than in those that died (AIS=5; ISS=34) (p< 0.001). There was a statistically significant difference in AIS and ISS values between conscious (AIS=2.7; ISS=25.9) and unconscious (AIS=3.2; ISS=33) patients (p< 0.001). Of the 224 patients that did not survive, 18 (8%) were hemodynamically unstable. Survival depended on hemodynamic stability at admission; the ISS and AIS values were associated with the injuries and state of consciousness at admission. Hemodynamic stability, state of consciousness, and ISS and AIS values were the quality predictors of survival after abdominal traumatic injury.

  11. Comparisons of the Outcome Prediction Performance of Injury Severity Scoring Tools Using the Abbreviated Injury Scale 90 Update 98 (AIS 98) and 2005 Update 2008 (AIS 2008)

    PubMed Central

    Tohira, Hideo; Jacobs, Ian; Mountain, David; Gibson, Nick; Yeo, Allen

    2011-01-01

    The Abbreviated Injury Scale (AIS) was revised in 2005 and updated in 2008 (AIS 2008). We aimed to compare the outcome prediction performance of AIS-based injury severity scoring tools by using AIS 2008 and AIS 98. We used all major trauma patients hospitalized to the Royal Perth Hospital between 1994 and 2008. We selected five AIS-based injury severity scoring tools, including Injury Severity Score (ISS), New Injury Severity Score (NISS), modified Anatomic Profile (mAP), Trauma and Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOT). We selected survival after injury as a target outcome. We used the area under the Receiver Operating Characteristic curve (AUROC) as a performance measure. First, we compared the five tools using all cases whose records included all variables for the TRISS (complete dataset) using a 10-fold cross-validation. Second, we compared the ISS and NISS for AIS 98 and AIS 2008 using all subjects (whole dataset). We identified 1,269 and 4,174 cases for a complete dataset and a whole dataset, respectively. With the 10-fold cross-validation, there were no clear differences in the AUROCs between the AIS 98- and AIS 2008-based scores. With the second comparison, the AIS 98-based ISS performed significantly worse than the AIS 2008-based ISS (p<0.0001), while there was no significant difference between the AIS 98- and AIS 2008-based NISSs. Researchers should be aware of these findings when they select an injury severity scoring tool for their studies. PMID:22105401

  12. Comparisons of the Outcome Prediction Performance of Injury Severity Scoring Tools Using the Abbreviated Injury Scale 90 Update 98 (AIS 98) and 2005 Update 2008 (AIS 2008).

    PubMed

    Tohira, Hideo; Jacobs, Ian; Mountain, David; Gibson, Nick; Yeo, Allen

    2011-01-01

    The Abbreviated Injury Scale (AIS) was revised in 2005 and updated in 2008 (AIS 2008). We aimed to compare the outcome prediction performance of AIS-based injury severity scoring tools by using AIS 2008 and AIS 98. We used all major trauma patients hospitalized to the Royal Perth Hospital between 1994 and 2008. We selected five AIS-based injury severity scoring tools, including Injury Severity Score (ISS), New Injury Severity Score (NISS), modified Anatomic Profile (mAP), Trauma and Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOT). We selected survival after injury as a target outcome. We used the area under the Receiver Operating Characteristic curve (AUROC) as a performance measure. First, we compared the five tools using all cases whose records included all variables for the TRISS (complete dataset) using a 10-fold cross-validation. Second, we compared the ISS and NISS for AIS 98 and AIS 2008 using all subjects (whole dataset). We identified 1,269 and 4,174 cases for a complete dataset and a whole dataset, respectively. With the 10-fold cross-validation, there were no clear differences in the AUROCs between the AIS 98- and AIS 2008-based scores. With the second comparison, the AIS 98-based ISS performed significantly worse than the AIS 2008-based ISS (p<0.0001), while there was no significant difference between the AIS 98- and AIS 2008-based NISSs. Researchers should be aware of these findings when they select an injury severity scoring tool for their studies.

  13. Specific abbreviated injury scale values are responsible for the underestimation of mortality in penetrating trauma patients by the injury severity score.

    PubMed

    Rowell, Susan E; Barbosa, Ronald R; Diggs, Brian S; Schreiber, Martin A; Holcomb, J B; Wade, C E; Brasel, K J; Vercruysse, G; MacLeod, J; Dutton, R P; Hess, J R; Duchesne, J C; McSwain, N E; Muskat, P; Johannigamn, J; Cryer, H M; Tillou, A; Cohen, M J; Pittet, J F; Knudson, P; De Moya, M A; Schreiber, M A; Tieu, B; Brundage, S; Napolitano, L M; Brunsvold, M; Sihler, K C; Beilman, G; Peitzman, A B; Zenait, M S; Sperry, J; Alarcon, L; Croce, M A; Minei, J P; Kozar, R; Gonzalez, E A; Stewart, R M; Cohn, S M; Mickalek, J E; Bulger, E M; Cotton, B A; Nunez, T C; Ivatury, R; Meredith, J W; Miller, P; Pomper, J; Marin, B

    2011-08-01

    The Injury Severity Score (ISS) is widely used as a method for rating severity of injury. The ISS is the sum of the squares of the three worst Abbreviated Injury Scale (AIS) values from three body regions. Patients with penetrating injuries tend to have higher mortality rates for a given ISS than patients with blunt injuries. This is thought to be secondary to the increased prevalence of multiple severe injuries in the same body region in patients with penetrating injuries, which the ISS does not account for. We hypothesized that the mechanism-based difference in mortality could be attributed to certain ISS ranges and specific AIS values by body region. Outcome and injury scoring data were obtained from transfused patients admitted to 23 Level I trauma centers. ISS values were grouped into categories, and a logistic regression model was created. Mortality for each ISS category was determined and compared with the ISS 1 to 15 group. An interaction term was added to evaluate the effect of mechanism. Additional logistic regression models were created to examine each AIS category individually. There were 2,292 patients in the cohort. An overall interaction between ISS and mechanism was observed (p = 0.049). Mortality rates between blunt and penetrating patients with an ISS between 25 and 40 were significantly different (23.6 vs. 36.1%; p = 0.022). Within this range, the magnitude of the difference in mortality was far higher for penetrating patients with head injuries (75% vs. 37% for blunt) than truncal injuries (26% vs. 17% for blunt). Penetrating trauma patients with an AIS head of 4 or 5, AIS abdomen of 3, or AIS extremity of 3 all had adjusted mortality rates higher than blunt trauma patients with those values. Significant differences in mortality between blunt and penetrating trauma patients exist at certain ISS and AIS category values. The mortality difference is greatest for head injured patients.

  14. [The Abbreviated Injury Scale (AIS). Options and problems in application].

    PubMed

    Haasper, C; Junge, M; Ernstberger, A; Brehme, H; Hannawald, L; Langer, C; Nehmzow, J; Otte, D; Sander, U; Krettek, C; Zwipp, H

    2010-05-01

    The new AIS (Abbreviated Injury Scale) was released with an update by the AAAM (Association for the Advancement of Automotive Medicine) in 2008. It is a universal scoring system in the field of trauma applicable in clinic and research. In engineering it is used as a classification system for vehicle safety. The AIS can therefore be considered as an international, interdisciplinary and universal code of injury severity. This review focuses on a historical overview, potential applications and new coding options in the current version and also outlines the associated problems.

  15. Comparison of Turkish Injury Scale (TIS) with the Abbreviated Injury Scale (AIS).

    PubMed

    Günay, Yasemin; Yavuz, M Fatih; Eşiyok, Burcu

    2003-03-12

    According to the Turkish Penal Code, Section 456, an assailant is punished in a correlation to the severity of the victim's injury. In this study, the injury scale used in Turkey in the basis code 456 is compared with Abbreviated Injury Scale (AIS). For this aim, a total of 984 cases out of the total amount reported at the Traumatology Section of the Turkish Council for Forensic Medicine were randomly selected and evaluated retrospectively. In all, 40.7% of injuries were caused by blunt trauma, whereas 59.3% were caused by a penetrating trauma. According to the Turkish Injury Scale (TIS), 40.3% of the cases were scored to be of a first degree of injury, 15.6% as second degree and 44.1% as third degree. When compared, the score points 3, 4 and 5 in the AIS were seen to be nearly equivalent to the TIS of third degree. From this point of view, in the modified AIS 91.1% of first degree of injury, 51.2% of second degree and 97.2% of third degree of injury are harmonious with TIS. Generally, 83.2% of the cases are harmonious with the AIS system. The purpose of this study is to determine what was the source of differences and to focus on particular traumatic lesions in order to determine a possible rearrangement of the Turkish Injury Scale.

  16. Sorting variables for each case: a new algorithm to calculate injury severity score (ISS) using SPSS-PC.

    PubMed

    Linn, S

    One of the more often used measures of multiple injuries is the injury severity score (ISS). Determination of the ISS is based on the abbreviated injury scale (AIS). This paper suggests a new algorithm to sort the AISs for each case and calculate ISS. The program uses unsorted abbreviated injury scale (AIS) levels for each case and rearranges them in descending order. The first three sorted AISs representing the three most severe injuries of a person are then used to calculate injury severity score (ISS). This algorithm should be useful for analyses of clusters of injuries especially when more patients have multiple injuries.

  17. Defining major trauma using the 2008 Abbreviated Injury Scale.

    PubMed

    Palmer, Cameron S; Gabbe, Belinda J; Cameron, Peter A

    2016-01-01

    The Injury Severity Score (ISS) is the most ubiquitous summary score derived from Abbreviated Injury Scale (AIS) data. It is frequently used to classify patients as 'major trauma' using a threshold of ISS >15. However, it is not known whether this is still appropriate, given the changes which have been made to the AIS codeset since this threshold was first used. This study aimed to identify appropriate ISS and New Injury Severity Score (NISS) thresholds for use with the 2008 AIS (AIS08) which predict mortality and in-hospital resource use comparably to ISS >15 using AIS98. Data from 37,760 patients in a state trauma registry were retrieved and reviewed. AIS data coded using the 1998 AIS (AIS98) were mapped to AIS08. ISS and NISS were calculated, and their effects on patient classification compared. The ability of selected ISS and NISS thresholds to predict mortality or high-level in-hospital resource use (the need for ICU or urgent surgery) was assessed. An ISS >12 using AIS08 was similar to an ISS >15 using AIS98 in terms of both the number of patients classified major trauma, and overall major trauma mortality. A 10% mortality level was only seen for ISS 25 or greater. A NISS >15 performed similarly to both of these ISS thresholds. However, the AIS08-based ISS >12 threshold correctly classified significantly more patients than a NISS >15 threshold for all three severity measures assessed. When coding injuries using AIS08, an ISS >12 appears to function similarly to an ISS >15 in AIS98 for the purposes of identifying a population with an elevated risk of death after injury. Where mortality is a primary outcome of trauma monitoring, an ISS >12 threshold could be adopted to identify major trauma patients. Level II evidence--diagnostic tests and criteria. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. The Abbreviated Injury Scale and its correlation with preventable traumatic accidental deaths: a study from South Delhi.

    PubMed

    Rautji, R; Bhardwaj, D N; Dogra, T D

    2006-04-01

    Anatomic trauma scoring systems are fundamental to trauma research. The Abbreviated Injury Scale (AIS) and its derivative, the Injury Severity Score (ISS), are the most frequently used scales. In a prospective study, 400 autopsies of road traffic accident victims performed between January 2002 and December 2003 were coded according to the AIS and ISS methods. All the cases were classified into different injury groups according to the Injury Severity Scale. Fifty-eight cases (14.5%) were assigned an ISS value of <25; 244 (61%) cases were valued between 25-49; 38 cases (9.5%) were valued between 50-74 and 60 (15%) cases had a value of 75. On analysis of medical care, in cases with ISS<50, about 96% of the victims did not receive optimal care quickly enough with a lack of pre-hospital resuscitation measures and lengthy transportation time to hospital being of major importance.

  19. Abbreviated Injury Scale: not a reliable basis for summation of injury severity in trauma facilities?

    PubMed

    Ringdal, Kjetil G; Skaga, Nils Oddvar; Hestnes, Morten; Steen, Petter Andreas; Røislien, Jo; Rehn, Marius; Røise, Olav; Krüger, Andreas J; Lossius, Hans Morten

    2013-05-01

    Injury severity is most frequently classified using the Abbreviated Injury Scale (AIS) as a basis for the Injury Severity Score (ISS) and the New Injury Severity Score (NISS), which are used for assessment of overall injury severity in the multiply injured patient and in outcome prediction. European trauma registries recommended the AIS 2008 edition, but the levels of inter-rater agreement and reliability of ISS and NISS, associated with its use, have not been reported. Nineteen Norwegian AIS-certified trauma registry coders were invited to score 50 real, anonymised patient medical records using AIS 2008. Rater agreements for ISS and NISS were analysed using Bland-Altman plots with 95% limits of agreement (LoA). A clinically acceptable LoA range was set at ± 9 units. Reliability was analysed using a two-way mixed model intraclass correlation coefficient (ICC) statistics with corresponding 95% confidence intervals (CI) and hierarchical agglomerative clustering. Ten coders submitted their coding results. Of their AIS codes, 2189 (61.5%) agreed with a reference standard, 1187 (31.1%) real injuries were missed, and 392 non-existing injuries were recorded. All LoAs were wider than the predefined, clinically acceptable limit of ± 9, for both ISS and NISS. The joint ICC (range) between each rater and the reference standard was 0.51 (0.29,0.86) for ISS and 0.51 (0.27,0.78) for NISS. The joint ICC (range) for inter-rater reliability was 0.49 (0.19,0.85) for ISS and 0.49 (0.16,0.82) for NISS. Univariate linear regression analyses indicated a significant relationship between the number of correctly AIS-coded injuries and total number of cases coded during the rater's career, but no significant relationship between the rater-against-reference ISS and NISS ICC values and total number of cases coded during the rater's career. Based on AIS 2008, ISS and NISS were not reliable for summarising anatomic injury severity in this study. This result indicates a limitation in their use

  20. Improving the sensitivity and specificity of the abbreviated injury scale coding system.

    PubMed Central

    Kramer, C F; Barancik, J I; Thode, H C

    1990-01-01

    The Abbreviated Injury Scale with Epidemiologic Modifications (AIS 85-EM) was developed to make it possible to code information about anatomic injury types and locations that, although generally available from medical records, is not codable under the standard Abbreviated Injury Scale, published by the American Association for Automotive Medicine in 1985 (AIS 85). In a population-based sample of 3,223 motor vehicle trauma cases, 68 percent of the patients had one or more injuries that were coded to the AIS 85 body region nonspecific category external. When the same patients' injuries were coded using the AIS 85-EM coding procedure, only 15 percent of the patients had injuries that could not be coded to a specific body region. With AIS 85-EM, the proportion of codable head injury cases increased from 16 percent to 37 percent, thereby improving the potential for identifying cases with head and threshold brain injury. The data suggest that body region coding of all injuries is necessary to draw valid and reliable conclusions about changes in injury patterns and their sequelae. The increased specificity of body region coding improves assessments of the efficacy of injury intervention strategies and countermeasure programs using epidemiologic methodology. PMID:2116633

  1. Blunt gastric injuries.

    PubMed

    Oncel, Didem; Malinoski, Darren; Brown, Carlos; Demetriades, Demetrios; Salim, Ali

    2007-09-01

    Gastric rupture after blunt abdominal trauma is a rare injury with few reports in the literature. The purpose of this study was to review our experience with blunt gastric injuries and compare outcomes with small bowel or colon injuries. All patients with hollow viscus perforations after blunt abdominal trauma from 1992 to 2005 at our level I trauma center were reviewed. Of 35,033 blunt trauma admissions, there were 268 (0.7%) patients with a total of 319 perforating hollow viscus injuries, 25 (0.07%) of which were blunt gastric injuries. When compared with the small bowel or colon injuries, the blunt gastric injury group had a higher Injury Severity Score (22 versus 17, P = 0.04), more patients with a chest Abbreviated Injury Score greater than 2 (36% versus 12%, P < 0.01), and a shorter interval from injury to laparotomy (221 versus 366 minutes, P = 0.017). Multivariate analysis identified five independent risk factors for mortality: age older than 55 years, head Abbreviated Injury Score greater than 2, chest Abbreviated Injury Score greater than 2, the presence of hypotension on admission, and Glasgow Coma Scale 8 or less. The results of this study suggest that mortality in patients with blunt hollow viscus injuries can be attributed to concurrent head and chest injuries, but not the specific hollow viscus organ that is injured.

  2. Classification of the severe trauma patient with the Abbreviated Injury Scale: degree of correlation between versions 98 and 2005 (2008 update).

    PubMed

    Abajas Bustillo, Rebeca; Leal Costa, César; Ortego Mate, María Del Carmen; Zonfrillo, Mark R; Seguí Gómez, María; Durá Ros, María Jesús

    2018-02-01

    To explore differences in severity classifications according to 2 versions of the Abbreviated Injury Scale (AIS): version 2005 (the 2008 update) and the earlier version 98. To determine whether possible differences might have an impact on identifying severe trauma patients. Descriptive study and cross-sectional analysis of a case series of patients admitted to two spanish hospitals with out-of-hospital injuries between February 2012 and February 2013. For each patient we calculated the Injury Severity Score (ISS), the New Injury Severity Score (NISS), and the AIS scores according to versions 98 and 2005. The sample included 699 cases. The mean Severity (SD) age of patients was 52.7 (29.2) years, and 388 (55.5%) were males. Version 98 of the AIS correlated more strongly with both the ISS (2.6%) and the NISS (2.9%). The 2008 update of the AIS (version 2005) classified fewer trauma patients than version 98 at the severity levels indicated by the ISS and NISS.

  3. Development of a time sensitivity score for frequently occurring motor vehicle crash injuries.

    PubMed

    Schoell, Samantha L; Doud, Andrea N; Weaver, Ashley A; Talton, Jennifer W; Barnard, Ryan T; Martin, R Shayn; Meredith, J Wayne; Stitzel, Joel D

    2015-03-01

    Injury severity alone is a poor indicator of the time sensitivity of injuries. The purpose of the study was to quantify the urgency with which the most frequent motor vehicle crash injuries require treatment, according to expert physicians. The time sensitivity was quantified for the top 95% most frequently occurring Abbreviated Injury Scale (AIS) 2+ injuries in the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) 2000-2011. A Time Sensitivity Score was developed using expert physician survey data in which physicians were asked to determine whether a particular injury should go to a Level I/II trauma center and the urgency with which that injury required treatment. When stratifying by AIS severity, the mean Time Sensitivity Score increased with increasing AIS severity. The mean Time Sensitivity Scores by AIS severity were as follows: 0.50 (AIS 2); 0.78 (AIS 3); 0.92 (AIS 4); 0.97 (AIS 5); and 0.97 (AIS 6). When stratifying by anatomical region, the head, thorax, and abdomen were the most time sensitive. Appropriate triage depends on multiple factors, including the severity of an injury, the urgency with which it requires treatment, and the propensity of a significant injury to be missed. The Time Sensitivity Score did not correlate highly with the widely used AIS severity scores, which highlights the inability of AIS scores to capture all aspects of injury severity. The Time Sensitivity Score can be useful in Advanced Automatic Crash Notification systems for identifying highly time sensitive injuries in motor vehicle crashes requiring prompt treatment at a trauma center. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Interobserver Variability in Injury Severity Scoring After Combat Trauma: Different Perspectives, Different Values?

    PubMed

    Smith, Iain M; Naumann, David N; Guyver, Paul; Bishop, Jonathan; Davies, Simon; Lundy, Jonathan B; Bowley, Douglas M

    2015-01-01

    Anatomic measures of injury burden provide key information for studies of prehospital and in-hospital trauma care. The military version of the Abbreviated Injury Scale [AIS(M)] is used to score injuries in deployed military hospitals. Estimates of total trauma burden are derived from this. These scores are used for categorization of patients, assessment of care quality, and research studies. Scoring is normally performed retrospectively from chart review. We compared data recorded in the UK Joint Theatre Trauma Registry (JTTR) and scores calculated independently at the time of surgery by the operating surgeons to assess the concordance between surgeons and trauma nurse coordinators in assigning injury severity scores. Trauma casualties treated at a deployed Role 3 hospital were assigned AIS(M) scores by surgeons between 24 September 2012 and 16 October 2012. JTTR records from the same period were retrieved. The AIS(M), Injury Severity Score (ISS), and New Injury Severity Score (NISS) were compared between datasets. Among 32 matched casualties, 214 injuries were recorded in the JTTR, whereas surgeons noted 212. Percentage agreement for number of injuries was 19%. Surgeons scored 75 injuries as "serious" or greater compared with 68 in the JTTR. Percentage agreement for the maximum AIS(M), ISS, and NISS assigned to cases was 66%, 34%, and 28%, respectively, although the distributions of scores were not statistically different (median ISS: surgeons: 20 [interquartile range (IQR), 9-28] versus JTTR: 17.5 [IQR, 9-31.5], p = .7; median NISS: surgeons: 27 [IQR, 12-42] versus JTTR: 25.5 [IQR, 11.5-41], p = .7). There are discrepancies in the recording of AIS(M) between surgeons directly involved in the care of trauma casualties and trauma nurse coordinators working by retrospective chart review. Increased accuracy might be achieved by actively collaborating in this process. 2015.

  5. Total Intravenous Anesthesia Including Ketamine versus Volatile Gas Anesthesia for Combat-related Operative Traumatic Brain Injury

    DTIC Science & Technology

    2008-07-01

    receiving VGA with regard to Injury Severity Score, Glasgow Coma Scale score, base deficit, Head Abbreviated Injury Score, and craniectomy or craniotomy ...1, 2, or 3. Craniectomy or craniotomy was performed at the discretion of the neurosurgeon based on type of skull injury, severity of injury, and...perfectly on GCS ( 8, 8), base deficit ( 6, 6), Head Abbreviated Injury Score ( 3, 3) and craniectomy versus craniotomy . From these, subsets

  6. Developing a cumulative anatomic scoring system for military perineal and pelvic blast injuries.

    PubMed

    Mossadegh, Somayyeh; Midwinter, M; Parker, P

    2013-03-01

    Improvised explosive device (IED) yields in Afghanistan have increased resulting in more proximal injuries. The injury severity score (ISS) is an anatomic aggregate score of the three most severely injured anatomical areas but does not accurately predict severity in IED related pelvi-perineal trauma patients. A scoring system based on abbreviated injury score (AIS) was developed to reflect the severity of these injuries in order to better understand risk factors, develop a tool for future audit and improve performance. Using standard AIS descriptors, injury scales were constructed for the pelvis (1, minor to 6, maximal). The perineum was divided into anterior and posterior zones as relevant to injury patterns and blast direction with each soft tissue structure being allocated a score from its own severity scale. A cumulative score, from 1 to 36 for soft tissue, or a maximum of 42 if a pelvic fracture was involved, was created for all structures injured in the anterior and posterior zones. Using this new scoring system, 77% of patients survived with a pelvi-perineal trauma score (PPTS) below 5. There was a significant increase in mortality, number of pelvic fractures and amputations with increase in score when comparing the first group (score 1-5) to the second group (score 6-10). For scores between 6 and 16 survival was 42% and 22% for scores between 17 and 21. In our cohort of 62 survivors, 1 patient with an IED related pelvi-perineal injury had a 'theoretically un-survivable' maximal ISS of 75 and survived, whereas there were no survivors with a PPTS greater than 22 but this group had no-one with an ISS of 75 suggesting ISS is not an accurate reflection of the true severity of pelvi-perineal blast injury. This scoring system is the initial part of a more complex logistic regression model that will contribute towards a unique trauma scoring system to aid surgical teams in predicting fluid requirements and operative timelines. In austere environments, it may also

  7. National trends in pediatric blunt spleen and liver injury management and potential benefits of an abbreviated bed rest protocol.

    PubMed

    Dodgion, Christopher M; Gosain, Ankush; Rogers, Andrew; St Peter, Shawn D; Nichol, Peter F; Ostlie, Daniel J

    2014-06-01

    Recent reports suggest that an abbreviated bed rest protocol (ABRP) may safely reduce length of stay (LOS) and resource utilization in pediatric blunt spleen and liver injury (BSLI) patients. This study evaluates national temporal trends in BLSI management and estimates national reduction in LOS using an ABRP. Pediatric patients (<18 years old) sustaining BLSI were identified in the Kids' Inpatient Database from 2000 to 2009. Yearly rates of injury and operative intervention were examined and stratified by type of injury. APSA guidelines and the reported ABRP were applied based on abbreviated injury score (AIS) and compared with actual LOS. 22,153 patients were identified. Over the study period, operative rates for spleen and liver injuries and overall mortality significantly declined: LOS=3.1 days (±1.6) and 2.7 days (±1.9) for spleen and liver, respectively. If APSA guidelines were followed, the rates were LOS=3.7 days (±1.1) and 3.4 days (±0.7), respectively. Application of the ABRP would result in LOS=1.3 days (±0.5) for all BSLI patients. An ABRP could potentially save 1.7 hospital days/patient or 36,964 patient hospital days nationally. Our study confirms a significant national decrease in operative intervention and overall mortality in patients with BSLI. Additionally, it appears that a shorter observation period than the APSA guidelines is being utilized. The implementation of ABRP holds potential in further reducing LOS and resource utilization. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. New Methodology for an Expert-Designed Map From International Classification of Diseases (ICD) to Abbreviated Injury Scale (AIS) 3+ Severity Injury.

    PubMed

    Zonfrillo, Mark R; Weaver, Ashley A; Gillich, Patrick J; Price, Janet P; Stitzel, Joel D

    2015-01-01

    There has been a longstanding desire for a map to convert International Classification of Diseases (ICD) injury codes to Abbreviated Injury Scale (AIS) codes to reflect the severity of those diagnoses. The Association for the Advancement of Automotive Medicine (AAAM) was tasked by European Union representatives to create a categorical map classifying diagnoses codes as serious injury (Abbreviated Injury Scale [AIS] 3+), minor/moderate injury (AIS 1/2), or indeterminate. This study's objective was to map injury-related ICD-9-CM (clinical modification) and ICD-10-CM codes to these severity categories. Approximately 19,000 ICD codes were mapped, including injuries from the following categories: amputations, blood vessel injury, burns, crushing injury, dislocations/sprains/strains, foreign body, fractures, internal organ, nerve/spinal cord injury, intracranial, laceration, open wounds, and superficial injury/contusion. Two parallel activities were completed to create the maps: (1) An in-person expert panel and (2) an electronic survey. The panel consisted of expert users of AIS and ICD from North America, the United Kingdom, and Australia. The panel met in person for 5 days, with follow-up virtual meetings to create and revise the maps. Additional qualitative data were documented to resolve potential discrepancies in mapping. The electronic survey was completed by 95 injury coding professionals from North America, Spain, Australia, and New Zealand over 12 weeks. ICD-to-AIS maps were created for: ICD-9-CM and ICD-10-CM. Both maps indicated whether the corresponding AIS 2005/Update 2008 severity score for each ICD code was AIS 3+, 1/2, or indeterminable. Though some ICD codes could be mapped to multiple AIS codes, the maximum severity of all potentially mapped injuries determined the final severity categorization. The in-person panel consisted of 13 experts, with 11 Certified AIS specialists (CAISS) with a median of 8 years and an average of 15 years of coding experience

  9. Predicting work-related disability and medical cost outcomes: a comparison of injury severity scoring methods.

    PubMed

    Sears, Jeanne M; Blanar, Laura; Bowman, Stephen M

    2014-01-01

    Acute work-related trauma is a leading cause of death and disability among U.S. workers. Occupational health services researchers have described the pressing need to identify valid injury severity measures for purposes such as case-mix adjustment and the construction of appropriate comparison groups in programme evaluation, intervention, quality improvement, and outcome studies. The objective of this study was to compare the performance of several injury severity scores and scoring methods in the context of predicting work-related disability and medical cost outcomes. Washington State Trauma Registry (WTR) records for injuries treated from 1998 to 2008 were linked with workers' compensation claims. Several Abbreviated Injury Scale (AIS)-based injury severity measures (ISS, New ISS, maximum AIS) were estimated directly from ICD-9-CM codes using two software packages: (1) ICDMAP-90, and (2) Stata's user-written ICDPIC programme (ICDPIC). ICDMAP-90 and ICDPIC scores were compared with existing WTR scores using the Akaike Information Criterion, amount of variance explained, and estimated effects on outcomes. Competing risks survival analysis was used to evaluate work disability outcomes. Adjusted total medical costs were modelled using linear regression. The linked sample contained 6052 work-related injury events. There was substantial agreement between WTR scores and those estimated by ICDMAP-90 (kappa=0.73), and between WTR scores and those estimated by ICDPIC (kappa=0.68). Work disability and medical costs increased monotonically with injury severity, and injury severity was a significant predictor of work disability and medical cost outcomes in all models. WTR and ICDMAP-90 scores performed better with regard to predicting outcomes than did ICDPIC scores, but effect estimates were similar. Of the three severity measures, maxAIS was usually weakest, except when predicting total permanent disability. Injury severity was significantly associated with work disability

  10. A comparison of the Injury Severity Score and the Trauma Mortality Prediction Model.

    PubMed

    Cook, Alan; Weddle, Jo; Baker, Susan; Hosmer, David; Glance, Laurent; Friedman, Lee; Osler, Turner

    2014-01-01

    Performance benchmarking requires accurate measurement of injury severity. Despite its shortcomings, the Injury Severity Score (ISS) remains the industry standard 40 years after its creation. A new severity measure, the Trauma Mortality Prediction Model (TMPM), uses either the Abbreviated Injury Scale (AIS) or DRG International Classification of Diseases-9th Rev. (ICD-9) lexicons and may better quantify injury severity compared with ISS. We compared the performance of TMPM with ISS and other measures of injury severity in a single cohort of patients. We included 337,359 patient records with injuries reliably described in both the AIS and the ICD-9 lexicons from the National Trauma Data Bank. Five injury severity measures (ISS, maximum AIS score, New Injury Severity Score [NISS], ICD-9-Based Injury Severity Score [ICISS], TMPM) were computed using either the AIS or ICD-9 codes. These measures were compared for discrimination (area under the receiver operating characteristic curve), an estimate of proximity to a model that perfectly predicts the outcome (Akaike information criterion), and model calibration curves. TMPM demonstrated superior receiver operating characteristic curve, Akaike information criterion, and calibration using either the AIS or ICD-9 lexicons. Calibration plots demonstrate the monotonic characteristics of the TMPM models contrasted by the nonmonotonic features of the other prediction models. Severity measures were more accurate with the AIS lexicon rather than ICD-9. NISS proved superior to ISS in either lexicon. Since NISS is simpler to compute, it should replace ISS when a quick estimate of injury severity is required for AIS-coded injuries. Calibration curves suggest that the nonmonotonic nature of ISS may undermine its performance. TMPM demonstrated superior overall mortality prediction compared with all other models including ISS whether the AIS or ICD-9 lexicons were used. Because TMPM provides an absolute probability of death, it may

  11. Defining acute aortic syndrome after trauma: Are Abbreviated Injury Scale codes a useful surrogate descriptor?

    PubMed

    Leach, R; McNally, Donal; Bashir, Mohamad; Sastry, Priya; Cuerden, Richard; Richens, David; Field, Mark

    2012-10-01

    The severity and location of injuries resulting from vehicular collisions are normally recorded in Abbreviated Injury Scale (AIS) code; we propose a system to link AIS code to a description of acute aortic syndrome (AAS), thus allowing the hypothesis that aortic injury is progressive with collision kinematics to be tested. Standard AIS codes were matched with a clinical description of AAS. A total of 199 collisions that resulted in aortic injury were extracted from a national automotive collision database and the outcomes mapped onto AAS descriptions. The severity of aortic injury (AIS severity score) and stage of AAS progression were compared with collision kinematics and occupant demographics. Post hoc power analyses were used to estimate maximum effect size. The general demographic distribution of the sample represented that of the UK population in regard to sex and age. No significant relationship was observed between estimated test speed, collision direction, occupant location or seat belt use and clinical progression of aortic injury (once initiated). Power analysis confirmed that a suitable sample size was used to observe a medium effect in most of the cases. Similarly, no association was observed between injury severity and collision kinematics. There is sufficient information on AIS severity and location codes to map onto the clinical AAS spectrum. It was not possible, with this data set, to consider the influence of collision kinematics on aortic injury initiation. However, it was demonstrated that after initiation, further progression along the AAS pathway was not influenced by collision kinematics. This might be because the injury is not progressive, because the vehicle kinematics studied do not fully represent the kinematics of the occupants, or because an unknown factor, such as stage of cardiac cycle, dominates. Epidemiologic/prognostic study, level IV.

  12. Risk factors affecting injury severity determined by the MAIS score.

    PubMed

    Ferreira, Sara; Amorim, Marco; Couto, Antonio

    2017-07-04

    Traffic crashes result in a loss of life but also impact the quality of life and productivity of crash survivors. Given the importance of traffic crash outcomes, the issue has received attention from researchers and practitioners as well as government institutions, such as the European Commission (EC). Thus, to obtain detailed information on the injury type and severity of crash victims, hospital data have been proposed for use alongside police crash records. A new injury severity classification based on hospital data, called the maximum abbreviated injury scale (MAIS), was developed and recently adopted by the EC. This study provides an in-depth analysis of the factors that affect injury severity as classified by the MAIS score. In this study, the MAIS score was derived from the International Classification of Diseases. The European Union adopted an MAIS score equal to or greater than 3 as the definition for a serious traffic crash injury. Gains are expected from using both police and hospital data because the injury severities of the victims are detailed by medical staff and the characteristics of the crash and the site of its occurrence are also provided. The data were obtained by linking police and hospital data sets from the Porto metropolitan area of Portugal over a 6-year period (2006-2011). A mixed logit model was used to understand the factors that contribute to the injury severity of traffic victims and to explore the impact of these factors on injury severity. A random parameter approach offers methodological flexibility to capture individual-specific heterogeneity. Additionally, to understand the importance of using a reliable injury severity scale, we compared MAIS with length of hospital stay (LHS), a classification used by several countries, including Portugal, to officially report injury severity. To do so, the same statistical technique was applied using the same variables to analyze their impact on the injury severity classified according to LHS

  13. Differences and discrepancies between 2005 and 2008 Abbreviated Injury Scale versions - time to standardise

    PubMed Central

    2012-01-01

    The aim of this letter is to facilitate the standardisation of Abbreviated Injury Scale (AIS) codesets used to code injuries in trauma registries. We have compiled a definitive list of the changes which have been implemented between the AIS 2005 and Update 2008 versions. While the AIS 2008 codeset appears to have remained consistent since its release, we have identified discrepancies between the codesets in copies of AIS 2005 dictionaries. As a result, we recommend that use of the AIS 2005 should be discontinued in favour of the Update 2008 version. PMID:22301065

  14. Differences and discrepancies between 2005 and 2008 Abbreviated Injury Scale versions - time to standardise.

    PubMed

    Ringdal, Kjetil G; Hestnes, Morten; Palmer, Cameron S

    2012-02-02

    The aim of this letter is to facilitate the standardisation of Abbreviated Injury Scale (AIS) codesets used to code injuries in trauma registries. We have compiled a definitive list of the changes which have been implemented between the AIS 2005 and Update 2008 versions. While the AIS 2008 codeset appears to have remained consistent since its release, we have identified discrepancies between the codesets in copies of AIS 2005 dictionaries. As a result, we recommend that use of the AIS 2005 should be discontinued in favour of the Update 2008 version.

  15. Changing to AIS 2005 and agreement of injury severity scores in a trauma registry with scores based on manual chart review.

    PubMed

    Stewart, Kenneth E; Cowan, Linda D; Thompson, David M

    2011-09-01

    The Abbreviated Injury Scale (AIS) recently underwent a major revision from AIS 98 to AIS 05. AIS injury codes form the basis of widely used injury severity scores such as the injury severity score (ISS). ISS thresholds are often used in trauma case definitions and ISS is widely used in injury research to adjust for injury severity. This study evaluated changes from AIS 98 to AIS 05, the changes' effect on ISS distributions, and presents an application of the results. Injury descriptions from medical records of 137 randomly selected patients in the Oklahoma Trauma Registry (OTR) were obtained. A single trained coder used AIS 98 and AIS 05 to code each injury. ISS values were calculated and grouped into 4 categories: 1-8, 9-14, 16-24, >24. Paired ISS was compared using Kappa statistics and tests of symmetry. We identified common injury diagnoses for which AIS severity changed between versions. Estimates of the proportion of patients changing ISS groups were applied to the entire OTR to assess the impact on reporting and on a model for reimbursement. OTR AIS 98 and manual AIS 98-based ISS values had a weighted Kappa of 0.71. OTR AIS 98 and manual AIS 05-based ISS values had a Kappa of 0.58. Manual AIS 98 and manual AIS 05 ISS had the highest Kappa of 0.81, however, though the scores differed by only 1 ISS category, there were 30 discordant pairs. The distribution of these discordant pairs was not symmetrical (Bowker's S=30; df=6; p<0.0001) with AIS 05-based ISS values consistently shifted to a lower ISS category. Reductions in AIS severity and ISS values using AIS 05 were common for extremity fractures and thorax injuries. The results suggest fewer patients would be reported to the OTR or be eligible for reimbursement. Changing from AIS 98 to AIS 05 injury coding resulted in systematic changes in AIS codes and ISS. Specific injuries and body regions were differentially affected. Trauma registries and injury researchers that use AIS based injury coding can use this

  16. The value of the injury severity score in pediatric trauma: Time for a new definition of severe injury?

    PubMed

    Brown, Joshua B; Gestring, Mark L; Leeper, Christine M; Sperry, Jason L; Peitzman, Andrew B; Billiar, Timothy R; Gaines, Barbara A

    2017-06-01

    The Injury Severity Score (ISS) is the most commonly used injury scoring system in trauma research and benchmarking. An ISS greater than 15 conventionally defines severe injury; however, no studies evaluate whether ISS performs similarly between adults and children. Our objective was to evaluate ISS and Abbreviated Injury Scale (AIS) to predict mortality and define optimal thresholds of severe injury in pediatric trauma. Patients from the Pennsylvania trauma registry 2000-2013 were included. Children were defined as younger than 16 years. Logistic regression predicted mortality from ISS for children and adults. The optimal ISS cutoff for mortality that maximized diagnostic characteristics was determined in children. Regression also evaluated the association between mortality and maximum AIS in each body region, controlling for age, mechanism, and nonaccidental trauma. Analysis was performed in single and multisystem injuries. Sensitivity analyses with alternative outcomes were performed. Included were 352,127 adults and 50,579 children. Children had similar predicted mortality at ISS of 25 as adults at ISS of 15 (5%). The optimal ISS cutoff in children was ISS greater than 25 and had a positive predictive value of 19% and negative predictive value of 99% compared to a positive predictive value of 7% and negative predictive value of 99% for ISS greater than 15 to predict mortality. In single-system-injured children, mortality was associated with head (odds ratio, 4.80; 95% confidence interval, 2.61-8.84; p < 0.01) and chest AIS (odds ratio, 3.55; 95% confidence interval, 1.81-6.97; p < 0.01), but not abdomen, face, neck, spine, or extremity AIS (p > 0.05). For multisystem injury, all body region AIS scores were associated with mortality except extremities. Sensitivity analysis demonstrated ISS greater than 23 to predict need for full trauma activation, and ISS greater than 26 to predict impaired functional independence were optimal thresholds. An ISS greater than 25

  17. Estimating severity of burn in children: Pediatric Risk of Mortality (PRISM) score versus Abbreviated Burn Severity Index (ABSI).

    PubMed

    Berndtson, Allison E; Sen, Soman; Greenhalgh, David G; Palmieri, Tina L

    2013-09-01

    The purpose of our study is to validate the Pediatric Risk of Mortality (PRISM) score and compare the accuracy of PRISM predicted outcomes to the Abbreviated Burn Severity Index (ABSI). We hypothesized that the PRISM score is more accurate in predicting mortality and hospital length of stay than the ABSI in children with severe burns. All children <18 years of age admitted to a regional pediatric burn center between January 1, 2008 and July 1, 2010 were reviewed. Those with a Total Body Surface Area (TBSA) burn ≥20% who were admitted within 7 days of injury were selected for our study. Measured parameters included: demographics, burn characteristics, PRISM and ABSI scores at admission, and outcomes (mortality, hospital length of stay (LOS), ventilator days and cause of death). A total of 83 patients met criteria and had complete data sets. The mean age (±SEM) was 8.0±0.6 years, mean % TBSA burn 49.9±2.1%, 62.7% were male, and 45.8% had inhalation injury. Hospital LOS was 74.4±7.9 days, with 31.5±4.9 ventilator days. Mean PRISM score ranged from 14.2 to 16.0, with ABSI scores 7.9 to 8.5. Actual overall mortality was 18.1% compared to a PRISM predicted mortality of 19.8±2.5% (p<0.001, r=0.570). ABSI predicted mortality varied from 10 to 20% for a score of 7.9 to 30-50% for a score of 8.5. Logistic regression showed that both PRISM (p<0.001) and ABSI (p<0.001) mortality predictions accurately estimated actual mortality, which remained true in a combined model. ABSI was predictive of hospital LOS (p<0.001) and ventilator days (p<0.001) while PRISM was not (p=0.326 and p=0.863). Both PRISM and ABSI scores are predictive of mortality in severely burned children. Only ABSI correlates with hospital length of stay and ventilator days, and thus may also be more useful in predicting ICU resource utilization. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  18. Impact of the version of the abbreviated injury scale on injury severity characterization and quality assessment of trauma care.

    PubMed

    Tohira, Hideo; Jacobs, Ian; Matsuoka, Tetsuya; Ishikawa, Kazuo

    2011-07-01

    The Abbreviated Injury Scale (AIS) was updated in 2008 (AIS 2008). We aimed to investigate the impact of AIS 2008 on the characterization of injury severity and quality assessment of trauma care. We identified all blunt trauma patients in the Japan Trauma Data Bank. First, we converted AIS 98 codes to AIS 2008 codes using a mapping table. Next, we compared Injury Severity Scores (ISSs) and New ISSs (NISSs) based on AIS 98 and AIS 2008. We compared the proportion of major trauma (ISS >15) between the two AISs. We derived risk-adjusted models using the two AISs and separately ranked hospitals according to the observed-to-expected death (OE) ratio. We counted the number of performance outliers for the two rankings. We analyzed the association between the percent change in OE ratios and the proportion of NISS outliers (change in NISS of <-12). There were 19,899 subjects. The ISSs and NISSs based on AIS 2008 were significantly less than those based on AIS 98. The proportion of major trauma was 46.3% and 38.9% for AIS 98 and AIS 2008, respectively (p < 0.001). The numbers of performance outliers were different between the two rankings. There was a significant positive linear relationship between the percent change in the OE ratio and the proportion of NISS outliers. The use of different AIS versions influenced the selection of major trauma patients and affected the quality assessment of the trauma care. Researchers should be aware of these findings when selecting the version of the AIS.

  19. Ganga hospital open injury score in management of open injuries.

    PubMed

    Rajasekaran, S; Sabapathy, S R; Dheenadhayalan, J; Sundararajan, S R; Venkatramani, H; Devendra, A; Ramesh, P; Srikanth, K P

    2015-02-01

    Open injuries of the limbs offer challenges in management as there are still many grey zones in decision making regarding salvage, timing and type of reconstruction. As a result, there is still an unacceptable rate of secondary amputations which lead to tremendous waste of resources and psychological devastation of the patient and his family. Gustilo Anderson's classification was a major milestone in grading the severity of injury but however suffers from the disadvantages of imprecise definition, a poor interobserver correlation, inability to address the issue of salvage and inclusion of a wide spectrum of injuries in Type IIIb category. Numerous scores such as Mangled Extremity Severity Score, the Predictive Salvage Index, the Limb Salvage Index, Hannover Fracture Scale-97 etc have been proposed but all have the disadvantage of retrospective evaluation, inadequate sample sizes and poor sensitivity and specificity to amputation, especially in IIIb injuries. The Ganga Hospital Open Injury Score (GHOIS) was proposed in 2004 and is designed to specifically address the outcome in IIIb injuries of the tibia without vascular deficit. It evaluates the severity of injury to the three components of the limb--the skin, the bone and the musculotendinous structures separately on a grade from 0 to 5. Seven comorbid factors which influence the treatment and the outcome are included in the score with two marks each. The application of the total score and the individual tissue scores in management of IIIB injuries is discussed. The total score was shown to predict salvage when the value was 14 or less; amputation when the score was 17 and more. A grey zone of 15 and 16 is provided where the decision making had to be made on a case to case basis. The additional value of GHOIS was its ability to guide the timing and type of reconstruction. A skin score of more than 3 always required a flap and hence it indicated the need for an orthoplastic approach from the index procedure. Bone

  20. Fever Control Management Is Preferable to Mild Therapeutic Hypothermia in Traumatic Brain Injury Patients with Abbreviated Injury Scale 3-4: A Multi-Center, Randomized Controlled Trial.

    PubMed

    Hifumi, Toru; Kuroda, Yasuhiro; Kawakita, Kenya; Yamashita, Susumu; Oda, Yasutaka; Dohi, Kenji; Maekawa, Tsuyoshi

    2016-06-01

    In our prospective, multi-center, randomized controlled trial (RCT)-the Brain Hypothermia (B-HYPO) study-we could not show any difference on neurological outcomes in patients probably because of the heterogeneity in the severity of their traumatic condition. We therefore aimed to clarify and compare the effectiveness of the two therapeutic temperature management regimens in severe (Abbreviated Injury Scale [AIS] 3-4) or critical trauma patients (AIS 5). In the present post hoc B-HYPO study, we re-evaluated data based on the severity of trauma as AIS 3-4 or AIS 5 and compared Glasgow Outcome Scale score and mortality at 6 months by per-protocol analyses. Consequently, 135 patients were enrolled. Finally, 129 patients, that is, 47 and 31 patients with AIS 3-4 and 36 and 15 patients with AIS 5 were allocated to the mild therapeutic hypothermia (MTH) and fever control groups, respectively. No significant intergroup differences were observed with regard to age, gender, scores on head computed tomography (CT) scans, and surgical operation for traumatic brain injury (TBI), except for Injury Severity Score (ISS) in AIS 5. The fever control group demonstrated a significant reduction of TBI-related mortality compared with the MTH group (9.7% vs. 34.0%, p = 0.02) and an increase of favorable neurological outcomes (64.5% vs. 51.1%, p = 0.26) in patients with AIS 3-4, although the latter was not statistically significant. There was no difference in mortality or favorable outcome in patients with AIS 5. Fever control may be considered instead of MTH in patients with TBI (AIS 3-4).

  1. Validation of an abbreviated version of the Denver HIV risk score for prediction of HIV infection in an urban ED.

    PubMed

    Hsieh, Yu-Hsiang; Haukoos, Jason S; Rothman, Richard E

    2014-07-01

    We sought to evaluate the performance of an abbreviated version of the Denver HIV Risk Score in 2 urban emergency departments (ED) with known high undiagnosed HIV prevalence. We performed a secondary analysis of data collected prospectively between November 2005 and December 2009 as part of an ED-based nontargeted rapid HIV testing program from 2 sites. Demographics; HIV testing history; injection drug use; and select high-risk sexual behaviors, including men who have sex with men, were collected by standardized interview. Information regarding receptive anal intercourse and vaginal intercourse was either not collected or collected inconsistently and was thus omitted from the model to create its abbreviated version. The study cohort included 15184 patients with 114 (0.75%) newly diagnosed with HIV infection. HIV prevalence was 0.41% (95% confidence interval [CI], 0.21%-0.71%) for those with a score less than 20, 0.29% (95% CI, 0.14%-0.52%) for those with a score of 20 to 29, 0.65% (95% CI, 0.48%-0.87%) for those with a score of 30 to 39, 2.38% (95% CI, 1.68%-3.28%) for those with a score of 40 to 49, and 4.57% (95% CI, 2.09%-8.67%) for those with a score of 50 or higher. External validation resulted in good discrimination (area under the receiver operating characteristic curve, 0.75; 95% CI, 0.71-0.79). The calibration regression slope was 0.92 and its R(2) was 0.78. An abbreviated version of the Denver HIV Risk Score had comparable performance to that reported previously, offering a promising alternative strategy for HIV screening in the ED where limited sexual risk behavior information may be obtainable. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Fever Control Management Is Preferable to Mild Therapeutic Hypothermia in Traumatic Brain Injury Patients with Abbreviated Injury Scale 3–4: A Multi-Center, Randomized Controlled Trial

    PubMed Central

    Kuroda, Yasuhiro; Kawakita, Kenya; Yamashita, Susumu; Oda, Yasutaka; Dohi, Kenji; Maekawa, Tsuyoshi

    2016-01-01

    Abstract In our prospective, multi-center, randomized controlled trial (RCT)—the Brain Hypothermia (B-HYPO) study—we could not show any difference on neurological outcomes in patients probably because of the heterogeneity in the severity of their traumatic condition. We therefore aimed to clarify and compare the effectiveness of the two therapeutic temperature management regimens in severe (Abbreviated Injury Scale [AIS] 3–4) or critical trauma patients (AIS 5). In the present post hoc B-HYPO study, we re-evaluated data based on the severity of trauma as AIS 3–4 or AIS 5 and compared Glasgow Outcome Scale score and mortality at 6 months by per-protocol analyses. Consequently, 135 patients were enrolled. Finally, 129 patients, that is, 47 and 31 patients with AIS 3–4 and 36 and 15 patients with AIS 5 were allocated to the mild therapeutic hypothermia (MTH) and fever control groups, respectively. No significant intergroup differences were observed with regard to age, gender, scores on head computed tomography (CT) scans, and surgical operation for traumatic brain injury (TBI), except for Injury Severity Score (ISS) in AIS 5. The fever control group demonstrated a significant reduction of TBI-related mortality compared with the MTH group (9.7% vs. 34.0%, p = 0.02) and an increase of favorable neurological outcomes (64.5% vs. 51.1%, p = 0.26) in patients with AIS 3–4, although the latter was not statistically significant. There was no difference in mortality or favorable outcome in patients with AIS 5. Fever control may be considered instead of MTH in patients with TBI (AIS 3–4). PMID:26413933

  3. Scoring of anatomic injury after trauma: AIS 98 versus AIS 90--do the changes affect overall severity assessment?

    PubMed

    Skaga, Nils O; Eken, Torsten; Hestnes, Morten; Jones, J Mary; Steen, Petter A

    2007-01-01

    Although several changes were implemented in the 1998 update of the abbreviated injury scale (AIS 98) versus the previous AIS 90, both are still used worldwide for coding of anatomic injury in trauma. This could possibly invalidate comparisons between systems using different AIS versions. Our aim was to evaluate whether the use of different coding dictionaries affected estimation of Injury Severity Score (ISS), New Injury Severity Score (NISS) and probability of survival (Ps) according to TRISS in a hospital-based trauma registry. In a prospective study including 1654 patients from Ulleval University Hospital, a Norwegian trauma referral centre, patients were coded according to both AIS 98 and AIS 90. Agreement between the classifications of ISS, NISS and Ps according to TRISS methodology was estimated using intraclass correlation coefficients (ICC) with 95% CI. ISS changed for 378 of 1654 patients analysed (22.9%). One hundred and forty seven (8.9%) were coded differently due to different injury descriptions and 369 patients (22.3%) had a change in ISS value in one or more regions due to the different scoring algorithm for skin injuries introduced in AIS 98. This gave a minimal change in mean ISS (14.74 versus 14.54). An ICC value of 0.997 (95% CI 0.9968-0.9974) for ISS indicates excellent agreement between the scoring systems. There were no significant changes in NISS and Ps. There was excellent agreement for the overall population between ISS, NISS and Ps values obtained using AIS 90 and AIS 98 for injury coding. Injury descriptions for hypothermia were re-introduced in the recently published AIS 2005. We support this change as coding differences due to hypothermia were encountered in 4.3% of patients in the present study.

  4. Injury Severity Score coding: Data analyst v. emerging m-health technology.

    PubMed

    Spence, R T; Zargaran, E; Hameed, M; Fong, D; Shangguan, E; Martinez, R; Navsaria, P; Nicol, A

    2016-09-08

    The cost of Abbreviated Injury Scale (AIS) coding has limited its utility in areas of the world with the highest incidence of trauma. We hypothesised that emerging mobile health (m-health) technology could offer a cost-effective alternative to the current gold-standard AIS mechanism in a high-volume trauma centre in South Africa. A prospectively collected sample of consecutive patients admitted following a traumatic injury that required an operation during a 1-month period was selected for the study. AISs and Injury Severity Scores (ISSs) were generated by clinician-entered data using an m-health application (ISS eTHR) as well as by a team of AIS coders at Vancouver General Hospital, Canada (ISS VGH). Rater agreements for ISSs were analysed using Bland-Altman plots with 95% limits of agreement (LoA) and kappa statistics of the ISSs grouped into ordinal categories. Reliability was analysed using a two-way mixed-model intraclass correlation coefficient (ICC). Calibration and discrimination of univariate logistic regression models built to predict in-hospital complications using ISSs coded by the two methods were also compared. Fifty-seven patients were managed operatively during the study period. The mean age of the cohort was 27.2 years (range 14 - 62), and 96.3% were male. The mechanism of injury was penetrating in 93.4% of cases, of which 52.8% were gunshot injuries. The LoA fell within -8.6 - 9.4. The mean ISS difference was 0.4 (95% CI -0.8 - 1.6). The kappa statistic was 0.53. The ICC of the individual ISS was 0.88 (95% CI 0.81 - 0.93) and the categorical ISS was 0.81 (95% CI 0.68 - 0.87). Model performance to predict in-hospital complications using either the ISS eTHR or the ISS VGH was equivalent. ISSs calculated by the eTHR and gold-standard coding were comparable. Emerging m-health technology provides a cost-effective alternative for injury severity scoring.

  5. Developing and Validating an Abbreviated Version of the Microscale Audit for Pedestrian Streetscapes (MAPS-Abbreviated).

    PubMed

    Cain, Kelli L; Gavand, Kavita A; Conway, Terry L; Geremia, Carrie M; Millstein, Rachel A; Frank, Lawrence D; Saelens, Brian E; Adams, Marc A; Glanz, Karen; King, Abby C; Sallis, James F

    2017-06-01

    Macroscale built environment factors (e.g., street connectivity) are correlated with physical activity. Less-studied but more modifiable microscale elements (e.g., sidewalks) may also influence physical activity, but shorter audit measures of microscale elements are needed to promote wider use. This study evaluated the relation of an abbreviated 54-item streetscape audit tool with multiple measures of physical activity in four age groups. We developed a 54-item version from the original 120-item Microscale Audit of Pedestrian Streetscapes (MAPS). Audits were conducted on 0.25-0.45 mile routes from participant residences toward the nearest nonresidential destination for children (N=758), adolescents (N=897), younger adults (N=1,655), and older adults (N=367). Active transport and leisure physical activity were measured with surveys, and objective physical activity was measured with accelerometers. Items to retain from original MAPS were selected primarily by correlations with physical activity. Mixed linear regression analyses were conducted for MAPS-Abbreviated summary scores, adjusting for demographics, participant clustering, and macroscale walkability. MAPS-Abbreviated and original MAPS total scores correlated r=.94 The MAPS-Abbreviated tool was related similarly to physical activity outcomes as the original MAPS. Destinations and land use, streetscape and walking path characteristics, and overall total scores were significantly related to active transport in all age groups. Street crossing characteristics were related to active transport in children and older adults. Aesthetics and social characteristics were related to leisure physical activity in children and younger adults, and cul-de-sacs were related with physical activity in youth. Total scores were related to accelerometer-measured physical activity in children and older adults. MAPS-Abbreviated is a validated observational measure for use in research. The length and related cost of implementation has

  6. Developing and Validating an Abbreviated Version of the Microscale Audit for Pedestrian Streetscapes (MAPS-Abbreviated)

    PubMed Central

    Cain, Kelli L.; Gavand, Kavita A.; Conway, Terry L.; Geremia, Carrie M.; Millstein, Rachel A.; Frank, Lawrence D.; Saelens, Brian E.; Adams, Marc A.; Glanz, Karen; King, Abby C.; Sallis, James F.

    2017-01-01

    Purpose Macroscale built environment factors (e.g., street connectivity) are correlated with physical activity. Less-studied but more modifiable microscale elements (e.g., sidewalks) may also influence physical activity, but shorter audit measures of microscale elements are needed to promote wider use. This study evaluated the relation of an abbreviated 54-item streetscape audit tool with multiple measures of physical activity in four age groups. Methods We developed a 54-item version from the original 120-item Microscale Audit of Pedestrian Streetscapes (MAPS). Audits were conducted on 0.25-0.45 mile routes from participant residences toward the nearest nonresidential destination for children (N=758), adolescents (N=897), younger adults (N=1,655), and older adults (N=367). Active transport and leisure physical activity were measured with surveys, and objective physical activity was measured with accelerometers. Items to retain from original MAPS were selected primarily by correlations with physical activity. Mixed linear regression analyses were conducted for MAPS-Abbreviated summary scores, adjusting for demographics, participant clustering, and macroscale walkability. Results MAPS-Abbreviated and original MAPS total scores correlated r=.94 The MAPS-Abbreviated tool was related similarly to physical activity outcomes as the original MAPS. Destinations and land use, streetscape and walking path characteristics, and overall total scores were significantly related to active transport in all age groups. Street crossing characteristics were related to active transport in children and older adults. Aesthetics and social characteristics were related to leisure physical activity in children and younger adults, and cul-de-sacs were related with physical activity in youth. Total scores were related to accelerometer-measured physical activity in children and older adults. Conclusion MAPS-Abbreviated is a validated observational measure for use in research. The length and

  7. Double coding and mapping using Abbreviated Injury Scale 1998 and 2005: identifying issues for trauma data.

    PubMed

    Palmer, Cameron S; Niggemeyer, Louise E; Charman, Debra

    2010-09-01

    The 2005 version of the Abbreviated Injury Scale (AIS05) potentially represents a significant change in injury spectrum classification, due to a substantial increase in the codeset size and alterations to the agreed severity of many injuries compared to the previous version (AIS98). Whilst many trauma registries around the world are moving to adopt AIS05 or its 2008 update (AIS08), its effect on patient classification in existing registries, and the optimum method of comparing existing data collections with new AIS05 collections are unknown. The present study aimed to assess the potential impact of adopting the AIS05 codeset in an established trauma system, and to identify issues associated with this change. A current subset of consecutive major trauma patients admitted to two large hospitals in the Australian state of Victoria were double-coded in AIS98 and AIS05. Assigned codesets were also mapped to the other AIS version using code lists supplied in the AIS05 manual, giving up to four AIS codes per injury sustained. Resulting codesets were assessed for agreement in codes used, injury severity and calculated severity scores. 602 injuries sustained by 109 patients were compared. Adopting AIS05 would lead to a decrease in the number of designated major trauma patients in Victoria, estimated at 22% (95% confidence interval, 15-31%). Differences in AIS level between versions were significantly more likely to occur amongst head and chest injuries. Data mapped to a different codeset performed better in paired comparisons than raw AIS98 and AIS05 codesets, with data mapping of AIS05 codes back to AIS98 giving significantly higher levels of agreement in AIS level, ISS and NISS than other potential comparisons, and resulting in significantly fewer conversion problems than attempting to map AIS98 codes to AIS05. This study provides new insights into AIS codeset change impact. Adoption of AIS05 or AIS08 in established registries will decrease major trauma patient numbers

  8. Lateral automobile impacts and the risk of traumatic brain injury.

    PubMed

    Bazarian, Jeffrey J; Fisher, Susan Gross; Flesher, William; Lillis, Robert; Knox, Kerry L; Pearson, Thomas A

    2004-08-01

    We determine the relative risk and severity of traumatic brain injury among occupants of lateral impacts compared with occupants of nonlateral impacts. This was a secondary analysis of the National Highway Traffic Safety Administration's National Automotive Sampling System, Crashworthiness Data Systems for 2000. Analysis was restricted to occupants of vehicles in which at least 1 person experienced an injury with Abbreviated Injury Scale score greater than 2. Traumatic brain injury was defined as an injury to the head or skull with an Abbreviated Injury Scale score greater than 2. Outcomes were analyzed using the chi2 test and multivariate logistic regression, with adjustment of variance to account for weighted probability sampling. Of the 1,115 occupants available for analysis, impact direction was lateral for 230 (18.42%) occupants and nonlateral for 885 (81.58%) occupants. One hundred eighty-seven (16.07%) occupants experienced a traumatic brain injury, 14.63% after lateral and 16.39% after nonlateral impact. The unadjusted relative risk of traumatic brain injury after lateral impact was 0.89 (95% confidence interval [CI] 0.51 to 1.56). After adjusting for several important crash-related variables, the relative risk of traumatic brain injury was 2.60 (95% CI 1.1 to 6.0). Traumatic brain injuries were more severe after lateral impact according to Abbreviated Injury Scale and Glasgow Coma Scale scores. The proportion of fatal or critical crash-related traumatic brain injuries attributable to lateral impact was 23.5%. Lateral impact is an important independent risk factor for the development of traumatic brain injury after a serious motor vehicle crash. Traumatic brain injuries incurred after lateral impact are more severe than those resulting from nonlateral impact. Vehicle modifications that increase head protection could reduce crash-related severe traumatic brain injuries by up to 61% and prevent up to 2,230 fatal or critical traumatic brain injuries each year

  9. [Predictive quality of the injury severity score in the systematic use of cranial MRI].

    PubMed

    Woischneck, D; Lerch, K; Kapapa, T; Skalej, M; Firsching, R

    2010-09-01

    The ABBREVIATED INJURY SCORE (AIS) for the head is mostly coded on the basis of cranial computed tomography (CT). It defines, to a large extent, the predictive potency of the INJURY SEVERITY SCORE (ISS). The present study investigates whether the predictive capacity of the ISS can be improved by the systematic use of data from cranial MRI. 167 patients, who had been in a coma for at least 24 hours following trauma, underwent an MRI examination within 8 days. All had been found to have an intracranial injury on initial CT. 49 % had also suffered extracranial injuries. The GLASGOW OUTCOME SCALE (GOS) was determined 6 months post trauma. AIS, ISS and GOS values were rated as ordinal measurements. A contingency table was used as the statistical method of analysis, with a significance assumed as p < 0.05 (Chi (2) test). The median ISS based on CT was 16 and did not correlate with the GOS. 63 % of the patients revealed brain stem lesions on MRI. If these were coded with an AIS of 5, the median ISS increased significantly to 29. Thus, the correlation to the GOS was now significant. At ISS scores of 5-9, 18 % of the patients died; at scores of 50-54 the rate of favourable treatment outcomes still amounted to 50 %. Since it is now known that brain stem lesions can also have a favourable prognosis, the AIS coding was modified and adapted to the mortality of the singular types of lesion. Hence the median ISS again decreased to 16. The correlation to the GOS was significant, and the predictive potency of the ISS further improved. The prognostic potency of the REVISED INJURY SEVERITY CLASSIFICATION (RISC) score was improved by use of adapted MRI data. If visible brain stem lesions on MRI were coded according to the AIS guidelines, there was a significant increase in the ISS which correlated significantly to the GOS. If the AIS coding was adjusted to the prognostic significance of individual brain stem lesions, there was a further improvement in the prognostic

  10. Model for predicting the injury severity score.

    PubMed

    Hagiwara, Shuichi; Oshima, Kiyohiro; Murata, Masato; Kaneko, Minoru; Aoki, Makoto; Kanbe, Masahiko; Nakamura, Takuro; Ohyama, Yoshio; Tamura, Jun'ichi

    2015-07-01

    To determine the formula that predicts the injury severity score from parameters that are obtained in the emergency department at arrival. We reviewed the medical records of trauma patients who were transferred to the emergency department of Gunma University Hospital between January 2010 and December 2010. The injury severity score, age, mean blood pressure, heart rate, Glasgow coma scale, hemoglobin, hematocrit, red blood cell count, platelet count, fibrinogen, international normalized ratio of prothrombin time, activated partial thromboplastin time, and fibrin degradation products, were examined in those patients on arrival. To determine the formula that predicts the injury severity score, multiple linear regression analysis was carried out. The injury severity score was set as the dependent variable, and the other parameters were set as candidate objective variables. IBM spss Statistics 20 was used for the statistical analysis. Statistical significance was set at P  < 0.05. To select objective variables, the stepwise method was used. A total of 122 patients were included in this study. The formula for predicting the injury severity score (ISS) was as follows: ISS = 13.252-0.078(mean blood pressure) + 0.12(fibrin degradation products). The P -value of this formula from analysis of variance was <0.001, and the multiple correlation coefficient (R) was 0.739 (R 2  = 0.546). The multiple correlation coefficient adjusted for the degrees of freedom was 0.538. The Durbin-Watson ratio was 2.200. A formula for predicting the injury severity score in trauma patients was developed with ordinary parameters such as fibrin degradation products and mean blood pressure. This formula is useful because we can predict the injury severity score easily in the emergency department.

  11. Assessment of the effects and limitations of the 1998 to 2008 Abbreviated Injury Scale map using a large population-based dataset.

    PubMed

    Palmer, Cameron S; Franklyn, Melanie

    2011-01-07

    Trauma systems should consistently monitor a given trauma population over a period of time. The Abbreviated Injury Scale (AIS) and derived scores such as the Injury Severity Score (ISS) are commonly used to quantify injury severities in trauma registries. To reflect contemporary trauma management and treatment, the most recent version of the AIS (AIS08) contains many codes which differ in severity from their equivalents in the earlier 1998 version (AIS98). Consequently, the adoption of AIS08 may impede comparisons between data coded using different AIS versions. It may also affect the number of patients classified as major trauma. The entire AIS98-coded injury dataset of a large population based trauma registry was retrieved and mapped to AIS08 using the currently available AIS98-AIS08 dictionary map. The percentage of codes which had increased or decreased in severity, or could not be mapped, was examined in conjunction with the effect of these changes to the calculated ISS. The potential for free text information accompanying AIS coding to improve the quality of AIS mapping was explored. A total of 128280 AIS98-coded injuries were evaluated in 32134 patients, 15471 patients of whom were classified as major trauma. Although only 4.5% of dictionary codes decreased in severity from AIS98 to AIS08, this represented almost 13% of injuries in the registry. In 4.9% of patients, no injuries could be mapped. ISS was potentially unreliable in one-third of patients, as they had at least one AIS98 code which could not be mapped. Using AIS08, the number of patients classified as major trauma decreased by between 17.3% and 30.3%. Evaluation of free text descriptions for some injuries demonstrated the potential to improve mapping between AIS versions. Converting AIS98-coded data to AIS08 results in a significant decrease in the number of patients classified as major trauma. Many AIS98 codes are missing from the existing AIS map, and across a trauma population the AIS08 dataset

  12. Validity and reliability of Abbreviated Mental Test Score (AMTS) among older Iranian.

    PubMed

    Foroughan, Mahshid; Wahlund, Lars-Olof; Jafari, Zahra; Rahgozar, Mehdi; Farahani, Ida G; Rashedi, Vahid

    2017-11-01

    Cognitive impairment is common among older people and is associated with increased morbidity and mortality. The main aim of this study was to evaluate the validity of the Persian version of the Abbreviated Mental Test Score (AMTS) as a screening tool for dementia. Data were obtained from a cross-sectional study. One hundred and one older adults who were members of Iranian Alzheimer Association and 101 of their siblings were entered into this study by convenient sampling. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for diagnosing dementia and the Mini-Mental State Examination were used as the study tools. The gathered data were analyzed by the Mann-Whitney U-test, the Kruskal-Wallis test, Spearman's rank correlation coefficient, and the receiver-operating characteristic. The AMTS could successfully differentiate the dementia group from the non-dementia group. Scores were significantly correlated with Diagnostic and Statistical Manual of Mental Disorders diagnosis for dementia and Mini-Mental State Examination scores (P < 0.001). Educational level (P < 0.001) and male sex (P = 0.015) were positively associated with AMTS, whereas (P < 0.001) was negatively associated with AMTS. Total Cronbach's α coefficient was 0.90. The scores 6 and 7 showed the optimum balance between sensitivity (99% and 94%, respectively) and specificity (85% and 86%, respectively). The Persian version of the AMTS is a valid cognitive assessment tool for older Iranian adults and can be used for dementia screening in Iran. © 2017 Japanese Psychogeriatric Society.

  13. A New Weighted Injury Severity Scoring System: Better Predictive Power for Pediatric Trauma Mortality.

    PubMed

    Shi, Junxin; Shen, Jiabin; Caupp, Sarah; Wang, Angela; Nuss, Kathryn E; Kenney, Brian; Wheeler, Krista K; Lu, Bo; Xiang, Henry

    2018-05-02

    An accurate injury severity measurement is essential for the evaluation of pediatric trauma care and outcome research. The traditional Injury Severity Score (ISS) does not consider the differential risks of the Abbreviated Injury Scale (AIS) from different body regions nor is it pediatric specific. The objective of this study was to develop a weighted injury severity scoring (wISS) system for pediatric blunt trauma patients with better predictive power than ISS. Based on the association between mortality and AIS from each of the six ISS body regions, we generated different weights for the component AIS scores used in the calculation of ISS. The weights and wISS were generated using the National Trauma Data Bank (NTDB). The Nationwide Emergency Department Sample (NEDS) was used to validate our main results. Pediatric blunt trauma patients less than 16 years were included, and mortality was the outcome. Discrimination (areas under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value, concordance) and calibration (Hosmer-Lemeshow statistic) were compared between the wISS and ISS. The areas under the receiver operating characteristic curves from the wISS and ISS are 0.88 vs. 0.86 in ISS=1-74 and 0.77 vs. 0.64 in ISS=25-74 (p<0.0001). The wISS showed higher specificity, positive predictive value, negative predictive value, and concordance when they were compared at similar levels of sensitivity. The wISS had better calibration (smaller Hosmer-Lemeshow statistic) than the ISS (11.6 versus 19.7 for ISS=1-74 and 10.9 versus 12.6 for ISS= 25-74). The wISS showed even better discrimination with the NEDS. By weighting the AIS from different body regions, the wISS had significantly better predictive power for mortality than the ISS, especially in critically injured children.Level of Evidence and study typeLevel IV Prognostic/Epidemiological.

  14. Development and validation of a complementary map to enhance the existing 1998 to 2008 Abbreviated Injury Scale map

    PubMed Central

    2011-01-01

    Introduction Many trauma registries have used the Abbreviated Injury Scale 1990 Revision Update 98 (AIS98) to classify injuries. In the current AIS version (Abbreviated Injury Scale 2005 Update 2008 - AIS08), injury classification and specificity differ substantially from AIS98, and the mapping tools provided in the AIS08 dictionary are incomplete. As a result, data from different AIS versions cannot currently be compared. The aim of this study was to develop an additional AIS98 to AIS08 mapping tool to complement the current AIS dictionary map, and then to evaluate the completed map (produced by combining these two maps) using double-coded data. The value of additional information provided by free text descriptions accompanying assigned codes was also assessed. Methods Using a modified Delphi process, a panel of expert AIS coders established plausible AIS08 equivalents for the 153 AIS98 codes which currently have no AIS08 map. A series of major trauma patients whose injuries had been double-coded in AIS98 and AIS08 was used to assess the maps; both of the AIS datasets had already been mapped to another AIS version using the AIS dictionary maps. Following application of the completed (enhanced) map with or without free text evaluation, up to six AIS codes were available for each injury. Datasets were assessed for agreement in injury severity measures, and the relative performances of the maps in accurately describing the trauma population were evaluated. Results The double-coded injuries sustained by 109 patients were used to assess the maps. For data conversion from AIS98, both the enhanced map and the enhanced map with free text description resulted in higher levels of accuracy and agreement with directly coded AIS08 data than the currently available dictionary map. Paired comparisons demonstrated significant differences between direct coding and the dictionary maps, but not with either of the enhanced maps. Conclusions The newly-developed AIS98 to AIS08

  15. Development and validation of a complementary map to enhance the existing 1998 to 2008 Abbreviated Injury Scale map.

    PubMed

    Palmer, Cameron S; Franklyn, Melanie; Read-Allsopp, Christine; McLellan, Susan; Niggemeyer, Louise E

    2011-05-08

    Many trauma registries have used the Abbreviated Injury Scale 1990 Revision Update 98 (AIS98) to classify injuries. In the current AIS version (Abbreviated Injury Scale 2005 Update 2008 - AIS08), injury classification and specificity differ substantially from AIS98, and the mapping tools provided in the AIS08 dictionary are incomplete. As a result, data from different AIS versions cannot currently be compared. The aim of this study was to develop an additional AIS98 to AIS08 mapping tool to complement the current AIS dictionary map, and then to evaluate the completed map (produced by combining these two maps) using double-coded data. The value of additional information provided by free text descriptions accompanying assigned codes was also assessed. Using a modified Delphi process, a panel of expert AIS coders established plausible AIS08 equivalents for the 153 AIS98 codes which currently have no AIS08 map. A series of major trauma patients whose injuries had been double-coded in AIS98 and AIS08 was used to assess the maps; both of the AIS datasets had already been mapped to another AIS version using the AIS dictionary maps. Following application of the completed (enhanced) map with or without free text evaluation, up to six AIS codes were available for each injury. Datasets were assessed for agreement in injury severity measures, and the relative performances of the maps in accurately describing the trauma population were evaluated. The double-coded injuries sustained by 109 patients were used to assess the maps. For data conversion from AIS98, both the enhanced map and the enhanced map with free text description resulted in higher levels of accuracy and agreement with directly coded AIS08 data than the currently available dictionary map. Paired comparisons demonstrated significant differences between direct coding and the dictionary maps, but not with either of the enhanced maps. The newly-developed AIS98 to AIS08 complementary map enabled transformation of the

  16. Mobile health technology transforms injury severity scoring in South Africa.

    PubMed

    Spence, Richard Trafford; Zargaran, Eiman; Hameed, S Morad; Navsaria, Pradeep; Nicol, Andrew

    2016-08-01

    The burden of data collection associated with injury severity scoring has limited its application in areas of the world with the highest incidence of trauma. Since January 2014, electronic records (electronic Trauma Health Records [eTHRs]) replaced all handwritten records at the Groote Schuur Hospital Trauma Unit in South Africa. Data fields required for Glasgow Coma Scale, Revised Trauma Score, Kampala Trauma Score, Injury Severity Score (ISS), and Trauma Score-Injury Severity Score calculations are now prospectively collected. Fifteen months after implementation of eTHR, the injury severity scores were compared as predictors of mortality on three accounts: (1) ability to discriminate (area under receiver operating curve, ROC); (2) ability to calibrate (observed versus expected ratio, O/E); and (3) feasibility of data collection (rate of missing data). A total of 7460 admissions were recorded by eTHR from April 1, 2014 to July 7, 2015, including 770 severely injured patients (ISS > 15) and 950 operations. The mean age was 33.3 y (range 13-94), 77.6% were male, and the mechanism of injury was penetrating in 39.3% of cases. The cohort experienced a mortality rate of 2.5%. Patient reserve predictors required by the scores were 98.7% complete, physiological injury predictors were 95.1% complete, and anatomic injury predictors were 86.9% complete. The discrimination and calibration of Trauma Score-Injury Severity Score was superior for all admissions (ROC 0.9591 and O/E 1.01) and operatively managed patients (ROC 0.8427 and O/E 0.79). In the severely injured cohort, the discriminatory ability of Revised Trauma Score was superior (ROC 0.8315), but no score provided adequate calibration. Emerging mobile health technology enables reliable and sustainable injury severity scoring in a high-volume trauma center in South Africa. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Validation of a modified table to map the 1998 Abbreviated Injury Scale to the 2008 scale and the use of adjusted severities.

    PubMed

    Tohira, Hideo; Jacobs, Ian; Mountain, David; Gibson, Nick; Yeo, Allen; Ueno, Masato; Watanabe, Hiroaki

    2011-12-01

    The Abbreviated Injury Scale 2008 (AIS 2008) is the most recent injury coding system. A mapping table from a previous AIS 98 to AIS 2008 is available. However, AIS 98 codes that are unmappable to AIS 2008 codes exist in this table. Furthermore, some AIS 98 codes can be mapped to multiple candidate AIS 2008 codes with different severities. We aimed to modify the original table to adjust the severities and to validate these changes. We modified the original table by adding links from unmappable AIS 98 codes to AIS 2008 codes. We applied the original table and our modified table to AIS 98 codes for major trauma patients. We also assigned candidate codes with different severities the weighted averages of their severities as an adjusted severity. The proportion of cases whose injury severity scores (ISSs) were computable were compared. We also compared the agreement of the ISS and New ISS (NISS) between manually determined AIS 2008 codes (MAN) and mapped codes by using our table (MAP) with unadjusted or adjusted severities. All and 72.3% of cases had their ISSs computed by our modified table and the original table, respectively. The agreement between MAN and MAP with respect to the ISS and NISS was substantial (intraclass correlation coefficient = 0.939 for ISS and 0.943 for NISS). Using adjusted severities, the agreements of the ISS and NISS improved to 0.953 (p = 0.11) and 0.963 (p = 0.007), respectively. Our modified mapping table seems to allow more ISSs to be computed than the original table. Severity scores exhibited substantial agreement between MAN and MAP. The use of adjusted severities improved these agreements further.

  18. Assessment of the effects and limitations of the 1998 to 2008 Abbreviated Injury Scale map using a large population-based dataset

    PubMed Central

    2011-01-01

    Background Trauma systems should consistently monitor a given trauma population over a period of time. The Abbreviated Injury Scale (AIS) and derived scores such as the Injury Severity Score (ISS) are commonly used to quantify injury severities in trauma registries. To reflect contemporary trauma management and treatment, the most recent version of the AIS (AIS08) contains many codes which differ in severity from their equivalents in the earlier 1998 version (AIS98). Consequently, the adoption of AIS08 may impede comparisons between data coded using different AIS versions. It may also affect the number of patients classified as major trauma. Methods The entire AIS98-coded injury dataset of a large population based trauma registry was retrieved and mapped to AIS08 using the currently available AIS98-AIS08 dictionary map. The percentage of codes which had increased or decreased in severity, or could not be mapped, was examined in conjunction with the effect of these changes to the calculated ISS. The potential for free text information accompanying AIS coding to improve the quality of AIS mapping was explored. Results A total of 128280 AIS98-coded injuries were evaluated in 32134 patients, 15471 patients of whom were classified as major trauma. Although only 4.5% of dictionary codes decreased in severity from AIS98 to AIS08, this represented almost 13% of injuries in the registry. In 4.9% of patients, no injuries could be mapped. ISS was potentially unreliable in one-third of patients, as they had at least one AIS98 code which could not be mapped. Using AIS08, the number of patients classified as major trauma decreased by between 17.3% and 30.3%. Evaluation of free text descriptions for some injuries demonstrated the potential to improve mapping between AIS versions. Conclusions Converting AIS98-coded data to AIS08 results in a significant decrease in the number of patients classified as major trauma. Many AIS98 codes are missing from the existing AIS map, and across

  19. Patterns of injury to restrained children in side impact motor vehicle crashes: the side impact syndrome.

    PubMed

    Orzechowski, Kelly M; Edgerton, Elizabeth A; Bulas, Dorothy I; McLaughlin, Patrick M; Eichelberger, Martin R

    2003-06-01

    Injury patterns among children in frontal collisions have been well documented, but little information exists regarding injuries to children in side impact collisions. Restrained children 14-years-old or younger admitted to the hospital for crash injuries were analyzed. Data concerning injuries, medical treatment, and outcome were correlated with crash data. Case reviews achieved consensus regarding injury contact points. Side impacts were compared with frontal impacts. These results were then compared with data from the National Automotive Sampling System. There were no differences between the groups with respect to age, sex, restraint type, or seat position. Compared with frontal crashes, children in side impacts were more likely to have an Injury Severity Score > 15 (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.7-5.8) and were more likely to have Abbreviated Injury Scale score 2+ injuries to the head (OR, 2.5; 95% CI, 1.4-4.4), chest (OR, 4.0; 95% CI, 2.0-8.0), and cervical spine (OR, 3.7; 95% CI, 1.2-11.3). When compared with National Automotive Sampling System data, similar trends were seen regarding Abbreviated Injury Scale score 2+ injuries to the head, chest, and extremities. In this study population, side impacts resulted in more injuries to the head, cervical spine, and chest. Knowledge of this pattern-the side impact syndrome-can help guide diagnosis, treatment, and prevention strategy.

  20. Injury patterns and preventability in prehospital motor vehicle crash fatalities in Victoria.

    PubMed

    Ryan, Matt; Stella, Julian; Chiu, Herman; Ragg, Michael

    2004-08-01

    To examine the pattern of anatomical injury in victims of motor vehicle crashes who die prior to reaching hospital. Cases were identified where death was an unexpected outcome. A retrospective review of autopsy case records including police reports, of all persons who died in motor vehicle crashes between 1 January 1998 and 31 December 1999 and underwent full autopsy at the Victorian Institute of Forensic Medicine (VIFM). Those cases where the victim died in the prehospital phase were examined. Abbreviate Injury Scores and Injury Severity Scores were calculated in each case. Bull's probit analysis was used to identify unexpected deaths. There were 352 motor road crash fatalities identified that underwent autopsy at the VIFM in the study period. Two hundred and six of these were prehospital deaths involving motor vehicles, which satisfied specified criteria. 82% (95% CI: 77.7-86.3%) of cases had Abbreviated Injury Scores of 5 (critical) or 6 (incompatible with life). 80.1% (95% CI: 75.7-84.5%) had an Injury Severity Score greater than 40. 36.9% (95% CI: 34.5-39.3%) of cases had the maximum Injury Severity score of 75. 88.8% (95% CI: 85-92.7%) of cases sustained a head injury and 83.9% (95% CI: 79.8-88.2%) a chest injury. Possibly preventable fatality was identified in 30 (14.6% 95% CI: 13.9-15.3%) cases. In motor vehicle crash fatalities, most victims who die before reaching hospital do so because of major injury, with the head and chest the commonest regions involved. A large proportion of these injuries could be considered unsurvivable regardless of treatment. Earlier intervention or retrieval of such patients is unlikely to influence outcome in the majority of cases.

  1. Functional Movement Screen: Pain versus composite score and injury risk.

    PubMed

    Alemany, Joseph A; Bushman, Timothy T; Grier, Tyson; Anderson, Morgan K; Canham-Chervak, Michelle; North, William J; Jones, Bruce H

    2017-11-01

    The Functional Movement Screen (FMS™) has been used as a screening tool to determine musculoskeletal injury risk using composite scores based on movement quality and/or pain. However, no direct comparisons between movement quality and pain have been quantified. Retrospective injury data analysis. Male Soldiers (n=2154, 25.0±1.3years; 26.2±.7kg/m 2 ) completed the FMS (scored from 0 points (pain) to 3 points (no pain and perfect movement quality)) with injury data over the following six months. The FMS is seven movements. Injury data were collected six months after FMS completion. Sensitivity, specificity, receiver operator characteristics and positive and negative predictive values were calculated for pain occurrence and low (≤14 points) composite score. Risk, risk ratios (RR) and 95% confidence intervals were calculated for injury risk. Pain was associated with slightly higher injury risk (RR=1.62) than a composite score of ≤14 points (RR=1.58). When comparing injury risk between those who scored a 1, 2 or 3 on each individual movement, no differences were found (except deep squat). However, Soldiers who experienced pain on any movement had a greater injury risk than those who scored 3 points for that movement (p<0.05). A progressive increase in the relative risk occurred as the number of movements in which pain occurrence increased, so did injury risk (p<0.01). Pain occurrence may be a stronger indicator of injury risk than a low composite score and provides a simpler method of evaluating injury risk compared to the full FMS. Published by Elsevier Ltd.

  2. Estimating injury severity using the Barell matrix

    PubMed Central

    Clark, D E; Ahmad, S

    2006-01-01

    Objective To determine whether the Barell matrix (Inj Prev 2002;8:91–6) could effectively categorize injuries by severity. Methods Injury diagnoses of cases in the 2002 US Nationwide Inpatient Sample were classified according to the Barell matrix. For each cell of the matrix, the authors used ICDMAP‐90 to determine the predominant Abbreviated Injury Score (AIS) and body region, and calculated the weighted proportion surviving (bPScell) among patients with any diagnosis in that cell. These findings were used to estimate maximum AIS (bAISmax), ISS (bISS), and the minimum or product of bPScell (bPSmin, bPSprod) for injured patients in the 1996–2000 US National Hospital Discharge Surveys. Case survival was determined for different scores, and outcome models using age, sex, comorbidity, mechanism, and bISS or bPSmin were compared to models using ISS calculated from ICDMAP‐90 (mISS) or using ICISS. Results Case survival decreased with increasing bAISmax or bISS; survival was closely approximated by bPSmin, and also increased monotonically with bPSprod. Outcome models using bISS or bPSmin were similar to those using mISS or ICISS. An Abbreviated Barell Categorization, with only four groups, was also effective. Conclusion Barell matrix categorization of administrative data allows severity scoring similar to that obtainable with ICDMAP‐90 or ICISS. PMID:16595426

  3. Recent trends in the management of combined pancreatoduodenal injuries.

    PubMed

    Lopez, Peter P; Benjamin, Robert; Cockburn, Mark; Amortegui, Jose D; Schulman, Carl I; Soffer, Dror; Blackbourne, Lorne H; Habib, Fahim; Jerokhimov, Igor; Trankel, Susan; Cohn, Stephen M

    2005-10-01

    In an effort to better characterize the natural history of pancreatoduodenal injuries, we present a review of clinical experiences in the treatment of combined traumatic pancreatoduodenal injuries, focusing on patients in extremis. Records of patients with abdominal trauma admitted to a level 1 trauma center from 1997 to 2001 were reviewed. Of 240 patients who sustained a pancreatic or duodenal injury, 33 had combined pancreatoduodenal injuries. Eighty-two per cent of the patients (27/33) in this series had penetrating injuries, 72 per cent (24) sustained gunshot wounds (GSW). Thirty-one patients were male, and the mean age was 33 years (range, 7-74). These patients presented with an average Injury Severity Score (ISS) of 22 +/- 12 and an average Glasgow Coma Score of 14 +/- 2. Overall length of stay was 39 +/- 59 days (range, 0-351 days). These 33 patients underwent a total of 57 laparotomies with an average of 1.7 operations per patient (range, 1 to 5 operations). Eighty-four per cent of the patients had an associated gastrointestinal injury and 45 per cent had a major vascular injury. Thirteen of the 33 (39%) patients presented in extremis, all 13 underwent an abbreviated laparotomy. The complication rate was 36 per cent, including fistula, abscess, pancreatitis, and organ dysfunction. There were 6 hospital deaths for a mortality rate of 18 per cent. Pancreatoduodenal injuries are associated with a variety of other serious injuries, which add to the overall complexity of these patients. Abbreviated laparotomy may be helpful when managing combined pancreatoduodenal injuries in patients who are in extremis.

  4. Mortality Risk in Pediatric Motor Vehicle Crash Occupants: Accounting for Developmental Stage and Challenging Abbreviated Injury Scale Metrics.

    PubMed

    Doud, Andrea N; Weaver, Ashley A; Talton, Jennifer W; Barnard, Ryan T; Schoell, Samantha L; Petty, John K; Stitzel, Joel D

    2015-01-01

    Survival risk ratios (SRRs) and their probabilistic counterpart, mortality risk ratios (MRRs), have been shown to be at odds with Abbreviated Injury Scale (AIS) severity scores for particular injuries in adults. SRRs have been validated for pediatrics but have not been studied within the context of pediatric age stratifications. We hypothesized that children with similar motor vehicle crash (MVC) injuries may have different mortality risks (MR) based upon developmental stage and that these MRs may not correlate with AIS severity. The NASS-CDS 2000-2011 was used to define the top 95% most common AIS 2+ injuries among MVC occupants in 4 age groups: 0-4, 5-9, 10-14, and 15-18 years. Next, the National Trauma Databank 2002-2011 was used to calculate the MR (proportion of those dying with an injury to those sustaining the injury) and the co-injury-adjusted MR (MRMAIS) for each injury within 6 age groups: 0-4, 5-9, 10-14, 15-18, 0-18, and 19+ years. MR differences were evaluated between age groups aggregately, between age groups based upon anatomic injury patterns and between age groups on an individual injury level using nonparametric Wilcoxon tests and chi-square or Fisher's exact tests as appropriate. Correlation between AIS and MR within each age group was also evaluated. MR and MRMAIS distributions of the most common AIS 2+ injuries were right skewed. Aggregate MR of these most common injuries varied between the age groups, with 5- to 9-year-old and 10- to 14-year-old children having the lowest MRs and 0- to 4-year-old and 15- to 18-year-old children and adults having the highest MRs (all P <.05). Head and thoracic injuries imparted the greatest mortality risk in all age groups with median MRMAIS ranging from 0 to 6% and 0 to 4.5%, respectively. Injuries to particular body regions also varied with respect to MR based upon age. For example, thoracic injuries in adults had significantly higher MRMAIS than such injuries among 5- to 9-year-olds and 10- to 14-year

  5. Detecting severe injuries of the upper body in multiple trauma patients.

    PubMed

    Horst, Klemens; Hildebrand, Frank; Kobbe, Philipp; Pfeifer, Roman; Lichte, Philipp; Andruszkow, Hagen; Lefering, Rolf; Pape, Hans Christoph

    2015-12-01

    The clavicle limits the upper thoracic cage and connects the body and upper extremities. The clavicle is easy to examine and is visible on standard emergency room radiographs. We hypothesized that clavicular fracture in polytrauma patients would indicate the presence of further injuries of the upper extremities, head, neck, and thorax. A population-based trauma registry was used. All patients were documented between 2002 and 2013. Inclusion criteria were age ≥16 y and injury severity score (ISS) ≥16. Patients were divided into two groups according to the presence or absence of a clavicular fracture (group C+ and group C-). Scoring was based on the abbreviated injury scale, ISS, and new injury severity score. Trauma mechanisms, demographics, and the posttraumatic clinical course were compared. In total, 4790 patients with clavicular fracture (C+) and 41,775 without (C-) were included; the mean ISS was 30 ± 11 (C+) versus 28 ± 12 (C-). Patients with clavicular fracture had a longer stay on the intensive care unit with 12 ± 14 versus 10 ± 13 d. Injuries to the thoracic wall, severe lung injuries as well as injuries to the cervical spine were significantly increased in C+ patients. Thoracic injuries as well as injuries of the shoulder girdle and/or arm showed an increased abbreviated injury scale in the C+ group. A clinically relevant coincidence of clavicular fractures with injuries of the chest and upper extremity was found. As clavicular fractures can be diagnosed easily, it might also help to reduce the incidence of missed injuries of the chest and upper extremity. Therefore, special attention should be paid on thoracic as well as upper extremity injures during the second and tertiary surveys in case of clavicular fractures. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Assessing injury severity in bicyclists involved in traffic accidents to more effectively prevent fatal bicycle injuries in Japan.

    PubMed

    Gomei, Sayaka; Hitosugi, Masahito; Ikegami, Keiichi; Tokudome, Shogo

    2013-10-01

    The objective of this study was to clarify the relationship between injury severity in bicyclists involved in traffic accidents and patient outcome or type of vehicle involved in order to propose effective measures to prevent fatal bicycle injuries. Hospital records were reviewed for all patients from 2007 to 2010 who had been involved in a traffic accident while riding a bicycle and were subsequently transferred to the Shock Trauma Center of Dokkyo Medical University Koshigaya Hospital. Patient outcomes and type of vehicle that caused the injury were examined. The mechanism of injury, Abbreviated Injury Scale (AIS) score, and Injury Severity Score (ISS) of the patient were determined. A total of 115 patients' records were reviewed. The mean patient age was 47.1 ± 27.4 years. The average ISS was 23.9, with an average maximum AIS (MAIS) score of 3.7. The ISS, MAIS score, head AIS score, and chest AIS score were well correlated with patient outcome. The head AIS score was significantly higher in patients who had died (mean of 4.4); however, the ISS, MAIS score, and head AIS score did not differ significantly according to the type of vehicle involved in the accident. The mean head AIS scores were as high as 2.4 or more for accidents involving any type of vehicle. This study provides useful information for forensic pathologists who suspect head injuries in bicyclists involved in traffic accidents. To effectively reduce bicyclist fatalities from traffic accidents, helmet use should be required for all bicyclists.

  7. Evaluation of playground injuries based on ICD, E codes, international classification of external cause of injury codes (ICECI), and abbreviated injury scale coding systems.

    PubMed

    Tan, N C; Ang, A; Heng, D; Chen, J; Wong, H B

    2007-01-01

    The survey is aimed to describe the epidemiology of playground related injuries in Singapore based on the ICD-9, AIS/ ISS and PTS scoring systems, and mechanisms and causes of such injuries according to E codes and ICECI codes. A cross-sectional questionnaire survey examined children (< 16 years old), who sought treatment for or died of unintentional injuries in the ED of three hospitals, two primary care centers and the sole Forensic Medicine Department of Singapore. A data dictionary was compiled using guidelines from CDC/WHO. The ISS, AIS and PTS, ICD-9, ICECI v1 and E codes were used to describe the details of the injuries. 19,094 childhood injuries were recorded in the database, of which 1617 were playground injuries (8.5%). The injured children (mean age=6.8 years, SD 2.9 years) were predo-minantly male (M:F ratio = 1.71:1). Falls were the most frequent in-juries (70.7%) using ICECI. 25.0% of injuries involved radial and ulnar fractures (ICD-9 code). 99.4% of these injuries were minor, with PTS scores of 9-12. Children aged 6-10 years, were prone to upper limb injuries (71.1%) based on AIS. The use of international coding systems in injury surveillance facilitated standardisation of description and comparison of playground injuries.

  8. Comparative outcome of bomb explosion injuries versus high-powered gunshot injuries of the upper extremity in a civilian setting.

    PubMed

    Luria, Shai; Rivkin, Gurion; Avitzour, Malka; Liebergall, Meir; Mintz, Yoav; Mosheiff, Ram

    2013-03-01

    Explosion injuries to the upper extremity have specific clinical characteristics that differ from injuries due to other mechanisms. To evaluate the upper extremity injury pattern of attacks on civilian targets, comparing bomb explosion injuries to gunshot injuries and their functional recovery using standard outcome measures. Of 157 patients admitted to the hospital between 2000 and 2004, 72 (46%) sustained explosion injuries and 85 (54%) gunshot injuries. The trauma registry files were reviewed and the patients completed the DASH Questionnaire (Disabilities of Arm, Shoulder and Hand) and SF-12 (Short Form-12) after a minimum period of 1 year. Of the 157 patients, 72 (46%) had blast injuries and 85 (54%) had shooting injuries. The blast casualties had higher Injury Severity Scores (47% vs. 22% with a score of > 16, P = 0.02) and higher percent of patients treated in intensive care units (47% vs. 28%, P = 0.02). Although the Abbreviated Injury Scale score of the upper extremity injury was similar in the two groups, the blast casualties were found to have more bilateral and complex soft tissue injuries and were treated surgically more often. No difference was found in the SF-12 or DASH scores between the groups at follow up. The casualties with upper extremity blast injuries were more severely injured and sustained more bilateral and complex soft tissue injuries to the upper extremity. However, the rating of the local injury to the isolated limb is similar, as was the subjective functional recovery.

  9. Establishing inter-rater reliability scoring in a state trauma system.

    PubMed

    Read-Allsopp, Christine

    2004-01-01

    Trauma systems rely on accurate Injury Severity Scoring (ISS) to describe trauma patient populations. Twenty-seven (27) Trauma Nurse Coordinators and Data Managers across the state of New South Wales, Australia trauma network were instructed in the uses and techniques of the Abbreviated Injury Scale (AIS) from the Association for the Advancement of Automotive Medicine. The aim is to provide accurate, reliable and valid data for the state trauma network. Four (4) months after the course a coding exercise was conducted to assess inter-rater reliability. The results show that inter-rater reliability is with accepted international standards.

  10. Mapping Abbreviated Injury Scale data from 1990 to 1998 versions: a stepping-stone in the contemporary evaluation of trauma.

    PubMed

    Palmer, Cameron S; Lang, Jacelle; Russell, Glen; Dallow, Natalie; Harvey, Kathy; Gabbe, Belinda; Cameron, Peter

    2013-11-01

    Many trauma registries have used the 1990 revision of the Abbreviated Injury Scale (AIS; AIS90) to code injuries sustained by trauma patients. Due to changes made to the AIS codeset since its release, AIS90-coded data lacks currency in the assessment of injury severity. The ability to map between the 1998 revision of AIS (AIS98) and the current (2008) AIS version (AIS08) already exists. The development of a map for transforming AIS90-coded data into AIS98 would therefore enable contemporary injury severity estimates to be derived from AIS90-coded data. Differences between the AIS90 and AIS98 codesets were identified, and AIS98 maps were generated for AIS90 codes which changed or were not present in AIS98. The effectiveness of this map in describing the severity of trauma using AIS90 and AIS98 was evaluated using a large state registry dataset, which coded injury data using AIS90 over several years. Changes in Injury Severity Scores (ISS) calculated using AIS90 and mapped AIS98 codesets were assessed using three distinct methods. Forty-nine codes (out of 1312) from the AIS90 codeset changed or were not present in AIS98. Twenty-four codes required the assignment of maps to AIS98 equivalents. AIS90-coded data from 78,075 trauma cases were used to evaluate the map. Agreement in calculated ISS between coded AIS90 data and mapped AIS98 data was very high (kappa=0.971). The ISS changed in 1902 cases (2.4%), and the mean difference in ISS across all cases was 0.006 points. The number of cases classified as major trauma using AIS98 decreased by 0.8% compared with AIS90. A total of 3102 cases (4.0%) sustained at least one AIS90 injury which required mapping to AIS98. This study identified the differences between the AIS90 and AIS98 codesets, and generated maps for the conversion process. In practice, the differences between AIS90- and AIS98-coded data were very small. As a result, AIS90-coded data can be mapped to the current AIS version (AIS08) via AIS98, with little

  11. Soccer Injury Movement Screen (SIMS) Composite Score Is Not Associated With Injury Among Semi-Professional Soccer Players.

    PubMed

    McCunn, Robert; Fünten, Karen Aus der; Whalan, Matthew; Sampson, John A; Meyer, Tim

    2018-05-08

    Study Design Prospective cohort. Background The association between movement quality and injury is equivocal. No soccer-specific movement assessment has been prospectively investigated in relation to injury risk. Objectives To investigate the association between a soccer-specific movement quality assessment and injury risk among semi-professional soccer players. Methods Semi-professional soccer players (n=306) from 12 clubs completed the Soccer Injury Movement Screen (SIMS) during the pre-season period. Individual training/match exposure and non-contact time loss injuries were recorded prospectively for the entirety of the 2016 season. Relative risks (RR) were calculated, and presented with 90% confidence intervals (CI), for the SIMS composite and individual sub-test scores from generalized linear models with Poisson distribution offset for exposure. Results When considering non-contact time loss lower extremity injuries (primary level of analysis), there was a most likely trivial association with the SIMS composite score. Similarly, SIMS composite score demonstrated most likely to likely trivial associations to all injury categories included in the secondary level of analysis (non-contact time loss hip/groin, thigh, knee and ankle injuries). When considering hamstring strains and ankle sprains specifically (tertiary level of analysis) the SIMS composite score, again, demonstrated very likely trivial associations. A total of 262 non-contact time loss injuries were recorded. The overall (training and match exposure combined) incidence of non-contact time loss injury was 12/1000 hours. Conclusion The SIMS composite score demonstrated no association to any of the investigated categories of soccer-related injury. The SIMS composite score should not be used to group players into 'high' or 'low' risk groups. Level of Evidence Prognosis, level 4. J Orthop Sports Phys Ther, Epub 8 May 2018. doi:10.2519/jospt.2018.8037.

  12. A comparison of KABCO and AIS injury severity metrics using CODES linked data.

    PubMed

    Burch, Cynthia; Cook, Lawrence; Dischinger, Patricia

    2014-01-01

    The research objective is to compare the consistency of distributions between crash assigned (KABCO) and hospital assigned (Abbreviated Injury Scale, AIS) injury severity scoring systems for 2 states. The hypothesis is that AIS scores will be more consistent between the 2 studied states (Maryland and Utah) than KABCO. The analysis involved Crash Outcome Data Evaluation System (CODES) data from 2 states, Maryland and Utah, for years 2006-2008. Crash report and hospital inpatient data were linked probabilistically and International Classification of Diseases (CMS 2013) codes from hospital records were translated into AIS codes. KABCO scores from police crash reports were compared to those AIS scores within and between the 2 study states. Maryland appears to have the more severe crash report KABCO scoring for injured crash participants, with close to 50 percent of all injured persons being coded as a level B or worse, and Utah observes approximately 40 percent in this group. When analyzing AIS scores, some fluctuation was seen within states over time, but the distribution of MAIS is much more comparable between states. Maryland had approximately 85 percent of hospitalized injured cases coded as MAIS = 1 or minor. In Utah this percentage was close to 80 percent for all 3 years. This is quite different from the KABCO distributions, where Maryland had a smaller percentage of cases in the lowest injury severity category as compared to Utah. This analysis examines the distribution of 2 injury severity metrics different in both design and collection and found that both classifications are consistent within each state from 2006 to 2008. However, the distribution of both KABCO and Maximum Abbreviated Injury Scale (MAIS) varies between the states. MAIS was found to be more consistent between states than KABCO.

  13. Patterns in deer-related traffic injuries over a decade: the Mayo Clinic experience.

    PubMed

    Smoot, Dustin L; Zielinski, Martin D; Cullinane, Daniel C; Jenkins, Donald H; Schiller, Henry J; Sawyer, Mark D

    2010-08-17

    Our American College of Surgeons Level 1 Trauma Center serves a rural population. As a result, there is a unique set of accidents that are not present in an urban environment such as deer related motor vehicle crashes (dMVC). We characterized injury patterns between motorcycle/all-terrain vehicles (MCC) and automobile (MVC) crashes related to dMVC (deer motor vehicle crash) with the hypotheses that MCC will present with higher Injury Severity Score (ISS) and that it would be related to whether the driver struck the deer or swerved. The records of 157 consecutive patients evaluated at our institution for injury related to dMVC from January 1st, 1997 to December 31st, 2006 were reviewed from our prospectively collected trauma database. Demographic, clinical, and crash specific parameters were abstracted. Injury severity was analyzed by the Abbreviated Injury Scale score for each body region as well as the overall Injury Severity Score (ISS). Motorcycle crashes presented with a higher median ISS than MVCs (14 vs 5, p < 0.001). Median Abbreviated Injury Score (AIS) of the spine for MCC riders was higher (3 vs 0, p < 0.001) if they swerved rather than collided. Seventy-seven percent of riders were not wearing a helmet which did not result in a statistically significant increase in median ISS (16 vs 10), head AIS (2 vs 0) or spine AIS (0 vs 0).Within the MVC group, there was no difference between swerving and hitting the deer in any AIS group. Forty-seven percent of drivers were not wearing seat belts which resulted in similar median ISS (6 vs 5) and AIS of all body regions. Motorcycle operators suffered higher ISS. There were no significant differences in median ISS if a driver involved in a deer-related motor vehicle crash swerved rather than collided, was helmeted, or restrained.

  14. Traumatic aortic injury score (TRAINS): an easy and simple score for early detection of traumatic aortic injuries in major trauma patients with associated blunt chest trauma.

    PubMed

    Mosquera, Victor X; Marini, Milagros; Muñiz, Javier; Asorey-Veiga, Vanesa; Adrio-Nazar, Belen; Boix, Ricardo; Lopez-Perez, José M; Pradas-Montilla, Gonzalo; Cuenca, José J

    2012-09-01

    To develop a risk score based on physical examination and chest X-ray findings to rapidly identify major trauma patients at risk of acute traumatic aortic injury (ATAI). A multicenter retrospective study was conducted with 640 major trauma patients with associated blunt chest trauma classified into ATAI (aortic injury) and NATAI (no aortic injury) groups. The score data set included 76 consecutive ATAI and 304 NATAI patients from a single center, whereas the validation data set included 52 consecutive ATAI and 208 NATAI patients from three independent institutions. Bivariate analysis identified variables potentially influencing the presentation of aortic injury. Confirmed variables by logistic regression were assigned a score according to their corresponding beta coefficient which was rounded to the closest integer value (1-4). Predictors of aortic injury included widened mediastinum, hypotension less than 90 mmHg, long bone fracture, pulmonary contusion, left scapula fracture, hemothorax, and pelvic fracture. Area under receiver operating characteristic curve was 0.96. In the score data set, sensitivity was 93.42 %, specificity 85.85 %, Youden's index 0.79, positive likelihood ratio 6.60, and negative likelihood ratio 0.08. In the validation data set, sensitivity was 92.31 % and specificity 85.1 %. Given the relative infrequency of traumatic aortic injury, which often leads to missed or delayed diagnosis, application of our score has the potential to draw necessary clinical attention to the possibility of aortic injury, thus providing the chance of a prompt specific diagnostic and therapeutic management.

  15. Child and Adult Pedestrian Impact: The Influence of Vehicle Type on Injury Severity

    PubMed Central

    Henary, Basem Y.; Crandall, Jeff; Bhalla, Kavi; Mock, Charles N.; Roudsari, Bahman S.

    2003-01-01

    In the United States, the vehicle fleet is shifting from predominantly passenger cars (automobiles) to SUVs, light trucks, and vans (LTV). This study investigates how pedestrian severe injury and mortality are associated with vehicle type and pedestrian age. The Pedestrian Crash Data Study (PCDS) database for years 1994–1998 was used for a cross-sectional study design. Outcome measures were Injury Severity Score, Maximum Abbreviated Injury Score, Abbreviated Injury Scale, Pedestrian Mortality, Functional Capacity Index and Life Years Lost to Injury. Compared to children, adult pedestrians were more likely to sustain severe injury (OR = 2.81; 95% CI: 1.56–5.06) or mortality (OR = 2.91; 95% CI: 1.10–7.74) when examining all vehicle types. However, after adjusting for vehicle type and impact speed, this association was not statistically significant at p < 0.05. Compared to passenger cars, pedestrians struck by LTV were more likely to have severe injuries (OR = 1.31; 95% CI: 0.88–1.94) or mortality (OR = 1.40; 95% CI: 0.84–2.34) for all pedestrians. Adjusting for pedestrian age, this association was more obvious and significant at lower impact speeds (≤ 30 km/h); odds ratios of severe injury and mortality were 3.34 (p< 0.01) and 1.87 (p= 0.07), respectively. Adults hit by LTV had the highest risk of injury and mortality. These findings indicate that pedestrian age, vehicle engineering design and impact speed are highly contributing to risks of pedestrian injury and mortality. PMID:12941221

  16. Development and Validation of an Abbreviated Questionnaire to Easily Measure Cognitive Failure in ICU Survivors: A Multicenter Study.

    PubMed

    Wassenaar, Annelies; de Reus, Jorn; Donders, A Rogier T; Schoonhoven, Lisette; Cremer, Olaf L; de Lange, Dylan W; van Dijk, Diederik; Slooter, Arjen J C; Pickkers, Peter; van den Boogaard, Mark

    2018-01-01

    To develop and validate an abbreviated version of the Cognitive Failure Questionnaire that can be used by patients as part of self-assessment to measure functional cognitive outcome in ICU survivors. A retrospective multicenter observational study. The ICUs of two Dutch university hospitals. Adult ICU survivors. None. Cognitive functioning was evaluated between 12 and 24 months after ICU discharge using the full 25-item Cognitive Failure Questionnaire (CFQ-25). Incomplete CFQ-25 questionnaires were excluded from analysis. Forward selection in a linear regression model was used in hospital A to assess which of the CFQ-25 items should be included to prevent a significant loss of correlation between an abbreviated and the full CFQ-25. Subsequently, the performance of an abbreviated Cognitive Failure Questionnaire was determined in hospital B using Pearson's correlation. A Bland-Altman plot was used to examine whether the reduced-item outcome scores of an abbreviated Cognitive Failure Questionnaire were a replacement for the full CFQ-25 outcome scores. Among 1,934 ICU survivors, 1,737 were included, 819 in hospital A, 918 in hospital B. The Pearson's correlation between the abbreviated 14-item Cognitive Failure Questionnaire (CFQ-14) and the CFQ-25 was 0.99. The mean of the difference scores was -0.26, and 95% of the difference scores fell within +5 and -5.5 on a 100-point maximum score. It is feasible to use the abbreviated CFQ-14 to measure self-reported cognitive failure in ICU survivors as this questionnaire has a similar performance as the full CFQ-25.

  17. Abbreviations in Maritime English

    ERIC Educational Resources Information Center

    Yang, Zhirong

    2011-01-01

    Aiming at the phenomena that more and more abbreviations occur in maritime English correspondences, the composing laws of the abbreviations in maritime English correspondence are analyzed, and the correct methods to answer the abbreviations are pointed out, and the translation method of abbreviations are summarized in this article, and the…

  18. Major influence of interobserver reliability on polytrauma identification with the Injury Severity Score (ISS): Time for a centralised coding in trauma registries?

    PubMed

    Maduz, Roman; Kugelmeier, Patrick; Meili, Severin; Döring, Robert; Meier, Christoph; Wahl, Peter

    2017-04-01

    The Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) find increasingly widespread use to assess trauma burden and to perform interhospital benchmarking through trauma registries. Since 2015, public resource allocation in Switzerland shall even be derived from such data. As every trauma centre is responsible for its own coding and data input, this study aims at evaluating interobserver reliability of AIS and ISS coding. Interobserver reliability of the AIS and ISS is analysed from a cohort of 50 consecutive severely injured patients treated in 2012 at our institution, coded retrospectively by 3 independent and specifically trained observers. Considering a cutoff ISS≥16, only 38/50 patients (76%) were uniformly identified as polytraumatised or not. Increasing the cut off to ≥20, this increased to 41/50 patients (82%). A difference in the AIS of ≥ 1 was present in 261 (16%) of possible codes. Excluding the vast majority of uninjured body regions, uniformly identical AIS severity values were attributed in 67/193 (35%) body regions, or 318/579 (55%) possible observer pairings. Injury severity all too often is neither identified correctly nor consistently when using the AIS. This leads to wrong identification of severely injured patients using the ISS. Improving consistency of coding through centralisation is recommended before scores based on the AIS are to be used for interhospital benchmarking and resource allocation in the treatment of severely injured patients. Copyright © 2017. Published by Elsevier Ltd.

  19. The impact of the AIS 2005 revision on injury severity scores and clinical outcome measures.

    PubMed

    Salottolo, Kristin; Settell, April; Uribe, Phyllis; Akin, Shelley; Slone, Denetta Sue; O'Neal, Erika; Mains, Charles; Bar-Or, David

    2009-09-01

    The abbreviated injury scale (AIS) was updated in 2005 from the AIS 1998 version. The purpose of this study is to describe the effects of this change on injury severity scoring and outcome measures. Analyses were performed on all trauma patients consecutively admitted over a 6-month period at two geographically separate Level I trauma centers. Injuries were manually double-coded according to the AIS 05 and the AIS 98. Changes in AIS, ISS, and new ISS (NISS) were analysed using paired t-tests. Apparent differences in outcome by ISS strata (<16, 16-24, >24) were compared for AIS 05 versus AIS 98 using the Wald-type statistic. Lastly, the percent of patients with a change in ISS strata are reported. There were 2250 patients included in the study. Nearly half (46.4%) of AIS codes changed, resulting in a different AIS score for 18.9% of all codes. The mean ISS was significantly lower using the AIS 05 (11.7) versus the AIS 98 (13.3, p<0.001). Similarly, the mean NISS was significantly lower (16.3 versus 18.7, p<0.001). In the ISS strata 16-24 an apparent increase in mortality, length of stay, and percent of patients not discharged home was observed for the AIS 05 versus AIS 98. Changes in outcome measures for this stratum were as follows (AIS 98 versus AIS 05): mortality, 4.3% versus 7.7% (p=0.002); hospital length of stay, 5.2 days versus 7.3 days (p<0.001); percent of patients not discharged home, 39.2% versus 49.3% (p<0.001). Finally, there was a 20.5% reduction in patients with an ISS>or=16 and a 26.2% reduction in patients with an ISS>or=25 using the AIS 05. The AIS revision had a significant impact on overall injury severity measures, clinical outcome measures, and percent of patients in each ISS strata. Therefore, the AIS revision affects the ability to directly compare data generated using AIS 05 and AIS 98 which has implications in trauma research, reimbursement and ACS accreditation.

  20. An injury mortality prediction based on the anatomic injury scale

    PubMed Central

    Wang, Muding; Wu, Dan; Qiu, Wusi; Wang, Weimi; Zeng, Yunji; Shen, Yi

    2017-01-01

    Abstract To determine whether the injury mortality prediction (IMP) statistically outperforms the trauma mortality prediction model (TMPM) as a predictor of mortality. The TMPM is currently the best trauma score method, which is based on the anatomic injury. Its ability of mortality prediction is superior to the injury severity score (ISS) and to the new injury severity score (NISS). However, despite its statistical significance, the predictive power of TMPM needs to be further improved. Retrospective cohort study is based on the data of 1,148,359 injured patients in the National Trauma Data Bank hospitalized from 2010 to 2011. Sixty percent of the data was used to derive an empiric measure of severity of different Abbreviated Injury Scale predot codes by taking the weighted average death probabilities of trauma patients. Twenty percent of the data was used to create computing method of the IMP model. The remaining 20% of the data was used to evaluate the statistical performance of IMP and then be compared with the TMPM and the single worst injury by examining area under the receiver operating characteristic curve (ROC), the Hosmer–Lemeshow (HL) statistic, and the Akaike information criterion. IMP exhibits significantly both better discrimination (ROC-IMP, 0.903 [0.899–0.907] and ROC-TMPM, 0.890 [0.886–0.895]) and calibration (HL-IMP, 9.9 [4.4–14.7] and HL-TMPM, 197 [143–248]) compared with TMPM. All models show slight changes after the extension of age, gender, and mechanism of injury, but the extended IMP still dominated TMPM in every performance. The IMP has slight improvement in discrimination and calibration compared with the TMPM and can accurately predict mortality. Therefore, we consider it as a new feasible scoring method in trauma research. PMID:28858124

  1. [The importance of Injury Severity Score (ISS) in the management of thoracolumbar burst fracture].

    PubMed

    Rezende, Rodrigo; Avanzi, Osmar

    2009-02-01

    There are few publications which relate the injury severity score (ISS) to the thoracolumbar burst fractures. For that reason and for the frequency in which they occur, we have evaluated the severity of the trauma in these patients. We have evaluated 190 burst fractures in the spinal cord according to Denis, using the codes of Abbreviated Injury Scales (AIS) for the calculation of the ISS, which uses the three parts of the human body with major severity. These lesions are a squared number and the results are summed up. Among 190 cases evaluated, the median value of the ISS was 13 and the average was 14,4. Males presented a higher ISS than females. The young adult patients presented an average and a median value of the ISS higher than the old patients. The higher the ISS is, the longer the hospitalization period is, except for the patients with the ISS over 35. The fractures in thoracic level show the ISS higher than the rest. The ISS is directly related to surgical treatment and mortality. The ISS values which were found show that a less severe trauma can cause a burst thoracic or lumbar spinal cord fracture. The value of the ISS has not shown correlation to the sex and the fracture level, but it is proportional to the hospitalization period, the surgical treatment and the mortality rate. This result shows a value which is inversely proportional to the age of the patients.

  2. North American Clinical Trials Network (NACTN) for Treatment of Spinal Cord Injury: A Consortium of Military, Veterans Administration, and Civilian Hospitals

    DTIC Science & Technology

    2011-01-31

    of the patient on arrival and includes a clinical evaluation, 5 measurement of state of consciousness with the Glasgow Coma Scale (GCS) and of...associated injuries with the Abbreviated Injury Scale . The American Spinal Injury Association impairment scale (AIS) is scored on admission and at key...the AIS Impairment Scale , and where appropriate, the Functional Independence Measure FIM™, the Spinal Cord Independence Measure (SCIM), and the

  3. The Military Injury Severity Score (mISS): A better predictor of combat mortality than Injury Severity Score (ISS).

    PubMed

    Le, Tuan D; Orman, Jean A; Stockinger, Zsolt T; Spott, Mary Ann; West, Susan A; Mann-Salinas, Elizabeth A; Chung, Kevin K; Gross, Kirby R

    2016-07-01

    The Military Injury Severity Score (mISS) was developed to better predict mortality in complex combat injuries but has yet to be validated. US combat trauma data from Afghanistan and Iraq from January 1, 2003, to December 31, 2014, from the US Department of Defense Trauma Registry (DoDTR) were analyzed. Military ISS, a variation of the ISS, was calculated and compared with standard ISS scores.Receiver operating characteristic curve, area under the curve, and Hosmer-Lemeshow statistics were used to discriminate and calibrate between mISS and ISS. Wilcoxon-Mann-Whitney, t test and χ tests were used, and sensitivity and specificity calculated. Logistic regression was used to calculate the likelihood of mortality associated with levels of mISS and ISS overall. Thirty thousand three hundred sixty-four patients were analyzed. Most were male (96.8%). Median age was 24 years (interquartile range [IQR], 21-29 years). Battle injuries comprised 65.3%. Penetrating (39.5%) and blunt (54.2%) injury types and explosion (51%) and gunshot wound (15%) mechanisms predominated. Overall mortality was 6.0%.Median mISS and ISS were similar in survivors (5 [IQR, 2-10] vs. 5 [IQR, 2-10]) but different in nonsurvivors, 30 (IQR, 16-75) versus 24 (IQR, 9-23), respectively (p < 0.0001). Military ISS and ISS were discordant in 17.6% (n = 5,352), accounting for 56.2% (n = 1,016) of deaths. Among cases with discordant severity scores, the median difference between mISS and ISS was 9 (IQR, 7-16); range, 1 to 59. Military ISS and ISS shared 78% variability (R = 0.78).Area under the curve was higher in mISS than in ISS overall (0.82 vs. 0.79), for battle injury (0.79 vs. 0.76), non-battle injury (0.87 vs. 0.86), penetrating (0.81 vs. 0.77), blunt (0.77 vs. 0.75), explosion (0.81 vs. 0.78), and gunshot (0.79 vs. 0.73), all p < 0.0001. Higher mISS and ISS were associated with higher mortality. Compared with ISS, mISS had higher sensitivity (81.2 vs. 63.9) and slightly lower specificity (80.2 vs. 85

  4. Development of the Abbreviated Masculine Gender Role Stress Scale

    PubMed Central

    Swartout, Kevin M.; Parrott, Dominic J.; Cohn, Amy M.; Hagman, Brett T.; Gallagher, Kathryn E.

    2014-01-01

    Data gathered from six independent samples (n = 1,729) that assessed men’s masculine gender role stress in college and community males were aggregated used to determine the reliability and validity of an abbreviated version of the Masculine Gender Role Stress Scale (MGRS scale). The 15 items with the highest item-to-total scale correlations were used to create an abbreviated MGRS scale. Psychometric properties of each of the 15-items were examined with Item Response Theory (IRT) analysis, using the discrimination and threshold parameters. IRT results showed that the abbreviated scale may hold promise at capturing the same amount of information as the full 40-item scale. Relative to the 40-item scale, the total score of the abbreviated MGRS scale demonstrated comparable convergent validity using the measurement domains of masculine identity, hyper-masculinity, trait anger, anger expression, and alcohol involvement. An abbreviated MGRS scale may be recommended for use in clinical practice and research settings to reduce cost, time, and patient/participant burden. Additionally, IRT analyses identified items with higher discrimination and threshold parameters that may be used to screen for problematic gender role stress in men who may be seen in routine clinical or medical practice. PMID:25528163

  5. Development of the Abbreviated Masculine Gender Role Stress Scale.

    PubMed

    Swartout, Kevin M; Parrott, Dominic J; Cohn, Amy M; Hagman, Brett T; Gallagher, Kathryn E

    2015-06-01

    Data gathered from 6 independent samples (n = 1,729) that assessed men's masculine gender role stress in college and community males were aggregated used to determine the reliability and validity of an abbreviated version of the Masculine Gender Role Stress (MGRS) Scale. The 15 items with the highest item-to-total scale correlations were used to create an abbreviated MGRS Scale. Psychometric properties of each of the 15 items were examined with item response theory (IRT) analysis, using the discrimination and threshold parameters. IRT results showed that the abbreviated scale may hold promise at capturing the same amount of information as the full 40-item scale. Relative to the 40-item scale, the total score of the abbreviated MGRS Scale demonstrated comparable convergent validity using the measurement domains of masculine identity, hypermasculinity, trait anger, anger expression, and alcohol involvement. An abbreviated MGRS Scale may be recommended for use in clinical practice and research settings to reduce cost, time, and patient/participant burden. Additionally, IRT analyses identified items with higher discrimination and threshold parameters that may be used to screen for problematic gender role stress in men who may be seen in routine clinical or medical practice. (c) 2015 APA, all rights reserved).

  6. [Occupational injuries among construction workers in Hong Kong].

    PubMed

    Huang, Zihui; Chen, Weiqing

    2002-02-01

    To explore the nature and severity of occupational injuries among construction workers and its risk factors in Hong Kong. One hundred and twenty-two injured construction workers in a public hospital and an equal number of workmate controls were studied. Contents included socio -demographic characteristics, the availability and use of safety equipment, smoking and alcohol consumption, etc. Abbreviated injury scale (AIS) and injury severity score (ISS) were employed for describing the nature, pattern and severity of injuries. Single injuries were seen in 80% of cases. Of 149 injuries classified by body region, 49% were external, 26% involved either the upper or lower extremities, and 11% were spinal injuries. Working at height was associated with the injury severity score. Safety hazards were identified in the work environment in 68% of the cases. Significant odds ratios for accidents were obtained for 'no formal education', 'non safety training' and 'current smokers'. The results implicated that construction was a hazardous occupation in Hong Kong. Improving the work environment and promoting safety education among construction workers would be helpful for minimizing or eliminating occupational injuries in construction occupation in Hong Kong.

  7. Chest injuries associated with earthquakes: an analysis of injuries sustained during the 2008 Wen-Chuan earthquake in China.

    PubMed

    Hu, Jia; Guo, Ying-Qiang; Zhang, Er-Yong; Tan, Jin; Shi, Ying-Kang

    2010-08-01

    The goal of this study was to analyze the patterns, therapeutic modalities, and short-term outcomes of patients with chest injuries in the aftermath of the Wen-Chuan earthquake, which occurred on May 12, 2008 and registered 8.0 on the Richter scale. Of the 1522 patients who were referred to the West China Hospital of Sichuan University from May 12 to May 27, 169 patients (11.1%) had suffered major chest injuries. The type of injury, the presence of infection, Abbreviated Injury Score (AIS 2005), New Injury Severity Score (NISS), treatment, and short-term outcome were all documented for each case. Isolated chest injuries were diagnosed in 129 patients (76.3%), while multiple injuries with a major chest trauma were diagnosed in 40 patients (23.7%). The mean AIS and the median NISS of the hospitalized patients with chest injuries were 2.5 and 13, respectively. The mortality rate was 3.0% (5 patients). Most of the chest injuries were classified as minor to moderate trauma; however, coexistent multiple injuries and subsequent infection should be carefully considered in medical response strategies. Coordinated efforts among emergency medical support groups and prior training in earthquake preparedness and rescue in earthquake-prone areas are therefore necessary for efficient evacuation and treatment of catastrophic casualties.

  8. Using Abbreviated Injury Scale (AIS) codes to classify Computed Tomography (CT) features in the Marshall System.

    PubMed

    Lesko, Mehdi M; Woodford, Maralyn; White, Laura; O'Brien, Sarah J; Childs, Charmaine; Lecky, Fiona E

    2010-08-06

    The purpose of Abbreviated Injury Scale (AIS) is to code various types of Traumatic Brain Injuries (TBI) based on their anatomical location and severity. The Marshall CT Classification is used to identify those subgroups of brain injured patients at higher risk of deterioration or mortality. The purpose of this study is to determine whether and how AIS coding can be translated to the Marshall Classification Initially, a Marshall Class was allocated to each AIS code through cross-tabulation. This was agreed upon through several discussion meetings with experts from both fields (clinicians and AIS coders). Furthermore, in order to make this translation possible, some necessary assumptions with regards to coding and classification of mass lesions and brain swelling were essential which were all approved and made explicit. The proposed method involves two stages: firstly to determine all possible Marshall Classes which a given patient can attract based on allocated AIS codes; via cross-tabulation and secondly to assign one Marshall Class to each patient through an algorithm. This method can be easily programmed in computer softwares and it would enable future important TBI research programs using trauma registry data.

  9. Using Abbreviated Injury Scale (AIS) codes to classify Computed Tomography (CT) features in the Marshall System

    PubMed Central

    2010-01-01

    Background The purpose of Abbreviated Injury Scale (AIS) is to code various types of Traumatic Brain Injuries (TBI) based on their anatomical location and severity. The Marshall CT Classification is used to identify those subgroups of brain injured patients at higher risk of deterioration or mortality. The purpose of this study is to determine whether and how AIS coding can be translated to the Marshall Classification Methods Initially, a Marshall Class was allocated to each AIS code through cross-tabulation. This was agreed upon through several discussion meetings with experts from both fields (clinicians and AIS coders). Furthermore, in order to make this translation possible, some necessary assumptions with regards to coding and classification of mass lesions and brain swelling were essential which were all approved and made explicit. Results The proposed method involves two stages: firstly to determine all possible Marshall Classes which a given patient can attract based on allocated AIS codes; via cross-tabulation and secondly to assign one Marshall Class to each patient through an algorithm. Conclusion This method can be easily programmed in computer softwares and it would enable future important TBI research programs using trauma registry data. PMID:20691038

  10. [Application of Ocular Trauma Score in Mechanical Ocular Injury in Forensic Medicine].

    PubMed

    Xiang, Jian; Guo, Zhao-ming; Wang, Xu; Yu, Li-li; Liu, Hui

    2015-10-01

    To evaluate the application value for the prognosis of mechanical ocular injury cases using ocular trauma score (OTS). Four hundred and eleven cases of mechanical ocular trauma were retrospectively reviewed. Of the 449 eyes, there were 317 closed globe injury and 132 open globe injury. OTS variables included numerical values as initial visual acuity, rupture, endophthalmitis, perforat- ing or penetrating injury, retinal detachment and relative afferent pupillary block. The differences be- tween the distribution of the final visual acuity and the probability of standard final visual acuity were compared to analyze the correlation between OTS category and final visual acuity. The different types of ocular trauma were compared. Compared with the distribution of final visual acuity in standard OTS score, the ratio in OTS-3 category was statistically different in present study, and no differences were found in other categories. Final visual acuity showed a great linear correlation with OTS category (r = 0.71) and total score (r = 0.73). Compared with closed globe injury, open globe injury was generally associated with lower total score and poorer prognosis. Rupture injury had poorer prognosis compared with penetrating injury. The use of OTS for the patients with ocular trauma can provide re- liable information for the evaluation of prognosis in forensic medicine.

  11. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience.

    PubMed

    Veysi, Veysi T; Nikolaou, Vassilios S; Paliobeis, Christos; Efstathopoulos, Nicolas; Giannoudis, Peter V

    2009-10-01

    A review of prospectively collected data in our trauma unit for the years 1998-2003 was undertaken. Adult patients who suffered multiple trauma with an Injury Severity Score (ISS) of >/=16, admitted to hospital for more than 72 hours and with sustained blunt chest injuries were included in the study. Demographic details including pre-hospital care, trauma history, admission vital signs, blood transfusions, details of injuries and their abbreviated injury scores (AIS), operations, length of intensive care unit and hospital stays, Injury Severity Score (ISS) and mortality were analysed. Fulfilling the inclusion criteria with at least one chest injury were 1,164 patients. The overall mortality reached 18.7%. As expected, patients in the higher AIS groups had both a higher overall ISS and mortality rate with one significant exception; patients with minor chest injuries (AIS(chest) = 1) were associated with mortality comparable to injuries involving an AIS(chest) = 3. Additionally, the vast majority of polytraumatised patients with an AIS(chest) = 1 died in ICU sooner than patients of groups 2-5.

  12. Chronic consequences of acute injuries: worse survival after discharge.

    PubMed

    Shafi, Shahid; Renfro, Lindsay A; Barnes, Sunni; Rayan, Nadine; Gentilello, Larry M; Fleming, Neil; Ballard, David

    2012-09-01

    The Trauma Quality Improvement Program uses inhospital mortality to measure quality of care, which assumes patients who survive injury are not likely to suffer higher mortality after discharge. We hypothesized that survival rates in trauma patients who survive to discharge remain stable afterward. Patients treated at an urban Level I trauma center (2006-2008) were linked with the Social Security Administration Death Master File. Survival rates were measured at 30, 90, and 180 days and 1 and 2 years from injury among two groups of trauma patients who survived to discharge: major trauma (Abbreviated Injury Scale score ≥ 3 injuries, n = 2,238) and minor trauma (Abbreviated Injury Scale score ≤ 2 injuries, n = 1,171). Control groups matched to each trauma group by age and sex were simulated from the US general population using annual survival probabilities from census data. Kaplan-Meier and log-rank analyses conditional upon survival to each time point were used to determine changes in risk of mortality after discharge. Cox proportional hazards models with left truncation at the time of discharge were used to determine independent predictors of mortality after discharge. The survival rate in trauma patients with major injuries was 92% at 30 days posttrauma and declined to 84% by 3 years (p > 0.05 compared with general population). Minor trauma patients experienced a survival rate similar to the general population. Age and injury severity were the only independent predictors of long-term mortality given survival to discharge. Log-rank tests conditional on survival to each time point showed that mortality risk in patients with major injuries remained significantly higher than the general population for up to 6 months after injury. The survival rate of trauma patients with major injuries remains significantly lower than survival for minor trauma patients and the general population for several months postdischarge. Surveillance for early identification and treatment of

  13. Applicability of an established management algorithm for destructive colon injuries after abbreviated laparotomy: a 17-year experience.

    PubMed

    Sharpe, John P; Magnotti, Louis J; Weinberg, Jordan A; Shahan, Charles P; Cullinan, Darren R; Marino, Katy A; Fabian, Timothy C; Croce, Martin A

    2014-04-01

    For more than a decade, operative decisions (resection plus anastomosis vs diversion) for colon injuries, at our institution, have followed a defined management algorithm based on established risk factors (pre- or intraoperative transfusion requirements of more than 6 units packed RBCs and/or presence of significant comorbid diseases). However, this management algorithm was originally developed for patients managed with a single laparotomy. The purpose of this study was to evaluate the applicability of this algorithm to destructive colon injuries after abbreviated laparotomy (AL) and to determine whether additional risk factors should be considered. Consecutive patients over a 17-year period with colon injuries after AL were identified. Nondestructive injuries were managed with primary repair. Destructive wounds were resected at the initial laparotomy followed by either a staged diversion (SD) or a delayed anastomosis (DA) at the subsequent exploration. Outcomes were evaluated to identify additional risk factors in the setting of AL. We identified 149 patients: 33 (22%) patients underwent primary repair at initial exploration, 42 (28%) underwent DA, and 72 (49%) had SD. Two (1%) patients died before re-exploration. Of those undergoing DA, 23 (55%) patients were managed according to the algorithm and 19 (45%) were not. Adherence to the algorithm resulted in lower rates of suture line failure (4% vs 32%, p = 0.03) and colon-related morbidity (22% vs 58%, p = 0.03) for patients undergoing DA. No additional specific risk factors for suture line failure after DA were identified. Adherence to an established algorithm, originally defined for destructive colon injuries after single laparotomy, is likewise efficacious for the management of these injuries in the setting of AL. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Quality of life at 6 years after occupational injury.

    PubMed

    Chin, Wei-Shan; Guo, Yue Leon; Liao, Shih-Cheng; Wu, Hsueh-Ching; Kuo, Chun-Ya; Chen, Chih-Chieh; Shiao, Judith Shu-Chu

    2018-03-01

    Occupational injuries have considerable impact on workers' lives. However, data regarding workers' health-related quality of life (HRQOL) at several years after the injury are lacking. This study assessed workers' HRQOL at 6 years after occupational injury and determined related factors in each HRQOL domain. Workers who sustained an occupational injury in 2009 and who responded to a previous survey at 3 or 12 months after their injury were followed up in 2015. A total of 1715 participants were candidates for this study. The Taiwanese version of the World Health Organization Quality of Life scale-abbreviated version (WHOQOL-BREF) was used to assess their HRQOL. Multiple linear regression analysis identified predictive factors for HRQOL at 6 years after occupational injury. A total of 563 workers completed the questionnaire (response rate, 32.8%). Adverse life events and additional severe occupational injuries that occurred within the follow-up period, and decreased salary after the injury were significant factors for low scores in all domains of the WHOQOL-BREF. In addition, unmarried participants had low scores in the social relationship domain. Workers with family members requiring care scored low in the physical and environment domains. Workers whose injuries had major effects on their physical appearance had low scores in the physical and psychological domains. Workers with unstable employment had low scores in physical, psychological, and environment domains. At 6 years after occupational injury, workers' HRQOL was poor among those whose salaries decreased after the injury, after adjustment for other factors.

  15. Patterns in deer-related traffic injuries over a decade: the Mayo clinic experience

    PubMed Central

    2010-01-01

    Background Our American College of Surgeons Level 1 Trauma Center serves a rural population. As a result, there is a unique set of accidents that are not present in an urban environment such as deer related motor vehicle crashes (dMVC). We characterized injury patterns between motorcycle/all-terrain vehicles (MCC) and automobile (MVC) crashes related to dMVC (deer motor vehicle crash) with the hypotheses that MCC will present with higher Injury Severity Score (ISS) and that it would be related to whether the driver struck the deer or swerved. Methods The records of 157 consecutive patients evaluated at our institution for injury related to dMVC from January 1st, 1997 to December 31st, 2006 were reviewed from our prospectively collected trauma database. Demographic, clinical, and crash specific parameters were abstracted. Injury severity was analyzed by the Abbreviated Injury Scale score for each body region as well as the overall Injury Severity Score (ISS). Results Motorcycle crashes presented with a higher median ISS than MVCs (14 vs 5, p < 0.001). Median Abbreviated Injury Score (AIS) of the spine for MCC riders was higher (3 vs 0, p < 0.001) if they swerved rather than collided. Seventy-seven percent of riders were not wearing a helmet which did not result in a statistically significant increase in median ISS (16 vs 10), head AIS (2 vs 0) or spine AIS (0 vs 0). Within the MVC group, there was no difference between swerving and hitting the deer in any AIS group. Forty-seven percent of drivers were not wearing seat belts which resulted in similar median ISS (6 vs 5) and AIS of all body regions. Conclusions Motorcycle operators suffered higher ISS. There were no significant differences in median ISS if a driver involved in a deer-related motor vehicle crash swerved rather than collided, was helmeted, or restrained. PMID:20716341

  16. Abbreviated neuropsychological assessment in schizophrenia

    PubMed Central

    Harvey, Philip D.; Keefe, Richard S. E.; Patterson, Thomas L.; Heaton, Robert K.; Bowie, Christopher R.

    2008-01-01

    The aim of this study was to identify the best subset of neuropsychological tests for prediction of several different aspects of functioning in a large (n = 236) sample of older people with schizophrenia. While the validity of abbreviated assessment methods has been examined before, there has never been a comparative study of the prediction of different elements of cognitive impairment, real-world outcomes, and performance-based measures of functional capacity. Scores on 10 different tests from a neuropsychological assessment battery were used to predict global neuropsychological (NP) performance (indexed with averaged scores or calculated general deficit scores), performance-based indices of everyday-living skills and social competence, and case-manager ratings of real-world functioning. Forward entry stepwise regression analyses were used to identify the best predictors for each of the outcomes measures. Then, the analyses were adjusted for estimated premorbid IQ, which reduced the magnitude, but not the structure, of the correlations. Substantial amounts (over 70%) of the variance in overall NP performance were accounted for by a limited number of NP tests. Considerable variance in measures of functional capacity was also accounted for by a limited number of tests. Different tests constituted the best predictor set for each outcome measure. A substantial proportion of the variance in several different NP and functional outcomes can be accounted for by a small number of NP tests that can be completed in a few minutes, although there is considerable unexplained variance. However, the abbreviated assessments that best predict different outcomes vary across outcomes. Future studies should determine whether responses to pharmacological and remediation treatments can be captured with brief assessments as well. PMID:18720182

  17. Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury

    PubMed Central

    Majercik, Sarah; Bledsoe, Joseph; Ryser, David; Hopkins, Ramona O.; Fair, Joseph E.; Frost, R. Brock; MacDonald, Joel; Barrett, Ryan; Horn, Susan; Pisani, David; Bigler, Erin D.; Gardner, Scott; Stevens, Mark; Larson, Michael J.

    2016-01-01

    Introduction Day-of-injury (DOI) brain lesion volumes in traumatic brain injury (TBI) patients are rarely used to predict long-term outcomes in the acute setting. The purpose of this study was to investigate the relationship between acute brain injury lesion volume and rehabilitation outcomes in patients with TBI at a Level One Trauma Center. Methods Patients with TBI who were admitted to our rehabilitation unit after the acute care trauma service from February 2009-July 2011 were eligible for the study. Demographic data and outcome variables including cognitive and motor FIM scores, length of stay (LOS) in the rehabilitation unit, and ability to return to home were obtained. DOI quantitative injury lesion volumes and degree of midline shift were obtained from day-of-injury (DOI) brain computed tomography (CT) scans. A multiple step-wise regression model including 13 independent variables was created. This model was used to predict post-rehabilitation outcomes, including FIM scores and ability to return to home. P<0.05 was considered significant. Results 96 patients were enrolled in the study. Mean age was 43±21 years, admission Glasgow Coma Score 8.4±4.8, Injury Severity Score 24.7±9.9, and head Abbreviated Injury Scale score 3.73±0.97. Acute hospital length of stay (LOS) was 12.3±8.9 days and rehabilitation LOS was 15.9±9.3 days. Day-of-injury TBI lesion volumes were inversely associated with cognitive FIM scores at rehabilitation admission (p=0.004) and discharge (p=0.004) and inversely associated with ability to be discharged to home after rehabilitation (p=0.006). Conclusion In a cohort of patients with moderate to severe TBI requiring a rehabilitation unit stay after the acute care hospital stay, DOI brain injury lesion volumes are associated with worse cognitive FIM scores at the time of rehabilitation admission and discharge. Smaller injury volumes were associated with eventual discharge to home. Volumetric neuroimaging in the acute injury phase may

  18. MEDLARS Abbreviations for Medical Journal Titles

    PubMed Central

    Charen, Thelma; Gillespie, Constantine J.

    1971-01-01

    The National Library of Medicine announces its adoption of the Anglo-American standard for the formulation of journal title abbreviations according to the American National Standard for the Abbreviation of Titles of Periodicals (1969), with individual words abbreviated, in turn, according to the International List of Periodical Title Word Abbreviations (1970). The history of the activity of the specific Z39 Committee of USASI (now ANSI) concerned with journal title abbreviations is reviewed, covering the period from 1962 to the present. A history of the National Clearinghouse for Periodical Title Word Abbreviations and of the International List is also given. Former NLM usage is compared with the forms of the present International List and examples show the major changes in NLM abbreviations. The NLM Rules for Abbreviation of Periodical Titles as derived from the new standard are appended. PMID:5146764

  19. Comparing traditional and novel injury scoring systems in a US level-I trauma center: an opportunity for improved injury surveillance in low- and middle-income countries.

    PubMed

    Laytin, Adam D; Dicker, Rochelle A; Gerdin, Martin; Roy, Nobhojit; Sarang, Bhakti; Kumar, Vineet; Juillard, Catherine

    2017-07-01

    In most low- and middle-income countries (LMICs), the resources to accurately quantify injury severity using traditional injury scoring systems are limited. Novel injury scoring systems appear to have adequate discrimination for mortality in LMIC contexts, but they have not been rigorously compared where traditional injury scores can be accurately calculated. To determine whether novel injury scoring systems perform as well as traditional ones in a HIC with complete and comprehensive data collection. Data from an American level-I trauma registry collected 2008-2013 were used to compare three traditional injury scoring systems: Injury Severity Score (ISS); Revised Trauma Score (RTS); and Trauma Injury Severity Score (TRISS); and three novel injury scoring systems: Kampala Trauma Score (KTS); Mechanism, GCS, Age and Pressure (MGAP) score; and GCS, Age and Pressure (GAP) score. Logistic regression was used to assess the association between each scoring system and mortality. Standardized regression coefficients (β 2 ), Akaike information criteria, area under the receiver operating characteristics curve, and the calibration line intercept and slope were used to evaluate the discrimination and calibration of each model. Among 18,746 patients, all six scores were associated with hospital mortality. GAP had the highest effect size, and KTS had the lowest median Akaike information criteria. Although TRISS discriminated best, the discrimination of KTS approached that of TRISS and outperformed GAP, MGAP, RTS, and ISS. MGAP was best calibrated, and KTS was better calibrated than RTS, GAP, ISS, or TRISS. The novel injury scoring systems (KTS, MGAP, and GAP), which are more feasible to calculate in low-resource settings, discriminated hospital mortality as well as traditional injury scoring systems (ISS and RTS) and approached the discrimination of a sophisticated, data-intensive injury scoring system (TRISS) in a high-resource setting. Two novel injury scoring systems (KTS and

  20. Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury.

    PubMed

    Majercik, Sarah; Bledsoe, Joseph; Ryser, David; Hopkins, Ramona O; Fair, Joseph E; Brock Frost, R; MacDonald, Joel; Barrett, Ryan; Horn, Susan; Pisani, David; Bigler, Erin D; Gardner, Scott; Stevens, Mark; Larson, Michael J

    2017-01-01

    Day-of-injury (DOI) brain lesion volumes in traumatic brain injury (TBI) patients are rarely used to predict long-term outcomes in the acute setting. The purpose of this study was to investigate the relationship between acute brain injury lesion volume and rehabilitation outcomes in patients with TBI at a level one trauma center. Patients with TBI who were admitted to our rehabilitation unit after the acute care trauma service from February 2009-July 2011 were eligible for the study. Demographic data and outcome variables including cognitive and motor Functional Independence Measure (FIM) scores, length of stay (LOS) in the rehabilitation unit, and ability to return to home were obtained. The DOI quantitative injury lesion volumes and degree of midline shift were obtained from DOI brain computed tomography scans. A multiple stepwise regression model including 13 independent variables was created. This model was used to predict postrehabilitation outcomes, including FIM scores and ability to return to home. A p value less than 0.05 was considered significant. Ninety-six patients were enrolled in the study. Mean age was 43 ± 21 years, admission Glasgow Coma Score was 8.4 ± 4.8, Injury Severity Score was 24.7 ± 9.9, and head Abbreviated Injury Scale score was 3.73 ± 0.97. Acute hospital LOS was 12.3 ± 8.9 days, and rehabilitation LOS was 15.9 ± 9.3 days. Day-of-injury TBI lesion volumes were inversely associated with cognitive FIM scores at rehabilitation admission (p = 0.004) and discharge (p = 0.004) and inversely associated with ability to be discharged to home after rehabilitation (p = 0.006). In a cohort of patients with moderate to severe TBI requiring a rehabilitation unit stay after the acute care hospital stay, DOI brain injury lesion volumes are associated with worse cognitive FIM scores at the time of rehabilitation admission and discharge. Smaller-injury volumes were associated with eventual discharge to home. Volumetric neuroimaging in the acute

  1. 40 CFR 87.2 - Abbreviations.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 21 2013-07-01 2013-07-01 false Abbreviations. 87.2 Section 87.2... POLLUTION FROM AIRCRAFT AND AIRCRAFT ENGINES General Provisions § 87.2 Abbreviations. The abbreviations used... pressure ratio SNsmoke number [77 FR 36381, June 18, 2012] ...

  2. 40 CFR 87.2 - Abbreviations.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 20 2014-07-01 2013-07-01 true Abbreviations. 87.2 Section 87.2... POLLUTION FROM AIRCRAFT AND AIRCRAFT ENGINES General Provisions § 87.2 Abbreviations. The abbreviations used... pressure ratio SNsmoke number [77 FR 36381, June 18, 2012] ...

  3. Sports injury or trauma? Injuries of the competition off-road motorcyclist.

    PubMed

    Colburn, Nona T; Meyer, Richard D

    2003-03-01

    A prospective analysis of the injuries of off-road competition motorcyclist at four International Six Day Enduro (ISDE) events was performed utilizing the injury severity score (ISS) and the abbreviated injury scale (AIS). Of the 1787 participants, approximately 10% received injuries that required attention from a medical response unit. The majority (85%) sustained a mild injury (mean ISS 3.9). Loss of control while jumping and striking immovable objects were important risk determinants for serious injury. Although seasoned in off-road experiences, mean 15.3 years, 54% of those injured were first year rookies to the ISDE event. Speeds were below 50 km/h in the majority of accidents (80%), and were not statistically correlated with severity. The most frequently injured anatomical regions were the extremities (57%). The most common types of injury were ligamentous (50%). Seventy-seven percent of all fractures were AIS grades 1 and 2. The most common fractures were those of the foot and ankle (36%). Multiple fractures involving different anatomical regions, or a combination of serious injuries was seen with only one rider. When compared to the injuries of the street motorcyclist, competition riders had lower AIS grades of head and limb trauma. Off-road motorcycle competition is a relatively safe sport with injury rates comparably less than those of contact sports such as American football and hockey.

  4. Patterns of severe injury in pediatric car crash victims: Crash Injury Research Engineering Network database.

    PubMed

    Brown, J Kristine; Jing, Yuezhou; Wang, Stewart; Ehrlich, Peter F

    2006-02-01

    Motor vehicle crashes (MVCs) account for 50% of pediatric trauma. Safety improvements are typically tested with child crash dummies using an in vitro model. The Crash Injury Research Engineering Network (CIREN) provides an in vivo validation process. Previous research suggest that children in lateral crashes or front-seat locations have higher Injury Severity Scale scores and lower Glasgow Coma Scale scores than those in frontal-impact crashes. However, specific injury patterns and crash characteristics have not been characterized. Data were collected from the CIREN multidisciplinary crash reconstruction network (10 pediatric trauma centers). Injuries were examined with regard to crash direction (frontal/lateral), restraint use, seat location, and change in velocity at impact (DeltaV). Injuries were limited to Abbreviated Injury Scale (AIS) scores of 3 or higher and included head, thoracic, abdominal, pelvic, spine, and long bone (orthopedic) injuries. Standard age groupings (0-4, 5-9, 10-14, and 15-18 years) were used. Statistical analyses used Fisher's Exact test and multiple logistic regressions. Four hundred seventeen MVCs with 2500 injuries were analyzed (males = 219, females = 198). Controlling for DeltaV and age, children in lateral-impact crashes (n = 232) were significantly more likely to suffer severe injuries to the head and thorax as compared with children in frontal crashes (n = 185), who were more likely to suffer severe spine and orthopedic injuries. Children in a front-seat (n = 236) vs those in a back-seat (n = 169) position had more injuries to the thoracic (27% vs 17%), abdominal (21% vs 13%), pelvic (11% vs 1%), and orthopedic (28% vs 10%) regions (P < .05 for all). Seat belts were protective for pelvic (5% vs 12% unbelted) and orthopedic (15% vs 40%) injuries (odds ratio = 3, P < .01 for both). A reproducible pattern of injury is noted for children involved in lateral-impact crashes characterized by head and chest injuries. The Injury Severity

  5. Identifying injuries and motor vehicle collision characteristics that together are suggestive of diaphragmatic rupture.

    PubMed

    Reiff, Donald A; McGwin, Gerald; Metzger, Jesse; Windham, Samuel T; Doss, Marilyn; Rue, Loring W

    2002-12-01

    Diaphragmatic rupture (DR) remains a diagnostic challenge because of the lack of an accurate test demonstrating the injury. Our purpose was to identify motor vehicle collision (MVC) characteristics and patient injuries that collectively could identify the presence of a DR. The National Automotive Sampling System was used to identify occupants involved in MVCs from 1995 to 1999 who sustained abdominal (Abbreviated Injury Scale score >or= 2) and/or thoracic injuries (Abbreviated Injury Scale score >or= 2). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to quantify the association between patient injuries, vehicle collision characteristics, and DR. Sensitivity and specificity were also calculated to determine the ability of organ injury and MVC characteristics to correctly classify patients with and without DR. Overall, occupants sustaining a DR had a significantly higher delta-V (DeltaV) (49.8 kilometers per hour [kph] vs. 33.8 kph, p< 0.0001) and a greater degree of occupant compartment intrusion (70.6 cm vs. 48.3 cm, p< 0.0001). Specific abdominal and thoracic organ injuries were associated with DR, including thoracic aortic tears (OR, 5.2; 95% CI, 2.2-12.5), splenic injury (OR, 8.4; 95% CI, 3.9-17.8), pelvic fractures (OR, 4.7; 95% CI, 2.7-8.0), and hepatic injuries (OR, 4.2; 95% CI, 1.7-10.6). Combining frontal or near-side lateral occupant compartment intrusion >or= 30 cm or DeltaV >or= 40 kph with specific organ injuries generated a sensitivity for indicating the likelihood of diaphragm injury ranging from 68% to 89%. Patients with any of the following characteristics had a sensitivity for detecting DR of 91%: splenic injury, pelvic fracture, DeltaV >or= 40 kph, or occupant compartment intrusion from any direction >or= 30 cm. Specific MVC characteristics combined with patient injuries have been identified that are highly suggestive of DR. For this subpopulation, additional invasive procedures including exploratory laparotomy, laparoscopy

  6. Which AIS based scoring system is the best predictor of outcome in orthopaedic blunt trauma patients?

    PubMed

    Harwood, Paul J; Giannoudis, Peter V; Probst, Christian; Van Griensven, Martijn; Krettek, Christian; Pape, Hans-Christoph

    2006-02-01

    Abbreviated Injury Scale (AIS)-based systems-the Injury Severity Score (ISS), New Injury Severity Score (NISS), and AISmax-are used to assess trauma patients. The merits of each in predicting outcome are controversial. A large prospective database was used to assess their predictive capacity using receiver operator characteristic curves. In all, 10,062 adult, blunt-trauma patients met the inclusion criteria. All systems were significant outcome predictors for sepsis, multiple organ failure (MOF), length of hospital stay, length of intensive care unit (ICU) admission and mortality (p < 0.0001). NISS was a significantly better predictor than the ISS for mortality (p < 0.0001). NISS was equivalent to the AISmax for mortality prediction and superior in patients with orthopaedic injuries. NISS was significantly better for sepsis, MOF, ICU stay, and total hospital stay (p < 0.0001). NISS is superior or equivalent to the ISS and AISmax for prediction of all investigated outcomes in a population of blunt trauma patients. As NISS is easier to calculate, its use is recommended to stratify patients for clinical and research purposes.

  7. A comparison of "life threatening injury" concept in the Turkish Penal Code and trauma scoring systems.

    PubMed

    Fedakar, Recep; Aydiner, Ahmet Hüsamettin; Ercan, Ilker

    2007-07-01

    To compare accuracy and to check the suitability of the Glasgow Coma Scale (GCS), the Revised Trauma Score (RTS), the Injury Severity Score (ISS), the New Injury Severity Score (NISS) and the Trauma and Injury Severity Score (TRISS), the scoring systems widely used in international trauma studies, in the evaluation of the "life threatening injury" concept established by the Turkish Penal Code. The age, sex, type of trauma, type and localizations of wounds, GCS, RTS, ISS, NISS and TRISS values, the decision of life threatening injury of 627 trauma patients admitted to Emergency Department of the Uludag University Medical School Hospital in year 2003 were examined. A life-threatening injury was present in 35.2% of the cases examined. GCS, RTS, ISS, NISS and TRISS confirmed the decision of life threatening injury with percentages of 74.8%, 76.9%, 88.7%, 86.6% and 68.6%, respectively. The best cut-off point 14 was determined in the ISS system with 79.6% sensitivity and 93.6% specificity. All of the cases with sole linear skull fracture officially decided as life threatening injury had an ISS of 5, a NISS of 6 and the best scores of GCS (15), RTS (7.8408) and TRISS (100%). ISS and NISS appeared to be the best trauma scoring systems that can be used for the decision of life threatening injury, compared with GCS, RTS and TRISS. Thus, ISS and NISS can be acceptable for using the evaluation of the life threatening injury concept established by the Turkish Penal Code.

  8. Traumatic brain injury (TBI) outcomes in an LMIC tertiary care centre and performance of trauma scores.

    PubMed

    Samanamalee, Samitha; Sigera, Ponsuge Chathurani; De Silva, Ambepitiyawaduge Pubudu; Thilakasiri, Kaushila; Rashan, Aasiyah; Wadanambi, Saman; Jayasinghe, Kosala Saroj Amarasiri; Dondorp, Arjen M; Haniffa, Rashan

    2018-01-08

    This study evaluates post-ICU outcomes of patients admitted with moderate and severe Traumatic Brain Injury (TBI) in a tertiary neurocritical care unit in an low middle income country and the performance of trauma scores: A Severity Characterization of Trauma, Trauma and Injury Severity Score, Injury Severity Score and Revised Trauma Score in this setting. Adult patients directly admitted to the neurosurgical intensive care units of the National Hospital of Sri Lanka between 21st July 2014 and 1st October 2014 with moderate or severe TBI were recruited. A telephone administered questionnaire based on the Glasgow Outcome Scale Extended (GOSE) was used to assess functional outcome of patients at 3 and 6 months after injury. The economic impact of the injury was assessed before injury, and at 3 and 6 months after injury. One hundred and one patients were included in the study. Survival at ICU discharge, 3 and 6 months after injury was 68.3%, 49.5% and 45.5% respectively. Of the survivors at 3 months after injury, 43 (86%) were living at home. Only 19 (38%) patients had a good recovery (as defined by GOSE 7 and 8). Three months and six months after injury, respectively 25 (50%) and 14 (30.4%) patients had become "economically dependent". Selected trauma scores had poor discriminatory ability in predicting mortality. This observational study of patients sustaining moderate or severe TBI in Sri Lanka (a LMIC) reveals only 46% of patients were alive at 6 months after ICU discharge and only 20% overall attained a good (GOSE 7 or 8) recovery. The social and economic consequences of TBI were long lasting in this setting. Injury Severity Score, Revised Trauma Score, A Severity Characterization of Trauma and Trauma and Injury Severity Score, all performed poorly in predicting mortality in this setting and illustrate the need for setting adapted tools.

  9. Blunt Cardiac Injury in the Severely Injured – A Retrospective Multicentre Study

    PubMed Central

    Hanschen, Marc; Kanz, Karl-Georg; Kirchhoff, Chlodwig; Khalil, Philipe N.; Wierer, Matthias; van Griensven, Martijn; Laugwitz, Karl-Ludwig; Biberthaler, Peter; Lefering, Rolf; Huber-Wagner, Stefan

    2015-01-01

    Background Blunt cardiac injury is a rare trauma entity. Here, we sought to evaluate the relevance and prognostic significance of blunt cardiac injury in severely injured patients. Methods In a retrospective multicentre study, using data collected from 47,580 patients enrolled to TraumaRegister DGU (1993-2009), characteristics of trauma, prehospital / hospital trauma management, and outcome analysis were correlated to the severity of blunt cardiac injury. The severity of cardiac injury was assessed according to the abbreviated injury score (AIS score 1-6), the revised injury severity score (RISC) allowed comparison of expected outcome with injury severity-dependent outcome. N = 1.090 had blunt cardiac trauma (AIS 1-6) (2.3% of patients). Results Predictors of blunt cardiac injury could be identified. Sternal fractures indicate a high risk of the presence of blunt cardiac injury (AIS 0 [control]: 3.0%; AIS 1: 19.3%; AIS 2-6: 19.1%). The overall mortality rate was 13.9%, minor cardiac injury (AIS 1) and severe cardiac injury (AIS 2-6) are associated with higher rates. Severe blunt cardiac injury (AIS 4 and AIS 5-6) is associated with a higher mortality (OR 2.79 and 4.89, respectively) as compared to the predicted average mortality (OR 2.49) of the study collective. Conclusion Multiple injured patients with blunt cardiac trauma are at high risk to be underestimated. Careful evaluation of trauma patients is able to predict the presence of blunt cardiac injury. The severity of blunt cardiac injury needs to be stratified according to the AIS score, as the patients’ outcome is dependent on the severity of cardiac injury. PMID:26136126

  10. Revised Baux Score and updated Charlson comorbidity index are independently associated with mortality in burns intensive care patients.

    PubMed

    Heng, Jacob S; Clancy, Olivia; Atkins, Joanne; Leon-Villapalos, Jorge; Williams, Andrew J; Keays, Richard; Hayes, Michelle; Takata, Masao; Jones, Isabel; Vizcaychipi, Marcela P

    2015-11-01

    The purpose of the current study was to utilise established scoring systems to analyse the association of (i) burn injury severity, (ii) comorbid status and (iii) associated systemic physiological disturbance with inpatient mortality in patients with severe burn injuries admitted to intensive care. Case notes of all patients with acute thermal injuries affecting ≥15% total body surface area (TBSA) admitted to the Burns Intensive Care Unit (BICU) at Chelsea and Westminster Hospital during a 10-year period were retrospectively reviewed. Revised Baux Score, Belgian Outcome in Burn Injury (BOBI) Score, Abbreviated Burn Severity Index (ABSI), APACHE II Score, Sequential Organ Failure Assessment (SOFA) Score and Updated Charlson Comorbidity Index (CCI) were computed for each patient and analysed for association with inpatient mortality. Ninety mechanically ventilated patients (median age 45.7 years, median % TBSA burned 36.5%) were included. 72 patients had full thickness burns and 35 patients had inhalational injuries. Forty-four patients died in hospital while 46 survived to discharge. In a multivariate logistic regression model, only the Revised Baux Score (p<0.001) and updated CCI (p=0.014) were independently associated with mortality. This gave a ROC curve with area under the curve of 0.920. On multivariate cox regression survival analysis, only the Revised Baux Score (p<0.001) and the updated CCI (p=0.004) were independently associated with shorter time to death. Our data suggest that the Revised Baux Score and the updated CCI are independently associated with inpatient mortality in patients admitted to intensive care with burn injuries affecting ≥15% TBSA. This emphasises the importance of comorbidities in the prognosis of patients with severe burn injuries. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  11. Lower Quarter Y-Balance Test Scores and Lower Extremity Injury in NCAA Division I Athletes.

    PubMed

    Lai, Wilson C; Wang, Dean; Chen, James B; Vail, Jeremy; Rugg, Caitlin M; Hame, Sharon L

    2017-08-01

    Functional movement tests that are predictive of injury risk in National Collegiate Athletic Association (NCAA) athletes are useful tools for sports medicine professionals. The Lower Quarter Y-Balance Test (YBT-LQ) measures single-leg balance and reach distances in 3 directions. To assess whether the YBT-LQ predicts the laterality and risk of sports-related lower extremity (LE) injury in NCAA athletes. Case-control study; Level of evidence, 3. The YBT-LQ was administered to 294 NCAA Division I athletes from 21 sports during preparticipation physical examinations at a single institution. Athletes were followed prospectively over the course of the corresponding season. Correlation analysis was performed between the laterality of reach asymmetry and composite scores (CS) versus the laterality of injury. Receiver operating characteristic (ROC) analysis was used to determine the optimal asymmetry cutoff score for YBT-LQ. A multivariate regression analysis adjusting for sex, sport type, body mass index, and history of prior LE surgery was performed to assess predictors of earlier and higher rates of injury. Neither the laterality of reach asymmetry nor the CS correlated with the laterality of injury. ROC analysis found optimal cutoff scores of 2, 9, and 3 cm for anterior, posteromedial, and posterolateral reach, respectively. All of these potential cutoff scores, along with a cutoff score of 4 cm used in the majority of prior studies, were associated with poor sensitivity and specificity. Furthermore, none of the asymmetric cutoff scores were associated with earlier or increased rate of injury in the multivariate analyses. YBT-LQ scores alone do not predict LE injury in this collegiate athlete population. Sports medicine professionals should be cautioned against using the YBT-LQ alone to screen for injury risk in collegiate athletes.

  12. Pediatric blunt cerebrovascular injury: the McGovern screening score.

    PubMed

    Herbert, Joseph P; Venkataraman, Sidish S; Turkmani, Ali H; Zhu, Liang; Kerr, Marcia L; Patel, Rajan P; Ugalde, Irma T; Fletcher, Stephen A; Sandberg, David I; Cox, Charles S; Kitagawa, Ryan S; Day, Arthur L; Shah, Manish N

    2018-03-16

    OBJECTIVE The objective of this study was to assess the incidence, diagnosis, and treatment of pediatric blunt cerebrovascular injury (BCVI) at a busy Level 1 trauma center and to develop a tool for accurately predicting pediatric BCVI and the need for diagnostic testing. METHODS This is a retrospective cohort study of a prospectively collected database of pediatric patients who had sustained blunt trauma (patient age range 0-15 years) and were treated at a Level 1 trauma center between 2005 and 2015. Digital subtraction angiography, MR angiography, or CT angiography was used to confirm BCVI. Recently, the Utah score has emerged as a screening tool specifically targeted toward evaluating BCVI risk in the pediatric population. Using logistical regression and adding mechanism of injury as a logit, the McGovern score was able to use the Utah score as a starting point to create a more sensitive screening tool to identify which pediatric trauma patients should receive angiographic imaging due to a high risk for BCVI. RESULTS A total of 12,614 patients (mean age 6.6 years) were admitted with blunt trauma and prospectively registered in the trauma database. Of these, 460 (3.6%) patients underwent angiography after blunt trauma: 295 (64.1%), 107 (23.3%), 6 (1.3%), and 52 (11.3%) patients underwent CT angiography, MR angiography, digital subtraction angiography, and a combination of imaging modalities, respectively. The BCVI incidence (n = 21; 0.17%) was lower than that in a comparable adult group (p < 0.05). The mean patient was age 10.4 years with a mean follow-up of 7.5 months. Eleven patients (52.4%) were involved in a motor vehicle collision, with a mean Glasgow Coma Scale score of 8.6. There were 8 patients (38.1%) with carotid canal fracture, 6 patients (28.6%) with petrous bone fracture, and 2 patients (9.5%) with infarction on initial presentation. Eight patients (38.1%) were managed with observation alone. The Denver, modified Memphis, Eastern Association for the

  13. Big for small: Validating brain injury guidelines in pediatric traumatic brain injury.

    PubMed

    Azim, Asad; Jehan, Faisal S; Rhee, Peter; O'Keeffe, Terence; Tang, Andrew; Vercruysse, Gary; Kulvatunyou, Narong; Latifi, Rifat; Joseph, Bellal

    2017-12-01

    Brain injury guidelines (BIG) were developed to reduce overutilization of neurosurgical consultation (NC) as well as computed tomography (CT) imaging. Currently, BIG have been successfully applied to adult populations, but the value of implementing these guidelines among pediatric patients remains unassessed. Therefore, the aim of this study was to evaluate the established BIG (BIG-1 category) for managing pediatric traumatic brain injury (TBI) patients with intracranial hemorrhage (ICH) without NC (no-NC). We prospectively implemented the BIG-1 category (normal neurologic examination, ICH ≤ 4 mm limited to one location, no skull fracture) to identify pediatric TBI patients (age, ≤ 21 years) that were to be managed no-NC. Propensity score matching was performed to match these no-NC patients to a similar cohort of patients managed with NC before the implementation of BIG in a 1:1 ratio for demographics, severity of injury, and type as well as size of ICH. Our primary outcome measure was need for neurosurgical intervention. A total of 405 pediatric TBI patients were enrolled, of which 160 (NC, 80; no-NC, 80) were propensity score matched. The mean age was 9.03 ± 7.47 years, 62.1% (n = 85) were male, the median Glasgow Coma Scale score was 15 (13-15), and the median head Abbreviated Injury Scale score was 2 (2-3). A subanalysis based on stratifying patients by age groups showed a decreased in the use of repeat head CT (p = 0.02) in the no-NC group, with no difference in progression (p = 0.34) and the need for neurosurgical intervention (p = 0.9) compared with the NC group. The BIG can be safely and effectively implemented in pediatric TBI patients. Reducing repeat head CT in pediatric patients has long-term sequelae. Likewise, adhering to the guidelines helps in reducing radiation exposure across all age groups. Therapeutic/care management, level III.

  14. Severe Pediatric Head Injury During the Iraq and Afghanistan Conflicts.

    PubMed

    Klimo, Paul; Ragel, Brian T; Jones, G Morgan; McCafferty, Randall

    2015-07-01

    Much has been written about injuries sustained by US and coalition soldiers during the Global War on Terrorism campaigns. However, injuries to civilians, including children, have been less well documented. To describe the epidemiologic features and outcomes associated with isolated severe head injury in children during Operations Enduring Freedom and Iraqi Freedom (OEF and OIF). A retrospective review of children (<18 years old) in the Joint Theater Trauma Registry with isolated head injury (defined as an Abbreviated Injury Score Severity Code >3) and treated at a US combat support hospital in Iraq or Afghanistan (2004-2012). The primary outcome was in-hospital mortality. We identified 647 children with severe isolated head injuries: 337 from OEF, 268 from OIF, and 42 nontheater specific. Most were boys (76%; median age = 8 years). Penetrating injuries were most common (60.6%). Overall, 330 (51%) children underwent a craniotomy/craniectomy; 156 (24.1%) succumbed to their injuries. Admission Glasgow Coma Score was predictive of survival among the entire cohort and each of the individual conflicts. Male sex also significantly increased the odds of survival for the entire group and OEF, but not for OIF. Closed-head injury improved the predictive ability of our model but did not reach statistical significance as an independent factor. This is the largest study of combat-related isolated head injuries in children. Admission Glasgow Coma Score and male sex were found to be predictive of survival. Assets to comprehensively care for the pediatric patient should be established early in future conflicts.

  15. The Youth Throwing Score: Validating Injury Assessment in Young Baseball Players.

    PubMed

    Ahmad, Christopher S; Padaki, Ajay S; Noticewala, Manish S; Makhni, Eric C; Popkin, Charles A

    2017-02-01

    Epidemic levels of shoulder and elbow injuries have been reported recently in youth and adolescent baseball players. Despite the concerning frequency of these injuries, no instrument has been validated to assess upper extremity injury in this patient population. Purpose/Hypothesis: The purpose of this study was to validate an upper extremity assessment tool specifically designed for young baseball players. We hypothesized that this tool will be both reliable and valid. Cohort study (diagnosis); Level of evidence, 2. The Youth Throwing Score (YTS) was constructed by an interdisciplinary team of providers and coaches as a tool to assess upper extremity injury in youth and adolescent baseball players (age range, 10-18 years). The psychometric properties of the test were then determined. A total of 223 players completed the final survey. The players' mean age was 14.3 ± 2.7 years. Pilot analysis showed that none of the 14 questions received a mean athlete importance rating less than 3 of 5, and the final survey read at a Flesch-Kincaid level of 4.1, which is appropriate for patients aged 9 years and older. The players self-assigned their injury status, resulting in a mean instrument score of 59.7 ± 8.4 for the 148 players "playing without pain," 42.0 ± 11.5 for the 60 players "playing with pain," and 40.4 ± 10.5 for the 15 players "not playing due to pain." Players playing without pain scored significantly higher than those playing with pain and those not playing due to pain ( P < .001). Psychometric analysis showed a test-retest intraclass correlation coefficient of 0.90 and a Cronbach alpha intra-item reliability coefficient of 0.93, indicating excellent reliability and internal consistency. Pearson correlation coefficients of 0.65, 0.62, and 0.31 were calculated between the YTS and the Pediatric Outcomes Data Collection Instrument sports/physical functioning module, the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score, and the Quick Disabilities of the

  16. 7 CFR 771.2 - Abbreviations and definitions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Abbreviations and definitions. 771.2 Section 771.2... AGRICULTURE SPECIAL PROGRAMS BOLL WEEVIL ERADICATION LOAN PROGRAM § 771.2 Abbreviations and definitions. The following abbreviations and definitions apply to this part: (a) Abbreviations: APHIS means the Animal and...

  17. Variability in interhospital trauma data coding and scoring: A challenge to the accuracy of aggregated trauma registries.

    PubMed

    Arabian, Sandra S; Marcus, Michael; Captain, Kevin; Pomphrey, Michelle; Breeze, Janis; Wolfe, Jennefer; Bugaev, Nikolay; Rabinovici, Reuven

    2015-09-01

    Analyses of data aggregated in state and national trauma registries provide the platform for clinical, research, development, and quality improvement efforts in trauma systems. However, the interhospital variability and accuracy in data abstraction and coding have not yet been directly evaluated. This multi-institutional, Web-based, anonymous study examines interhospital variability and accuracy in data coding and scoring by registrars. Eighty-two American College of Surgeons (ACS)/state-verified Level I and II trauma centers were invited to determine different data elements including diagnostic, procedure, and Abbreviated Injury Scale (AIS) coding as well as selected National Trauma Data Bank definitions for the same fictitious case. Variability and accuracy in data entries were assessed by the maximal percent agreement among the registrars for the tested data elements, and 95% confidence intervals were computed to compare this level of agreement to the ideal value of 100%. Variability and accuracy in all elements were compared (χ testing) based on Trauma Quality Improvement Program (TQIP) membership, level of trauma center, ACS verification, and registrar's certifications. Fifty registrars (61%) completed the survey. The overall accuracy for all tested elements was 64%. Variability was noted in all examined parameters except for the place of occurrence code in all groups and the lower extremity AIS code in Level II trauma centers and in the Certified Specialist in Trauma Registry- and Certified Abbreviated Injury Scale Specialist-certified registrar groups. No differences in variability were noted when groups were compared based on TQIP membership, level of center, ACS verification, and registrar's certifications, except for prehospital Glasgow Coma Scale (GCS), where TQIP respondents agreed more than non-TQIP centers (p = 0.004). There is variability and inaccuracy in interhospital data coding and scoring of injury information. This finding casts doubt on the

  18. The AIS-2005 Revision in Severe Traumatic Brain Injury: Mission Accomplished or Problems for Future Research?

    PubMed Central

    Carroll, Christopher P.; Cochran, Joseph A.; Price, Janet P.; Guse, Clare E.; Wang, Marjorie C.

    2010-01-01

    The Abbreviated Injury Scale (AIS) is commonly used to score injury severity and describe types of injuries. In 2005, the AIS-Head section was revised to capture more detailed information about head injuries and to better reflect their clinical severity, but the impact of these changes is largely unknown. The purpose of this study was to compare AIS-1998 and AIS-2005 coding of traumatic brain injuries (TBI) using medical records at a single Level I trauma center. We included patients with severe TBI (Glasgow Coma Scale 3–8) after blunt injury, excluding those who were missing medical records. Detailed descriptions of injuries were collected, then manually coded into AIS-1998 and AIS-2005 by the same Certified AIS Specialist. Compared to AIS-1998, AIS-2005 coded the same injuries with lower severity scores [p<0.01] and with decreased mean and maximum AIS-Head scores [p<0.01]. Of the types of traumatic brain injuries, most of the changes occurred among cerebellar and cerebral injuries. Traumatic hypoxic brain injury secondary to systemic dysfunction was captured by AIS-2005 but not by AIS-1998. However, AIS-2005 captured fewer loss of consciousness cases due to changes in criteria for coding concussive injury. In conclusion, changes from AIS-1998 to AIS-2005 result in significant differences in severity scores and types of injuries captured. This may complicate future TBI research by precluding direct comparison to datasets using AIS-1998. TBIs should be coded into the same AIS-version for comparison or evaluation of trends, and specify which AIS-version is used. PMID:21050606

  19. The AIS-2005 Revision in Severe Traumatic Brain Injury: Mission Accomplished or Problems for Future Research?

    PubMed

    Carroll, Christopher P; Cochran, Joseph A; Price, Janet P; Guse, Clare E; Wang, Marjorie C

    2010-01-01

    The Abbreviated Injury Scale (AIS) is commonly used to score injury severity and describe types of injuries. In 2005, the AIS-Head section was revised to capture more detailed information about head injuries and to better reflect their clinical severity, but the impact of these changes is largely unknown. The purpose of this study was to compare AIS-1998 and AIS-2005 coding of traumatic brain injuries (TBI) using medical records at a single Level I trauma center. We included patients with severe TBI (Glasgow Coma Scale 3-8) after blunt injury, excluding those who were missing medical records. Detailed descriptions of injuries were collected, then manually coded into AIS-1998 and AIS-2005 by the same Certified AIS Specialist. Compared to AIS-1998, AIS-2005 coded the same injuries with lower severity scores [p<0.01] and with decreased mean and maximum AIS-Head scores [p<0.01]. Of the types of traumatic brain injuries, most of the changes occurred among cerebellar and cerebral injuries. Traumatic hypoxic brain injury secondary to systemic dysfunction was captured by AIS-2005 but not by AIS-1998. However, AIS-2005 captured fewer loss of consciousness cases due to changes in criteria for coding concussive injury. In conclusion, changes from AIS-1998 to AIS-2005 result in significant differences in severity scores and types of injuries captured. This may complicate future TBI research by precluding direct comparison to datasets using AIS-1998. TBIs should be coded into the same AIS-version for comparison or evaluation of trends, and specify which AIS-version is used.

  20. Validation of ICDPIC software injury severity scores using a large regional trauma registry.

    PubMed

    Greene, Nathaniel H; Kernic, Mary A; Vavilala, Monica S; Rivara, Frederick P

    2015-10-01

    Administrative or quality improvement registries may or may not contain the elements needed for investigations by trauma researchers. International Classification of Diseases Program for Injury Categorisation (ICDPIC), a statistical program available through Stata, is a powerful tool that can extract injury severity scores from ICD-9-CM codes. We conducted a validation study for use of the ICDPIC in trauma research. We conducted a retrospective cohort validation study of 40,418 patients with injury using a large regional trauma registry. ICDPIC-generated AIS scores for each body region were compared with trauma registry AIS scores (gold standard) in adult and paediatric populations. A separate analysis was conducted among patients with traumatic brain injury (TBI) comparing the ICDPIC tool with ICD-9-CM embedded severity codes. Performance in characterising overall injury severity, by the ISS, was also assessed. The ICDPIC tool generated substantial correlations in thoracic and abdominal trauma (weighted κ 0.87-0.92), and in head and neck trauma (weighted κ 0.76-0.83). The ICDPIC tool captured TBI severity better than ICD-9-CM code embedded severity and offered the advantage of generating a severity value for every patient (rather than having missing data). Its ability to produce an accurate severity score was consistent within each body region as well as overall. The ICDPIC tool performs well in classifying injury severity and is superior to ICD-9-CM embedded severity for TBI. Use of ICDPIC demonstrates substantial efficiency and may be a preferred tool in determining injury severity for large trauma datasets, provided researchers understand its limitations and take caution when examining smaller trauma datasets. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. A new tool for coding and interpreting injuries in fatal airplane crashes: the crash injury pattern assessment tool application to the Air France Flight AF447 disaster (Rio de Janeiro-Paris), 1st of June 2009.

    PubMed

    Schuliar, Yves; Chapenoire, Stéphane; Miras, Alain; Contrand, Benjamin; Lagarde, Emmanuel

    2014-09-01

    For investigation of air disasters, crash reconstruction is obtained using data from flight recorders, physical evidence from the site, and injuries patterns of the victims. This article describes a new software, Crash Injury Pattern Assessment Tool (CIPAT), to code and analyze injuries. The coding system was derived from the Abbreviated Injury Score (AIS). Scores were created corresponding to the amount of energy required causing the trauma (ER), and the software was developed to compute summary variables related to the position (assigned seat) of victims. A dataset was built from the postmortem examination of 154/228 victims of the Air France disaster (June 2009), recovered from the Atlantic Ocean after a complex and difficult task at a depth of 12790 ft. The use of CIPAT allowed to precise cause and circumstances of deaths and confirmed major dynamics parameters of the crash event established by the French Civil Aviation Safety Investigation Authority. © 2014 American Academy of Forensic Sciences.

  2. Correlation Between Euro NCAP Pedestrian Test Results and Injury Severity in Injury Crashes with Pedestrians and Bicyclists in Sweden.

    PubMed

    Strandroth, Johan; Sternlund, Simon; Lie, Anders; Tingvall, Claes; Rizzi, Matteo; Kullgren, Anders; Ohlin, Maria; Fredriksson, Rikard

    2014-11-01

    Pedestrians and bicyclists account for a significant share of deaths and serious injuries in the road transport system. The protection of pedestrians in car-to-pedestrian crashes has therefore been addressed by friendlier car fronts and since 1997, the European New Car Assessment Program (Euro NCAP) has assessed the level of protection for most car models available in Europe. In the current study, Euro NCAP pedestrian scoring was compared with real-life injury outcomes in car-to-pedestrian and car-tobicyclist crashes occurring in Sweden. Approximately 1200 injured pedestrians and 2000 injured bicyclists were included in the study. Groups of cars with low, medium and high pedestrian scores were compared with respect to pedestrian injury severity on the Maximum Abbreviated Injury Scale (MAIS)-level and risk of permanent medical impairment (RPMI). Significant injury reductions to both pedestrians and bicyclists were found between low and high performing cars. For pedestrians, the reduction of MAIS2+, MAIS3+, RPMI1+ and RPMI10+ ranged from 20-56% and was significant on all levels except for MAIS3+ injuries. Pedestrian head injuries had the highest reduction, 80-90% depending on level of medical impairment. For bicyclist, an injury reduction was only observed between medium and high performing cars. Significant injury reductions were found for all body regions. It was also found that cars fitted with autonomous emergency braking including pedestrian detection might have a 60-70% lower crash involvement than expected. Based on these results, it was recommended that pedestrian protection are implemented on a global scale to provide protection for vulnerable road users worldwide.

  3. High velocity missile-related colorectal injuries: In-theatre application of injury scores and their effects on ostomy rates.

    PubMed

    Kaymak, Şahin; Ünlü, Aytekin; Harlak, Ali; Ersöz, Nail; Şenocak, Rahman; Coşkun, Ali Kağan; Zeybek, Nazif; Lapsekili, Emin; Kozak, Orhan

    2016-03-01

    Treatment of colorectal injuries (CRIs) remains a significant cause of morbidity and mortality. The aim of the present study was to analyze treatment trends of Turkish surgeons and effects of the American Association for the Surgery of Trauma (AAST), Injury Severity (ISS), and Penetrating Abdominal Trauma Index (PATI) scoring systems on decision-making processes and clinical outcomes. Data regarding high velocity missile (HVM)-related CRIs were retrospectively gathered. Four patient groups were included: Group 1 (stoma), Group 2 (no stoma in primary surgery), Group 2a (conversion to stoma in secondary surgery), and Group 2b (remaining Group 2 patients). Groups 1, 2, 2a, and 2b included 39 (66%), 20 (34%), 6 (30%), and 14 (70%) casualties, respectively. Ostomies were performed in casualties with significantly higher AAST scores (p<0.001). However, PATI and ISS scores were not decisive factors in the performance of ostomy (p=0.61; p=0.28, respectively). Ostomy rates of civilian and military surgeons were 62% and 68%, respectively (p=0.47). Receiver operating characteristic (ROC) analysis showed that AAST score was a more accurate guide for performing ostomy, with sensitivity and specificity rates of 80% and 92.9%, respectively. Clinical significance of diversion in HVM-related CRIs remains. Stomas were associated with lower complication rates and significantly higher AAST colon/rectum injury scores.

  4. Safety of repair for severe duodenal injuries.

    PubMed

    Velmahos, George C; Constantinou, Constantinos; Kasotakis, George

    2008-01-01

    There is ongoing debate about the management of severe duodenal injuries (SDIs), and earlier studies have recommended pyloric exclusion. The objective of this study was to compare primary repair with pyloric exclusion to examine if primary repair can be safely used in SDIs. The medical records of 193 consecutive patients who were admitted between August 1992 and January 2004 with duodenal injuries were reviewed. After excluding early deaths (n = 50), low-grade duodenal injuries (n = 81), and pancreatoduodenectomies for catastrophic trauma (n = 12), a total of 50 patients with SDIs (grade III, IV, or V) were analyzed. Primary repair (PR--simple duodenorrhaphy or resection and primary anastomosis) was performed in 34 (68%) and pyloric exclusion (PE) in 16 (32%). Characteristics and outcomes of these two groups were compared. PE and PR patients were similar for age, injury severity score, abdominal abbreviated injury score, physiologic status on admission, time to operation, and most abdominal organs injured. PE patients had more pancreatic injuries (63% vs. 24%, p < 0.01), a higher frequency of injuries to the first and second part of the duodenum (79% vs. 42%, p = 0.02), and a nonsignificant trend toward more grade IV and V injuries (37% vs. 18%, p = 0.11). There was no difference in morbidity (including complications specific to the duodenal repair), mortality, and intensive care unit and hospital length of stay between the two groups. Pyloric exclusion is not necessary for all patients with SDIs, as previously suggested. Selected SDI patients can be safely managed by simple primary repair.

  5. The impact of safety belt use on liver injuries in motor vehicle crashes: the importance of motor vehicle safety systems.

    PubMed

    Holbrook, Troy Lisa; Hoyt, David B; Eastman, A Brent; Sise, Michael J; Kennedy, Frank; Velky, Tom; Conroy, Carol; Pacyna, Sharon; Erwin, Steve

    2007-08-01

    Liver injuries (LIs) are one of the most serious and common consequences of motor vehicle crashes (MVCs). In the unstable patient, early detection of LI based on clinical suspicion will improve acute trauma care and outcomes. The specific objectives of this analysis are to identify crash scene and occupant risk factors for LI from MVC. Crash Injury Research and Engineering Network data were used to identify risk factors for LI; age, sex, safety belt use, air bag deployment, DeltaV (change in velocity), principal direction of force, vehicle crush, and intrusion. Occupants with LI were compared with four control groups without LI; (1) no abdominal (ABD) injury (NO_ABD), (2) any ABD (ANY_ABD), (3) ABD Abbreviated Injury Scale score of 1 to 2 (ABD_1-2), and (4) ABD Abbreviated Injury Scale score of 3 or more (ABD_3+). LI occupants were compared with each control group and odds ratios (OR) for risk of LI were computed. There were 311 Crash Injury Research and Engineering Network subjects aged 5 or more years with LI. The total mean Injury Severity Score was 37.6. LI was strongly and significantly associated with safety belt restraint use without air bag deployment, compared with each control group: Liver injury - restrained + air bag not deployed versus (1) NO_ABD, N = 1,519; OR = 4.4, (2) ANY_ABD, N = 317; OR = 2.6, (3) ABD_1 to 2, N = 155; OR = 3.1, (4) ABD_3+, N = 217; OR = 2.4 (p < 0.001). This association was independent of driver or passenger status and principal direction of force. LIs were also strongly and significantly associated with greater vehicle interior intrusion. LIs were strongly associated with a safety belt restraint in use in the absence of air bag deployment during MVC. This data may have profound importance to the trauma surgeon as an early indicator for LI during resuscitation. These findings also have important implications for future research efforts to improve safety systems in motor vehicles and reduce morbidity and mortality from MVCs in the

  6. A comprehensive subaxial cervical spine injury severity assessment model using numeric scores and its predictive value for surgical intervention.

    PubMed

    Tsou, Paul M; Daffner, Scott D; Holly, Langston T; Shamie, A Nick; Wang, Jeffrey C

    2012-02-10

    Multiple factors contribute to the determination for surgical intervention in the setting of cervical spinal injury, yet to date no unified classification system exists that predicts this need. The goals of this study were twofold: to create a comprehensive subaxial cervical spine injury severity numeric scoring model, and to determine the predictive value of this model for the probability of surgical intervention. In a retrospective cohort study of 333 patients, neural impairment, patho-morphology, and available spinal canal sagittal diameter post-injury were selected as injury severity determinants. A common numeric scoring trend was created; smaller values indicated less favorable clinical conditions. Neural impairment was graded from 2-10, patho-morphology scoring ranged from 2-15, and post-injury available canal sagittal diameter (SD) was measured in millimeters at the narrowest point of injury. Logistic regression analysis was performed using the numeric scores to predict the probability for surgical intervention. Complete neurologic deficit was found in 39 patients, partial deficits in 108, root injuries in 19, and 167 were neurologically intact. The pre-injury mean canal SD was 14.6 mm; the post-injury measurement mean was 12.3 mm. The mean patho-morphology score for all patients was 10.9 and the mean neurologic function score was 7.6. There was a statistically significant difference in mean scores for neural impairment, canal SD, and patho-morphology for surgical compared to nonsurgical patients. At the lowest clinical score for each determinant, the probability for surgery was 0.949 for neural impairment, 0.989 for post-injury available canal SD, and 0.971 for patho-morphology. The unit odds ratio for each determinant was 1.73, 1.61, and 1.45, for neural impairment, patho-morphology, and canal SD scores, respectively. The subaxial cervical spine injury severity determinants of neural impairment, patho-morphology, and post-injury available canal SD have

  7. Glasgow Coma Scale and Outcomes after Structural Traumatic Head Injury in Early Childhood

    PubMed Central

    Heather, Natasha L.; Derraik, José G. B.; Beca, John; Hofman, Paul L.; Dansey, Rangi; Hamill, James; Cutfield, Wayne S.

    2013-01-01

    Objective To assess the association of the Glasgow Coma Scale (GCS) with radiological evidence of head injury (the Abbreviated Injury Scale for the head region, AIS-HR) in young children hospitalized with traumatic head injury (THI), and the predictive value of GCS and AIS-HR scores for long-term impairment. Methods Our study involved a 10-year retrospective review of a database encompassing all patients admitted to Starship Children’s Hospital (Auckland, New Zealand, 2000–2010) with THI. Results We studied 619 children aged <5 years at the time of THI, with long-term outcome data available for 161 subjects. Both GCS and AIS-HR scores were predictive of length of intensive care unit and hospital stay (all p<0.001). GCS was correlated with AIS-HR (ρ=-0.46; p<0.001), although mild GCS scores (13–15) commonly under-estimated the severity of radiological injury: 42% of children with mild GCS scores had serious–critical THI (AIS-HR 3–5). Increasingly severe GCS or AIS-HR scores were both associated with a greater likelihood of long-term impairment (neurological disability, residual problems, and educational support). However, long-term impairment was also relatively common in children with mild GCS scores paired with structural THI more severe than a simple linear skull fracture. Conclusion Severe GCS scores will identify most cases of severe radiological injury in early childhood, and are good predictors of poor long-term outcome. However, young children admitted to hospital with structural THI and mild GCS scores have an appreciable risk of long-term disability, and also warrant long-term follow-up. PMID:24312648

  8. Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries.

    PubMed

    Ege, Tolga; Unlu, Aytekin; Tas, Huseyin; Bek, Dogan; Turkan, Selim; Cetinkaya, Aytac

    2015-01-01

    Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities. Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method), injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6-32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6-11) and 9.24 (range 6-11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4-7) and 5.19 (range 3-8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for upper and lower extremities was 84% and 86.6%; negative

  9. Correlation between hypermobility score and injury rate in artistic gymnastics.

    PubMed

    Bukva, Bojan; Vrgoč, Goran; Madić, Dejan; Sporiš, Goran; Trajković, Nebojša

    2018-01-10

    Generalized Joint Hypermobility (GJH) is suggested as a contributing factor for injuries in young athletes and adults. It is presumed that GJH causes decreased joint stability, thereby increasing the risk of joint and soft tissue injuries during sports activities. The aim of this study was to determine the correlation between the hypermobility rate (using the Beighton`s modification of the Carter-Wilkinson criteria of hypermobility) in gymnasts and injury rate, during the period of one year. This study observed 24 artistic gymnasts (11-26 years old), members of Qatar National Team in artistic gymnastics. We examined the Beighton joint hypermobility screen and a seasonal injury survey. The gymnasts characteristics (age, gender) and gymnastics characteristics (training per day and number of years in training artistic gymnastics) and its' relations to injury rate were also included. The most common injury was the lower back pain injury, followed by knee, shoulder, hip and ankle injuries. We found strong correlation of number of years gymnastics training and injury rate (p<0.001). There is no significant correlation in the numbers of hours training during one week and hypermobility score to numbers of injuries (p>0.05). According to this study there is no correlation between GJH rate and injury rate in artistic gymnasts in Qatar. Total training period in gymnastics have greater contribution in injury rate.

  10. 7 CFR 762.102 - Abbreviations and definitions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 7 2014-01-01 2014-01-01 false Abbreviations and definitions. 762.102 Section 762.102 Agriculture Regulations of the Department of Agriculture (Continued) FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS GUARANTEED FARM LOANS § 762.102 Abbreviations and definitions. Abbreviations and...

  11. 7 CFR 762.102 - Abbreviations and definitions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 7 2012-01-01 2012-01-01 false Abbreviations and definitions. 762.102 Section 762.102 Agriculture Regulations of the Department of Agriculture (Continued) FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS GUARANTEED FARM LOANS § 762.102 Abbreviations and definitions. Abbreviations and...

  12. 7 CFR 762.102 - Abbreviations and definitions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 7 2011-01-01 2011-01-01 false Abbreviations and definitions. 762.102 Section 762.102 Agriculture Regulations of the Department of Agriculture (Continued) FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS GUARANTEED FARM LOANS § 762.102 Abbreviations and definitions. Abbreviations and...

  13. Abbreviation definition identification based on automatic precision estimates.

    PubMed

    Sohn, Sunghwan; Comeau, Donald C; Kim, Won; Wilbur, W John

    2008-09-25

    The rapid growth of biomedical literature presents challenges for automatic text processing, and one of the challenges is abbreviation identification. The presence of unrecognized abbreviations in text hinders indexing algorithms and adversely affects information retrieval and extraction. Automatic abbreviation definition identification can help resolve these issues. However, abbreviations and their definitions identified by an automatic process are of uncertain validity. Due to the size of databases such as MEDLINE only a small fraction of abbreviation-definition pairs can be examined manually. An automatic way to estimate the accuracy of abbreviation-definition pairs extracted from text is needed. In this paper we propose an abbreviation definition identification algorithm that employs a variety of strategies to identify the most probable abbreviation definition. In addition our algorithm produces an accuracy estimate, pseudo-precision, for each strategy without using a human-judged gold standard. The pseudo-precisions determine the order in which the algorithm applies the strategies in seeking to identify the definition of an abbreviation. On the Medstract corpus our algorithm produced 97% precision and 85% recall which is higher than previously reported results. We also annotated 1250 randomly selected MEDLINE records as a gold standard. On this set we achieved 96.5% precision and 83.2% recall. This compares favourably with the well known Schwartz and Hearst algorithm. We developed an algorithm for abbreviation identification that uses a variety of strategies to identify the most probable definition for an abbreviation and also produces an estimated accuracy of the result. This process is purely automatic.

  14. 14 CFR 34.2 - Abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Abbreviations. 34.2 Section 34.2 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT FUEL VENTING AND EXHAUST EMISSION REQUIREMENTS FOR TURBINE ENGINE POWERED AIRPLANES General Provisions § 34.2 Abbreviations...

  15. 14 CFR 34.2 - Abbreviations.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Abbreviations. 34.2 Section 34.2 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT FUEL VENTING AND EXHAUST EMISSION REQUIREMENTS FOR TURBINE ENGINE POWERED AIRPLANES General Provisions § 34.2 Abbreviations...

  16. 14 CFR 34.2 - Abbreviations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Abbreviations. 34.2 Section 34.2 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT FUEL VENTING AND EXHAUST EMISSION REQUIREMENTS FOR TURBINE ENGINE POWERED AIRPLANES General Provisions § 34.2 Abbreviations...

  17. 14 CFR 34.2 - Abbreviations.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Abbreviations. 34.2 Section 34.2 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT FUEL VENTING AND EXHAUST EMISSION REQUIREMENTS FOR TURBINE ENGINE POWERED AIRPLANES General Provisions § 34.2 Abbreviations...

  18. 40 CFR 600.003 - Abbreviations.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 31 2013-07-01 2013-07-01 false Abbreviations. 600.003 Section 600.003 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) ENERGY POLICY FUEL ECONOMY AND GREENHOUSE GAS EXHAUST EMISSIONS OF MOTOR VEHICLES General Provisions § 600.003 Abbreviations. The...

  19. 40 CFR 600.003 - Abbreviations.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 31 2012-07-01 2012-07-01 false Abbreviations. 600.003 Section 600.003 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) ENERGY POLICY FUEL ECONOMY AND GREENHOUSE GAS EXHAUST EMISSIONS OF MOTOR VEHICLES General Provisions § 600.003 Abbreviations. The...

  20. 40 CFR 600.003 - Abbreviations.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 30 2014-07-01 2014-07-01 false Abbreviations. 600.003 Section 600.003 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) ENERGY POLICY FUEL ECONOMY AND GREENHOUSE GAS EXHAUST EMISSIONS OF MOTOR VEHICLES General Provisions § 600.003 Abbreviations. The...

  1. 40 CFR 91.303 - Acronyms and abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Acronyms and abbreviations. 91.303 Section 91.303 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS....303 Acronyms and abbreviations. (a) The acronyms and abbreviations in § 91.5 apply to this subpart. (b...

  2. 40 CFR 90.303 - Symbols, acronyms, abbreviations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 20 2011-07-01 2011-07-01 false Symbols, acronyms, abbreviations. 90.303 Section 90.303 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS... Equipment Provisions § 90.303 Symbols, acronyms, abbreviations. (a) The acronyms and abbreviations in § 90.5...

  3. 40 CFR 90.303 - Symbols, acronyms, abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Symbols, acronyms, abbreviations. 90.303 Section 90.303 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS... Equipment Provisions § 90.303 Symbols, acronyms, abbreviations. (a) The acronyms and abbreviations in § 90.5...

  4. 40 CFR 91.303 - Acronyms and abbreviations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 20 2011-07-01 2011-07-01 false Acronyms and abbreviations. 91.303 Section 91.303 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS....303 Acronyms and abbreviations. (a) The acronyms and abbreviations in § 91.5 apply to this subpart. (b...

  5. Thoracic injuries sustained by severely injured front-seat passengers and drivers: injury patterns and their relationship to crash characteristics.

    PubMed

    Stübig, Timo; Brand, Stephan; Zeckey, Christian; Beltran, Michael J; Otte, Dietmar; Krettek, Christian; Haasper, Carl

    2013-01-01

    Thoracic injuries are common in vehicle crashes, but only a few studies thus far have analysed the relationship between injury characteristics and collision details and discussed the possible implications for future vehicle design and prevention. In this study, the crash details were prospectively collected at the scene of injury between 2004 and 2009 for severely injured patients. The collected data included the type of collision, angle of impact and change of velocity on impact as well as injury characteristics and patient demographics, including abbreviated injury scale (AIS) and injury severity score (ISS).There were 5998 accidents involving 8830 patients over this five-year period; 31 met the inclusion criteria (23 males and eight females). The mean ISS was 37 ± 12.68, the mean AIS Thorax was 4.0. Lung contusions were found in 90% of the patients, pneumothoraces in 58% and rib fractures in 81%. There was a significant relationship between accident deceleration speed (ΔV), AIS Thorax (p = 0.02) and the incidence of pneumothoraces (p = 0.046). The analysis showed a high overall incidence of thoracic injuries in car passengers. Future improvements in automobile safety and design should seek to reduce the incidence of thoracic injuries by uniform vehicle deformation and further implementation of side airbags.

  6. Overweight children: are they at increased risk for severe injury in motor vehicle collisions?

    PubMed

    Zaveri, Pavan P; Morris, Danielle M; Freishtat, Robert J; Brown, Kathleen

    2009-09-01

    Obesity is an epidemic in the United States. The relationship between traumatic injury and obesity in children is not well-studied. We hypothesized that overweight children suffer more severe injuries, different distributions of injuries and improper use of restraints in motor vehicle collisions. We conducted a secondary analysis of the CIREN database of motor vehicle collisions of subjects 2-17 years old. Overweight was defined as a BMI percentile for age >85%. Significant injury was an Injury Severity Score (ISS) >15 or an Abbreviated Injury Scale (AIS) score greater than one. Further analysis looked at injuries classified as head, trunk, or extremities and appropriateness of restraints. Odds ratios compared the overweight to lean groups. 335 subjects met inclusion criteria with 35.5% of cases being overweight. For significant injury, overweight cases had an odds ratio of 1.2 [95% CI: 0.8-1.9]. Analysis by AIS for overall significant injury and to specific body regions also did not show any significant associations. Overweight versus lean subjects had an odds ratio of 1.3 [95% CI: 0.8-2.1] for improper use of restraints. We found no significant relationship between pediatric injury severity, distribution of injuries, or restraint use and being overweight. Limitations of this study were the small sample size in this database and the large number of unrestrained subjects.

  7. Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries

    PubMed Central

    Ege, Tolga; Unlu, Aytekin; Tas, Huseyin; Bek, Dogan; Turkan, Selim; Cetinkaya, Aytac

    2015-01-01

    Background: Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities. Materials and Methods: Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method), injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Results: Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6–32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6–11) and 9.24 (range 6–11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4–7) and 5.19 (range 3–8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for

  8. Comparisons of survival predictions using survival risk ratios based on International Classification of Diseases, Ninth Revision and Abbreviated Injury Scale trauma diagnosis codes.

    PubMed

    Clarke, John R; Ragone, Andrew V; Greenwald, Lloyd

    2005-09-01

    We conducted a comparison of methods for predicting survival using survival risk ratios (SRRs), including new comparisons based on International Classification of Diseases, Ninth Revision (ICD-9) versus Abbreviated Injury Scale (AIS) six-digit codes. From the Pennsylvania trauma center's registry, all direct trauma admissions were collected through June 22, 1999. Patients with no comorbid medical diagnoses and both ICD-9 and AIS injury codes were used for comparisons based on a single set of data. SRRs for ICD-9 and then for AIS diagnostic codes were each calculated two ways: from the survival rate of patients with each diagnosis and when each diagnosis was an isolated diagnosis. Probabilities of survival for the cohort were calculated using each set of SRRs by the multiplicative ICISS method and, where appropriate, the minimum SRR method. These prediction sets were then internally validated against actual survival by the Hosmer-Lemeshow goodness-of-fit statistic. The 41,364 patients had 1,224 different ICD-9 injury diagnoses in 32,261 combinations and 1,263 corresponding AIS injury diagnoses in 31,755 combinations, ranging from 1 to 27 injuries per patient. All conventional ICD-9-based combinations of SRRs and methods had better Hosmer-Lemeshow goodness-of-fit statistic fits than their AIS-based counterparts. The minimum SRR method produced better calibration than the multiplicative methods, presumably because it did not magnify inaccuracies in the SRRs that might occur with multiplication. Predictions of survival based on anatomic injury alone can be performed using ICD-9 codes, with no advantage from extra coding of AIS diagnoses. Predictions based on the single worst SRR were closer to actual outcomes than those based on multiplying SRRs.

  9. 40 CFR 116.2 - Abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Abbreviations. 116.2 Section 116.2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS DESIGNATION OF HAZARDOUS SUBSTANCES § 116.2 Abbreviations. ppm=parts per million mg=milligram(s) kg=kilogram(s) mg/l=milligrams(s) per...

  10. 40 CFR 116.2 - Abbreviations.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 23 2012-07-01 2012-07-01 false Abbreviations. 116.2 Section 116.2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS DESIGNATION OF HAZARDOUS SUBSTANCES § 116.2 Abbreviations. ppm=parts per million mg=milligram(s) kg=kilogram(s) mg/l=milligrams(s) per...

  11. 40 CFR 116.2 - Abbreviations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 22 2011-07-01 2011-07-01 false Abbreviations. 116.2 Section 116.2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS DESIGNATION OF HAZARDOUS SUBSTANCES § 116.2 Abbreviations. ppm=parts per million mg=milligram(s) kg=kilogram(s) mg/l=milligrams(s) per...

  12. Synonym extraction and abbreviation expansion with ensembles of semantic spaces.

    PubMed

    Henriksson, Aron; Moen, Hans; Skeppstedt, Maria; Daudaravičius, Vidas; Duneld, Martin

    2014-02-05

    Terminologies that account for variation in language use by linking synonyms and abbreviations to their corresponding concept are important enablers of high-quality information extraction from medical texts. Due to the use of specialized sub-languages in the medical domain, manual construction of semantic resources that accurately reflect language use is both costly and challenging, often resulting in low coverage. Although models of distributional semantics applied to large corpora provide a potential means of supporting development of such resources, their ability to isolate synonymy from other semantic relations is limited. Their application in the clinical domain has also only recently begun to be explored. Combining distributional models and applying them to different types of corpora may lead to enhanced performance on the tasks of automatically extracting synonyms and abbreviation-expansion pairs. A combination of two distributional models - Random Indexing and Random Permutation - employed in conjunction with a single corpus outperforms using either of the models in isolation. Furthermore, combining semantic spaces induced from different types of corpora - a corpus of clinical text and a corpus of medical journal articles - further improves results, outperforming a combination of semantic spaces induced from a single source, as well as a single semantic space induced from the conjoint corpus. A combination strategy that simply sums the cosine similarity scores of candidate terms is generally the most profitable out of the ones explored. Finally, applying simple post-processing filtering rules yields substantial performance gains on the tasks of extracting abbreviation-expansion pairs, but not synonyms. The best results, measured as recall in a list of ten candidate terms, for the three tasks are: 0.39 for abbreviations to long forms, 0.33 for long forms to abbreviations, and 0.47 for synonyms. This study demonstrates that ensembles of semantic spaces can

  13. Synonym extraction and abbreviation expansion with ensembles of semantic spaces

    PubMed Central

    2014-01-01

    Background Terminologies that account for variation in language use by linking synonyms and abbreviations to their corresponding concept are important enablers of high-quality information extraction from medical texts. Due to the use of specialized sub-languages in the medical domain, manual construction of semantic resources that accurately reflect language use is both costly and challenging, often resulting in low coverage. Although models of distributional semantics applied to large corpora provide a potential means of supporting development of such resources, their ability to isolate synonymy from other semantic relations is limited. Their application in the clinical domain has also only recently begun to be explored. Combining distributional models and applying them to different types of corpora may lead to enhanced performance on the tasks of automatically extracting synonyms and abbreviation-expansion pairs. Results A combination of two distributional models – Random Indexing and Random Permutation – employed in conjunction with a single corpus outperforms using either of the models in isolation. Furthermore, combining semantic spaces induced from different types of corpora – a corpus of clinical text and a corpus of medical journal articles – further improves results, outperforming a combination of semantic spaces induced from a single source, as well as a single semantic space induced from the conjoint corpus. A combination strategy that simply sums the cosine similarity scores of candidate terms is generally the most profitable out of the ones explored. Finally, applying simple post-processing filtering rules yields substantial performance gains on the tasks of extracting abbreviation-expansion pairs, but not synonyms. The best results, measured as recall in a list of ten candidate terms, for the three tasks are: 0.39 for abbreviations to long forms, 0.33 for long forms to abbreviations, and 0.47 for synonyms. Conclusions This study demonstrates

  14. Injury patterns of soldiers in the second Lebanon war.

    PubMed

    Schwartz, Dagan; Glassberg, Elon; Nadler, Roy; Hirschhorn, Gil; Marom, Ophir Cohen; Aharonson-Daniel, Limor

    2014-01-01

    In the second Lebanon war in 2006, the Israeli Defense Forces fought against well-prepared and well-equipped paramilitary forces. The conflict took place near the Israeli border and major Israeli medical centers. Good data records were maintained throughout the campaign, allowing accurate analysis of injury characteristics. This study is an in-depth analysis of injury mechanisms, severity, and anatomic locations. Data regarding all injured soldiers were collected from all care points up to the definitive care hospitals and were cross-referenced. In addition, trauma branch physicians and nurses interviewed medical teams to validate data accuracy. Injuries were analyzed using Injury Severity Score (ISS) (when precise anatomic data were available) and multiple injury patterns scoring for all. A total of 833 soldiers sustained combat-related injury during the study period, including 119 fatalities (14.3%). Although most soldiers (361) sustained injury only to one Abbreviated Injury Scale (AIS) region, the average number of regions per soldier was 2.0 but was 1.5 for survivors versus 4.2 for fatalities. Current war injury classifications have limitations that hinder valid comparisons between campaigns and settings. In addition, limitation on full autopsy in war fatalities further hinders data use. To partly compensate for those limitations, we have looked at the correlation between fatality rates and number of involved anatomic regions and found it to be strong. We have also found high fatality rates in some "combined" injuries such as head and chest injuries (71%) or in the abdomen and an extremity (75%). The use of multiinjury patterns analysis may help understand fatality rates and improve the utility of war injury analysis. Epidemiologic study, level III.

  15. Optimization of MRI-based scoring scales of brain injury severity in children with unilateral cerebral palsy.

    PubMed

    Pagnozzi, Alex M; Fiori, Simona; Boyd, Roslyn N; Guzzetta, Andrea; Doecke, James; Gal, Yaniv; Rose, Stephen; Dowson, Nicholas

    2016-02-01

    Several scoring systems for measuring brain injury severity have been developed to standardize the classification of MRI results, which allows for the prediction of functional outcomes to help plan effective interventions for children with cerebral palsy. The aim of this study is to use statistical techniques to optimize the clinical utility of a recently proposed template-based scoring method by weighting individual anatomical scores of injury, while maintaining its simplicity by retaining only a subset of scored anatomical regions. Seventy-six children with unilateral cerebral palsy were evaluated in terms of upper limb motor function using the Assisting Hand Assessment measure and injuries visible on MRI using a semiquantitative approach. This cohort included 52 children with periventricular white matter injury and 24 with cortical and deep gray matter injuries. A subset of the template-derived cerebral regions was selected using a data-driven region selection algorithm. Linear regression was performed using this subset, with interaction effects excluded. Linear regression improved multiple correlations between MRI-based and Assisting Hand Assessment scores for both periventricular white matter (R squared increased to 0.45 from 0, P < 0.0001) and cortical and deep gray matter (0.84 from 0.44, P < 0.0001) cohorts. In both cohorts, the data-driven approach retained fewer than 8 of the 40 template-derived anatomical regions. The equal or better prediction of the clinically meaningful Assisting Hand Assessment measure using fewer anatomical regions highlights the potential of these developments to enable enhanced quantification of injury and prediction of patient motor outcome, while maintaining the clinical expediency of the scoring approach.

  16. Same Abbreviated Injury Scale Values May Be Associated with Different Risks to Mortality in Trauma Patients: A Cross-Sectional Retrospective Study Based on the Trauma Registry System in a Level I Trauma Center.

    PubMed

    Rau, Cheng-Shyuan; Wu, Shao-Chun; Kuo, Pao-Jen; Chen, Yi-Chun; Chien, Peng-Chen; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua

    2017-12-11

    The Abbreviated Injury Scale (AIS) measures injury severity of a trauma patient with a numeric method for ranking anatomy-based specific injuries. The summation of the squares of the three most severe injuries in the AIS of six predefined body regions comprises the Injury Severity Score (ISS). It assumes that the mortality of a given AIS value is similar across all body regions. However, such an assumption is less explored in the literature. In this study, we aimed to compare the mortality rates of the patients with the same AIS value in different injured body regions in a level I trauma center. Hospitalized adult trauma patients with isolated serious to critical injury (AIS of 3 to 5) between 1 January 2009, and 31 December 2016, from the Trauma Registry System in a level I trauma center were grouped according to the injured body regions (including, the head/neck, thorax, abdomen, or extremities) and were exclusively compared according to their AIS stratum. Categorical data were compared using the two-sided Fisher exact or Pearson chi-square tests. ANOVA with Games-Howell post hoc test was performed to assess the differences in continuous data of the patients with injury in different body regions. The primary outcome of the study was in-hospital mortality. The adjusted odds ratios (AORs) were estimated using a stepwise selection of a multivariable regression model adjusted by controlling the confounding variables such as sex, age, comorbidities, and ISS. Survival curves were estimated with the Kaplan-Meier approach with a corresponding log-rank test. The patients with AIS of 5 for abdomen injury and those with AIS of 3 for extremity injury had a significantly lower odds of adjusted mortality (adjusted odds ratio (AOR) 0.1, 95% confidence interval (CI) 0.01-0.39, p = 0.004 and AOR 0.3, 95% CI 0.15-0.51, p < 0.001, respectively) than that of the patients with head/neck injury. However, the patients with AIS of 4 for extremity injury demonstrated significantly higher

  17. Same Abbreviated Injury Scale Values May Be Associated with Different Risks to Mortality in Trauma Patients: A Cross-Sectional Retrospective Study Based on the Trauma Registry System in a Level I Trauma Center

    PubMed Central

    Rau, Cheng-Shyuan; Wu, Shao-Chun; Kuo, Pao-Jen; Chen, Yi-Chun; Chien, Peng-Chen; Hsieh, Hsiao-Yun

    2017-01-01

    The Abbreviated Injury Scale (AIS) measures injury severity of a trauma patient with a numeric method for ranking anatomy-based specific injuries. The summation of the squares of the three most severe injuries in the AIS of six predefined body regions comprises the Injury Severity Score (ISS). It assumes that the mortality of a given AIS value is similar across all body regions. However, such an assumption is less explored in the literature. In this study, we aimed to compare the mortality rates of the patients with the same AIS value in different injured body regions in a level I trauma center. Hospitalized adult trauma patients with isolated serious to critical injury (AIS of 3 to 5) between 1 January 2009, and 31 December 2016, from the Trauma Registry System in a level I trauma center were grouped according to the injured body regions (including, the head/neck, thorax, abdomen, or extremities) and were exclusively compared according to their AIS stratum. Categorical data were compared using the two-sided Fisher exact or Pearson chi-square tests. ANOVA with Games-Howell post hoc test was performed to assess the differences in continuous data of the patients with injury in different body regions. The primary outcome of the study was in-hospital mortality. The adjusted odds ratios (AORs) were estimated using a stepwise selection of a multivariable regression model adjusted by controlling the confounding variables such as sex, age, comorbidities, and ISS. Survival curves were estimated with the Kaplan–Meier approach with a corresponding log-rank test. The patients with AIS of 5 for abdomen injury and those with AIS of 3 for extremity injury had a significantly lower odds of adjusted mortality (adjusted odds ratio (AOR) 0.1, 95% confidence interval (CI) 0.01–0.39, p = 0.004 and AOR 0.3, 95% CI 0.15–0.51, p < 0.001, respectively) than that of the patients with head/neck injury. However, the patients with AIS of 4 for extremity injury demonstrated significantly

  18. Comparison of whole-body post mortem 3D CT and autopsy evaluation in accidental blunt force traumatic death using the abbreviated injury scale classification.

    PubMed

    Daly, Barry; Abboud, Samir; Ali, Zabiullah; Sliker, Clint; Fowler, David

    2013-02-10

    Although 3D CT imaging data are available on survivors of accidental blunt trauma, little similar data has been collected and classified on major injuries in victims of fatal injuries. This study compared the sensitivity of post mortem computed tomography (PMCT) with that of conventional autopsy for major trauma findings classified according to the trauma Abbreviated Injury Scale (AIS). Whole-body 3D PMCT imaging data and full autopsy findings were analyzed on 21 victims of accidental blunt force trauma death. All major injuries were classified on the AIS scale with ratings from 3 (serious) to 6 (unsurvivable). Agreement between sensitivity of autopsy and PMCT for major injuries was determined. A total of 195 major injuries were detected (mean per fatality, 9.3; range, 1-14). Skeletal injuries by AIS grade included 37 grade 3, 45 grade 4, 12 grade 5, and 2 grade 6 major findings. Soft tissue injuries included 10 grade 3, 68 grade 4, 16 grade 5, and 5 grade 6 major findings. Of these, PMCT detected 165 (88 skeletal, 77 soft tissue), and autopsy detected 127 (59 skeletal, 68 soft tissue). PMCT agreed with autopsy in 86% and 76% of skeletal and soft tissue injuries, respectively. PMCT detected an additional 37 skeletal and 31 soft tissue injuries that were not identified at autopsy. Autopsy detected 8 skeletal and 22 soft tissue injuries that were not detected by PMCT. PMCT was more sensitive for skeletal (P=0.05) and head and neck region injury (P=0.043) detection. PMCT showed a trend for greater sensitivity than autopsy, but this did not reach statistical significance (P=0.083). 3D PMCT detected significantly more skeletal injuries than autopsy and a similar number of soft tissue injuries to autopsy and promises to be a sensitive tool for detection and classification of skeletal injuries in fatal blunt force accidental trauma. Use of the AIS scale allows standardized categorization and quantification of injuries that contribute to death in such cases and allows more

  19. Overcoming barriers to population-based injury research: development and validation of an ICD10-to-AIS algorithm.

    PubMed

    Haas, Barbara; Xiong, Wei; Brennan-Barnes, Maureen; Gomez, David; Nathens, Avery B

    2012-02-01

    Hospital administrative databases are a useful source of population-level data on injured patients; however, these databases use the International Classification of Diseases (ICD) system, which does not provide a direct means of estimating injury severity. We created and validated a crosswalk to derive Abbreviated Injury Scale (AIS) scores from injury-related diagnostic codes in the tenth revision of the ICD (ICD-10). We assessed the validity of the crosswalk using data from the Ontario Trauma Registry Comprehensive Data Set (OTRCDS). The AIS and Injury Severity Scores (ISS) derived using the algorithm were compared with those assigned by expert abstractors. We evaluated the ability of the algorithm to identify patients with AIS scores of 3 or greater. We used κ and intraclass correlation coefficients (ICC) as measures of concordance. In total, 10 431 patients were identified in the OTRCDS. The algorithm accurately identified patients with at least 1 AIS score of 3 or greater (κ 0.65), as well as patients with a head AIS score of 3 or greater (κ 0.78). Mapped and abstracted ISS were similar; ICC across the entire cohort was 0.83 (95% confidence interval 0.81-0.84), indicating good agreement. When comparing mapped and abstracted ISS, the difference between scores was 10 or less in 87% of patients. Concordance between mapped and abstracted ISS was similar across strata of age, mechanism of injury and mortality. Our ICD-10-to-AIS algorithm produces reliable estimates of injury severity from data available in administrative databases. This algorithm can facilitate the use of administrative data for population-based injury research in jurisdictions using ICD-10.

  20. 40 CFR 60.4103 - Measurements, abbreviations, and acronyms.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 6 2010-07-01 2010-07-01 false Measurements, abbreviations, and acronyms. 60.4103 Section 60.4103 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR....4103 Measurements, abbreviations, and acronyms. Measurements, abbreviations, and acronyms used in this...

  1. 40 CFR 60.4103 - Measurements, abbreviations, and acronyms.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 6 2011-07-01 2011-07-01 false Measurements, abbreviations, and acronyms. 60.4103 Section 60.4103 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR....4103 Measurements, abbreviations, and acronyms. Measurements, abbreviations, and acronyms used in this...

  2. A Score for Predicting Acute Kidney Injury After Coronary Artery Bypass Graft Surgery in an Asian Population.

    PubMed

    Mithiran, Harish; Kunnath Bonney, Glenn; Bose, Saideep; Subramanian, Srinivas; Zhe Yan, Zan Ng; Zong En, Seth Yeak; Papadimas, Evangelos; Chauhan, Ishaan; MacLaren, Graeme; Kofidis, Theodoros

    2016-10-01

    To develop a scoring system to predict acute kidney injury in Asian patients after coronary artery bypass grafting. A retrospective analysis of data collected in an institutional cardiac database. A tertiary academic hospital in a large metropolitan city. The study comprised 954 patients with coronary artery disease. All patients underwent coronary artery bypass surgery with cardiopulmonary bypass but did not undergo any other concomitant procedures. The main outcome measured was acute kidney injury as defined by the Acute Kidney Injury Network criteria. The following 6 clinical variables were independent predictors of kidney injury: age>60 years, diabetes requiring insulin, estimated glomerular filtration rate<60 mL/min/1.73 m(2), ejection fraction<40%, cardiopulmonary bypass time>140 minutes, and aortic cross-clamp time>100 minutes. These variables were used to develop the Singapore Acute Kidney Injury score. The Singapore Acute Kidney Injury score is a simple way to predict, at the time of admission to the intensive care unit, an Asian patient's risk of developing acute kidney injury after coronary artery bypass surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. The effect of correct cross-chest clip use on injury outcomes in young children during motor vehicle crashes.

    PubMed

    Woodford, Evangeline; Brown, Julie; Bilston, Lynne E

    2018-05-19

    Traffic crashes have high mortality and morbidity for young children. Though many specialized child restraint systems improve injury outcomes, no large-scale studies have investigated the cross-chest clip's role during a crash, despite concerns in some jurisdictions about the potential for neck contact injuries from the clips. This study aimed to investigate the relationship between cross-chest clip use and injury outcomes in children between 0 and 4 years of age. Child passengers between 0 and 4 years of age were selected from the NASS-CDS data sets (2003-2014). Multiple regression analysis was used to model injury outcomes while controlling for age, crash severity, crash direction, and restraint type. The primary outcomes were overall Abbreviated Injury Score (AIS) 2+ injury, and the presence of any neck injury. Across all children aged 0-4 years, correct chest clip use was associated with decreased Abbreviated Injury Scale (AIS) 2+ injury (odds ratio [OR] = 0.44, 95% confidence interval [CI], 0.21-0.91) and was not associated with neck injury. However, outcomes varied by age. In children <12 months old, chest clip use was associated with decreased AIS 2+ injury (OR = 0.09, 95% CI, 0.02-0.44). Neck injury (n = 7, all AIS 1) for this age group only occurred with correct cross-chest clip use. For 1- to 4-year-old children, cross-chest clip use had no association with AIS 2+ injury, and correct use significantly decreased the odds of neck injury (OR = 0.49; 95% CI, 0.27-0.87) compared to an incorrectly used or absent cross-chest clip. No serious injuries were directly caused by the chest clips. Correct cross-chest clip use appeared to reduce injury in crashes, and there was no evidence of serious clip-induced injury in children in 5-point harness restraints.

  4. 40 CFR 96.303 - Measurements, abbreviations, and acronyms.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 21 2011-07-01 2011-07-01 false Measurements, abbreviations, and acronyms. 96.303 Section 96.303 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR..., abbreviations, and acronyms. Measurements, abbreviations, and acronyms used in this subpart and subparts BBBB...

  5. 40 CFR 1042.905 - Symbols, acronyms, and abbreviations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 33 2011-07-01 2011-07-01 false Symbols, acronyms, and abbreviations... Definitions and Other Reference Information § 1042.905 Symbols, acronyms, and abbreviations. The following symbols, acronyms, and abbreviations apply to this part: ABTAveraging, banking, and trading. AECDauxiliary...

  6. 40 CFR 1033.905 - Symbols, acronyms, and abbreviations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 33 2011-07-01 2011-07-01 false Symbols, acronyms, and abbreviations. 1033.905 Section 1033.905 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR....905 Symbols, acronyms, and abbreviations. The following symbols, acronyms, and abbreviations apply to...

  7. General practitioner understanding of abbreviations used in hospital discharge letters.

    PubMed

    Chemali, Mark; Hibbert, Emily J; Sheen, Adrian

    2015-08-03

    To determine the incidence of abbreviation use in electronic hospital discharge letters (eDLs) and general practitioner understanding of abbreviations used in eDLsDesign, setting and participants: Retrospective audit of abbreviation use in 200 sequential eDLs was conducted at Nepean Hospital, Sydney, a tertiary referral centre, from 18 December to 31 December 2012. The 15 most commonly used abbreviations and five clinically important abbreviations were identified from the audit. A survey questionnaire using these abbreviations in context was then mailed to 240 GPs in the area covered by the Nepean Blue Mountains Local Health District to determine their understanding of these abbreviations. Number of abbreviations and frequency of their use in eDLs, and GPs' understanding of abbreviations used in the survey. 321 abbreviations were identified in the eDL audit; 48.6% were used only once. Fifty five per cent of GPs (132) responded to the survey. No individual abbreviation was correctly interpreted by all GPs. Six abbreviations were misinterpreted by more than a quarter of GPs. These were SNT (soft non-tender), TTE (transthoracic echocardiogram), EST (exercise stress test), NKDA (no known drug allergies), CTPA (computed tomography pulmonary angiogram), ORIF (open reduction and internal fixation). These abbreviations were interpreted incorrectly by 47.0% (62), 33.3% (44), 33.3% (44) 32.6% (43), 31.1% (41) and 28.0% (37) of GPs, respectively. Abbreviations used in hospital eDLs are not well understood by the GPs who receive them. This has potential to adversely affect patient care in the transition from hospital to community care.

  8. Overcoming barriers to population-based injury research: development and validation of an ICD-10–to–AIS algorithm

    PubMed Central

    Haas, Barbara; Xiong, Wei; Brennan-Barnes, Maureen; Gomez, David; Nathens, Avery B.

    2012-01-01

    Background Hospital administrative databases are a useful source of population-level data on injured patients; however, these databases use the International Classification of Diseases (ICD) system, which does not provide a direct means of estimating injury severity. We created and validated a crosswalk to derive Abbreviated Injury Scale (AIS) scores from injury-related diagnostic codes in the tenth revision of the ICD (ICD-10). Methods We assessed the validity of the crosswalk using data from the Ontario Trauma Registry Comprehensive Data Set (OTR-CDS). The AIS and Injury Severity Scores (ISS) derived using the algorithm were compared with those assigned by expert abstractors. We evaluated the ability of the algorithm to identify patients with AIS scores of 3 or greater. We used κ and intraclass correlation coefficients (ICC) as measures of concordance. Results In total, 10 431 patients were identified in the OTR-CDS. The algorithm accurately identified patients with at least 1 AIS score of 3 or greater (κ 0.65), as well as patients with a head AIS score of 3 or greater (κ 0.78). Mapped and abstracted ISS were similar; ICC across the entire cohort was 0.83 (95% confidence interval 0.81–0.84), indicating good agreement. When comparing mapped and abstracted ISS, the difference between scores was 10 or less in 87% of patients. Concordance between mapped and abstracted ISS was similar across strata of age, mechanism of injury and mortality. Conclusion Our ICD-10–to–AIS algorithm produces reliable estimates of injury severity from data available in administrative databases. This algorithm can facilitate the use of administrative data for population-based injury research in jurisdictions using ICD-10. PMID:22269308

  9. Prognostic value of FOUR and GCS scores in determining mortality in patients with traumatic brain injury.

    PubMed

    Saika, Amrit; Bansal, Sonia; Philip, Mariamma; Devi, Bhagavatula Indira; Shukla, Dhaval P

    2015-09-01

    The Glasgow Coma Scale (GCS) is considered the gold standard for assessment of unconsciousness in patients with traumatic brain injury (TBI) against which other scales are compared. To overcome the disadvantages of GCS, the Full Outline Of Unresponsiveness (FOUR) score was proposed. We aimed to compare the predictability of FOUR score and GCS for early mortality, after moderate and severe TBI. This is a prospective observational study of patients with moderate and severe TBI. Both FOUR and GCS scores were determined at admission. The primary outcome was mortality at the end of 2 weeks of injury. A total of 138 (117 males) patients were included in the study. Out of these, 17 (12.3 %) patients died within 2 weeks of injury. The mean GCS and FOUR scores were 9.5 (range, 3-13) and 11 (0-16), respectively. The total GCS and FOUR scores were significantly lower in patients who did not survive. At a cut-off score of 7 for FOUR score, the AUC was 0.97, with sensitivity of 97.5 and specificity of 88.2 % (p < 0.0001). For GCS score, AUC was 0.95, with sensitivity of 98.3 % and specificity of 82.4 % with cut-off score of 6 (p < 0.0001). The correlation coefficient was 0.753 (p < 0.001) between the GCS and FOUR scores. The predictive value of the FOUR score on admission of patients with TBI is no better than the GCS score.

  10. Predicting in-hospital mortality of traffic victims: A comparison between AIS-and ICD-9-CM-related injury severity scales when only ICD-9-CM is reported.

    PubMed

    Van Belleghem, Griet; Devos, Stefanie; De Wit, Liesbet; Hubloue, Ives; Lauwaert, Door; Pien, Karen; Putman, Koen

    2016-01-01

    Injury severity scores are important in the context of developing European and national goals on traffic safety, health-care benchmarking and improving patient communication. Various severity scores are available and are mostly based on Abbreviated Injury Scale (AIS) or International Classification of Diseases (ICD). The aim of this paper is to compare the predictive value for in-hospital mortality between the various severity scores if only International Classification of Diseases, 9th revision, Clinical Modification ICD-9-CM is reported. To estimate severity scores based on the AIS lexicon, ICD-9-CM codes were converted with ICD Programmes for Injury Categorization (ICDPIC) and four AIS-based severity scores were derived: Maximum AIS (MaxAIS), Injury Severity Score (ISS), New Injury Severity Score (NISS) and Exponential Injury Severity Score (EISS). Based on ICD-9-CM, six severity scores were calculated. Determined by the number of injuries taken into account and the means by which survival risk ratios (SRRs) were calculated, four different approaches were used to calculate the ICD-9-based Injury Severity Scores (ICISS). The Trauma Mortality Prediction Model (TMPM) was calculated with the ICD-9-CM-based model averaged regression coefficients (MARC) for both the single worst injury and multiple injuries. Severity scores were compared via model discrimination and calibration. Model comparisons were performed separately for the severity scores based on the single worst injury and multiple injuries. For ICD-9-based scales, estimation of area under the receiver operating characteristic curve (AUROC) ranges between 0.94 and 0.96, while AIS-based scales range between 0.72 and 0.76, respectively. The intercept in the calibration plots is not significantly different from 0 for MaxAIS, ICISS and TMPM. When only ICD-9-CM codes are reported, ICD-9-CM-based severity scores perform better than severity scores based on the conversion to AIS. Copyright © 2015 Elsevier Ltd. All

  11. Proper coding of the Abbreviated Injury Scale: can clinical parameters help as surrogates in estimating blood loss?

    PubMed

    Burkhardt, M; Holstein, J H; Moersdorf, P; Kristen, A; Lefering, R; Pohlemann, T; Pizanis, A

    2014-08-01

    The Abbreviated Injury Scale (AIS) requires the estimation of the lost blood volume for some severity assignments. This study aimed to develop a rule of thumb for facilitating AIS coding by using objective clinical parameters as surrogate markers of blood loss. Using the example of pelvic ring fractures, a retrospective analysis of TraumaRegister DGU(®) data from 2002 to 2011 was performed. As potential surrogate markers of blood loss, we recorded the hemoglobin (Hb) level, systolic blood pressure (SBP), base excess (BE), Quick's value, units of packed red blood cells (PRBCs) transfused before intensive care unit (ICU) admission, and mortality within 24 h. We identified 11,574 patients with pelvic ring fractures (Tile/OTA classification: 39 % type A, 40 % type B, 21 % type C). Type C fractures were 73.1 % AISpelvis 4 and 26.9 % AISpelvis 5. Type B fractures were 47 % AISpelvis 3, 47 % AISpelvis 4, and 6 % AISpelvis 5. In type C fractures, cut-off values of <7 g/dL Hb, <90 mmHg SBP, <-9 mmol/L BE, <35 % Quick's value, >15 units PRBCs, and death within 24 h had a positive predictive value of 47 % and a sensitivity of 62 % for AISpelvis 5. In type B fractures, these cut-off values had poor sensitivity (48 %) and positive predictive value (11 %) for AISpelvis 5. We failed to develop a rule of thumb for facilitating a proper future AIS coding using the example of pelvic ring fractures. The estimation of blood loss for severity assignment still remains a noteworthy weakness in the AIS coding of traumatic injuries.

  12. The FOUR score and GCS as predictors of outcome after traumatic brain injury.

    PubMed

    McNett, Molly; Amato, Shelly; Gianakis, Anastasia; Grimm, Dawn; Philippbar, Sue Ann; Belle, Josie; Moran, Cristina

    2014-08-01

    The Glasgow Coma Scale (GCS) is a routine component of a neurological exam for critically ill traumatic brain injury (TBI) patients, yet has been criticized for not accurately depicting verbal status among intubated patients or including brain stem reflexes. Preliminary research on the Full Outline of UnResponsiveness (FOUR) Scale suggests it overcomes these limitations. Research is needed to determine correlations with patient outcomes. The aims of this study were to: (1) examine correlations between 24 and 72 h FOUR and GCS scores and functional/cognitive outcomes; (2) determine relationship between 24 and 72 h FOUR scores and mortality. Prospective cohort study. Data gathered on adult TBI patients at a Level I trauma center. FOUR scores assigned at 24, 72 h. Functional outcome measured by functional independence measure scores at rehabilitation discharge; cognitive status measured by Weschler Memory Scale scores 3 months post-injury. n = 136. Mean age 53.1. 72 h FOUR and GCS scores correlated with functional outcome (r s = 0.34, p = 0.05; r s = 0.39, p = 0.02), but not cognitive status. Receiver operating characteristic curves were comparable for FOUR and GCS at 24 and 72 h for functional status (24 h FOUR, GCS = 0.625, 0.602, respectively; 72 h FOUR, GCS = 0.640, 0.688), cognitive status (24 h FOUR, GCS = 0.703, 0.731; 72 h FOUR, GCS = 0.837, 0.674), and mortality (24 h FOUR, GCS = 0.913, 0.935; 72 h FOUR, GCS = 0.837, 0.884). FOUR is comparable to GCS in terms of predictive ability for functional status, cognitive outcome 3 months post-injury, and in-hospital mortality.

  13. Effect of Age on Glasgow Coma Scale in Patients with Moderate and Severe Traumatic Brain Injury: An Approach with Propensity Score-Matched Population.

    PubMed

    Rau, Cheng-Shyuan; Wu, Shao-Chun; Chen, Yi-Chun; Chien, Peng-Chen; Hsieh, Hsiao-Yun; Kuo, Pao-Jen; Hsieh, Ching-Hua

    2017-11-13

    Background: The most widely used methods of describing traumatic brain injury (TBI) are the Glasgow Coma Scale (GCS) and the Abbreviated Injury Scale (AIS). Recent evidence suggests that presenting GCS in older patients may be higher than that in younger patients for an equivalent anatomical severity of TBI. This study aimed to assess these observations with a propensity-score matching approach using the data from Trauma Registry System in a Level I trauma center. Methods: We included all adult patients (aged ≥20 years old) with moderate to severe TBI from 1 January 2009 to 31 December 2016. Patients were categorized into elderly (aged ≥65 years) and young adults (aged 20-64 years). The severity of TBI was defined by an AIS score in the head (AIS 3‒4 and 5 indicate moderate and severe TBI, respectively). We examined the differences in the GCS scores by age at each head AIS score. Unpaired Student's t - and Mann-Whitney U -tests were used to analyze normally and non-normally distributed continuous data, respectively. Categorical data were compared using either the Pearson chi-square or two-sided Fisher's exact tests. Matched patient populations were allocated in a 1:1 ratio according to the propensity scores calculated using NCSS software with the following covariates: sex, pre-existing chronic obstructive pulmonary disease, systolic blood pressure, hemoglobin, sodium, glucose, and alcohol level. Logistic regression was used to evaluate the effects of age on the GCS score in each head AIS stratum. Results: The study population included 2081 adult patients with moderate to severe TBI. These patients were categorized into elderly ( n = 847) and young adults ( n = 1234): each was exclusively further divided into three groups of patients with head AIS of 3, 4, or 5. In the 162 well-balanced pairs of TBI patients with head AIS of 3, the elderly demonstrated a significantly higher GCS score than the young adults (14.1 ± 2.2 vs. 13.1 ± 3.3, respectively; p = 0

  14. 40 CFR 86.203-94 - Abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) CONTROL OF EMISSIONS FROM NEW AND IN-USE HIGHWAY VEHICLES AND ENGINES Emission Regulations for 1994 and Later Model Year Gasoline-Fueled New Light-Duty Vehicles, New Light-Duty Trucks and New Medium-Duty Passenger Vehicles; Cold Temperature Test Procedures § 86.203-94 Abbreviations. The abbreviations in subpart...

  15. Acronyms, initialisms, and abbreviations: Fourth Revision

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Tolman, B.J.

    1994-04-01

    This document lists acronyms used in technical writing. The immense list is supplemented by an appendix containing chemical elements, classified information access, common abbreviations used for functions, conversion factors for selected SI units, a flowcharting template, greek alphabet, metrix terminology, proofreader`s marks, signs and symbols, and state abbreviations.

  16. An analysis of the relationship between bodily injury severity and fall height in victims of fatal falls from height.

    PubMed

    Teresiński, Grzegorz; Milaszkiewicz, Anna; Cywka, Tomasz

    2016-01-01

    Aim of the study: One of the basic issues discussed in forensic literature regarding falls from a height is determination of fall heights and differentiation between suicidal and accidental falls. The aim of the study was to verify the usefulness of the available methods for the purposes of forensic expertises. Material and methods: The study encompassed fatalities of falls from a height whose autopsies were performed in the Department of Forensic Medicine in Lublin. Results: Similarly to other authors, the severity of injuries was assessed using the Abbreviated Injury Scale (AIS) and injury severity score (ISS). The study findings demonstrated a statistically significant correlation between the fall height and the severity of injuries according to ISS and a statistically significant difference in fall heights between the groups of accidents and suicides.

  17. A novel practical scoring for early diagnosis of traumatic bowel injury without obvious solid organ injury in hemodynamically stable patients.

    PubMed

    Zarour, Ahmad; El-Menyar, Ayman; Khattabi, Mazen; Tayyem, Raed; Hamed, Osama; Mahmood, Ismail; Abdelrahman, Husham; Chiu, William; Al-Thani, Hassan

    2014-01-01

    To develop a scoring tool based on clinical and radiological findings for early diagnosis and intervention in hemodynamically stable patients with traumatic bowel and mesenteric injury (TBMI) without obvious solid organ injury (SOI). A retrospective analysis was conducted for all traumatic abdominal injury patients in Qatar from 2008 to 2011. Data included demographics and clinical, radiological and operative findings. Multivariate logistic regression was performed to analyze the predictors for the need of therapeutic laparotomy. A total of 105 patients met the inclusion criteria with a mean age of 33 ± 15. Motor Vehicle Crashes (58%) and fall (21%) were the major MOI. Using Receiver operating characteristic curve, Z-score of >9 was the cutoff point (AUC = 0.98) for high probability of the presence of TBMI requiring surgical intervention. Z-Score >9 was found to have sensitivity (96.7%), specificity (97.4%), PPV (93.5%) and NPV (98.7%). Multivariate regression analysis found Z-score (>9) to be an independent predictor for the need of exploratory laparotomy (OR7.0; 95% CI: 2.46-19.78, p = 0.001). This novel tool for early diagnosis of TBMI is found to be simple and helpful in selecting stable patients with free intra-abdominal fluid without SOI for exploratory Laparotomy. However, further prospective studies are warranted. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  18. Acute diabetes insipidus in severe head injury: a prospective study.

    PubMed

    Hadjizacharia, Pantelis; Beale, Elizabeth O; Inaba, Kenji; Chan, Linda S; Demetriades, Demetrios

    2008-10-01

    The incidence and risk factors for acute diabetes insipidus after severe head injury and the effect of this complication on outcomes have not been evaluated in any large prospective studies. We conducted a prospective study of all patients admitted to the surgical ICU of a Level I trauma center with severe head injury (head Abbreviated Injury Score [AIS] >or= 3). The following potential risk factors with p < 0.2 on bivariate analysis were included in a stepwise logistic regression to identify independent risk factors for diabetes insipidus and its association with mortality: age, mechanism of injury (blunt or penetrating), blood pressure, Glasgow Coma Scale, Injury Severity Score, head and other body area AIS, skull fracture, cerebral edema and shift, intracranial hemorrhage, and pneumocephaly. There were 436 patients (blunt injuries, 392; penetrating injuries, 44); 387 patients had isolated head injury. Diabetes insipidus occurred in 15.4% of all patients (blunt, 12.5%; penetrating, 40.9%; p < 0.0001) and in 14.7% of patients with isolated head injury (blunt, 11.8%; penetrating, 39.5%; p < 0.0001). The presence of major extracranial injuries did not influence the incidence of diabetes insipidus. Independent risk factors for diabetes insipidus in isolated head injury were Glasgow Coma Scale3. Diabetes insipidus was an independent risk factor for death (adjusted odds ratio, 3.96; 95% CI [1.65, 9.72]; adjusted p value = 0.002). The incidence of acute diabetes insipidus in severe head injury is high, especially in penetrating injuries. Independent risk factors for diabetes insipidus include a Glasgow Coma Scale3. Acute diabetes insipidus was associated with significantly increased mortality.

  19. Examining the association of injury with the Functional Movement Screen and Landing Error Scoring System in military recruits undergoing 16 weeks of introductory fitness training.

    PubMed

    Everard, Eoin; Lyons, Mark; Harrison, Andrew J

    2018-06-01

    To examine the association of injury with the Functional Movement Screen (FMS) and Landing Error Scoring System (LESS) in military recruits undergoing an intensive 16-week training block. Prospective cohort study. One hundred and thirty-two entry-level male soldiers (18-25years) were tested using the FMS and LESS. The participants underwent an intensive 16-week training program with injury data recorded daily. Chi-squared statistics were used to examine associations between injury risk and (1) poor LESS scores, (2) any score of 1 on the FMS and (3) composite FMS score of ≤14. A composite FMS score of ≤14 was not a significant predictor of injury. LESS scores of >5 and having a score of 1 on any FMS test were significantly associated with injury. LESS scores had greater relative risk, sensitivity and specificity (2.2 (95% CI=1.48-3.34); 71% and 87% respectively) than scores of 1 on the FMS (relative risk=1.32 (95% CI=1.0-1.7); sensitivity=50% and specificity=76%). There was no association between composite FMS score and injury but LESS scores and scores of 1 in the FMS test were significantly associated with injury in varying degrees. LESS scores had a much better association with injury than both any scores of 1 on the FMS and a combination of LESS scores and scores of 1 on the FMS. Furthermore, the LESS provides comparable information related to injury risk as other well-established markers associated with injury such as age, muscular strength and previous injury. Copyright © 2017. Published by Elsevier Ltd.

  20. Injury profiles related to mortality in patients with a low Injury Severity Score: a case-mix issue?

    PubMed

    Joosse, Pieter; Schep, Niels W L; Goslings, J Carel

    2012-07-01

    Outcome prediction models are widely used to evaluate trauma care. External benchmarking provides individual institutions with a tool to compare survival with a reference dataset. However, these models do have limitations. In this study, the hypothesis was tested whether specific injuries are associated with increased mortality and whether differences in case-mix of these injuries influence outcome comparison. A retrospective study was conducted in a Dutch trauma region. Injury profiles, based on injuries most frequently endured by unexpected death, were determined. The association between these injury profiles and mortality was studied in patients with a low Injury Severity Score by logistic regression. The standardized survival of our population (Ws statistic) was compared with North-American and British reference databases, with and without patients suffering from previously defined injury profiles. In total, 14,811 patients were included. Hip fractures, minor pelvic fractures, femur fractures, and minor thoracic injuries were significantly associated with mortality corrected for age, sex, and physiologic derangement in patients with a low injury severity. Odds ratios ranged from 2.42 to 2.92. The Ws statistic for comparison with North-American databases significantly improved after exclusion of patients with these injuries. The Ws statistic for comparison with a British reference database remained unchanged. Hip fractures, minor pelvic fractures, femur fractures, and minor thoracic wall injuries are associated with increased mortality. Comparative outcome analysis of a population with a reference database that differs in case-mix with respect to these injuries should be interpreted cautiously. Prognostic study, level II.

  1. Improvement in GOS and GOSE scores 6 and 12 months after severe traumatic brain injury.

    PubMed

    Corral, Luisa; Ventura, José Luis; Herrero, José Ignacio; Monfort, Jose Luis; Juncadella, Montserrat; Gabarrós, Andreu; Bartolomé, Carlos; Javierre, Casimiro F; García-Huete, Lucía

    2007-11-01

    To assess improvements in Glasgow Outcome Scale (GOS) and GOS extended (GOSE) scores between 6 months and 1 year following severe traumatic brain injury (TBI). One studied 214 adult patients with severe TBI with Glasgow Coma Scale (GCS) <9 admitted to Intensive Care Unit (ICU). GOS scores were obtained 6 and 12 months after injury in 195 subjects. Patients were predominantly male (84%) and median age was 35 years. Outcome (GOS and GOSE at 6 months and 1 year) was better in the high GCS score at admission (6-8) group than in the low score group (3-5). The improvement in GOS scores between 6 months and 1 year was greater in the high GCS score at admission group than in the low score group. At 6 months, 75 patients had died and 120 survived. None died between the 6-12-month assessments; at 12 months, 36% had improved GOS score. GOS scores improved between 6-12 months after severe TBI in 36% of survivors and it is concluded that the expectancy of improvement is incomplete at 6 months. This improvement was greater in patients with better GCS scores (6-8) at admission than in those with worse GCS scores (3-5).

  2. Efficacy of beta-blockade after isolated blunt head injury: does race matter?

    PubMed

    Bukur, Marko; Mohseni, Shahin; Mosheni, Shahin; Ley, Eric; Salim, Ali; Margulies, Daniel; Talving, Peep; Demetriades, Demetrios; Inaba, Kenji

    2012-04-01

    Several retrospective clinical studies and recent prospective animal models demonstrate improved outcomes with beta-blocker administration after isolated blunt head injury. However, no investigations to date have examined the influence of race on the potential therapeutic effectiveness of these medications. Our hypothesis was that mortality benefits associated with beta-blocker exposure after isolated blunt head injury varies based on ethnicity. The trauma registry and the surgical intensive care unit (ICU) databases of an academic Level I trauma center were used to identify all patients sustaining blunt head injury requiring ICU admission from July 1998 to December 2009. Patients sustaining major associated extracranial injuries (Abbreviated Injury Scale [AIS] score ≥ 3 in any body region) were excluded. Patient demographics, injury profile, Injury Severity Score, and beta-blocker exposure were abstracted. The primary outcome evaluated was in-hospital mortality stratified by ethnicity. During the 11-year study period, 3,750 patients were admitted to the Los Angeles County + University of Southern California Medical Center trauma ICU because of blunt trauma. Of these, 65% (n = 2,446) had an "isolated" head injury. When stratified by race, most patients were Hispanics (60%), followed by Whites (21%), Asians (11%), and African Americans (8%). After adjusting for confounding variables with multivariate regression, only those of Asian and Hispanic descent demonstrated significantly improved outcomes associated with beta-blocker administration. Our results indicate that beta-blockade after traumatic brain injury may not benefit all races equally. Further prospective research is necessary to assess this discrepancy in treatment benefit and explore other possible therapeutic interventions.

  3. The relation between Glasgow Coma Scale score and later cerebral atrophy in paediatric traumatic brain injury.

    PubMed

    Ghosh, Alokananda; Wilde, Elisabeth A; Hunter, Jill V; Bigler, Erin D; Chu, Zili; Li, Xiaoqi; Vasquez, Ana C; Menefee, Deleene; Yallampalli, Ragini; Levin, Harvey S

    2009-03-01

    To examine initial Glasgow Coma Scale (GCS) score and its relationship with later cerebral atrophy in children with traumatic brain injury (TBI) using Quantitative Magnetic Resonance Imaging (QMRI) at 4 months post-injury. It was hypothesized that a lower GCS score would predict later generalized atrophy. As a guide in assessing paediatric TBI patients, the probability of developing chronic cerebral atrophy was determined based on the initial GCS score. The probability model used data from 45 paediatric patients (mean age = 13.6) with mild-to-severe TBI and 41 paediatric (mean age = 12.4) orthopaedically-injured children. This study found a 24% increase in the odds of developing an abnormal ventricle-to-brain ratio (VBR) and a 27% increase in the odds of developing reduced white matter percentage on neuroimaging with each numerical drop in GCS score. Logistic regression models with cut-offs determined by normative QMRI data confirmed that a lower initial GCS score predicts later atrophy. GCS is a commonly used measure of injury severity. It has proven to be a prognostic indicator of cognitive recovery and functional outcome and is also predictive of later parenchymal change.

  4. Bayesian Scoring Systems for Military Pelvic and Perineal Blast Injuries: Is it Time to Take a New Approach?

    PubMed

    Mossadegh, Somayyeh; He, Shan; Parker, Paul

    2016-05-01

    Various injury severity scores exist for trauma; it is known that they do not correlate accurately to military injuries. A promising anatomical scoring system for blast pelvic and perineal injury led to the development of an improved scoring system using machine-learning techniques. An unbiased genetic algorithm selected optimal anatomical and physiological parameters from 118 military cases. A Naïve Bayesian model was built using the proposed parameters to predict the probability of survival. Ten-fold cross validation was employed to evaluate its performance. Our model significantly out-performed Injury Severity Score (ISS), Trauma ISS, New ISS, and the Revised Trauma Score in virtually all areas; positive predictive value 0.8941, specificity 0.9027, accuracy 0.9056, and area under curve 0.9059. A two-sample t test showed that the predictive performance of the proposed scoring system was significantly better than the other systems (p < 0.001). With limited resources and the simplest of Bayesian methodologies, we have demonstrated that the Naïve Bayesian model performed significantly better in virtually all areas assessed by current scoring systems used for trauma. This is encouraging and highlights that more can be done to improve trauma systems not only for our military injured, but also for civilian trauma victims. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  5. Let it snow: how snowfall and injury mechanism affect ski and snowboard injuries in Vail, Colorado, 2011-2012.

    PubMed

    Moore, S Jason; Knerl, Dana

    2013-08-01

    Current research examining the impact of mechanism of injury and daily snowfall amounts on injury severity among skiers and snowboarders is limited. The purpose of this study was to define correlations between injury mechanism and daily snowfall on injury patterns and severity among skiers and snowboarders. This observational study analyzed daily snowfall measurements coupled with trauma admissions during the 2011 and 2012 ski seasons from a Level III trauma center servicing a large North American ski resort. Post hoc adjusted analyses and multivariate modeling was used to determine independent predictors of increased injury severity. Six hundred forty-four trauma admissions were analyzed, with primary research considerations detailing the variances in injury severity resulting from collisions with other skiers or snowboarders and daily total snowfall. Findings demonstrated that collisions were independently associated with increased (1) injury severity (Injury Severity Score [ISS ≥ 16]) (odds ratio [OR], 3.9; 95% confidence interval [CI], 2.0-7.6; p < 0.001), (2) thoracic injury severity (Abbreviated Injury Scale [AIS] score ≥ 3) (OR, 7.5; 95% CI, 3.7-15.0; p < 0.001), and (3) renal injuries (OR, 3.2; 95% CI, 1.2-8.1; p = 0.017) as well as and axial skeleton fractures (OR, 4.5; 95% CI, 2.6-7.7; p < 0.001). In addition, mean ISS was significantly higher in the setting of a collision when compared with a fall (8.6 vs. 5.8; p < 0.001). Findings regarding total snowfall demonstrate a negative correlation between snowfall and injury severity (r = -0.08, p = 0.05); the majority (65.5%) of injuries were sustained when there was 1 inch or less of recent snowfall, and a snowfall total of 2 inches or less was independently associated with increased injury severity (ISS ≥ 16) (OR, 3.1; 95% CI, 1.1-9.1; p = 0.036). Collisions between snowsport enthusiasts and total trace snowfall predict an increase in injury severity among alpine skiers and snowboarders. Findings from

  6. The role of trauma team leaders in missed injuries: does specialty matter?

    PubMed

    Leeper, W Robert; Leeper, Terrence John; Vogt, Kelly Nancy; Charyk-Stewart, Tanya; Gray, Daryl Kenneth; Parry, Neil Geordie

    2013-09-01

    Previous studies have identified missed injuries as a common and potentially preventable occurrence in trauma care. Several patient- and injury-related variables have been identified, which predict for missed injuries; however, differences in rate and severity of missed injuries between surgeon and nonsurgeon trauma team leaders (TTLs) have not previously been reported. A retrospective review was conducted on a random sample of 10% of all trauma patients (Injury Severity Score [ISS] > 12) from 1999 to 2009 at a Canadian Level I trauma center. Missed injuries were defined as those identified greater than 24 hours after presentation and were independently adjudicated by two reviewers. TTLs were identified as either surgeons or nonsurgeons. Of our total trauma population of 2,956 patients, 300 charts were randomly pulled for detailed review. Missed injuries occurred in 46 patients (15%). Most common missed injuries were fractures (n = 32, 70%) and thoracic injuries (n = 23, 50%). The majority of missed injuries resulted in minor morbidity with only 5 (11%) requiring operative intervention. On univariate analysis, higher ISS (p < 0.01), higher maximum Abbreviated Injury Scale (MAIS) score of the thorax (p < 0.01), and nonsurgeon TTL status were predictive of missed injuries (p = 0.02). Multivariable logistic regression revealed that, after adjustment for age, ISS, and severe head injuries, the presence of a nonsurgeon TTL was associated with an increased odds of missed injury (odds ratio, 2.15; 95% confidence interval, 1.10-4.20). Missed injuries occurred in 15% of patients. A unique finding was the increased odds of missed injury with nonsurgeon TTLs. Further research should be undertaken to explore this relationship, elucidate potential causes, and propose interventions to narrow this discrepancy between TTL provider types. Therapeutic study, level IV. Prognostic and epidemiologic study, level III.

  7. Twelve-month prospective cohort study of patients with severe traumatic brain injury and their relatives: Coping, satisfaction with life and neurological functioning.

    PubMed

    Haller, Chiara S

    2017-01-01

    To examine the associations between the functioning of patients with severe traumatic brain injury (TBI), and their relatives' coping style and quality of life across 12 months post-injury. Prospective, population-based cohort study assessing 188 patients with severe TBI (Abbreviated Injury Scale of the head region [HAIS] score >3), and their relatives, 3, 6 and 12 months post-injury. Data were drawn from a larger national study run in Switzerland (2007-2011). Patient assessment: Glasgow Coma Outcome Scale Extended (GOSE), Patient Competency Rating Scale for Neurorehabilitation (PCRS-NR). Relative assessment: Health-Related Quality of Life (HRQoL; 12-item short form health survey [SF-12]), Coping Inventory for Stressful Situations (CISS). Mixed linear models were run separately for ages >50 and ≤50 (i.e. bimodal distribution). Patients' GOSE score was associated with relatives' reported mental SF-12 scores across age (ps < 0.01). Relatives' CISS was associated with patients' PCRS score (age > 50 years): Total and cognitive functioning decreased as emotion-oriented coping increased (ps = 0.01), while interpersonal functioning increased as task-oriented coping increased (p = 0.01) and decreased as avoidance-oriented coping increased (p = 0.02). Patients' functioning and relatives' mental HRQoL and coping strategies are associated with each other.

  8. Trauma with Injury Severity Score of 75: Are These Unsurvivable Injuries?

    PubMed Central

    Peng, Jin; Wheeler, Krista; Shi, Junxin; Groner, Jonathan Ira; Haley, Kathryn Jo; Xiang, Huiyun

    2015-01-01

    Trauma patients with an ISS=75 have been deliberately excluded from some trauma studies because they were assumed to have "unsurvivable injuries." This study aimed to assess the true mortality among patients with an ISS=75, and to examine the characteristics and primary diagnoses of these patients. Retrospective review of the 2006-2010 U.S. Nationwide Emergency Department Sample (NEDS) generated 2,815 patients with an ISS=75 for analysis, representing an estimated 13,569 patients in the country. Dispositions from the emergency department and hospital for these patients were tabulated by trauma center level. Survivors and non-survivors were compared using Pearson's chi-square test. Primary diagnosis codes of these patients were tabulated by mortality status. Overall, about 48.6% of patients with an ISS=75 were discharged alive, 25.8% died and 25.6% had unknown mortality status. The mortality risks of these patients did not vary significantly across different levels of trauma centers (15.6% vs. 13.0%, P = 0.16). Non-survivors were more likely than survivors to: be male (81.2% vs. 74.4%, P < 0.0001), be over 65 years (20.3% vs. 10.2%, P < 0.0001), be uninsured (33.8% vs. 19.1%), have at least one chronic condition (58.0% vs. 43.7%, P <0.0001), sustain life-threatening injuries (79.2% vs. 49.4%, P<0.0001), sustain penetrating injuries (42.0% vs. 25.9%, P<0.0001), and have injuries caused by motor vehicle crashes (32.9% vs. 21.1%, P<0.0001) or firearms (21.9% vs. 4.4%, P<0.0001). The most frequent diagnosis code was 862.8 (injury to multiple and unspecified intrathoracic organs, without mention of open wound into cavity). Our results revealed that at least half of patients with an ISS=75 survived, demonstrating that the rationale for excluding patients with an ISS=75 from analysis is not always justified. To avoid bias and inaccurate results, trauma researchers should examine the mortality status of patients with an ISS=75 before exclusion, and explicitly describe their

  9. Combat injury coding: a review and reconfiguration.

    PubMed

    Lawnick, Mary M; Champion, Howard R; Gennarelli, Thomas; Galarneau, Michael R; D'Souza, Edwin; Vickers, Ross R; Wing, Vern; Eastridge, Brian J; Young, Lee Ann; Dye, Judy; Spott, Mary Ann; Jenkins, Donald H; Holcomb, John; Blackbourne, Lorne H; Ficke, James R; Kalin, Ellen J; Flaherty, Stephen

    2013-10-01

    The current civilian Abbreviated Injury Scale (AIS), designed for automobile crash injuries, yields important information about civilian injuries. It has been recognized for some time, however, that both the AIS and AIS-based scores such as the Injury Severity Score (ISS) are inadequate for describing penetrating injuries, especially those sustained in combat. Existing injury coding systems do not adequately describe (they actually exclude) combat injuries such as the devastating multi-mechanistic injuries resulting from attacks with improvised explosive devices (IEDs). After quantifying the inapplicability of current coding systems, the Military Combat Injury Scale (MCIS), which includes injury descriptors that accurately characterize combat anatomic injury, and the Military Functional Incapacity Scale (MFIS), which indicates immediate tactical functional impairment, were developed by a large tri-service military and civilian group of combat trauma subject-matter experts. Assignment of MCIS severity levels was based on urgency, level of care needed, and risk of death from each individual injury. The MFIS was developed based on the casualty's ability to shoot, move, and communicate, and comprises four levels ranging from "Able to continue mission" to "Lost to military." Separate functional impairments were identified for injuries aboard ship. Preliminary evaluation of MCIS discrimination, calibration, and casualty disposition was performed on 992 combat-injured patients using two modeling processes. Based on combat casualty data, the MCIS is a new, simpler, comprehensive severity scale with 269 codes (vs. 1999 in AIS) that specifically characterize and distinguish the many unique injuries encountered in combat. The MCIS integrates with the MFIS, which associates immediate combat functional impairment with minor and moderate-severity injuries. Predictive validation on combat datasets shows improved performance over AIS-based tools in addition to improved face

  10. 7 CFR 1951.852 - Definitions and abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE... which constitutes a margin or buffer for meeting obligations within the ordinary operating cycle of the business. (b) Abbreviations. The following abbreviations are applicable: B&I—Business and Industry CSA...

  11. Severity of child pedestrian injuries due to bonnet-type-vehicle collision.

    PubMed

    Hitosugi, Masahito; Kawato, Hitoshi; Gomei, Sayaka; Mizuno, Koji; Tokudome, Shogo

    2013-10-01

    The aim of this study was to clarify the pattern of child pedestrian injury, injury severity, and its relation to collision velocity in bonnet-type-vehicle collision. In-depth data were retrospectively collected from the Institute for Traffic Accident Research and Data Analysis on pedestrians younger than 13 years old with any bodily injuries from collisions with bonnet-type vehicles between 1993 and 2004. Forty-seven patients from 43 collisions with a mean age of 6.9 ± 2.5 years were included in the study. Injury severity was not significantly different between patients who were hit by the front of the vehicle and those who were hit by the side of the vehicle. In front collisions, impact with the vehicle was associated with significantly higher Abbreviated Injury Scale (AIS) scores than those for impact with the road, especially for the lower extremities (mean: 1.2 vs 0.2, P < 0.001). Injury severity of the lower extremities and collision velocity were examined. The estimated collision velocity of the vehicle was not significantly different between patients with lower extremity AIS scores of 0 or 1 and those of 2 or 3. Some pediatric pedestrians suffer from collisions with bonnet-type vehicles without lower extremity fractures owing to the characteristics of child pedestrians. Providing injury prevention programs for children in communities and schools, developing active safety devices in the vehicle, and modifying the vehicle body to a pediatric pedestrian-friendly structure may increase pedestrian protection. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

  12. 32 CFR 634.3 - Explanation of abbreviations and terms.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Explanation of abbreviations and terms. 634.3 Section 634.3 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL INVESTIGATIONS MOTOR VEHICLE TRAFFIC SUPERVISION Introduction § 634.3 Explanation of abbreviations and terms. Abbreviations...

  13. Trauma infant neurologic score predicts the outcome of traumatic brain injury in infants.

    PubMed

    Yi, Wei; Liu, Renzhong; Chen, Jian; Tao, Shengzhong; Humphrey, Okechi; Bergenheim, A Tommy

    2010-01-01

    To investigate the clinical features of infancy traumatic brain injury (TBI) and the prognostic value of the Trauma Infant Neurologic Score (TINS), infants < 2 years of age with TBI who were admitted from 2000 to 2007 were retrospectively studied. Fifty-six patients with a mean age of 13.3 ± 6.5 months (range = 2-24) were identified. The clinical diagnoses, in terms of the severest injury, included scalp hematomas (n = 2), skull bone fractures (n = 3), epidural hematomas (n = 21), subdural hematomas (n = 14), cerebral contusion and laceration (n = 4), intracerebral hematomas (n = 7), traumatic subarachnoid hemorrhage (n = 2), diffuse axonal injury (n = 2) and diffuse brain swelling (n = 1). The most common clinical presentations were vomiting (66.1%), paleness (55.4%), irritability (37.3%), pupillary abnormalities (35.7%) and altered consciousness (32.1%). The mechanism of injury included falls (n = 41), vehicle accident (n = 9), abuse (n = 4) and unknown (n = 2). The TINS score ranged from 1 to 10 with a mean of 3.6 (SD = 2.4) in the whole patient cohort. The Children's Coma Scores (CCS) on admission were 13-15 (n = 31), 9-12 (n = 7) and 3-8 (n = 18). Thirty-nine of the infants were operated on and the other 17 infants were treated nonsurgically. Forty-eight patients (86%) were followed up for a period of 1-8 years (mean = 4.4) after discharge. In the followed-up patient cohort, the mean TINS score at admission was 3.8 ± 2.5. The total clinical outcome, according to the Glasgow Outcome Scale (GOS), was: 37 (77.1%) good recovery, 4 (8.3%) moderately disabled, 1 (2.1%) vegetative and 6 (12.5%) dead. For those who were operated on the outcome was: 25 (78.1%) good recovery, 4 (12.5%) moderately disabled and 3 (9.4%) dead, and for those who were not operated on: 12 (75.0%) good recovery, 1 (6.3%) vegetative and 3 (25.0%) dead. At two years of follow-up, the GOS included 34 (73.9%) good recovery, 3 (6.5%) moderately disabled, 2 (4.3%) severely disabled, 1 (2

  14. Increased risk of pneumonia among ventilated patients with traumatic brain injury: every day counts!

    PubMed

    Hui, Xuan; Haider, Adil H; Hashmi, Zain G; Rushing, Amy P; Dhiman, Nitasha; Scott, Valerie K; Selvarajah, Shalini; Haut, Elliott R; Efron, David T; Schneider, Eric B

    2013-09-01

    Patients with traumatic brain injury (TBI) frequently require mechanical ventilation (MV). The objective of this study was to examine the association between time spent on MV and the development of pneumonia among patients with TBI. Patients older than 18 y with head abbreviated injury scale (AIS) scores coded 1-6 requiring MV in the National Trauma Data Bank 2007-2010 data set were included. The study was limited to hospitals reporting pneumonia cases. AIS scores were calculated using ICDMAP-90 software. Patients with injuries in any other region with AIS score >3, significant burns, or a hospital length of stay >30 d were excluded. A generalized linear model was used to determine the approximate relative risk of developing all-cause pneumonia (aspiration pneumonia, ventilator-associated pneumonia [VAP], and infectious pneumonia identified by the International Classification of Disease, Ninth Revision, diagnosis code) for each day of MV, controlling for age, gender, Glasgow coma scale motor score, comorbidity (Charlson comorbidity index) score, insurance status, and injury type and severity. Among the 24,525 patients with TBI who required MV included in this study, 1593 (6.5%) developed all-cause pneumonia. After controlling for demographic and injury factors, each additional day on the ventilator was associated with a 7% increase in the risk of pneumonia (risk ratio 1.07, 95% confidence interval 1.07-1.08). Patients who have sustained TBIs and require MV are at higher risk for VAP than individuals extubated earlier; therefore, shortening MV exposure will likely reduce the risk of VAP. As patients with TBI frequently require MV because of neurologic impairment, it is key to develop aggressive strategies to expedite ventilator independence. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Predicting performance and injury resilience from movement quality and fitness scores in a basketball team over 2 years.

    PubMed

    McGill, Stuart M; Andersen, Jordan T; Horne, Arthur D

    2012-07-01

    The purpose of this study was to see if specific tests of fitness and movement quality could predict injury resilience and performance in a team of basketball players over 2 years (2 playing seasons). It was hypothesized that, in a basketball population, movement and fitness scores would predict performance scores and that movement and fitness scores would predict injury resilience. A basketball team from a major American university (N = 14) served as the test population in this longitudinal trial. Variables linked to fitness, movement ability, speed, strength, and agility were measured together with some National Basketball Association (NBA) combine tests. Dependent variables of performance indicators (such as games and minutes played, points scored, assists, rebounds, steal, and blocks) and injury reports were tracked for the subsequent 2 years. Results showed that better performance was linked with having a stiffer torso, more mobile hips, weaker left grip strength, and a longer standing long jump, to name a few. Of the 3 NBA combine tests administered here, only a faster lane agility time had significant links with performance. Some movement qualities and torso endurance were not linked. No patterns with injury emerged. These observations have implications for preseason testing and subsequent training programs in an attempt to reduce future injury and enhance playing performance.

  16. Trauma patient adverse outcomes are independently associated with rib cage fracture burden and severity of lung, head, and abdominal injuries.

    PubMed

    Dunham, C Michael; Hileman, Barbara M; Ransom, Kenneth J; Malik, Rema J

    2015-01-01

    We hypothesized that lung injury and rib cage fracture quantification would be associated with adverse outcomes. Consecutive admissions to a trauma center with Injury Severity Score ≥ 9, age 18-75, and blunt trauma. CT scans were reviewed to score rib and sternal fractures and lung infiltrates. Sternum and each anterior, lateral, and posterior rib fracture was scored 1 = non-displaced and 2 = displaced. Rib cage fracture score (RCFS) = total rib fracture score + sternal fracture score + thoracic spine Abbreviated Injury Score (AIS). Four lung regions (right upper/middle, right lower, left upper, and left lower lobes) were each scored for % of infiltrate: 0% = 0; ≤ 20% = 1, ≤ 50% = 2, > 50% = 3; total of 4 scores = lung infiltrate score (LIS). Of 599 patients, 193 (32%) had 854 rib fractures. Rib fracture patients had more abdominal injuries (p < 0.001), hemo/pneumothorax (p < 0.001), lung infiltrates (p < 0.001), thoracic spine injuries (p = 0.001), sternal fractures (p = 0.0028) and death or need for mechanical ventilation ≥ 3 days (Death/Vdays ≥ 3) (p < 0.001). Death/Vdays ≥ 3 was independently associated with RCFS (p < 0.001), LIS (p < 0.001), head AIS (p < 0.001) and abdominal AIS (p < 0.001). Of the 193 rib fracture patients, Glasgow Coma Score 3-12 or head AIS ≥ 2 occurred in 43%. A lung infiltrate or hemo/pneumothorax occurred in 55%. Thoracic spine injury occurred in 23%. RCFS was 6.3 ± 4.4 and Death/Vdays ≥ 3 occurred in 31%. Death/Vdays ≥ 3 rates correlated with RCFS values: 19% for 1-3; 24% for 4-6; 42% for 7-12 and 65% for ≥ 13 (p < 0.001). Death/Vdays ≥ 3 was independently associated with RCFS (p = 0.02), LIS (p = 0.001), head AIS (p < 0.001) and abdominal AIS (p < 0.001). Death/Vdays ≥ 3 association was better for RCFS (p = 0.005) than rib fracture score (p = 0.08) or number of fractured ribs (p = 0.80). Rib fracture patients have increased risk for truncal injuries and adverse outcomes. Adverse outcomes are independently

  17. Influence of Acute Kidney Injury Defined by the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease Score on the Clinical Course of PICU Patients.

    PubMed

    Cabral, Felipe Cezar; Ramos Garcia, Pedro Celiny; Mattiello, Rita; Dresser, Daiane; Fiori, Humberto Holmer; Korb, Cecilia; Dalcin, Tiago Chagas; Piva, Jefferson Pedro

    2015-10-01

    To evaluate the predictive value of the pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease criteria for disease course severity in patients with or without acute kidney injury admitted to a PICU. Retrospective cohort study. A 12-bed PICU at a tertiary referral center in Southern Brazil. All patients admitted to the study unit over a 1-year period. A database of all eligible patients was analyzed retrospectively. Patients were classified by pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease score at admission and worst pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease score during PICU hospitalization. The outcomes of interest were length of PICU stay, duration of mechanical ventilation, duration of vasoactive drug therapy, and mortality. The Pediatric Index of Mortality 2 was used to assess overall disease severity at the time of PICU admission. Of 375 patients, 169 (45%) presented acute kidney injury at the time of admission and 37 developed acute kidney injury during PICU stay, for a total of 206 of 375 patients (55%) diagnosed with acute kidney injury during the study period. The median Pediatric Index of Mortality 2 score predicted a mortality rate of 9% among non-acute kidney injury patients versus a mortality rate of 16% among acute kidney injury patients (p = 0.006). The mortality of patients classified as pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease F was double that predicted by Pediatric Index of Mortality 2 (7 vs 3.2). Patients classified as having severe acute kidney injury (pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease I + F) exhibited higher mortality (14.1%; p = 0.001) and prolonged PICU length of stay (median, 7 d; p = 0.001) when compared with other patients. Acute kidney injury is a very frequent occurrence among patients admitted to PICUs. The degree of acute kidney injury severity, as assessed by the pediatric-modified Risk

  18. Use of Ganga Hospital Open Injury Severity Scoring for determination of salvage versus amputation in open type IIIB injuries of lower limbs in children-An analysis of 52 type IIIB open fractures.

    PubMed

    Venkatadass, K; Grandhi, Tarani Sai Prasanth; Rajasekaran, S

    2017-11-01

    Open injuries in children are rare compared to adults. In children with major open injuries, there is no specific scoring system to guide when to amputate or salvage the limb. The use of available adult scoring systems may lead to errors in management. The role of Ganga Hospital Open Injury Severity Scoring (GHOISS) for open injuries in adults is well established and its applicability for pediatric open injuries has not been studied. This study was done to analyse the usefulness of GHOISS in pediatric open injuries and to compare it with MESS(Mangled Extremity Severity Score). All children (0-18 years) who were admitted with Open type IIIB injuries of lower limbs between January 2008 and March 2015 were included. MESS and GHOISS were calculated for all the patients. There were 50 children with 52 type IIIB Open injuries of which 39 had open tibial fractures and 13 had open femur fractures. Out of 52 type IIIB open injuries, 48 were salvaged and 4 were amputated. A MESS score of 7 and above had sensitivity of 25% for amputation while GHOISS of 17 and above was found to be more accurate for determining amputation with sensitivity of 75% and specificity of 93.75%. GHOISS is a reliable predictor of injury severity in type IIIB open fractures in children and can be used as a guide for decision-making. The use of MESS score in children has a lower predictive value compared to GHOISS in deciding amputation versus salvage. A GHOISS of 17 or more has the highest sensitivity and specificity to predict amputation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Link-topic model for biomedical abbreviation disambiguation.

    PubMed

    Kim, Seonho; Yoon, Juntae

    2015-02-01

    The ambiguity of biomedical abbreviations is one of the challenges in biomedical text mining systems. In particular, the handling of term variants and abbreviations without nearby definitions is a critical issue. In this study, we adopt the concepts of topic of document and word link to disambiguate biomedical abbreviations. We newly suggest the link topic model inspired by the latent Dirichlet allocation model, in which each document is perceived as a random mixture of topics, where each topic is characterized by a distribution over words. Thus, the most probable expansions with respect to abbreviations of a given abstract are determined by word-topic, document-topic, and word-link distributions estimated from a document collection through the link topic model. The model allows two distinct modes of word generation to incorporate semantic dependencies among words, particularly long form words of abbreviations and their sentential co-occurring words; a word can be generated either dependently on the long form of the abbreviation or independently. The semantic dependency between two words is defined as a link and a new random parameter for the link is assigned to each word as well as a topic parameter. Because the link status indicates whether the word constitutes a link with a given specific long form, it has the effect of determining whether a word forms a unigram or a skipping/consecutive bigram with respect to the long form. Furthermore, we place a constraint on the model so that a word has the same topic as a specific long form if it is generated in reference to the long form. Consequently, documents are generated from the two hidden parameters, i.e. topic and link, and the most probable expansion of a specific abbreviation is estimated from the parameters. Our model relaxes the bag-of-words assumption of the standard topic model in which the word order is neglected, and it captures a richer structure of text than does the standard topic model by considering

  20. 49 CFR 179.2 - Definitions and abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Committee. (3) ASTM means American Society for Testing and Materials. (4) [Reserved] (5) Definitions in part... 49 Transportation 2 2010-10-01 2010-10-01 false Definitions and abbreviations. 179.2 Section 179.2... Introduction, Approvals and Reports § 179.2 Definitions and abbreviations. (a) The following apply in part 179...

  1. Driver air bag effectiveness by severity of the crash.

    PubMed Central

    Segui-Gomez, M

    2000-01-01

    OBJECTIVES: This analysis provided effectiveness estimates of the driver-side air bag while controlling for severity of the crash and other potential confounders. METHODS: Data were from the National Automotive Sampling System (1993-1996). Injury severity was described on the basis of the Abbreviated Injury Scale, Injury Severity Score, Functional Capacity Index, and survival. Ordinal, linear, and logistic multivariate regression methods were used. RESULTS: Air bag deployment in frontal or near-frontal crashes decreases the probability of having severe and fatal injuries (e.g., Abbreviated Injury Scale score of 4-6), including those causing a long-lasting high degree of functional limitation. However, air bag deployment in low-severity crashes increases the probability that a driver (particularly a woman) will sustain injuries of Abbreviated Injury Scale level 1 to 3. Air bag deployment exerts a net injurious effect in low-severity crashes and a net protective effect in high-severity crashes. The level of crash severity at which air bags are protective is higher for female than for male drivers. CONCLUSIONS: Air bag improvement should minimize the injuries induced by their deployment. One possibility is to raise their deployment level so that they deploy only in more severe crashes. PMID:11029991

  2. A Preliminary Study of Clinical Abbreviation Disambiguation in Real Time.

    PubMed

    Wu, Y; Denny, J C; Rosenbloom, S T; Miller, R A; Giuse, D A; Song, M; Xu, H

    2015-01-01

    To save time, healthcare providers frequently use abbreviations while authoring clinical documents. Nevertheless, abbreviations that authors deem unambiguous often confuse other readers, including clinicians, patients, and natural language processing (NLP) systems. Most current clinical NLP systems "post-process" notes long after clinicians enter them into electronic health record systems (EHRs). Such post-processing cannot guarantee 100% accuracy in abbreviation identification and disambiguation, since multiple alternative interpretations exist. Authors describe a prototype system for real-time Clinical Abbreviation Recognition and Disambiguation (rCARD) - i.e., a system that interacts with authors during note generation to verify correct abbreviation senses. The rCARD system design anticipates future integration with web-based clinical documentation systems to improve quality of healthcare records. When clinicians enter documents, rCARD will automatically recognize each abbreviation. For abbreviations with multiple possible senses, rCARD will show a ranked list of possible meanings with the best predicted sense at the top. The prototype application embodies three word sense disambiguation (WSD) methods to predict the correct senses of abbreviations. We then conducted three experments to evaluate rCARD, including 1) a performance evaluation of different WSD methods; 2) a time evaluation of real-time WSD methods; and 3) a user study of typing clinical sentences with abbreviations using rCARD. Using 4,721 sentences containing 25 commonly observed, highly ambiguous clinical abbreviations, our evaluation showed that the best profile-based method implemented in rCARD achieved a reasonable WSD accuracy of 88.8% (comparable to SVM - 89.5%) and the cost of time for the different WSD methods are also acceptable (ranging from 0.630 to 1.649 milliseconds within the same network). The preliminary user study also showed that the extra time costs by rCARD were about 5% of total

  3. Thoracic computed tomography is an effective screening modality in patients with penetrating injuries to the chest.

    PubMed

    Strumwasser, Aaron; Chong, Vincent; Chu, Eveline; Victorino, Gregory P

    2016-09-01

    The precise role of thoracic CT in penetrating chest trauma remains to be defined. We hypothesized that thoracic CT effectively screens hemodynamically normal patients with penetrating thoracic trauma to surgery vs. expectant management (NOM). A ten-year review of all penetrating torso cases was retrospectively analyzed from our urban University-based trauma center. We included hemodynamically normal patients (systolic blood pressure ≥90) with penetrating chest injuries that underwent screening thoracic CT. Hemodynamically unstable patients and diaphragmatic injuries were excluded. The sensitivity, specificity, positive predictive value and negative predictive value were calculated. A total of 212 patients (mean injury severity score=24, Abbreviated Injury Score for Chest=3.9) met inclusion criteria. Of these, 84.3% underwent NOM, 9.1% necessitated abdominal exploration, 6.6% underwent exploration for retained hemothorax/empyema, 6.6% underwent immediate thoracic exploration for significant injuries on chest CT, and 1.0% underwent delayed thoracic exploration for missed injuries. Thoracic CT had a sensitivity of 82%, specificity of 99%, positive predictive value of 90%, a negative predictive value of 99%, and an accuracy of 99% in predicting surgery vs. NOM. Thoracic CT has a negative predictive value of 99% in triaging hemodynamically normal patients with penetrating chest trauma. Screening thoracic CT successfully excludes surgery in patients with non-significant radiologic findings. Copyright © 2016. Published by Elsevier Ltd.

  4. Abbreviations for device names: a proposed methodology with specific examples.

    PubMed

    Alam, Murad; Dover, Jeffrey S; Alam, Murad; Goldman, Mitchel P; Kaminer, Michael S; Orringer, Jeffrey; Waldorf, Heidi; Alam, Murad; Avram, Mathew; Cohen, Joel L; Draelos, Zoe Diana; Dover, Jeffrey S; Hruza, George; Kilmer, Suzanne; Lawrence, Naomi; Lupo, Mary; Metelitsa, Andrei; Nestor, Mark; Ross, E Victor

    2013-04-01

    Many devices used in dermatology lack generic names. If investigators use commercial device names, they risk the appearance of bias. Alternatively, reliance on ad-hoc names and abbreviations may confuse readers who do not recognize these. To develop a system for assigning abbreviations to denote devices commonly used in dermatology. Secondarily, to use this system to create abbreviations for FDA-approved neurotoxins and prepackaged injectable soft-tissue augmentation materials. The American Society for Dermatologic Surgery convened a Lexicon Task Force in March 2012. One charge of this Task Force was to develop criteria for assigning abbreviations to medical devices. A modified consensus process was used. Abbreviations to denote devices were to be: based on a standardized approach; transparent to the casual reader; markedly brief; and in all cases, different than the commercial names. Three-letter all caps abbreviations, some with subscripts, were assigned to denote each of the approved neurotoxins and fillers. A common system of abbreviations for medical devices in dermatology may avoid the appearance of bias while ensuring effective communication. The proposed system may be expanded to name other devices, and the ensuing abbreviations may be suitable for journal articles, continuing medical education lectures, or other academic or clinical purposes. © 2013 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

  5. High-grade renal injuries are often isolated in sports-related trauma.

    PubMed

    Patel, Darshan P; Redshaw, Jeffrey D; Breyer, Benjamin N; Smith, Thomas G; Erickson, Bradley A; Majercik, Sarah D; Gaither, Thomas W; Craig, James R; Gardner, Scott; Presson, Angela P; Zhang, Chong; Hotaling, James M; Brant, William O; Myers, Jeremy B

    2015-07-01

    Most high-grade renal injuries (American Association for Surgery of Trauma (AAST) grades III-V) result from motor vehicle collisions associated with numerous concomitant injuries. Sports-related blunt renal injury tends to have a different mechanism, a solitary blow to the flank. We hypothesized that high-grade renal injury is often isolated in sports-related renal trauma. We identified patients with AAST grades III-V blunt renal injuries from four level 1 trauma centres across the United States between 1/2005 and 1/2014. Patients were divided into "Sport" or "Non-sport" related groups. Outcomes included rates of hypotension (systolic blood pressure <90mm Hg), tachycardia (>110bpm), concomitant abdominal injury, and procedural/surgical intervention between sports and non-sports related injury. 320 patients met study criteria. 18% (59) were sports-related injuries with the most common mechanisms being skiing, snowboarding and contact sports (25%, 25%, and 24%, respectively). Median age was 24 years for sports and 30 years for non-sports related renal injuries (p=0.049). Males were more commonly involved in sports related injuries (85% vs. 72%, p=0.011). Median injury severity score was lower for sports related injuries (10 vs. 27, p<0.001). There was no difference in renal abbreviated injury scale scores. Sports related trauma was more likely to be isolated without other significant injury (69% vs. 39% (p<0.001)). Haemodynamic instability was present in 40% and 51% of sports and non-sports renal injuries (p=0.30). Sports injuries had lower transfusion (7% vs. 47%, p<0.001) and lower mortality rates (0% vs. 6%, p=0.004). There was no difference in renal-specific procedural interventions between the two groups (17% sports vs. 18% non-sports, p=0.95). High-grade sports-related blunt renal trauma is more likely to occur in isolation without other abdominal or thoracic injuries and clinicians must have a high suspicion of renal injury with significant blows to the flank

  6. High-grade renal injuries are often isolated in sports-related trauma

    PubMed Central

    Patel, Darshan P.; Redshaw, Jeffrey D.; Breyer, Benjamin N.; Smith, Thomas G.; Erickson, Bradley A.; Majercik, Sarah D.; Gaither, Thomas W.; Craig, James R.; Gardner, Scott; Presson, Angela P.; Zhang, Chong; Hotaling, James M.; Brant, William O.; Myers, Jeremy B.

    2016-01-01

    Introduction Most high-grade renal injuries (American Association for Surgery of Trauma (AAST) grades III–V) result from motor vehicle collisions associated with numerous concomitant injuries. Sports-related blunt renal injury tends to have a different mechanism, a solitary blow to the flank. We hypothesized that high-grade renal injury is often isolated in sports-related renal trauma. Material and methods We identified patients with AAST grades III–V blunt renal injuries from four level 1 trauma centres across the United States between 1/2005 and 1/2014. Patients were divided into “Sport” or “Non-sport” related groups. Outcomes included rates of hypotension (systolic blood pressure <90 mm Hg), tachycardia (>110 bpm), concomitant abdominal injury, and procedural/surgical intervention between sports and non-sports related injury. Results 320 patients met study criteria. 18% (59) were sports-related injuries with the most common mechanisms being skiing, snowboarding and contact sports (25%, 25%, and 24%, respectively). Median age was 24 years for sports and 30 years for non-sports related renal injuries (p = 0.049). Males were more commonly involved in sports related injuries (85% vs. 72%, p = 0.011). Median injury severity score was lower for sports related injuries (10 vs. 27, p < 0.001). There was no difference in renal abbreviated injury scale scores. Sports related trauma was more likely to be isolated without other significant injury (69% vs. 39% (p < 0.001)). Haemodynamic instability was present in 40% and 51% of sports and non-sports renal injuries (p = 0.30). Sports injuries had lower transfusion (7% vs. 47%, p < 0.001) and lower mortality rates (0% vs. 6%, p = 0.004). There was no difference in renal-specific procedural interventions between the two groups (17% sports vs. 18% non-sports, p = 0.95). Conclusions High-grade sports-related blunt renal trauma is more likely to occur in isolation without other abdominal or thoracic injuries and

  7. AIS 2005: a contemporary injury scale.

    PubMed

    Gennarelli, Thomas A; Wodzin, Elaine

    2006-12-01

    To determine and to quantify outcome from injury demands that multiple factors be universally applied so that there is uniform understanding that the same outcome is understood for the same injury. It is thus important to define the variables used in any outcome assessment. Critical to defining outcomes is the need for a universal language that defines individual injuries. The abbreviated injury scale (AIS) is the only dictionary specifically designed as a system to define the severity of injuries throughout the body. In addition to a universal injury language, it provides measures of injury severity that can be used to stratify and classify injury severity in all body regions. Its revision, AIS 2005 will be discussed here.

  8. 40 CFR 87.2 - Acronyms and abbreviations.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...) Definitions. § 87.2 Acronyms and abbreviations. Link to an amendment published at 77 FR 36381, June 18, 2012... 25365, May 8, 1997; 74 FR 56374, Oct. 30, 2009] Effective Date Note: At 77 FR 36381, June 18, 2012, § 87... 40 Protection of Environment 21 2012-07-01 2012-07-01 false Acronyms and abbreviations. 87.2...

  9. Pre-season adductor squeeze test and HAGOS function sport and recreation subscale scores predict groin injury in Gaelic football players.

    PubMed

    Delahunt, Eamonn; Fitzpatrick, Helen; Blake, Catherine

    2017-01-01

    To determine if pre-season adductor squeeze test and HAGOS function, sport and recreation subscale scores can identify Gaelic football players at risk of developing groin injury. Prospective study. Senior inter-county Gaelic football team. Fifty-five male elite Gaelic football players (age = 24.0 ± 2.8 years, body mass = 84.48 ± 7.67 kg, height = 1.85 ± 0.06 m, BMI = 24.70 ± 1.77 kg/m 2 ) from a single senior inter-county Gaelic football team. Occurrence of groin injury during the season. Ten time-loss groin injuries were registered representing 13% of all injuries. The odds ratio for sustaining a groin injury if pre-season adductor squeeze test score was below 225 mmHg, was 7.78. The odds ratio for sustaining a groin injury if pre-season HAGOS function, sport and recreation subscale score was < 87.5 was 8.94. Furthermore, for each additional point on the numerical rating scale pain rating during performance of the adductor squeeze test, the odds of groin injury increased by 2.16. This study provides preliminary evidence that pre-season adductor squeeze test and HAGOS function, sport and recreation subscale scores can be used to identify Gaelic football players at risk of developing groin injury. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. 40 CFR 97.3 - Measurements, abbreviations, and acronyms.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Measurements, abbreviations, and acronyms. 97.3 Section 97.3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Trading Program General Provisions § 97.3 Measurements, abbreviations, and acronyms. Measurements...

  11. 40 CFR 97.103 - Measurements, abbreviations, and acronyms.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Measurements, abbreviations, and acronyms. 97.103 Section 97.103 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Annual Trading Program General Provisions § 97.103 Measurements, abbreviations, and acronyms...

  12. Using Multivariate Base Rates to Interpret Low Scores on an Abbreviated Battery of the Delis-Kaplan Executive Function System.

    PubMed

    Karr, Justin E; Garcia-Barrera, Mauricio A; Holdnack, James A; Iverson, Grant L

    2017-05-01

    Executive function consists of multiple cognitive processes that operate as an interactive system to produce volitional goal-oriented behavior, governed in large part by frontal microstructural and physiological networks. Identification of deficits in executive function in those with neurological or psychiatric conditions can be difficult because the normal variation in executive function test scores, in healthy adults when multiple tests are used, is largely unknown. This study addresses that gap in the literature by examining the prevalence of low scores on a brief battery of executive function tests. The sample consisted of 1,050 healthy individuals (ages 16-89) from the standardization sample for the Delis-Kaplan Executive Function System (D-KEFS). Seven individual test scores from the Trail Making Test, Color-Word Interference Test, and Verbal Fluency Test were analyzed. Low test scores, as defined by commonly used clinical cut-offs (i.e., ≤25th, 16th, 9th, 5th, and 2nd percentiles), occurred commonly among the adult portion of the D-KEFS normative sample (e.g., 62.8% of the sample had one or more scores ≤16th percentile, 36.1% had one or more scores ≤5th percentile), and the prevalence of low scores increased with lower intelligence and fewer years of education. The multivariate base rates (BR) in this article allow clinicians to understand the normal frequency of low scores in the general population. By use of these BRs, clinicians and researchers can improve the accuracy with which they identify executive dysfunction in clinical groups, such as those with traumatic brain injury or neurodegenerative diseases. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  13. Mechanisms, injuries and helmet use in cyclists presenting to an inner city emergency department.

    PubMed

    Dinh, Michael M; Kastelein, Christopher; Hopkins, Roy; Royle, Timothy J; Bein, Kendall J; Chalkley, Dane R; Ivers, Rebecca

    2015-08-01

    The objectives of the present study were to describe the injury profiles of cyclists presenting to an ED and determine the risk of significant head injury associated with bicycle helmet use. This was a retrospective single trauma centre study of all adult cyclists presenting to an inner city ED and undergoing a trauma team review between January 2012 and June 2014. The outcome of interest was significant head injury defined as any head injury with an Abbreviated Injury Scale score of two or more. Variables analysed included demographic characteristics, helmet use at time of incident, location, time and the presence of intoxication. The most common body regions were upper limb injuries (57%), followed by head injuries (43%), facial injuries (30%) and lower limb injuries (24%). A lower proportion of people wearing helmets had significant head injury (17% vs 31%, P = 0.018) or facial injury (26% vs 48%, P = 0.0017) compared with non-helmet users. After adjustment for important covariates, helmet use was associated with a 70% decrease in the odds of significant head injury (odds ratio 0.34, 95% confidence interval 0.15, 0.76, P = 0.008). Head injuries were common after inner city cycling incidents. The use of helmets was associated with a reduction in significant head injury. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  14. 40 CFR 96.3 - Measurements, abbreviations, and acronyms.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Measurements, abbreviations, and acronyms. 96.3 Section 96.3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... IMPLEMENTATION PLANS NOX Budget Trading Program General Provisions § 96.3 Measurements, abbreviations, and...

  15. 40 CFR 97.303 - Measurements, abbreviations, and acronyms.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... acronyms. 97.303 Section 97.303 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Ozone Season Trading Program General Provisions § 97.303 Measurements, abbreviations, and acronyms. Measurements, abbreviations, and acronyms used in this subpart and subparts BBBB through IIII are defined as...

  16. 40 CFR 97.103 - Measurements, abbreviations, and acronyms.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... acronyms. 97.103 Section 97.103 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Annual Trading Program General Provisions § 97.103 Measurements, abbreviations, and acronyms. Measurements, abbreviations, and acronyms used in this subpart and subparts BB through II are defined as...

  17. 40 CFR 97.203 - Measurements, abbreviations, and acronyms.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... acronyms. 97.203 Section 97.203 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Trading Program General Provisions § 97.203 Measurements, abbreviations, and acronyms. Measurements, abbreviations, and acronyms used in this subpart and subparts BBB through III are defined as follows: Btu...

  18. 40 CFR 97.303 - Measurements, abbreviations, and acronyms.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... acronyms. 97.303 Section 97.303 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Ozone Season Trading Program General Provisions § 97.303 Measurements, abbreviations, and acronyms. Measurements, abbreviations, and acronyms used in this subpart and subparts BBBB through IIII are defined as...

  19. Effect of admission fascia iliaca compartment blocks on post-operative abbreviated mental test scores in elderly fractured neck of femur patients: a retrospective cohort study.

    PubMed

    Odor, Peter M; Chis Ster, Irina; Wilkinson, Iain; Sage, Frederic

    2017-01-05

    Post-operative cognitive impairment is common in elderly patients following surgery for hip fracture, with undertreated pain being an important etiological factor. Non-opioid based analgesic techniques, such as nerve blocks, may help reduce the risk of cognitive complications. The aim of this study was to investigate whether receiving a fascia iliaca compartment block (FICB) as part of a pre-operative analgesic regime increased the odds of high post-operative abbreviated mental test scores (AMTS) when compared with conventional analgesia without a nerve block. A retrospective data analysis of a cohort of 959 patients, aged ≥ 65 years with a diagnosis of hip fracture and admitted to a single hospital over a two-year period was performed. A standardized analgesic regime was used on all patients, and 541/959 (56.4%) of included patients received a FICB. Provision of the FICB was primarily determined by availability of an anesthetist, rather than by patient status and condition. Post-operative cognitive ordinal outcomes were defined by AMTS severity as high (score of ≥9/10), moderate, (score of 7-8) and low (score of ≤6). A multivariable ordinal logistic regression analysis was performed on patient status and clinical care factors, including admission AMTS, age, gender, source of admission, time to surgery, type of anesthesia and ASA score. Admission FICB was associated with higher adjusted odds for a high AMTS (score of ≥9) relative to lower AMTS (score of ≤8) than conventional analgesia only (OR = 1.80, 95% CI 1.27-2.54; p = 0.001). Increasing age, lower AMTS on admission to hospital, and being admitted from a residential or nursing home were associated with worse cognitive outcomes. Mode of anesthesia or surgery did not significantly influence post-operative AMTS. Post-operative AMTS is influenced by pre-operative analgesic regimes in elderly patients with hip fracture. Provision of a FICB to patients on arrival to hospital may improve early

  20. Triage and Injury Severity Scoring Systems Conference Held at Washington, D.C. on 26-28 September 1983.

    DTIC Science & Technology

    1984-02-01

    AD = 37 925 TRIAGE AND INJURY SEVERITY SCORING SYSTEMS CONFERENCE i (U) WASHINGTON HOSPITAL CENTER DC H R CHAMPION ET AL. FEB 84 DAMDI7-83-G-9529...PROCESSING SHEET PREVIOUS EDITION MAY 3E USED UNTIL CDTIC 70A STOCK IS EXHAUSTED. AD TRIAGE ALM INJURY SEVERITY SCORING SYSTEMS CONFERENCE FINAL REPORT... WORK UNIT NUMBERS The Washington Hospital Center 62734A.3MI62734A875.AG.151 Washington, D.C. 20010 I I. CONTROLLING OFFICE NAME AND ADDRESS 12. REPORT

  1. Traditional systolic blood pressure targets underestimate hypotension-induced secondary brain injury.

    PubMed

    Brenner, Megan; Stein, Deborah M; Hu, Peter F; Aarabi, Bizhan; Sheth, Kevin; Scalea, Thomas M

    2012-05-01

    Vital signs, particularly blood pressure, are often manipulated to maximize perfusion and optimize recovery from severe traumatic brain injury (sTBI). We investigated the utility of automated continuously recorded vital signs to predict outcomes after sTBI. Sixty patients with head Abbreviated Injury Scale score ≥ 3, age >14 years, "isolated" TBI, and need for intracranial pressure monitoring were prospectively enrolled at a single, large urban tertiary care facility. Outcome was measured by mortality and extended Glasgow Outcome Scale (GOSE) at 12 months. Continuous, automated, digital data were collected every 6 seconds for 72 hours after admission, and 5-minute means of systolic blood pressure (SBP) were recorded. We calculated SBP as pressure × time dose (PTD) to describe the cumulative amplitude and duration of episodes above and below clinical thresholds. The extent and duration of the insults were calculated as percent time (%time), PTD, and PTD per day (PTD/D) of defined thresholds (SBP: <90 mm Hg, <100 mm Hg, <110 mm Hg, and <120 mm Hg; mean arterial pressure: <60 mm Hg and <70 mm Hg; heart rate: >100 bpm and >120 bpm; and SpO(2): <88% and <92%) for the first 12 hours, 24 hours, and 48 hours of intensive care unit admission. We analyzed their ability to predict mortality and GOSE by receiver operator characteristics. Mean age was 33.9 (range, 16-83) years, mean admission Glasgow Coma Scale score 6.4 ± 3, and mean head Abbreviated Injury Scale score 4.2 ± 0.72. The 30-day mortality rate was 13.3%. Of the 45 patients in whom GOSE at 12 months was available, 28 (62%) had good neurologic outcomes (GOSE score >4). Traditional markers of poor outcome (admission SBP, admission Glasgow Coma Scale, and Marshall score) were not different between groups with good or poor outcome. PTD, PTD/D, and %time SBP <110 mm Hg and SBP <120 mm Hg predicted mortality at 12 hours, 24 hours, and 48 hours (p < 0.04). Percent time SBP <110 mm Hg in the first 24 hours was

  2. 40 CFR 96.103 - Measurements, abbreviations, and acronyms.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Measurements, abbreviations, and acronyms. 96.103 Section 96.103 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... IMPLEMENTATION PLANS CAIR NOX Annual Trading Program General Provisions § 96.103 Measurements, abbreviations, and...

  3. 40 CFR 96.203 - Measurements, abbreviations, and acronyms.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 21 2011-07-01 2011-07-01 false Measurements, abbreviations, and acronyms. 96.203 Section 96.203 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... acronyms. Measurements, abbreviations, and acronyms used in this subpart and subparts BBB through III are...

  4. 40 CFR 96.3 - Measurements, abbreviations, and acronyms.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 21 2011-07-01 2011-07-01 false Measurements, abbreviations, and acronyms. 96.3 Section 96.3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... acronyms. Measurements, abbreviations, and acronyms used in this part are defined as follows: Btu—British...

  5. 40 CFR 96.103 - Measurements, abbreviations, and acronyms.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 21 2011-07-01 2011-07-01 false Measurements, abbreviations, and acronyms. 96.103 Section 96.103 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... acronyms. Measurements, abbreviations, and acronyms used in this subpart and subparts BB through II are...

  6. 40 CFR 90.403 - Symbols, acronyms, and abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Symbols, acronyms, and abbreviations. 90.403 Section 90.403 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Gaseous Exhaust Test Procedures § 90.403 Symbols, acronyms, and abbreviations. (a) The acronyms and...

  7. 40 CFR 97.3 - Measurements, abbreviations, and acronyms.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... acronyms. 97.3 Section 97.3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Trading Program General Provisions § 97.3 Measurements, abbreviations, and acronyms. Measurements, abbreviations, and acronyms used in this part are defined as follows: Btu-British thermal unit. CO2-carbon...

  8. 40 CFR 90.403 - Symbols, acronyms, and abbreviations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 20 2011-07-01 2011-07-01 false Symbols, acronyms, and abbreviations. 90.403 Section 90.403 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Gaseous Exhaust Test Procedures § 90.403 Symbols, acronyms, and abbreviations. (a) The acronyms and...

  9. Pedestrians injured by automobiles: risk factors for cervical spine injuries.

    PubMed

    Yanar, Hakan; Demetriades, Demetrios; Hadjizacharia, Pantelis; Hatzizacharia, Pantelis; Nomoto, Shirley; Salim, Ali; Inaba, Kenji; Rhee, Peter; Chan, Linda S

    2007-12-01

    Diagnosis of cervical spine injuries (CSI) in multitrauma patients, especially in the presence of head trauma, can be difficult. Identification of risk factors associated with CSI can help avoid missed or delayed diagnosis. Trauma registry study of pedestrian injuries caused by being hit by an automobile. Data abstracted for each patient included age, gender, Glasgow Coma Score on admission, Injury Severity Score, Abbreviated Injury Scale (AIS) for each body area, level of cervical spine injuries, and associated injuries. The incidence of spine injuries was derived for 4 age groups (14 years and younger, 15 to 55 years, 56 to 65 years, and older than 65 years). Logistic regression analysis was performed to identify risk factors associated with CSI. There were 8,401 pedestrian injuries caused by automobiles, and 178 patients (2.1%) had CSI. Incidence of CSI increased with age (0.3% in the age group 14 years and younger, 2.2% in the group 15 to 55 years, 3.7% in the group 56 to 65 years, and 4.4% in the group older than 65 years). Using the youngest age group (14 years and younger) as reference, relative risk of CSI in the other groups was 7.0, 12.1, and 14.2, respectively (p < 0.0001). Patients with severe head trauma (AIS > 3) were significantly more likely to have CSI than patients with less severe head injuries (AIS injuries with no head trauma, there was not even a single case of CSI. Stepwise logistic regression analysis identified age, severe head injury (AIS > 3), severe chest trauma (AIS > 3), pelvic fracture, and femur fracture as independent risk factors for CSI. Incidence of CSI after injuries to pedestrians hit by automobiles increases with age and severity of head trauma. Age, severe head trauma, severe chest trauma, pelvic fracture, and femur fractures are independent predictors of CSI.

  10. Inter-radiologist agreement for CT scoring of pediatric splenic injuries and effect on an established clinical practice guideline.

    PubMed

    Leschied, Jessica R; Mazza, Michael B; Davenport, Matthew; Chong, Suzanne T; Smith, Ethan A; Hoff, Carrie N; Ladino-Torres, Maria F; Khalatbari, Shokoufeh; Ehrlich, Peter F; Dillman, Jonathan R

    2016-02-01

    The American Pediatric Surgical Association (APSA) advocates for the use of a clinical practice guideline to direct management of hemodynamically stable pediatric spleen injuries. The clinical practice guideline is based on the CT score of the spleen injury according to the American Association for the Surgery of Trauma (AAST) CT scoring system. To determine the potential effect of radiologist agreement for CT scoring of pediatric spleen injuries on an established APSA clinical practice guideline. We retrospectively analyzed blunt splenic injuries occurring in children from January 2007 to January 2012 at a single level 1 trauma center (n = 90). Abdominal CT exams performed at clinical presentation were reviewed by four radiologists who documented the following: (1) splenic injury grade (AAST system), (2) arterial extravasation and (3) pseudoaneurysm. Inter-rater agreement for AAST injury grade was assessed using the multi-rater Fleiss kappa and Kendall coefficient of concordance. Inter-rater agreement was assessed using weighted (AAST injury grade) or prevalence-adjusted bias-adjusted (binary measures) kappa statistics; 95% confidence intervals were calculated. We evaluated the hypothetical effect of radiologist disagreement on an established APSA clinical practice guideline. Inter-rater agreement was good for absolute AAST injury grade (kappa: 0.64 [0.59–0.69]) and excellent for relative AAST injury grade (Kendall w: 0.90). All radiologists agreed on the AAST grade in 52% of cases. Based on an established clinical practice guideline, radiologist disagreement could have changed the decision for intensive care management in 11% (10/90) of children, changed the length of hospital stay in 44% (40/90), and changed the time to return to normal activity in 44% (40/90). Radiologist agreement when assigning splenic AAST injury grades is less than perfect, and disagreements have the potential to change management in a substantial number of pediatric patients.

  11. Traumatic injuries among adult obese patients in southern Taiwan: a cross-sectional study based on a trauma registry system.

    PubMed

    Chuang, Jung-Fang; Rau, Cheng-Shyuan; Kuo, Pao-Jen; Chen, Yi-Chun; Hsu, Shiun-Yuan; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua

    2016-03-18

    The adverse impact of obesity has been extensively studied in the general population; however, the added risk of obesity on trauma-related mortality remains controversial. This study investigated and compared mortality as well injury patterns and length of stay (LOS) in obese and normal-weight patients hospitalized for trauma in the hospital and intensive care unit (ICU) of a Level I trauma center in southern Taiwan. Detailed data of 880 obese adult patients with body mass index (BMI) ≥ 30 kg/m(2) and 5391 normal-weight adult patients (25 > BMI ≥ 18.5 kg/m(2)) who had sustained a trauma injury between January 1, 2009 and December 31, 2013 were retrieved from the Trauma Registry System. Pearson's chi-squared, Fisher's exact, and independent Student's t-tests were used to compare differences between groups. Propensity score matching with logistic regression was used to evaluate the effect of obesity on mortality. In this study, obese patients were more often men, motorcycle riders and pedestrians, and had a lower proportion of alcohol intoxication compared to normal-weight patients. Analysis of Abbreviated Injury Scale scores revealed that obese trauma patients presented with a higher rate of injury to the thorax, but a lower rate of facial injuries than normal-weight patients. No significant differences were found between obese and normal-weight patients regarding Injury Severity Score (ISS), Trauma-Injury Severity Score (TRISS), mortality, the proportion of patients admitted to the ICU, or LOS in ICU. After propensity score matching, logistic regression of 66 well-matched pairs did not show a significant influence of obesity on mortality (odds ratio: 1.51, 95% confidence interval: 0.54-4.23 p = 0.438). However, significantly longer hospital LOS (10.6 vs. 9.5 days, respectively, p = 0.044) was observed in obese patients than in normal-weight patients, particularly obese patients with pelvic, tibial, or fibular fractures. Compared to normal-weight patients, obese

  12. Interpreting Quality of Life after Brain Injury Scores: Cross-Walk with the Short Form-36.

    PubMed

    Wilson, Lindsay; Marsden-Loftus, Isaac; Koskinen, Sanna; Bakx, Wilbert; Bullinger, Monika; Formisano, Rita; Maas, Andrew; Neugebauer, Edmund; Powell, Jane; Sarajuuri, Jaana; Sasse, Nadine; von Steinbuechel, Nicole; von Wild, Klaus; Truelle, Jean-Luc

    2017-01-01

    The Quality of Life after Brain Injury (QOLIBRI) instruments are traumatic brain injury (TBI)-specific assessments of health-related quality of life (HRQoL), with established validity and reliability. The purpose of the study is to help improve the interpretability of the two QOLIBRI summary scores (the QOLIBRI Total score and the QOLBRI Overall Scale [OS] score). An analysis was conducted of 761 patients with TBI who took part in the QOLIBRI validation studies. A cross-walk between QOLIBRI scores and the SF-36 Mental Component Summary norm-based scoring system was performed using geometric mean regression analysis. The exercise supports a previous suggestion that QOLIBRI Total scores <60 indicate low or impaired HRQoL and indicate that the corresponding score on the QOLIBRI-OS is <52. The percentage of cases in the sample that fell into the "impaired HRQoL" category was 36% for the Mental Component Summary, 38% for the QOLIBRI Total, and 39% for the QOLIBRI-OS. Relationships between the QOLIBRI scales and the Glasgow Outcome Scale-Extended (GOSE), as a measure of global function, are presented in the form of means and standard deviations that allow comparison with other studies, and data on age and sex are presented for the QOLIBRI-OS. While bearing in mind the potential imprecision of the comparison, the findings provide a framework for evaluating QOLIBRI summary scores in relation to generic HRQoL that improves their interpretability.

  13. [Injuries to car passengers protected by air bags].

    PubMed

    Sefrin, P; Kuhnigk, H; Koburg, R

    2004-11-01

    The air bag, like the seatbelt, is a further development of the inside protection of motorcar passengers. However, the airbag has also been made responsible for severe internal injuries. In a retrospective case control study, 394 accidents in which the air bag was released were analysed. At least medium severe injuries (Maximum Abbreviated Injury Scale: MAIS > or = 2) occurred in 69 cases. Three different patterns of injury were distinguished depending on the level of difficulty of diagnosis by the emergency physician. Damage to the vehicles was scored in five intensities or damage grades. Thoracic injury was most frequently diagnosed in the patients (in 61.5 % of cases), followed by injuries to the lower (50.8 %) and upper extremities (47.7 %). Single injuries with a grade of severity of 2 (MAIS) predominated (59.7 %). In most of the cases the injury was easy to diagnose (64.6 %) because of external signs, in 24.6 % internal injuries were assumed and in only 10.8 % were there no sings of damage to body cavities. Most frequent were occult injuries in the thoracic region (100 %) and in the abdomen (74.4 %). However, occult injuries did not always conform to the grade of deformation to the vehicle, since in 66.7 % the grade of damage was 3. This was not true for the remaining types of injury because external injuries increased with the grade of damage to the vehicle. After the release of the air bag, occult injuries of the body cavities have to be expected, even if there are no signs of external injury. Women under 35 years of age are particularly endangered. There exists no minimum velocity for the occurrence of injuries to the body cavities because harm can simply be a result of the release of the air bag.

  14. Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after discharge.

    PubMed

    Kesinger, Matthew Ryan; Kumar, Raj G; Wagner, Amy K; Puyana, Juan Carlos; Peitzman, Andrew P; Billiar, Timothy R; Sperry, Jason L

    2015-02-01

    Long-term outcomes following traumatic brain injury (TBI) correlate with initial head injury severity and other acute factors. Hospital-acquired pneumonia (HAP) is a common complication in TBI. Limited information exists regarding the significance of infectious complications on long-term outcomes after TBI. We sought to characterize risks associated with HAP on outcomes 5 years after TBI. This study involved data from the merger of an institutional trauma registry and the Traumatic Brain Injury Model Systems outcome data. Individuals with severe head injuries (Abbreviated Injury Scale [AIS] score ≥ 4) who survived to rehabilitation were analyzed. Primary outcome was Glasgow Outcome Scale-Extended (GOSE) at 1, 2, and 5 years. GOSE was dichotomized into low (GOSE score < 6) and high (GOSE score ≥ 6). Logistic regression was used to determine adjusted odds of low GOSE score associated with HAP after controlling for age, sex, head and overall injury severity, cranial surgery, Glasgow Coma Scale (GCS) score, ventilation days, and other important confounders. A general estimating equation model was used to analyze all outcome observations simultaneously while controlling for within-patient correlation. A total of 141 individuals met inclusion criteria, with a 30% incidence of HAP. Individuals with and without HAP had similar demographic profiles, presenting vitals, head injury severity, and prevalence of cranial surgery. Individuals with HAP had lower presenting GCS score. Logistic regression demonstrated that HAP was independently associated with low GOSE scores at follow-up (1 year: odds ratio [OR], 6.39; 95% confidence interval [CI], 1.76-23.14; p = 0.005) (2 years: OR, 7.30; 95% CI, 1.87-27.89; p = 0.004) (5-years: OR, 6.89; 95% CI, 1.42-33.39; p = 0.017). Stratifying by GCS score of 8 or lower and early intubation, HAP remained a significant independent predictor of low GOSE score in all strata. In the general estimating equation model, HAP continued to be an

  15. Abbreviations: Their Effects on Comprehension of Classified Advertisements.

    ERIC Educational Resources Information Center

    Sokol, Kirstin R.

    Two experimental designs were used to test the hypothesis that abbreviations in classified advertisements decrease the reader's comprehension of such ads. In the first experimental design, 73 high school students read four ads (for employment, used cars, apartments for rent, and articles for sale) either with abbreviations or with all…

  16. Developing a burn injury severity score (BISS): adding age and total body surface area burned to the injury severity score (ISS) improves mortality concordance.

    PubMed

    Cassidy, J Tristan; Phillips, Michael; Fatovich, Daniel; Duke, Janine; Edgar, Dale; Wood, Fiona

    2014-08-01

    There is limited research validating the injury severity score (ISS) in burns. We examined the concordance of ISS with burn mortality. We hypothesized that combining age and total body surface area (TBSA) burned to the ISS gives a more accurate mortality risk estimate. Data from the Royal Perth Hospital Trauma Registry and the Royal Perth Hospital Burns Minimum Data Set were linked. Area under the receiver operating characteristic curve (AUC) measured concordance of ISS with mortality. Using logistic regression models with death as the dependent variable we developed a burn-specific injury severity score (BISS). There were 1344 burns with 24 (1.8%) deaths, median TBSA 5% (IQR 2-10), and median age 36 years (IQR 23-50). The results show ISS is a good predictor of death for burns when ISS≤15 (OR 1.29, p=0.02), but not for ISS>15 (ISS 16-24: OR 1.09, p=0.81; ISS 25-49: OR 0.81, p=0.19). Comparing the AUCs adjusted for age, gender and cause, ISS of 84% (95% CI 82-85%) and BISS of 95% (95% CI 92-98%), demonstrated superior performance of BISS as a mortality predictor for burns. ISS is a poor predictor of death in severe burns. The BISS combines ISS with age and TBSA and performs significantly better than the ISS. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  17. Checklist of Abbreviations and Acronyms in the Physics Literature.

    ERIC Educational Resources Information Center

    Bailey, Martha J.

    This document provides a listing of 500 abbreviations and acronyms related to physics with the definition of each. Each abbreviation was used in journals received by the Purdue University Physics Library during the years 1973-1976. (SL)

  18. Helmet use and injury severity among pediatric skiers and snowboarders in Colorado.

    PubMed

    Milan, Melissa; Jhajj, Sandeep; Stewart, Camille; Pyle, Laura; Moulton, Steven

    2017-02-01

    Skiing and snowboarding are popular winter recreational activities that are commonly associated with orthopedic type injuries. Unbeknownst to most parents, however, are the significant but poorly described risks for head, cervical spine and solid organ injuries. Although helmet use is not mandated for skiers and snowboarders outside of resort sponsored activities, we hypothesized that helmet use is associated with a lower risk of severe head injury, shorter ICU stay and shorter hospital length of stay. The trauma registry at a level I pediatric trauma center in the state of Colorado was queried for children ages 3-17years, who sustained an injury while skiing or snowboarding from 1/1/1999 to 12/31/2014. Injury severity was assessed by Abbreviated Injury Severity (AIS) score, injury severity score (ISS) and admission location. Head injury was broadly defined as any trauma to the body above the lower border of the mandible. Regression analysis was used to test associations of variables with injury severity. 549 children sustained snow sport related injuries during the 16year study period. The mean patient age was11±3years, most were male (74%) and the majority were Colorado residents (54%). The overall median ISS was 9 (IQR 4-9) and 78 children (14%) were admitted to the ICU. Colorado residents were nearly twice as likely to be wearing a helmet at the time of injury, compared to visitors from out-of-state (adjusted OR 1.86, 95% CI 1.24-2.76, p=0.002). In a multivariate analysis injury severity was significantly associated with injury while skiing (p=0.026), helmet use (p=0.0416), and sustaining a head injury (p<0.0001). In a separate multivariate analysis ICU admission was associated with head injury (p<0.0001) and wearing a helmet (p=0.0257); however, those wearing a helmet and admitted to the ICU had significantly lower ISS (p=0.007) and head AIS (p=0.011) scores than those who were not wearing a helmet at the time of injury. Visitors from out of state were less

  19. Allie: a database and a search service of abbreviations and long forms

    PubMed Central

    Yamamoto, Yasunori; Yamaguchi, Atsuko; Bono, Hidemasa; Takagi, Toshihisa

    2011-01-01

    Many abbreviations are used in the literature especially in the life sciences, and polysemous abbreviations appear frequently, making it difficult to read and understand scientific papers that are outside of a reader’s expertise. Thus, we have developed Allie, a database and a search service of abbreviations and their long forms (a.k.a. full forms or definitions). Allie searches for abbreviations and their corresponding long forms in a database that we have generated based on all titles and abstracts in MEDLINE. When a user query matches an abbreviation, Allie returns all potential long forms of the query along with their bibliographic data (i.e. title and publication year). In addition, for each candidate, co-occurring abbreviations and a research field in which it frequently appears in the MEDLINE data are displayed. This function helps users learn about the context in which an abbreviation appears. To deal with synonymous long forms, we use a dictionary called GENA that contains domain-specific terms such as gene, protein or disease names along with their synonymic information. Conceptually identical domain-specific terms are regarded as one term, and then conceptually identical abbreviation-long form pairs are grouped taking into account their appearance in MEDLINE. To keep up with new abbreviations that are continuously introduced, Allie has an automatic update system. In addition, the database of abbreviations and their long forms with their corresponding PubMed IDs is constructed and updated weekly. Database URL: The Allie service is available at http://allie.dbcls.jp/. PMID:21498548

  20. Allie: a database and a search service of abbreviations and long forms.

    PubMed

    Yamamoto, Yasunori; Yamaguchi, Atsuko; Bono, Hidemasa; Takagi, Toshihisa

    2011-01-01

    Many abbreviations are used in the literature especially in the life sciences, and polysemous abbreviations appear frequently, making it difficult to read and understand scientific papers that are outside of a reader's expertise. Thus, we have developed Allie, a database and a search service of abbreviations and their long forms (a.k.a. full forms or definitions). Allie searches for abbreviations and their corresponding long forms in a database that we have generated based on all titles and abstracts in MEDLINE. When a user query matches an abbreviation, Allie returns all potential long forms of the query along with their bibliographic data (i.e. title and publication year). In addition, for each candidate, co-occurring abbreviations and a research field in which it frequently appears in the MEDLINE data are displayed. This function helps users learn about the context in which an abbreviation appears. To deal with synonymous long forms, we use a dictionary called GENA that contains domain-specific terms such as gene, protein or disease names along with their synonymic information. Conceptually identical domain-specific terms are regarded as one term, and then conceptually identical abbreviation-long form pairs are grouped taking into account their appearance in MEDLINE. To keep up with new abbreviations that are continuously introduced, Allie has an automatic update system. In addition, the database of abbreviations and their long forms with their corresponding PubMed IDs is constructed and updated weekly. Database URL: The Allie service is available at http://allie.dbcls.jp/.

  1. Validation of the ocular trauma score for intraocular foreign bodies in deadly weapon-related open-globe injuries.

    PubMed

    Unal, Melih H; Aydin, Ali; Sonmez, Murat; Ayata, Ali; Ersanli, Dilaver

    2008-01-01

    To evaluate the prognostic value of the Ocular Trauma Score (OTS) in cases of deadly weapon-related open-globe injuries with intraocular foreign bodies. A retrospective, interventional case series included 20 eyes of 20 patients who had deadly weapon-related open-globe injuries with intraocular foreign bodies. The OTS was calculated for each patient by adding the determined numbers of OTS variables at presentation (initial visual acuity, rupture, endophthalmitis, perforating injury, retinal detachment, and afferent pupillary defect). Patients were categorized based on their score (category 1 through 5). Final visual acuities in the OTS categories were calculated and compared to those in OTS study group. No statistically significant difference was found between the categorical distributions of the study patients and those in the OTS study group. No patient in the study was in category 5. The OTS, which was designed to predict visual outcomes of general ocular trauma, may also provide reliable information about the prognosis of deadly weapon-related open-globe injuries with intraocular foreign bodies.

  2. Frequency, comprehension and attitudes of physicians towards abbreviations in the medical record.

    PubMed

    Hamiel, Uri; Hecht, Idan; Nemet, Achia; Pe'er, Liron; Man, Vitaly; Hilely, Assaf; Achiron, Asaf

    2018-05-01

    Abbreviations are common in the medical record. Their inappropriate use may ultimately lead to patient harm, yet little is known regarding the extent of their use and their comprehension. Our aim was to assess the extent of their use, their comprehension and physicians' attitudes towards them, using ophthalmology consults in a tertiary hospital as a model. We first mapped the frequency with which English abbreviations were used in the departments' computerised databases. We then used the most frequently used abbreviations as part of a cross-sectional survey designed to assess the attitudes of non-ophthalmologist physicians towards the abbreviations and their comprehension of them. Finally, we tested whether an online lecture would improve comprehension. 4375 records were screened, and 235 physicians responded to the survey. Only 42.5% knew at least 10% of the abbreviations, and no one knew them all. Ninety-two per cent of respondents admitted to searching online for the meanings of abbreviations, and 59.1% believe abbreviations should be prohibited in medical records. A short online lecture improved the number of respondents answering correctly at least 50% of the time from 1.2% to 42% (P<0.001). Abbreviations are common in medical records and are frequently misinterpreted. Online teaching is a valuable tool for physician education. The majority of respondents believed that misinterpreting abbreviations could negatively impact patient care, and that the use of abbreviations should be prohibited in medical records. Due to low rates of comprehension and negative attitudes towards abbreviations in medical communications, we believe their use should be discouraged. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Variation in seizure prophylaxis in severe pediatric traumatic brain injury.

    PubMed

    Ostahowski, Paige J; Kannan, Nithya; Wainwright, Mark S; Qiu, Qian; Mink, Richard B; Groner, Jonathan I; Bell, Michael J; Giza, Christopher C; Zatzick, Douglas F; Ellenbogen, Richard G; Boyle, Linda Ng; Mitchell, Pamela H; Vavilala, Monica S

    2016-10-01

    OBJECTIVE Posttraumatic seizure is a major complication following traumatic brain injury (TBI). The aim of this study was to determine the variation in seizure prophylaxis in select pediatric trauma centers. The authors hypothesized that there would be wide variation in seizure prophylaxis selection and use, within and between pediatric trauma centers. METHODS In this retrospective multicenter cohort study including 5 regional pediatric trauma centers affiliated with academic medical centers, the authors examined data from 236 children (age < 18 years) with severe TBI (admission Glasgow Coma Scale score ≤ 8, ICD-9 diagnosis codes of 800.0-801.9, 803.0-804.9, 850.0-854.1, 959.01, 950.1-950.3, 995.55, maximum head Abbreviated Injury Scale score ≥ 3) who received tracheal intubation for ≥ 48 hours in the ICU between 2007 and 2011. RESULTS Of 236 patients, 187 (79%) received seizure prophylaxis. In 2 of the 5 centers, 100% of the patients received seizure prophylaxis medication. Use of seizure prophylaxis was associated with younger patient age (p < 0.001), inflicted TBI (p < 0.001), subdural hematoma (p = 0.02), cerebral infarction (p < 0.001), and use of electroencephalography (p = 0.023), but not higher Injury Severity Score. In 63% cases in which seizure prophylaxis was used, the patients were given the first medication within 24 hours of injury, and 50% of the patients received the first dose in the prehospital or emergency department setting. Initial seizure prophylaxis was most commonly with fosphenytoin (47%), followed by phenytoin (40%). CONCLUSIONS While fosphenytoin was the most commonly used medication for seizure prophylaxis, there was large variation within and between trauma centers with respect to timing and choice of seizure prophylaxis in severe pediatric TBI. The heterogeneity in seizure prophylaxis use may explain the previously observed lack of relationship between seizure prophylaxis and outcomes.

  4. Validating the Use of ICD-9 Code Mapping to Generate Injury Severity Scores

    PubMed Central

    Fleischman, Ross J.; Mann, N. Clay; Dai, Mengtao; Holmes, James F.; Wang, N. Ewen; Haukoos, Jason; Hsia, Renee Y.; Rea, Thomas; Newgard, Craig D.

    2017-01-01

    The Injury Severity Score (ISS) is a measure of injury severity widely used for research and quality assurance in trauma. Calculation of ISS requires chart abstraction, so it is often unavailable for patients cared for in nontrauma centers. Whether ISS can be accurately calculated from International Classification of Diseases, Ninth Revision (ICD-9) codes remains unclear. Our objective was to compare ISS derived from ICD-9 codes with those coded by trauma registrars. This was a retrospective study of patients entered into 9 U.S. trauma registries from January 2006 through December 2008. Two computer programs, ICDPIC and ICDMAP, were used to derive ISS from the ICD-9 codes in the registries. We compared derived ISS with ISS hand-coded by trained coders. There were 24,804 cases with a mortality rate of 3.9%. The median ISS derived by both ICDPIC (ISS-ICDPIC) and ICDMAP (ISS-ICDMAP) was 8 (interquartile range [IQR] = 4–13). The median ISS in the registry (ISS-registry) was 9 (IQR = 4–14). The median difference between either of the derived scores and ISS-registry was zero. However, the mean ISS derived by ICD-9 code mapping was lower than the hand-coded ISS in the registries (1.7 lower for ICDPIC, 95% CI [1.7, 1.8], Bland–Altman limits of agreement = −10.5 to 13.9; 1.8 lower for ICDMAP, 95% CI [1.7, 1.9], limits of agreement = −9.6 to 13.3). ICD-9-derived ISS slightly underestimated ISS compared with hand-coded scores. The 2 methods showed moderate to substantial agreement. Although hand-coded scores should be used when possible, ICD-9-derived scores may be useful in quality assurance and research when hand-coded scores are unavailable. PMID:28033134

  5. Comprehensive and human capital crash costs by maximum police-reported injury severity within selected crash types.

    PubMed

    Zaloshnja, Eduard; Miller, Ted; Council, Forrest; Persaud, Bhagwant

    2004-01-01

    This paper presents estimates for both the economic and comprehensive costs per crash for three police-coded severity groupings within 16 selected crash types and within two speed limit categories (or=50 mph). The economic costs are hard dollar costs. The comprehensive costs include economic costs and quality of life losses. We merged previously developed costs per victim keyed on the Abbreviated Injury Scale (AIS) into US crash data files that scored injuries in both the AIS and police-coded severity scales to produce per crash estimates. The most costly crashes were non-intersection fatal/disabling injury crashes on a road with a speed limit of 50 miles per hour or higher where multiple vehicles crashed head-on or a single vehicle struck a human (over 1.69 and $1.16 million per crash, respectively). The annual cost of police-reported run-off-road collisions, which include both rollovers and object impacts, represented 34% of total costs.

  6. Comprehensive and Human Capital Crash Costs by Maximum Police-Reported Injury Severity Within Selected Crash Types

    PubMed Central

    Zaloshnja, Eduard; Miller, Ted; Council, Forrest; Persaud, Bhagwant

    2004-01-01

    This paper presents estimates for both the economic and comprehensive costs per crash for three police-coded severity groupings within 16 selected crash types and within two speed limit categories (<=45 and >=50 mph). The economic costs are hard dollar costs. The comprehensive costs include economic costs and quality of life losses. We merged previously developed costs per victim keyed on the Abbreviated Injury Scale (AIS) into US crash data files that scored injuries in both the AIS and police-coded severity scales to produce per crash estimates. The most costly crashes were non-intersection fatal/disabling injury crashes on a road with a speed limit of 50 miles per hour or higher where multiple vehicles crashed head-on or a single vehicle struck a human (over 1.69 and $1.16 million per crash, respectively). The annual cost of police-reported run-off-road collisions, which include both rollovers and object impacts, represented 34% of total costs. PMID:15319129

  7. Comparison of autopsy findings and injury severity scores in deaths due to traumatic asphyxia (perthes syndrome).

    PubMed

    Arslan, M N; Kertmen, Ç; Esen Melez, I; Melez, D O

    2018-05-01

    Traumatic asphyxia is a rare clinical syndrome usually caused by sudden and severe thoracic and/or thoracoabdominal compression. It presents with craniofacial cyanosis, petechiae, and subconjunctival haemorrhages. The present study employed a postmortem retrospective methodology to analyse autopsy findings and accompanying injuries in cases of death due to traumatic asphyxia. Four years of case files from a morgue department at a forensic medicine institute were searched and 53 cases of lethal traumatic asphyxia were found. These cases were then classified into groups and compared using the Injury Severity Score (ISS) and New Injury Severity Score (NISS) indices to measure trauma. The individuals had died due to occupational (n = 28; 52.8%), farm (n = 10; 18.9%), traffic (n = 9; 17.0%) or household (n = 6; 11.3%) accidents. At the external examination, conjunctival petechiae (60.4%) and petechiae on the face/neck (52.8%); at the autopsy, subpleural petechiae (58.5%) and petrous ridge hemorrgahe (without skull base fracture) (56.6%) were the most common findings. A finding of petrous ridge hemorrgahe was very common in the cases without any accompanying injuries (Group A in which mean Injury Severity Score was 0.83 ± 0.98). Traumatic asphyxia is usually suspected from the given circumstances before an autosopy is performed. In cases without hospitalisation, any of the following signs may lead the physician to diagnose traumatic asphyxia as the cause of death: petechiae on the upper parts of the body and conjunctiva, petechiae on serous membranes (including subpleural regions), signs of petrous ridge haemorrhage without skull base fracture. Copyright © 2018 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  8. The Brain and Spinal Injury Center score: a novel, simple, and reproducible method for assessing the severity of acute cervical spinal cord injury with axial T2-weighted MRI findings.

    PubMed

    Talbott, Jason F; Whetstone, William D; Readdy, William J; Ferguson, Adam R; Bresnahan, Jacqueline C; Saigal, Rajiv; Hawryluk, Gregory W J; Beattie, Michael S; Mabray, Marc C; Pan, Jonathan Z; Manley, Geoffrey T; Dhall, Sanjay S

    2015-10-01

    Previous studies that have evaluated the prognostic value of abnormal changes in signals on T2-weighted MRI scans of an injured spinal cord have focused on the longitudinal extent of this signal abnormality in the sagittal plane. Although the transverse extent of injury and the degree of spared spinal cord white matter have been shown to be important for predicting outcomes in preclinical animal models of spinal cord injury (SCI), surprisingly little is known about the prognostic value of altered T2 relaxivity in humans in the axial plane. The authors undertook a retrospective chart review of 60 patients who met the inclusion criteria of this study and presented to the authors' Level I trauma center with an acute blunt traumatic cervical SCI. Within 48 hours of admission, all patients underwent MRI examination, which included axial and sagittal T2 images. Neurological symptoms, evaluated with the grades according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS), at the time of admission and at hospital discharge were correlated with MRI findings. Five distinct patterns of intramedullary spinal cord T2 signal abnormality were defined in the axial plane at the injury epicenter. These patterns were assigned ordinal values ranging from 0 to 4, referred to as the Brain and Spinal Injury Center (BASIC) scores, which encompassed the spectrum of SCI severity. The BASIC score strongly correlated with neurological symptoms at the time of both hospital admission and discharge. It also distinguished patients initially presenting with complete injury who improved by at least one AIS grade by the time of discharge from those whose injury did not improve. The authors' proposed score was rapid to apply and showed excellent interrater reliability. The authors describe a novel 5-point ordinal MRI score for classifying acute SCIs on the basis of axial T2-weighted imaging. The proposed BASIC score stratifies the SCIs according to the extent of transverse T2

  9. Machine learning with naturally labeled data for identifying abbreviation definitions.

    PubMed

    Yeganova, Lana; Comeau, Donald C; Wilbur, W John

    2011-06-09

    The rapid growth of biomedical literature requires accurate text analysis and text processing tools. Detecting abbreviations and identifying their definitions is an important component of such tools. Most existing approaches for the abbreviation definition identification task employ rule-based methods. While achieving high precision, rule-based methods are limited to the rules defined and fail to capture many uncommon definition patterns. Supervised learning techniques, which offer more flexibility in detecting abbreviation definitions, have also been applied to the problem. However, they require manually labeled training data. In this work, we develop a machine learning algorithm for abbreviation definition identification in text which makes use of what we term naturally labeled data. Positive training examples are naturally occurring potential abbreviation-definition pairs in text. Negative training examples are generated by randomly mixing potential abbreviations with unrelated potential definitions. The machine learner is trained to distinguish between these two sets of examples. Then, the learned feature weights are used to identify the abbreviation full form. This approach does not require manually labeled training data. We evaluate the performance of our algorithm on the Ab3P, BIOADI and Medstract corpora. Our system demonstrated results that compare favourably to the existing Ab3P and BIOADI systems. We achieve an F-measure of 91.36% on Ab3P corpus, and an F-measure of 87.13% on BIOADI corpus which are superior to the results reported by Ab3P and BIOADI systems. Moreover, we outperform these systems in terms of recall, which is one of our goals.

  10. Road Traffic Related Injury Severity in Truck Drivers: A Prospective Medical and Technical Analysis of 582 Truck Crashes.

    PubMed

    Decker, Sebastian; Otte, Dietmar; Muller, Christian Walter; Omar, Mohamed; Krettek, Christian; Haasper, Carl; Brand, Stephan

    2016-06-01

    While cyclists and pedestrians are known to be at significant risk for severe injuries when exposed to road traffic accidents (RTA) involving trucks, little is known about RTA injury risk for truck drivers. The aim of this study was to analyze the injury severity in truck drivers following RTAs. Our local accident research unit prospectively documented 43000 RTAs involving 582 trucks between 2000 and 2011. Injury severity, including the abbreviated injury scale (AIS) and the maximum abbreviated injury scale (MAIS) were analyzed. Technical parameters (e.g. delta-v, direction of impact), the location of accident, and its dependency on the road type were also taken into consideration. Thirteen percent (77/582) of truck drivers were injured. Extremities were found to be at highest risk of injury with the lower extremities (36x) being injured most severely (10x: AIS 2 and 3). Death occurred only after collisions with other trucks, and severity of injuries increased with an increased speed limit. The maximum abbreviated injury scale was higher in the crash opponents (56x MAIS ≥ 3) compared to the truck drivers (8x MAIS ≥ 3). Overall, 82% of the crash opponents were injured. The safety of truck drivers is assured by their vehicles, the consequence being that the risk of becoming injured is likely to be low. However, the legs especially are at high risk for severe injuries during RTAs. This probability increases in the instance of a collision with another truck. Nevertheless, in RTAs involving trucks and regular passenger vehicles, the other party is in higher risk of injury.

  11. School Readiness and the Draw-a-Man Test: An Empiricaly Derived Alternative to Harris' Scoring System.

    ERIC Educational Resources Information Center

    Simner, Marvin L.

    1985-01-01

    An abbreviated scoring system for the Goodenough-Harris Draw-A-Man Test found that three items had the same overall potential for correctly identifying at-risk kindergarteners as more time-consuming scoring methods. (CL)

  12. Nonoperative management of splenic injury in combat: 2002-2012.

    PubMed

    Mitchell, Thomas A; Wallum, Timothy E; Becker, Tyson E; Aden, James K; Bailey, Jeffrey A; Blackbourne, Lorne H; White, Christopher E

    2015-03-01

    Selective nonoperative management of combat-related blunt splenic injury (BSI) is controversial. We evaluated the impact of the November 2008 blunt abdominal trauma clinical practice guideline that permitted selective nonoperative management of some patients with radiological suggestion of hemoperitoneum on implementation of nonoperative management (NOM) of splenic injury in austere environments. Retrospective evaluation of patients with splenic injuries from November 2002 through January 2012 in Iraq and Afghanistan was performed. International Classification of Diseases, 9th Revision, Clinical Modification procedure codes identified patients as laparotomy with splenectomy, or NOM. Delayed operative management had no operative intervention at earlier North American Treaty Organization (NATO) medical treatment facilities (MTFs), and had a definitive intervention at a latter NATO MTFs. Intra-abdominal complications and overall mortality were juxtaposed. A total of 433 patients had splenic injuries from 2002 to 2012. Initial NOM of BSI from 2002 to 2008 compared to 2009-2012 was 44.1% and 47.2%, respectively (p=0.75). Delayed operative management and NOM completion had intra-abdominal complication and mortality rates of 38.1% and 9.1% (p<0.01), and 6.3% and 8.1% (p=0.77). Despite high-energy explosive injuries, NATO Role II MTFs radiological constraints and limited medical resources, hemodynamically normal patients with BSI and low abdominal abbreviated injury scores underwent NOM in austere environments. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  13. Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma: A Propensity Score Analysis.

    PubMed

    Olthof, Dominique C; Joosse, Pieter; Bossuyt, Patrick M M; de Rooij, Philippe P; Leenen, Loek P H; Wendt, Klaus W; Bloemers, Frank W; Goslings, J Carel

    2016-05-01

    Non-operative management (NOM) is the standard of care in hemodynamically stable patients with blunt splenic injury after trauma. Splenic artery embolization (SAE) is reported to increase observation success rate. Studies demonstrating improved splenic salvage rates with SAE primarily compared SAE with historical controls. The aim of this study was to investigate whether SAE improves success rate compared to observation alone in contemporaneous patients with blunt splenic injury. We included adult patients with blunt splenic injury admitted to five Level 1 Trauma Centers between January 2009 and December 2012 and selected for NOM. Successful treatment was defined as splenic salvage and no splenic re-intervention. We calculated propensity scores, expressing the probability of undergoing SAE, using multivariable logistic regression and created five strata based on the quintiles of the propensity score distribution. A weighted relative risk (RR) was calculated across strata to express the chances of success with SAE. Two hundred and six patients were included in the study. Treatment was successful in 180 patients: 134/146 (92 %) patients treated with observation and 48/57 (84 %) patients treated with SAE. The weighted RR for success with SAE was 1.17 (0.94-1.45); for complications, the weighted RR was 0.71 (0.41-1.22). The mean number of transfused blood products was 4.4 (SD 9.9) in the observation group versus 9.1 (SD 17.2) in the SAE group. After correction for confounders with propensity score stratification technique, there was no significant difference between embolization and observation alone with regard to successful treatment in patients with blunt splenic injury after trauma.

  14. Traumatic pulmonary pseudocysts after blunt chest trauma: Prevalence, mechanisms of injury, and computed tomography findings.

    PubMed

    Cho, Hyun Jin; Jeon, Yang Bin; Ma, Dae Sung; Lee, Jung Nam; Chung, Min

    2015-09-01

    Traumatic pulmonary pseudocyst (TPP) is a rare complication of blunt chest trauma and closely related with severe injury. However, it has been poorly documented. We present a retrospective review of TPP cases treated at our hospital. The medical records and chest computed tomography scans of patients with TPP treated from January 2010 to December 2013 were retrospectively studied. A total of 978 patients underwent chest computed tomography for blunt chest trauma during the study period, and 81 (8.3%) had a total of 150 TPPs. The most common mechanism of injury was being struck by a motorized vehicle (n = 25, 30.9%). The mean (SD) Injury Severity Score (ISS) of the 81 patients was 33.2 (11.4). The prevalence of TPP was higher in younger patients (p = 0.011), but the total number of fractured ribs was significantly lower (p = 0.001). In a subgroup analysis performed according to pseudocyst location, the intraparenchymal group had more severe injuries than the subpleural group (ISS, 23.3 vs. 32.4, p < 0.001; chest Abbreviated Injury Scale [AIS] score, 3.4 vs. 4.0, p < 0.001; number of associated injuries, 2.9 vs. 4.0, p = 0.001). By multivariate analysis, ISS, age, and number of associated injuries were significantly different in these two groups (p = 0.038, p = 0.006, and p = 0.045, respectively). The prevalence of TPP among cases of blunt chest trauma was 8.3% and was higher in those struck by a vehicle and younger patients. Intraparenchymal pseudocyst was found to be related to more severe injuries. TPP was a self-limiting condition that does not require specific treatment. Prognostic/epidemiologic study, level IV.

  15. Abbreviations and acronyms guide

    NASA Technical Reports Server (NTRS)

    1971-01-01

    A selected list of abbreviations and acronyms in use throughout the Jet Propulsion Laboratory is presented. The compilation includes NASA and JPL facilities and organizations, federal government agencies, international organizations, engineering and scientific associations and societies, commercial organizations, and words and phrases with technical and financial applications.

  16. Permanent sequelae in sports injuries: a population based study

    PubMed Central

    Marchi, A.; Di, B; Messi, G.; Gazzola, G.

    1999-01-01

    AIM—To identify permanent sequelae after sports injuries in children and adolescents.
METHODS—In 1985, a prospective register was drawn up of all sports related injuries reported that year by the residents of Trieste, Italy aged 6-15 years. Moderate to severe injuries (scoring ⩾ 2 on the abbreviated injury scale (AIS)) were the object of a longitudinal clinical study. In 1988, 30.9% of the 220 subjects enrolled had sequelae. A further follow up was undertaken in 1997.
RESULTS—The follow up in 1997 involved 54 subjects (26 girls; average age 24.5 years). Subjective and objective sequelae, by now considered to be permanent, were found in 61.1%, corresponding to 15% of the AIS ⩾ 2 injuries recorded in 1985. The prevalence of sequelae was similar in the two sexes, in relation to the child's age at time of injury, and in the different sports practised. It was higher in relation to the severity of the lesion (89% of AIS 3injuries examined, 56% of AIS 2 injuries) and to the type of lesion and its location. With regard to AIS ⩾ 2 injuries, permanent sequelae were found in 50% of ankle fractures, 43% of elbow fractures, 33% of leg/foot fractures, 25% of knee sprains, and 23% of ankle sprains.
CONCLUSIONS—The frequency of sequelae in sports injuries in children and adolescents is high. The risk appears to be connected to certain anatomical and functional age characteristics. Prevention strategies should include specific assessment of physical fitness and adequate follow up after the accident, particularly rehabilitation.

 PMID:10490437

  17. Traumatic brain injury: It is all about definition.

    PubMed

    Savitsky, B; Givon, A; Rozenfeld, M; Radomislensky, I; Peleg, K

    2016-01-01

    TBI may be defined by different methods. Some may be most useful for immediate clinical purposes, however less optimal for epidemiologic research. Other methods, such as the Abbreviated Injury Score (AIS), may prove more beneficial for this task, if the cut-off-points for their categories are defined correctly. To reveal the optimal cut-off-points for AIS in definition of severity of TBI in order to ensure uniformity between future studies of TBI. Mortality of patients with TBI AIS 3, 4 was 1.9% and 2.9% respectively, comparing with 31.1% among TBI AIS 5+. Predictive discrimination ability of the model with cut-off-points of 5+ for TBI AIS (in comparison with other cut-off-points) was better. Patients with missing Glasgow Coma Scale (GCS) in the ED had an in-hospital mortality rate of 11.5%. In this group, 25% had critical TBI according to AIS. Normal GCS didn't indicate an absence of head injury, as, among patients with GCS 15 in the ED, 26% had serious/critical TBI injury. Moreover, 7% of patients with multiple injury and GCS 3-8 had another reason than head injury for unconsciousness. This study recommends the adoption of an AIS cut-off ≥ 5 as a valid definition of severe TBI in epidemiological studies, while AIS 3-4 may be defined as 'moderate' TBI and AIS 1-2 as 'mild'.

  18. Development and validation of the Sports Athlete Foot and Ankle Score: an instrument for sports-related ankle injuries.

    PubMed

    Morssinkhof, M L A; Wang, O; James, L; van der Heide, H J L; Winson, I G

    2013-09-01

    Many existing scoring systems assess ankle function, but there is no evidence that any of them has been validated in a group of patients with a higher demand on their ankle function. Problems include ceiling effects, not being able to detect change or they do not contain a sports-subscale. The aim of this study was to create a validated self-administered scoring system for ankle injuries in the higher performing athlete. First, 26 patients were interviewed to solicit opinions needed to create the final score, which is modified from the Foot and Ankle Outcome Score (FAOS). Second, SAFAS was validated in a group of 25 athletes with and 14 athletes without ankle injury. It is a self-administered region specific sports foot and ankle score that contains four subscales assessing the levels of symptoms, pain, daily living and sports. The Spearman correlation coefficients between SAFAS and the Foot and Ankle Ability Measure (FAAM) ranged from 0.78 to 0.88. Content validity is established by key informant interviews, expert opinions and a high satisfaction rate of 75%. Cronbach's alpha indicated good internal consistency of each subscale ranging from 0.77 to 0.92. SAFAS has shown good evidence for being a valid instrudent for assessing sports-related ankle injuries in high-performing athletes. Copyright © 2013 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  19. The correlation between pedestrian injury severity in real-life crashes and Euro NCAP pedestrian test results.

    PubMed

    Strandroth, Johan; Rizzi, Matteo; Sternlund, Simon; Lie, Anders; Tingvall, Claes

    2011-12-01

    The aim of the present study was to estimate the correlation between Euro NCAP pedestrian rating scores and injury outcome in real-life car-to-pedestrian crashes, with special focus on long-term disability. Another aim was to determine whether brake assist (BA) systems affect the injury outcome in real-life car-to-pedestrian crashes and to estimate the combined effects in injury reduction of a high Euro NCAP ranking score and BA. In the current study, the Euro NCAP pedestrian scoring was compared with the real-life outcome in pedestrian crashes that occurred in Sweden during 2003 to 2010. The real-life crash data were obtained from the data acquisition system Swedish Traffic Accident Data Acquisition (STRADA), which combines police records and hospital admission data. The medical data consisted of International Classification of Diseases (ICD) diagnoses and Abbreviated Injury Scale (AIS) scoring. In all, approximately 500 pedestrians submitted to hospital were included in the study. Each car model was coded according to Euro NCAP pedestrian scores. In addition, the presence or absence of BA was coded for each car involved. Cars were grouped according to their scoring. Injury outcomes were analyzed with AIS and, at the victim level, with permanent medical impairment. This was done by translating the injury scores for each individual to the risk of serious consequences (RSC) at 1, 5, and 10 percent risk of disability level. This indicates the total risk of a medical disability for each victim, given the severity and location of injuries. The mean RSC (mRSC) was then calculated for each car group and t-tests were conducted to falsify the null hypothesis at p ≤ .05 that the mRSC within the groups was equal. The results showed a significant reduction of injury severity for cars with better pedestrian scoring, although cars with a high score could not be studied due to lack of cases. The reduction in RSC for medium-performing cars in comparison with low-performing cars

  20. 16 CFR 300.9 - Abbreviations, ditto marks, and asterisks.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Abbreviations, ditto marks, and asterisks. 300.9 Section 300.9 Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS RULES AND REGULATIONS UNDER THE WOOL PRODUCTS LABELING ACT OF 1939 Labeling § 300.9 Abbreviations...

  1. Copenhagen hip and groin outcome score (HAGOS) in male soccer: reference values for hip and groin injury-free players.

    PubMed

    Thorborg, Kristian; Branci, Sonia; Stensbirk, Frederik; Jensen, Jesper; Hölmich, Per

    2014-04-01

    Reference values are needed in order to interpret the Copenhagen Hip and Groin Outcome Score (HAGOS) in male soccer players with hip and groin pain. The aim of this study was to establish reference values for HAGOS in hip and groin injury-free male soccer players. We included 444 groin injury-free soccer players from 40 clubs (divisions 1-4) in Eastern Denmark, mean age (SD) 23.6 (4.4), training soccer 3.4 (1) times per week. All players were hip and groin injury-free at the time of inclusion (beginning of season, 2011). Of the 444 hip and groin injury-free players, 301 reported no hip and/or groin pain in either the present or the previous season, and 143 reported that they had experienced hip and/or groin pain in the previous season. Players (n=143) with hip and groin pain in the previous season displayed lower scores than players without (n=301), for all HAGOS subscales (p<0.001). Age and playing level were not related to HAGOS. The 95% reference ranges for HAGOS subscales in hip and groin injury-free soccer players, with no pain in the previous or present season (n=301), are: pain: 80.1-100, symptoms: 64.3-100, activities of daily living: 80.3-100, sport and recreational activities: 71.9-100, participation in physical activity: 75-100 and quality of living: 75-100. Lower HAGOS subscales are seen in soccer players who have experienced hip and/or groin pain in the previous season, compared with those who have not. Median HAGOS subscale scores in hip and groin injury-free soccer players are in proximity to the maximum score (100 points).

  2. Etiologies of pediatric craniofacial injuries: a comparison of injuries involving all-terrain vehicles and golf carts.

    PubMed

    White, Lauren C; McKinnon, Brian J; Hughes, C Anthony

    2013-03-01

    To determine incidence and etiologies of craniofacial injuries in the pediatric population through comparison of injuries caused by all-terrain vehicles and golf cart trauma. Case series with chart review. Level 1 trauma center. Retrospective review of pediatric traumas at a tertiary academic medical center from 2003 to 2012 identified 196 patients whose injuries resulted from accidents involving either all-terrain vehicles or golf carts. Data was collected and variables such as age, gender, driver vs. passenger, location of accident, Glasgow coma scale, Injury severity scale, Abbreviated injury scale, and presence or absence of helmet use were examined. 196 pediatric patients were identified: 68 patients had injuries resulting from golf cart accidents, and 128 patients from ATV accidents. 66.4% of ATV-related traumas were male, compared to 52.9% of golf cart-related traumas. Ages of injured patients were similar between the two modalities with average age of ATV traumas 10.8 (±4.0) years and golf cart traumas 10.0 (±4.6) years. Caucasians were most commonly involved in both ATV (79.7%) and golf cart traumas (85.3%). 58.6% of all ATV related trauma and 69.1% of all golf cart trauma resulted in craniofacial injuries. The most common craniofacial injury was a closed head injury with brief loss of consciousness, occurring in 46.1% of the ATV traumas and 54.4% of the golf cart traumas. Temporal bone fractures were the second most common type of craniofacial injury, occurring in 5.5% of ATV accidents and 7.4% of the golf cart traumas. Length of hospital stay and, cases requiring surgery and severity scores were similar between both populations. Intensive care admissions and injury severity scores approached but not reach statistical significance (0.096 and 0.083, respectively). The only statistically significant differences between the two modalities were helmet use (P=0.00018%) and days requiring ventilator assistance (P=0.025). ATVs and golf carts are often exempt

  3. 32 CFR 516.3 - Explanation of abbreviations and terms.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Explanation of abbreviations and terms. 516.3 Section 516.3 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY AID OF CIVIL AUTHORITIES AND PUBLIC RELATIONS LITIGATION General § 516.3 Explanation of abbreviations and terms. (a) The...

  4. Test Review: Wechsler Abbreviated Scale of Intelligence, Second Edition

    ERIC Educational Resources Information Center

    Irby, Sarah M.; Floyd, Randy G.

    2013-01-01

    The Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II; Wechsler, 2011) is a brief intelligence test designed for individuals aged 6 through 90 years. It is a revision of the Wechsler Abbreviated Scale of Intelligence (WASI; Wechsler, 1999). During revision, there were three goals: enhancing the link between the Wechsler…

  5. Common Medical Abbreviations and Terminology: Modularized Instruction for Nurses.

    ERIC Educational Resources Information Center

    Moseley, James L.

    A learning module to introduce nurses to the main medical abbreviations and often-used prefixes and suffixes is presented. Learning objectives of the module are: to provide the definitions of often-used suffixes and prefixes, and to identify definitions of medical abbreviations. The following materials are presented: a pretest consisting of 30…

  6. Surgical management of penetrating thoracic injuries during the Paris attacks on 13 November 2015.

    PubMed

    Boddaert, Guillaume; Mordant, Pierre; Le Pimpec-Barthes, Françoise; Martinod, Emmanuel; Aguir, Sonia; Leprince, Pascal; Raux, Mathieu; Couëtil, Jean-Paul; Fiore, Antonio; Lescot, Thomas; Malgras, Brice; Pons, François; Castier, Yves

    2017-06-01

    The Paris terrorist attacks on 13 November 2015 caused 482 casualties, including 130 deaths and 352 wounded. Facing these multisite terrorist attacks, Parisian public and military hospitals simultaneously managed numerous patients with penetrating thoracic injuries. The aim of this study was to analyse this cohort, the injury patterns, and assess the results of this mobilization. The clinical records of all patients admitted to Parisian public and military hospitals with a penetrating thoracic injury related to the Paris 13 November terrorist attacks were reviewed. The study group included 25 patients (7% of the casualties) with a mean age of 34 ± 8 years and a majority of gunshot wounds ( n =  20, 80%). Most patients presented with severe thoracic injury (Abbreviated Injury Score Thorax 3.3 ± 1.2), and also associated non-thoracic injuries in 21 cases (84%). The mean Injury Severity Score was 26.8 ± 9.4. Eight patients (32%) were managed with chest tube insertion and 17 (68%) required thoracic surgery. Lung resection, diaphragmatic repair, and lung suture were performed in 6 (36%), 6 (35%), and 5 cases (29%), respectively. Extra-thoracic surgical procedures were performed in 16 patients, mostly for injuries to the extremities. Postoperative mortality was 12% ( n =  3) and postoperative morbidity was 60% ( n =  15). The coordination of Parisian military and civilian hospitals allowed the surgical management of 25 patients. The mortality is high but consistent with what has been reported in previous series. The current times expose us to the threat of new terrorist attacks and require that the medical community be prepared. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  7. Admissions for isolated nonoperative mild head injuries: Sharing the burden among trauma surgery, neurosurgery, and neurology.

    PubMed

    Zhao, Ting; Mejaddam, Ali Y; Chang, Yuchiao; DeMoya, Marc A; King, David R; Yeh, Daniel D; Kaafarani, Haytham M A; Alam, Hasan B; Velmahos, George C

    2016-10-01

    Isolated nonoperative mild head injuries (INOMHI) occur with increasing frequency in an aging population. These patients often have multiple social, discharge, and rehabilitation issues, which far exceed the acute component of their care. This study was aimed to compare the outcomes of patients with INOMHI admitted to three services: trauma surgery, neurosurgery, and neurology. Retrospective case series (January 1, 2009 to August 31, 2013) at an academic Level I trauma center. According to an institutional protocol, INOMHI patients with Glasgow Coma Scale (GCS) of 13 to 15 were admitted on a weekly rotational basis to trauma surgery, neurosurgery, and neurology. The three populations were compared, and the primary outcomes were survival rate to discharge, neurological status at hospital discharge as measured by the Glasgow Outcome Score (GOS), and discharge disposition. Four hundred eighty-eight INOMHI patients were admitted (trauma surgery, 172; neurosurgery, 131; neurology, 185). The mean age of the study population was 65.3 years, and 58.8% of patients were male. Seventy-seven percent of patients has a GCS score of 15. Age, sex, mechanism of injury, Charlson Comorbidity Index, Injury Severity Score, Abbreviated Injury Scale in head and neck, and GCS were similar among the three groups. Patients who were admitted to trauma surgery, neurosurgery and neurology services had similar proportions of survivors (98.8% vs 95.7% vs 94.7%), and discharge disposition (home, 57.0% vs 61.6% vs 55.7%). The proportion of patients with GOS of 4 or 5 on discharge was slightly higher among patients admitted to trauma (97.7% vs 93.0% vs 92.4%). In a logistic regression model adjusting for Charlson Comorbidity Index CCI and Abbreviated Injury Scale head and neck scores, patients who were admitted to neurology or neurosurgery had significantly lower odds being discharged with GOS 4 or 5. While the trauma group had the lowest proportion of repeats of brain computed tomography (61

  8. Rhabdomyolysis among critically ill combat casualties: Associations with acute kidney injury and mortality.

    PubMed

    Stewart, Ian J; Faulk, Tarra I; Sosnov, Jonathan A; Clemens, Michael S; Elterman, Joel; Ross, James D; Howard, Jeffrey T; Fang, Raymond; Zonies, David H; Chung, Kevin K

    2016-03-01

    Rhabdomyolysis has been associated with poor outcomes in patients with traumatic injury, especially in the setting of acute kidney injury (AKI). However, rhabdomyolysis has not been systematically examined in a large cohort of combat casualties injured in the wars in Iraq and Afghanistan. We conducted a retrospective study of casualties injured during combat operations in Iraq and Afghanistan who were initially admitted to the intensive care unit from February 1, 2002, to February 1, 2011. Information on age, sex, Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), mechanism of injury, shock index, creatine kinase, and serum creatinine were collected. These variables were examined via multivariate logistic and Cox regression analyses to determine factors independently associated with rhabdomyolysis, AKI, and death. Of 6,011 admissions identified, a total of 2,109 patients met inclusion criteria and were included for analysis. Rhabdomyolysis, defined as creatine kinase greater than 5,000 U/L, was present in 656 subjects (31.1%). Risk factors for rhabdomyolysis identified on multivariable analysis included injuries to the abdomen and extremities, increased ISS, male sex, explosive mechanism of injury, and shock index greater than 0.9. After adjustment, patients with rhabdomyolysis had a greater than twofold increase in the odds of AKI. In the analysis for mortality, rhabdomyolysis was significantly associated with death until AKI was added, at which point it lost statistical significance. We found that rhabdomyolysis is associated with the development of AKI in combat casualties. While rhabdomyolysis was strongly associated with mortality on the univariate model and in conjunction with both ISS and age, it was not associated with mortality after the inclusion of AKI. This suggests that the effect of rhabdomyolysis on mortality may be mediated by AKI. Prognostic and epidemiologic study, level III.

  9. Effects of signal salience and noise on performance and stress in an abbreviated vigil

    NASA Astrophysics Data System (ADS)

    Helton, William Stokely

    Vigilance or sustained attention tasks traditionally require observers to detect predetermined signals that occur unpredictably over periods of 30 min to several hours (Warm, 1984). These tasks are taxing and have been useful in revealing the effects of stress agents, such as infectious disease and drugs, on human performance (Alluisi, 1969; Damos & Parker, 1994; Warm, 1993). However, their long duration has been an inconvenience. Recently, Temple and his associates (Temple et al., 2000) developed an abbreviated 12-min vigilance task that duplicates many of the findings with longer duration vigils. The present study was designed to explore further the similarity of the abbreviated task to long-duration vigils by investigating the effects of signal salience and jet-aircraft engine noise on performance, operator stress, and coping strategies. Forty-eight observers (24 males and 24 females) were assigned at random to each of four conditions resulting from the factorial combination of signal salience (high and low contrast signals) and background noise (quiet and jet-aircraft noise). As is the case with long-duration vigils (Warm, 1993), signal detection in the abbreviated task was poorer for low salience than for high salience signals. In addition, stress scores, as indexed by the Dundee Stress State Questionnaire (Matthews, Joiner, Gilliland, Campbell, & Falconer, 1999), were elevated in the low as compared to the high salience condition. Unlike longer vigils, however, (Becker, Warm, Dember, & Hancock, 1996), signal detection in the abbreviated task was superior in the presence of aircraft noise than in quiet. Noise also attenuated the stress of the vigil, a result that is counter to previous findings regarding the effects of noise in a variety of other scenarios (Clark, 1984). Examination of observers' coping responses, as assessed by the Coping Inventory for Task Situations (Matthews & Campbell, 1998), indicated that problem-focused coping was the overwhelming

  10. Variation in Intracranial Pressure Monitoring and Outcomes in Pediatric Traumatic Brain Injury

    PubMed Central

    Bennett, Tellen D.; Riva-Cambrin, Jay; Keenan, Heather T.; Korgenski, E. Kent; Bratton, Susan L.

    2015-01-01

    Objectives In children with traumatic brain injury (TBI), to describe between-hospital and patient-level variation in intracranial pressure (ICP) monitoring, and to evaluate ICP monitoring in association with hospital features and outcome Design Retrospective cohort study Setting Children’s hospitals participating in the Pediatric Health Information System database, January, 2001 to June, 2011 Participants Children (age < 18 years) with TBI and head/neck Abbreviated Injury Scale (AIS) score ≥ 3 who were ventilated for ≥ 96 consecutive hours or died in the first 4 days after admission Interventions None Outcome Measures ICP monitoring Results 4,667 children met study criteria. Hospital mortality was 41% (1,919/4,667). Overall, 55% (2,586/4,667) of patients received ICP monitoring. Expected hospital ICP monitoring rates after adjustment for patient age, cardiac arrest, inflicted injury, craniotomy or craniectomy, head/neck AIS, and injury severity score (ISS) were 47-60%. Observed hospital ICP monitoring rates were 14-83%. Hospitals with more observed ICP monitoring, relative to expected, and hospitals with higher patient volumes had lower rates of mortality or severe disability. After adjustment for between-hospital variation and patient severity of injury, ICP monitoring was independently associated with age ≥ 1 year (odds ratio [OR] 3.1, 95% confidence interval 2.5-3.8) versus age < 1 year. Conclusions There was significant between-hospital variation in ICP monitoring that cannot be attributed solely to differences in case mix. Hospitals that monitor ICP more often and hospitals with higher patient volumes had better patient outcomes. Infants with TBI are less likely to receive ICP monitoring than older children. PMID:22751878

  11. Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries.

    PubMed

    Shafi, Shahid; Barnes, Sunni A; Millar, D; Sobrino, Justin; Kudyakov, Rustam; Berryman, Candice; Rayan, Nadine; Dubiel, Rosemary; Coimbra, Raul; Magnotti, Louis J; Vercruysse, Gary; Scherer, Lynette A; Jurkovich, Gregory J; Nirula, Raminder

    2014-03-01

    Evidence-based management (EBM) guidelines for severe traumatic brain injuries (TBIs) were promulgated decades ago. However, the extent of their adoption into bedside clinical practices is not known. The purpose of this study was to measure compliance with EBM guidelines for management of severe TBI and its impact on patient outcome. This was a retrospective study of blunt TBI (11 Level I trauma centers, study period 2008-2009, n = 2056 patients). Inclusion criteria were an admission Glasgow Coma Scale score ≤ 8 and a CT scan showing TBI, excluding patients with nonsurvivable injuries-that is, head Abbreviated Injury Scale score of 6. The authors measured compliance with 6 nonoperative EBM processes (endotracheal intubation, resuscitation, correction of coagulopathy, intracranial pressure monitoring, maintaining cerebral perfusion pressure ≥ 50 cm H2O, and discharge to rehabilitation). Compliance rates were calculated for each center using multivariate regression to adjust for patient demographics, physiology, injury severity, and TBI severity. The overall compliance rate was 73%, and there was wide variation among centers. Only 3 centers achieved a compliance rate exceeding 80%. Risk-adjusted compliance was worse than average at 2 centers, better than average at 1, and the remainder were average. Multivariate analysis showed that increased adoption of EBM was associated with a reduced mortality rate (OR 0.88; 95% CI 0.81-0.96, p < 0.005). Despite widespread dissemination of EBM guidelines, patients with severe TBI continue to receive inconsistent care. Barriers to adoption of EBM need to be identified and mitigated to improve patient outcomes.

  12. SaRAD: a Simple and Robust Abbreviation Dictionary.

    PubMed

    Adar, Eytan

    2004-03-01

    Due to recent interest in the use of textual material to augment traditional experiments it has become necessary to automatically cluster, classify and filter natural language information. The Simple and Robust Abbreviation Dictionary (SaRAD) provides an easy to implement, high performance tool for the construction of a biomedical symbol dictionary. The algorithms, applied to the MEDLINE document set, result in a high quality dictionary and toolset to disambiguate abbreviation symbols automatically.

  13. The role of marshall and rotterdam score in predicting 30-day outcome of traumatic brain injury

    NASA Astrophysics Data System (ADS)

    Siahaan, A. M. P.; Akbar, T. Y. M.; Nasution, M. D.

    2018-03-01

    Traumatic brain injury (TBI) remains one of the leading causes of mortality and morbidity, especially in the young population. To predict the outcome of TBI, Marshall, and Rotterdam–CT Scan based scoring was mostly used. As many studies showed conflicting results regarding of the usage of both scoring, this study aims to determine the correlation between Rotterdam and Marshall scoring system with outcome in 30 days and found correlation among them. In 120 subjects with TBI that admitted to Adam Malik General Hospital, we found a significant association of both scorings with the 30-day Glasgow Outcome Score. Therefore, we recommend the use of Marshall and Rotterdam CT Score in initial assessment as a good predictor for patients with TBI.

  14. Nursing Activities Score and Acute Kidney Injury.

    PubMed

    Coelho, Filipe Utuari de Andrade; Watanabe, Mirian; Fonseca, Cassiane Dezoti da; Padilha, Katia Grillo; Vattimo, Maria de Fátima Fernandes

    2017-01-01

    to evaluate the nursing workload in intensive care patients with acute kidney injury (AKI). A quantitative study, conducted in an intensive care unit, from April to August of 2015. The Nursing Activities Score (NAS) and Kidney Disease Improving Global Outcomes (KDIGO) were used to measure nursing workload and to classify the stage of AKI, respectively. A total of 190 patients were included. Patients who developed AKI (44.2%) had higher NAS when compared to those without AKI (43.7% vs 40.7%), p <0.001. Patients with stage 1, 2 and 3 AKI showed higher NAS than those without AKI. A relationship was identified between stage 2 and 3 with those without AKI (p = 0.002 and p <0.001). The NAS was associated with the presence of AKI, the score increased with the progression of the stages, and it was associated with AKI, stage 2 and 3. avaliar a carga de trabalho de enfermagem em pacientes de terapia intensiva com lesão renal aguda (LRA). estudo quantitativo, em Unidade de Terapia Intensiva, no período de abril a agosto de 2015. O Nursing Activities Score (NAS) e o Kidney Disease Improving Global Outcomes (KDIGO) foram utilizados para medir a carga de trabalho de enfermagem e classificar o estágio da LRA, respectivamente. foram incluídos 190 pacientes. Os pacientes que desenvolveram LRA (44,2%) possuíam NAS superiores quando comparados aos sem LRA (43,7% vs 40,7%), p<0,001. Os pacientes com LRA nos estágios 1, 2 e 3 de LRA demonstraram NAS superiores aos sem LRA, houve relação entre os estágios 2 e 3 com os sem LRA, p=0,002 e p<0,001. o NAS apresentou associação com a existência de LRA, visto que seu valor aumenta com a progressão dos estágios, tendo associação com os estágios 2 e 3 de LRA.

  15. Patient-based Outcomes and Quality of Life after Salvageable Wartime Extremity Vascular Injury

    DTIC Science & Technology

    2014-01-01

    pattern. Reports on vascular injury from the civilian sector , including those using the National Trauma Data Bank , have been limited by an inability to...OIF/OEF) d Vascular injury ( AIS 2-6) d Vascular ICD-9 d No concomitant head injury d March 2002-August 2011 AIS , Abbreviated Injury Scale; ICD-9...had a greater proportion of patients who remained on active duty and fewer proportions of patients reporting unemployment (both P < .05). Group

  16. The epidemiology of traumatic brain injury in civilian inpatients of Chinese Military Hospitals, 2001-2007.

    PubMed

    Li, Yunming; Gu, Jianwen; Zhou, Jihong; Xia, Xun; Wang, Kuiying; Zheng, Xiushan; Kuang, Yongqin; Zhang, Xinyan; Ou, Shan; He, Ci; Zhu, Hui; Qiu, Jun

    2015-01-01

    To investigate the epidemiology of TBI in Chinese inpatients. Civilian inpatients of Chinese military hospitals diagnosed with TBI between 2001-2007 were identified using ICD-9-CM codes. Demographic characteristics, admission time, injury cause, injury severity, length of stay and outcomes were compared between ICD-9-CM diagnosis groups. In total, 203 553 civilian patients with TBI (74.86% male, 25.14% female) were identified from >200 Chinese military hospitals. TBI diagnoses increased by a mean of 4.67% each year. Admission peaked during the third quarter of the year and October annually. The leading causes of TBI were motor vehicle-traffic (51.41%), falls (21.49%) and assaults (15.77%). TBI was categorized by abbreviated injury scale score as mild in 36.64%, serious in 20.13%, severe in 26.81% and critical in 15.68% of inpatients. The mean length of stay was 17.8 ± 24.1 days. Recovery rate was 93.06% and mortality was 4.14%. The epidemiological data may contribute to the development of effective, targeted strategies to prevent TBI.

  17. Effectiveness of Booster Seats Compared With No Restraint or Seat Belt Alone for Crash Injury Prevention

    PubMed Central

    Ma, Xiaoguang; Griffin, Russell; McGwin, Gerald; Allison, David B.; Heymsfield, Steven B.; He, Wei; Zhu, Shankuan

    2013-01-01

    Objectives The objective was to evaluate the effectiveness of belt-positioning booster seats, compared with no restraint use and with seat belt use only, during motor vehicle crashes among U.S. children. Methods This was a retrospective matched cohort study with data from the 1998 through 2009 National Automotive Sampling System (NASS) Crashworthiness Data System (CDS). The study sample consisted of children aged 0 to 10 years who were not seated in the front seat of the vehicle. We used Cox proportional hazards models to estimate the risk of overall, fatal, and regional body injury. Results Children using seat belts in belt-positioning booster seats experienced less overall injury (Injury Severity Score [ISS] > 0, adjusted risk ratio [RR] = 0.73, 95% confidence interval [CI] = 0.55 to 0.96; Abbreviated Injury Scale [AIS] score of 2 or higher, adjusted RR = 0.30, 95% CI = 0.16 to 0.58; ISS > 8, adjusted RR = 0.19, 95% CI = 0.06 to 0.56), and less injury in most body regions except the neck (adjusted RR = 4.79, 95% CI = 1.43 to 16.00) than did children with no restraint use. Children using seat belts in belt-positioning booster seats had an equal risk of injury but higher risks of neck (adjusted RR = 1.86, 95% CI = 1.02 to 3.40) and thorax (adjusted RR = 2.86, 95% CI = 1.33 to 6.15) injury than did children restrained by seat belts only. Conclusions Children using belt-positioning booster seats appear to experience a higher risk of AIS > 0 injury to the neck and thorax than do children using seat belts only. Future research should examine whether the observed increase in neck and thorax injuries can be attributed to improper use of booster seats. PMID:24050794

  18. 40 CFR 600.503-78 - Abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 1978 Passenger Automobiles and for 1979 and Later Model Year Automobiles (Light Trucks and Passenger Automobiles)-Procedures for Determining Manufacturer's Average Fuel Economy § 600.503-78 Abbreviations. The...

  19. [Clinical significance of MESS scoring system in the treatment of fractures of lower limb combined with vascular injuries].

    PubMed

    Zhou, Fei-Ya; Guo, Xiao-Shan; Gao, Wei-Yang; Chen, Xing-Long; Li, Zhi-Jie; Jiang, Liang-Fu

    2010-06-01

    To study the clinical significance of MESS scoring system in the treatment of fractures of lower limb combined with vascular injuries, and to evaluate its reliance. From March 2006 to March 2008, 28 patients with fractures of lower limb combined with vascular injuries were graded by MESS scoring system. There were 17 patients were male and 11 patients were female, ranging in age from 23 to 53 years, averaged 38 years. Seventeen patients had fractures at the superior segment of tibia and fibia, 7 patients had fractures at the inferior segment of femur, and other 4 patients had dislocation of knee joint. Among the patients, 18 patients had MESS scores more than 7.0 point, in which 13 patients were treated with one-stage amputation, 5 patients were treated with two-stage amputation; the other 10 patients had the MESS scores less than 7.0 point, and were treated with open reduction and internal fixation, in which 8 patients were treated with transplantation of great saphenous vein to repair blood vessles, and 2 patients were treated with vascular end to end anastomosis. Among the patients, including 18 patients whose MESS scores more than 7.0 point were treated with one-stage or two-stage amputation, and 10 patients whose MESS scores less than 7.0 point were treated with limb salvage operations, all the limbs survived. During the follow-up period (ranged from 0.5 to 1 year, the movement and sensory function of the limbs recovered well. MESS is a simple and reliable tool to determine the proper strategy for the patients suffering from vascular injuries with fractures.

  20. 48 CFR 3002.270 - Abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Abbreviations. 3002.270 Section 3002.270 Federal Acquisition Regulations System DEPARTMENT OF HOMELAND SECURITY, HOMELAND SECURITY.... CBCACivilian Board of Contract Appeals CFOChief Financial Officer CIOChief Information Officer COCOChief of the...

  1. A comparison of the Full Outline of UnResponsiveness (FOUR) score and Glasgow Coma Score (GCS) in predictive modelling in traumatic brain injury.

    PubMed

    Kasprowicz, Magdalena; Burzynska, Malgorzata; Melcer, Tomasz; Kübler, Andrzej

    2016-01-01

    To compare the performance of multivariate predictive models incorporating either the Full Outline of UnResponsiveness (FOUR) score or Glasgow Coma Score (GCS) in order to test whether substituting GCS with the FOUR score in predictive models for outcome in patients after TBI is beneficial. A total of 162 TBI patients were prospectively enrolled in the study. Stepwise logistic regression analysis was conducted to compare the prediction of (1) in-ICU mortality and (2) unfavourable outcome at 3 months post-injury using as predictors either the FOUR score or GCS along with other factors that may affect patient outcome. The areas under the ROC curves (AUCs) were used to compare the discriminant ability and predictive power of the models. The internal validation was performed with bootstrap technique and expressed as accuracy rate (AcR). The FOUR score, age, the CT Rotterdam score, systolic ABP and being placed on ventilator within day one (model 1: AUC: 0.906 ± 0.024; AcR: 80.3 ± 4.8%) performed equally well in predicting in-ICU mortality as the combination of GCS with the same set of predictors plus pupil reactivity (model 2: AUC: 0.913 ± 0.022; AcR: 81.1 ± 4.8%). The CT Rotterdam score, age and either the FOUR score (model 3) or GCS (model 4) equally well predicted unfavourable outcome at 3 months post-injury (AUC: 0.852 ± 0.037 vs. 0.866 ± 0.034; AcR: 72.3 ± 6.6% vs. 71.9%±6.6%, respectively). Adding the FOUR score or GCS at discharge from ICU to predictive models for unfavourable outcome increased significantly their performances (AUC: 0.895 ± 0.029, p = 0.05; AcR: 76.1 ± 6.5%; p < 0.004 when compared with model 3; and AUC: 0.918 ± 0.025, p < 0.05; AcR: 79.6 ± 7.2%, p < 0.009 when compared with model 4), but there was no benefit from substituting GCS with the FOUR score. Results showed that FOUR score and GCS perform equally well in multivariate predictive modelling in TBI.

  2. Abbreviated MRI Protocols: Wave of the Future for Breast Cancer Screening.

    PubMed

    Chhor, Chloe M; Mercado, Cecilia L

    2017-02-01

    The purpose of this article is to describe the use of abbreviated breast MRI protocols for improving access to screening for women at intermediate risk. Breast MRI is not a cost-effective modality for screening women at intermediate risk, including those with dense breast tissue as the only risk. Abbreviated breast MRI protocols have been proposed as a way of achieving efficiency and rapid throughput. Use of these abbreviated protocols may increase availability and provide women with greater access to breast MRI.

  3. Application of the Mandible Injury Severity Score to Pediatric Mandibular Fractures.

    PubMed

    Swanson, Edward W; Susarla, Srinivas M; Ghasemzadeh, Ali; Mundinger, Gerhard S; Redett, Richard J; Tufaro, Anthony P; Manson, Paul N; Dorafshar, Amir H

    2015-07-01

    The Mandible Injury Severity Score (MISS) has been used to evaluate adult mandibular fractures. The purpose of this study was to evaluate the MISS in a cohort of pediatric patients. This was a retrospective study of pediatric patients treated for mandibular fractures over a 20-year period. Patients were included if they had computed tomographic imaging available for review and had at least 1 post-treatment visit. The primary predictor variable was the MISS. Secondary predictors were demographic and injury-associated factors. The outcome was treatment-associated complications. Descriptive, bivariate, and multiple logistic regression statistics were computed. One hundred sixteen patients with mandibular fractures were identified; 73 (62.9%) met the inclusion criteria. The sample's mean age was 8.5 ± 4.1 years; 44% were girls. Motor vehicle collisions (60%) and falls (15.1%) were the most common mechanisms. More than 50% of patients had an extra-mandibular injury. The mean MISS was 13.5 ± 7.8. Forty-five percent of the sample underwent open reduction and internal fixation. Complications were noted in 20.5% of patients, of which malocclusion was the most common (8.2%). Increasing MISS was associated with complications (P < .001). After controlling for the effects of age, mechanism, cervical spine and skull base injuries, and treatment, patients with an MISS of at least 14 were significantly more likely to have a complication (odds ratio = 4.0; 95% confidence interval, 1.05-15.0; P = .04). In pediatric patients with mandibular fractures, increased severity of injury is associated with complications, even after controlling for the effects of multiple confounders, including open treatment. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  4. 40 CFR 600.203-77 - Abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... ECONOMY AND CARBON-RELATED EXHAUST EMISSIONS OF MOTOR VEHICLES Fuel Economy Regulations for 1977 and Later Model Year Automobiles-Procedures for Calculating Fuel Economy Values § 600.203-77 Abbreviations. The...

  5. 40 CFR 600.403-77 - Abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... ECONOMY AND CARBON-RELATED EXHAUST EMISSIONS OF MOTOR VEHICLES Fuel Economy Regulations for 1977 and Later Model Year Automobiles-Dealer Availability of Fuel Economy Information § 600.403-77 Abbreviations. The...

  6. 40 CFR 600.403-77 - Abbreviations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... ECONOMY AND CARBON-RELATED EXHAUST EMISSIONS OF MOTOR VEHICLES Fuel Economy Regulations for 1977 and Later Model Year Automobiles-Dealer Availability of Fuel Economy Information § 600.403-77 Abbreviations. The...

  7. Penetrating injuries to the duodenum: An analysis of 879 patients from the National Trauma Data Bank, 2010 to 2014.

    PubMed

    Phillips, Bradley; Turco, Lauren; McDonald, Dan; Mause, Alison; Walters, Ryan W

    2017-11-01

    Despite wide belief that the duodenal Organ Injury Scale has been validated, this has not been reported in the published literature. Based on clinical experience, we hypothesize that the American Association for Surgery of Trauma Organ Injury Scale (AAST-OIS) for duodenal injuries can independently predict mortality. Our objectives were threefold: (1) describe the national profile of penetrating duodenal injuries, (2) identify predictors of morbidity and mortality, and (3) validate the duodenum AAST-OIS as a statistically significant predictor of mortality. Using the Abbreviated Injury Scale 2005 and International Classification of Diseases-9th Rev.-Clinical Modification (ICD-9-CM) E-codes, we identified 879 penetrating duodenal trauma patients from the National Trauma Data Bank between 2010 and 2014. We controlled patient-level covariates of age, biological sex, systolic blood pressure (SBP), Glasgow Coma Scale (GCS) score, pulse, Injury Severity Score (ISS), and Organ Injury Scale (OIS) grade. We estimated multivariable generalized linear mixed models to account for the nesting of patients within trauma centers. Our results indicated an overall mortality rate of 14.4%. Approximately 10% of patients died within 24 hours of admission, of whom 76% died in the first 6 hours. Patients averaged approximately five associated injuries, 45% of which involved the liver and colon. Statistically significant independent predictors of mortality were firearm mechanism, SBP, GCS, pulse, ISS, and AAST-OIS grade. Specifically, odds of death were decreased with 10 mm Hg higher admission SBP (13% decreased odds), one point higher GCS (14.4%), 10-beat lower pulse (8.2%), and 10-point lower ISS (51.0%). This study is the first to report the national profile of penetrating duodenal injuries. Using the National Trauma Data Bank, we identified patterns of injury, predictors of outcome, and validated the AAST-OIS for duodenal injuries as a statistically significant predictor of morbidity

  8. Reference Values for the Marx Activity Rating Scale in a Young Athletic Population: History of Knee Ligament Injury Is Associated With Higher Scores.

    PubMed

    Cameron, Kenneth L; Peck, Karen Y; Thompson, Brandon S; Svoboda, Steven J; Owens, Brett D; Marshall, Stephen W

    2015-01-01

    Activity-related patient-reported outcome measures are an important component of assessment after knee ligament injury in young and physically active patients; however, normative data for most activity scales are limited. To present reference values by sex for the Marx Activity Rating Scale (MARS) within a young and physically active population while accounting for knee ligament injury history and sex. Cross-sectional study. Level 2. All incoming freshman entering a US Service Academy in June of 2011 were recruited to participate in this study. MARS was administered to 1169 incoming freshmen (203 women) who consented to participate within the first week of matriculation. All subjects were deemed healthy and medically fit for military service on admission. Subjects also completed a baseline questionnaire that asked for basic demographic information and injury history. We calculated means with standard deviations, medians with interquartile ranges, and percentiles for ordinal and continuous variables, and frequencies and proportions for dichotomous variables. We also compared median scores by sex and history of knee ligament injury using the Kruskal-Wallis test. MARS was the primary outcome of interest. The median MARS score was significantly higher for men when compared with women (χ(2) = 13.22, df = 1, P < 0.001) with no prior history of knee ligament injury. In contrast, there was no significant difference in median MARS scores between men and women (χ(2) = 0.47, df = 1, P = 0.493) who reported a history of injury. Overall, median MARS scores were significantly higher among those who reported a history of knee ligament injury when compared with those who did not (χ(2) = 9.06, df = 1, P = 0.003). Assessing activity as a patient-reported outcome after knee ligament injury is important, and reference values for these instruments need to account for the influence of prior injury and sex. © 2015 The Author(s).

  9. 32 CFR Appendix B to Part 806 - Abbreviations and Acronyms

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 6 2013-07-01 2013-07-01 false Abbreviations and Acronyms B Appendix B to Part 806 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE ADMINISTRATION AIR FORCE FREEDOM OF INFORMATION ACT PROGRAM Pt. 806, App. B Appendix B to Part 806—Abbreviations and...

  10. Characteristics of Patients Injured in Road Traffic Accidents According to the New Injury Severity Score

    PubMed Central

    Lee, Jung Soo; Kim, Yeo Hyung; Yun, Jae Sung; Jung, Sang Eun; Chae, Choong Sik

    2016-01-01

    Objective To investigate the clinical characteristics of patients involved in road traffic accidents according to the New Injury Severity Score (NISS). Methods In this study, medical records of 1,048 patients admitted at three hospitals located in different regions between January and December 2014 were retrospectively reviewed. Only patients who received inpatient treatments covered by automobile insurance during the period were included. Accidents were classified as pedestrian, driver, passenger, motorcycle, or bicycle; and the severity of injury was assessed by the NISS. Results The proportion of pedestrian traffic accident (TA) was the highest, followed by driver, passenger, motorcycle and bicycle TA. The mean NISS was significantly higher in pedestrian and motorcycle TAs and lower in passenger TA. Analysis of differences in mean hospital length of stay (HLS) according to NISS injury severity revealed 4.97±4.86 days in the minor injury group, 8.91±5.93 days in the moderate injury group, 15.46±11.16 days in the serious injury group, 24.73±17.03 days in the severe injury group, and 30.86±34.03 days in the critical injury group (p<0.05). Conclusion The study results indicated that higher NISS correlated to longer HLS, fewer home discharges, and increasing mortality. Specialized hospitals for TA patient rehabilitation are necessary to reduce disabilities in TA patients. PMID:27152279

  11. Examination of the impact of airbags on renal injury using a national database.

    PubMed

    Smith, Thomas G; Wessells, Hunter B; Mack, Chris D; Kaufman, Robert; Bulger, Eileen M; Voelzke, Bryan B

    2010-09-01

    Little is known about preventative measures to lessen solid organ injury in motor vehicle collisions (MVCs). To evaluate the efficacy of airbags in reducing renal injuries in MVC, we analyzed renal injury rates in vehicles with and without airbags using the Crash Injury Research and Engineering Network (CIREN) database. The CIREN database was queried for MVC and renal injury from 1996 to September 2008. CIREN is weighted toward late model vehicles and selects more severely injured patients. Search fields were primary direction of force (PDOF), presence of airbags, and location of airbags (steering wheel, instrument panel, seat back, door panel, and roof-side curtain). Abdominal Abbreviated Injury Score was converted to AAST renal injury grade. Renal injury rates were compared between vehicles with and without frontal and side airbags. We reviewed 2,864 records and identified 139 renal injuries (28.9% AAST grade III to V). In MVCs with renal injuries, frontal impact was 54.7% of total (n = 76) and side impact was 45.3% of total (n = 63). Most occupants in frontal impact MVCs had exposure to a steering wheel airbag (74.9%); 16.6% had an instrument panel (passenger) airbags. In side impact MVCs, 32.2% of occupants had a side airbag. Compared with the non-airbags cohort, frontal airbags and side airbags were associated with a 45.3% and 52.8% reduction in renal injury, respectively. Passengers in automobiles with frontal and side airbags have a reduced rate of renal injury compared with those without airbags. Our data support further study of the role of airbags in reducing renal injury after MVC. Copyright 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Improvements in passive car safety led to decreased injury severity--a comparison between the 1970s and 1990s.

    PubMed

    Richter, Martinus; Pape, Hans-Christoph; Otte, Dietmar; Krettek, Christian

    2005-04-01

    The purpose of this study was to characterize changes in the mechanism and pattern of injury for vehicular trauma victims with modern vehicle design. Crash and injury severity were specifically investigated to isolate the influence of these improvements in vehicle design. Since 1972, a local, prospective, assessment of vehicular trauma victims on-scene and at medical institutions providing care has been performed including the following parameters: delta-v, collision speed, type of road using, abbreviated injury scale (AIS), injury severity score (ISS), incidence of polytrauma or death. Victims (for restrained car occupants, bicyclists, pedestrians) injured between 1973 and 1978, and between 1994 and 1999 were compared. Lower crash severity (delta-v, collision speed) and injury severity (AIS, ISS, incidence of polytrauma or death) were measured for restrained car occupants, bicyclists and pedestrians during the later period. The correlation coefficient between delta-v or vehicle collision speed and ISS was higher in the earlier period for car occupants, cyclists and pedestrians. This study suggests that the observed reduction in injury severity in restrained car occupants, bicyclists and pedestrians is not only linked to the reduction of crash severity, but also related to improvements in vehicle design beyond seat-belt use. Passive car safety led to decreased injury severity--a comparison.

  13. Prognostic value of major extracranial injury in traumatic brain injury: an individual patient data meta-analysis in 39,274 patients.

    PubMed

    van Leeuwen, Nikki; Lingsma, Hester F; Perel, Pablo; Lecky, Fiona; Roozenbeek, Bob; Lu, Juan; Shakur, Haleema; Weir, James; Steyerberg, Ewout W; Maas, Andrew I R

    2012-04-01

    Major extracranial injury (MEI) is common in traumatic brain injury (TBI) patients, but the effect on outcome is controversial. To assess the prognostic value of MEI on mortality after TBI in an individual patient data meta-analysis of 3 observational TBI studies (International Mission on Prognosis and Clinical Trial Design in TBI [IMPACT]), a randomized controlled trial (Corticosteroid Randomization After Significant Head Injury [CRASH]), and a trauma registry (Trauma Audit and Research Network [TARN]). MEI (extracranial injury with an Abbreviated Injury Scale ≥ 3 or requiring hospital admission) was related to mortality with logistic regression analysis, adjusted for age, Glasgow Coma Scale motor score, and pupil reactivity and stratified by TBI severity. We pooled odds ratios (ORs) with random-effects meta-analysis. We included 39,274 patients. Mortality was 25%, and 32% had MEI. MEI was a strong predictor for mortality in TARN, with adjusted odds ratios of 2.81 (95% confidence interval [CI], 2.44-3.23) in mild, 2.18 (95% CI, 1.80-2.65) in moderate, and 2.14 (95% CI, 1.95-2.35) in severe TBI patients. The prognostic effect was smaller in IMPACT and CRASH, with pooled adjusted odds ratios of 2.14 (95% CI, 0.93-4.91) in mild, 1.46 (95% CI, 1.14-1.85) in moderate, and 1.18 (95% CI, 1.03-1.55) in severe TBI. When patients who died within 6 hours after injury were excluded from TARN, the effect of MEI was comparable with IMPACT and CRASH. MEI is an important prognostic factor for mortality in TBI patients. However, the effect varies by population, which explains the controversy in the literature. The strength of the effect is smaller in patients with more severe brain injury and depends on time of inclusion in a study.

  14. Cannabidiol-treated rats exhibited higher motor score after cryogenic spinal cord injury.

    PubMed

    Kwiatkoski, Marcelo; Guimarães, Francisco Silveira; Del-Bel, Elaine

    2012-04-01

    Cannabidiol (CBD), a non-psychoactive constituent of cannabis, has been reported to induce neuroprotective effects in several experimental models of brain injury. We aimed at investigating whether this drug could also improve locomotor recovery of rats submitted to spinal cord cryoinjury. Rats were distributed into five experimental groups. Animals were submitted to laminectomy in vertebral segment T10 followed or not by application of liquid nitrogen for 5 s into the spinal cord at the same level to cause cryoinjury. The animals received injections of vehicle or CBD (20 mg/kg) immediately before, 3 h after and daily for 6 days after surgery. The Basso, Beattie, and Bresnahan motor evaluation test was used to assess motor function post-lesion one day before surgery and on the first, third, and seventh postoperative days. The extent of injury was evaluated by hematoxylin-eosin histology and FosB expression. Cryogenic lesion of the spinal cord resulted in a significant motor deficit. Cannabidiol-treated rats exhibited a higher Basso, Beattie, and Bresnahan locomotor score at the end of the first week after spinal cord injury: lesion + vehicle, day 1: zero, day 7: four, and lesion + Cannabidiol 20 mg/kg, day 1: zero, day 7: seven. Moreover, at this moment there was a significant reduction in the extent of tissue injury and FosB expression in the ventral horn of the spinal cord. The present study confirmed that application of liquid nitrogen to the spinal cord induces reproducible and quantifiable spinal cord injury associated with locomotor function impairments. Cannabidiol improved locomotor functional recovery and reduced injury extent, suggesting that it could be useful in the treatment of spinal cord lesions.

  15. 76 FR 65735 - Draft Guidance for Industry: Implementation of Acceptable Abbreviated Donor History Questionnaire...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-24

    ...] Draft Guidance for Industry: Implementation of Acceptable Abbreviated Donor History Questionnaire and... Acceptable Abbreviated Donor History Questionnaire and Accompanying Materials for Use in Screening Frequent... abbreviated donor history questionnaire and accompanying materials (aDHQ documents), version 1.3 dated August...

  16. Experimental Study of Thoracoabdominal Injuries Suffered from Caudocephalad Impacts Using Pigs

    PubMed Central

    Guan, Sishu; Liao, Zhikang; Xiang, Hongyi; Zhu, Xiyan; Wang, Zhong; Lai, Xinan

    2018-01-01

    To know the caudocephalad impact- (CCI-) induced injuries more clearly, 21 adult minipigs, randomly divided into three groups: control group (n = 3), group I (n = 9), and group II (n = 9), were used to perform the CCI experiments on a modified deceleration sled. Configured impact velocity was 0 m/s in the control group, 8 m/s in group I, and 11 m/s in group II. The kinematics and mechanical responses of the subjects were recorded and investigated. The functional change examination and the autopsies were carried out, with which the injuries were evaluated from the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS). The subjects in group I and group II experienced the caudocephalad loading at the peak pelvic accelerations of 108.92 ± 58.87 g and 139.13 g ± 78.54 g, with the peak abdomen pressures, 41.24 ± 16.89 kPa and 63.61 ± 65.83 kPa, respectively. The injuries of the spleen, lung, heart, and spine were detected frequently among the tested subjects. The maximal AIS (MAIS) of chest injuries was 4 in group I and 5 in group II, while both the MAIS of abdomen injuries in group I and group II were 5. The ISS in group II was 52.71 ± 6.13, significantly higher than in group I, 26.67 ± 5.02 (p < 0.05). The thoracoabdomen CCI injuries and the mechanical response addressed presently may be useful to conduct both the prevention studies against military or civilian injuries. PMID:29861783

  17. Parafoveal and foveal processing of abbreviations during eye fixations in reading: Making a case for case

    PubMed Central

    Slattery, Timothy J.; Schotter, Elizabeth R.; Berry, Raymond W.; Rayner, Keith

    2011-01-01

    The processing of abbreviations in reading was examined with an eye movement experiment. Abbreviations were of two distinct types: Acronyms (abbreviations that can be read with the normal grapheme-phoneme correspondence rules, such as NASA) and initialisms (abbreviations in which the grapheme-phoneme correspondences are letter names, such as NCAA). Parafoveal and foveal processing of these abbreviations was assessed with the use of the boundary change paradigm (Rayner, 1975). Using this paradigm, previews of the abbreviations were either identical to the abbreviation (NASA or NCAA), orthographically legal (NUSO or NOBA), or illegal (NRSB or NRBA). The abbreviations were presented as capital letter strings within normal, predominantly lowercase sentences and also sentences in all capital letters such that the abbreviations would not be visually distinct. The results indicate that acronyms and initialisms undergo different processing during reading, and that readers can modulate their processing based on low-level visual cues (distinct capitalization) in parafoveal vision. In particular, readers may be biased to process capitalized letter strings as initialisms in parafoveal vision when the rest of the sentence is normal, lower case letters. PMID:21480754

  18. Parafoveal and foveal processing of abbreviations during eye fixations in reading: making a case for case.

    PubMed

    Slattery, Timothy J; Schotter, Elizabeth R; Berry, Raymond W; Rayner, Keith

    2011-07-01

    The processing of abbreviations in reading was examined with an eye movement experiment. Abbreviations were of 2 distinct types: acronyms (abbreviations that can be read with the normal grapheme-phoneme correspondence [GPC] rules, such as NASA) and initialisms (abbreviations in which the GPCs are letter names, such as NCAA). Parafoveal and foveal processing of these abbreviations was assessed with the use of the boundary change paradigm (K. Rayner, 1975). Using this paradigm, previews of the abbreviations were either identical to the abbreviation (NASA or NCAA), orthographically legal (NUSO or NOBA), or illegal (NRSB or NRBA). The abbreviations were presented as capital letter strings within normal, predominantly lowercase sentences and also sentences in all capital letters such that the abbreviations would not be visually distinct. The results indicate that acronyms and initialisms undergo different processing during reading and that readers can modulate their processing based on low-level visual cues (distinct capitalization) in parafoveal vision. In particular, readers may be biased to process capitalized letter strings as initialisms in parafoveal vision when the rest of the sentence is normal, lowercase letters.

  19. Prehospital deaths from trauma: Are injuries survivable and do bystanders help?

    PubMed

    Oliver, G J; Walter, D P; Redmond, A D

    2017-05-01

    Deaths from trauma occurring in the prehospital phase of care are typically excluded from analysis in trauma registries. A direct historical comparison with Hussain and Redmond's study on preventable prehospital trauma deaths has shown that, two decades on, the number of potentially preventable deaths remains high. Using updated methodology, we aimed to determine the current nature, injury severity and survivability of traumatic prehospital deaths and to ascertain the presence of bystanders and their role following the point of injury including the frequency of first-aid delivery. We examined the Coroners' inquest files for deaths from trauma, occurring in the prehospital phase, over a three-year period in the Cheshire and Manchester (City), subsequently referred to as Manchester, Coronial jurisdictions. Injuries were scored using the Abbreviated-Injury-Scale (AIS-2008), Injury Severity Score (ISS) calculated and probability of survival estimated using the Trauma Audit and Research Network's outcome prediction model. One hundred and seventy-eight deaths were included in the study (one hundred and thirty-four Cheshire, forty-four Manchester). The World Health Organisation's recommendations consider those with a probability of survival between 25-50% as potentially preventable and those above 50% as preventable. The median ISS was 29 (Cheshire) and 27.5 (Manchester) with sixty-two (46%) and twenty-six (59%) respectively having a probability of survival in the potentially preventable and preventable ranges. Bystander presence during or immediately after the point of injury was 45% (Cheshire) and 39% (Manchester). Bystander intervention of any kind was 25% and 30% respectively. Excluding those found dead and those with a probability of survival less than 25%, bystanders were present immediately after the point of injury or "within minutes" in thirty-three of thirty-five (94%) Cheshire and ten of twelve (83%) Manchester. First aid of any form was attempted in fourteen

  20. FOUR Score Predicts Early Outcome in Patients After Traumatic Brain Injury.

    PubMed

    Nyam, Tee-Tau Eric; Ao, Kam-Hou; Hung, Shu-Yu; Shen, Mei-Li; Yu, Tzu-Chieh; Kuo, Jinn-Rung

    2017-04-01

    The aim of the study was to determine whether the Full Outline of UnResponsiveness (FOUR) score, which includes eyes opening (E), motor function (M), brainstem reflex (B), and respiratory pattern (R), can be used as an alternate method to the Glasgow Coma Scale (GCS) in predicting intensive care unit (ICU) mortality in traumatic brain injury (TBI) patients. From January 2015 to June 2015, patients with isolated TBI admitted to the ICU were enrolled. Three advanced practice nurses administered the FOUR score, GCS, Acute Physiology and Chronic Health Evaluation II (APACHE II), and Therapeutic Intervention Scoring System (TISS) concurrently from ICU admissions. The endpoint of observation was mortality when the patients left the ICU. Data are presented as frequency with percentages, mean with standard deviation, or median with interquartile range. Each measurement tool used area under the receiver operating characteristic curve to compare the predictive power between these four tools. In addition, the difference between survival and death was estimated using the Wilcoxon rank sum test. From 55 TBI patients, males (72.73 %) were represented more than females, the mean age was 63.1 ± 17.9, and 19 of 55 observations (35 %) had a maximum FOUR score of 16. The overall mortality rate was 14.6 %. The area under the receiver operating characteristic curve was 74.47 % for the FOUR score, 74.73 % for the GCS, 81.78 % for the APACHE II, and 53.32 % for the TISS. The FOUR score has similar predictive power of mortality compared to the GCS and APACHE II. Each of the parameters-E, M, B, and R-of the FOUR score showed a significant difference between mortality and survival group, while the verbal and eye-opening components of the GCS did not. Having similar predictive power of mortality compared to the GCS and APACHE II, the FOUR score can be used as an alternative in the prediction of early mortality in TBI patients in the ICU.

  1. Jugular bulb oxygen saturation correlates with Full Outline of Responsiveness score in severe traumatic brain injury patients

    PubMed Central

    Senapathi, Tjokorda Gde Agung; Wiryana, Made; Sinardja, Ketut; Nada, Ketut Wibawa; Sutawan, Ida Bagus Krisna Jaya; Ryalino, Christopher; Alphonso, Aloysius

    2017-01-01

    Background Maintaining brain oxygenation status is the main goal of treatment in severe traumatic brain injury (TBI). Jugular venous oxygen saturation (SjvO2) monitoring is a technique to estimate global balance between cerebral oxygen supply and its metabolic requirement. Full Outline of Responsiveness (FOUR) score, a new consciousness measurement scoring, is expected to become an alternative for Glasgow Coma Scale (GCS) in evaluating neurologic status of patients with severe traumatic head injury, especially for those under mechanical ventilation. Methods A total of 63 patients with severe TBI admitted to emergency department (ED) were included in this study. SjvO2 sampling was taken every 24 hours, until 72 hours after arrival. The assessment of FOUR score was conducted directly after each blood sample for SjvO2 was taken. Spearman’s rank correlation was used to determine the correlation between SjvO2 and FOUR score. Regression analysis was used to determine mortality predictors. Results From the 63 patients, a weak positive correlation between SjvO2 and FOUR score (r=0.246, p=0.052) was found upon admission. Meanwhile, strong and moderate negative correlation values were found in 48 hours (r=−0.751, p<0.001) and 72 hours (r=−0.49, p=0.002) after admission. Both FOUR score (p<0.001) and SjvO2 (p=0.04) were found to be independent mortality predictors in severe TBI. Conclusion There was a negative correlation between the value of SjvO2 and FOUR score at 48 and 72 hours after admission. Both SjvO2 and FOUR score are independent mortality predictors in severe TBI. PMID:28919828

  2. Teenager injury panorama in northern Sweden.

    PubMed

    Johansson, L; Eriksson, A; Björnstig, U

    2001-08-01

    To study non-fatal unintentional injuries among teenagers and to suggest preventive measures. The emergency care unit of the University Hospital, Umeå, Sweden. All injured teenagers (N = 1044) attending the emergency care unit during 1991 were asked to answer a questionnaire focusing on when, where and how the injury occurred. All available medical records were examined. Data were coded according to the Nordic Medico-Statistical Committees Classification for Accident Monitoring, NOMESCO, and to the Abbreviated Injury Scale, AIS. 1,043 teenagers were treated with sports and transportation related injuries as the most common ones. Most injuries were minor (AIS 1), transportation related injuries had the highest proportion of non-minor injuries (AIS > or = 2), 139 teenagers were admitted for in-patient care. Most injuries occurred during leisure/school time. Sports and transportation related injuries were most frequent. Body weight and length differs among teenagers, we suggest that teenagers should exercise and play together, not only by age, but also to some extent, to height and weight. Curfew laws, a compulsory bicycle helmet law are other injury reducing measures suggested.

  3. Injury perceptions, hope for recovery, and psychological status after spinal cord injury.

    PubMed

    Krause, James S; Edles, Philip A

    2014-05-01

    The purpose of this study was to investigate the relationship of injury perceptions and hope for recovery with life satisfaction, purpose in life, and depressive symptoms measured during inpatient rehabilitation after spinal cord injury (SCI). Participants included adults hospitalized for SCI inpatient rehabilitation (N = 208), each of whom completed a modified version of the Illness Perception Questionnaire and three outcome measures: the Purpose in Life Scale, the Satisfaction with Life Scale, and the abbreviated version of the Patient Health Questionnaire. Principal components analysis indicated an SCI perceptions factor regarding severity, permanence, and cure control of SCI, and a second factor related to hope for recovery. Whereas hope for recovery was nearly universal, injury perceptions were more varied. Favorable injury perceptions of SCI were predictive of purpose in life, whereas hope for recovery was predictive of life satisfaction. Hope for recovery and favorable SCI perceptions were related to positive psychological outcomes during inpatient rehabilitation, although the strength of the relationship was limited. (c) 2014 APA, all rights reserved.

  4. Effects of child age and body size on serious injury from passenger air-bag presence in motor vehicle crashes.

    PubMed

    Newgard, Craig D; Lewis, Roger J

    2005-06-01

    Current recommendations regarding children traveling in passenger vehicles equipped with passenger air bags are based, in part, on evidence that the air-bag-related risk of injury and death is higher for children < or =12 years of age. However, the age or body size required to allow a child to be seated safely in front of a passenger air bag is unknown. To evaluate specific cutoff points for age, height, and weight as effect modifiers of the association between the presence of a passenger air bag and serious injury among children involved in motor vehicle crashes (MVCs), while controlling for important crash factors. A national population-based cohort of children involved in MVCs and included in the National Automotive Sampling System (NASS) Crashworthiness Data System (CDS) database from 1995 to 2002 was studied. NASS CDS clusters, strata, and weights were included in all analyses. Children 0 to 18 years of age involved in MVCs and seated in the right front passenger seat. Serious injury, defined as an Abbreviated Injury Scale score of > or =3 for any body region. A total of 3790 patients (1 month to 18 years of age) were represented in the NASS CDS database during the 8-year period. Sixty children (1.6%) were seriously injured (Abbreviated Injury Scale score of > or =3). Among age, height, and weight, age of 0 to 14 years (versus 15-18 years) was the only consistent effect modifier of the association between air-bag presence (or air-bag deployment) and serious injury, particularly for crashes with a moderate probability of injury. In analyses stratified according to age and adjusted for important crash factors, children 0 to 14 years of age involved in frontal collisions seemed to be at increased risk of serious injury from air-bag presence (odds ratio [OR]: 2.66; 95% confidence interval [CI]: 0.23-30.9) and deployment (OR: 6.13; 95% CI: 0.30-126), although these values did not reach statistical significance. Among children 15 to 18 years of age involved in

  5. Clinical Course Score (CCS): a new clinical score to evaluate efficacy of neurotrauma treatment in traumatic brain injury and subarachnoid hemorrhage.

    PubMed

    Brandner, Sebastian; Kellermann, Isabel; Hore, Nirjhar; Bozhkov, Yavor; Buchfelder, Michael

    2015-01-01

    Neurotrauma continues to represent a challenging public health issue requiring continual improvement in therapeutic approaches. As no such current system exists, we present in this study the Clinical Course Score (CCS) as a new clinical score to evaluate the efficacy of neurotrauma treatment. The CCS was calculated in neurotrauma patients to be the difference between the grade of the Glasgow Outcome Scale 6 months after discharge from our department and the grade of a 1 to 5 point reduced Glasgow Coma Scale on admission. We assessed the CCS in a total of 248 patients (196 traumatic brain injury [TBI] patients and 52 subarachnoid hemorrhage [SAH] patients) who were treated in our Department of Neurosurgery between January 2011 and December 2012. We found negative CCS grades both in mild TBI and in mild SAH patients. In patients with severe TBI or SAH, we found positive CCS grades. In SAH patients, we found higher CCS scores in younger patients compared with elderly subjects in both mild and severe cases. The CCS can be useful in evaluating different therapeutic approaches during neurotrauma therapy. This new score might improve assessment of beneficial effects of therapeutic procedures.

  6. Abbreviations used in publications of the United States Geological Survey

    USGS Publications Warehouse

    ,

    1953-01-01

    The use of abbreviations in publications of the Geological Survey is determined by several forces working in different directions. Pulling in the direction of greater condensation and the freer use of abbreviations and symbols is the desire to achieve greater economy in publications. Working in the opposite direction is the desire to have the publications used more conveniently by an increasingly heterogeneous public.

  7. Parafoveal and Foveal Processing of Abbreviations during Eye Fixations in Reading: Making a Case for Case

    ERIC Educational Resources Information Center

    Slattery, Timothy J.; Schotter, Elizabeth R.; Berry, Raymond W.; Rayner, Keith

    2011-01-01

    The processing of abbreviations in reading was examined with an eye movement experiment. Abbreviations were of 2 distinct types: acronyms (abbreviations that can be read with the normal grapheme-phoneme correspondence [GPC] rules, such as NASA) and initialisms (abbreviations in which the GPCs are letter names, such as NCAA). Parafoveal and foveal…

  8. The academic challenge of teaching psychomotor skills for hemostasis of solid organ injury.

    PubMed

    Lucas, Charles E; Ledgerwood, Anna M

    2009-03-01

    This study highlights the inherent challenges of achieving psychomotor skills in an era of nonoperative therapy for solid organ injuries. Technical procedures on the liver, the most frequent intra-abdominal solid organ injured, were assessed in five decades. Guided by prospective assessment and registry data, all patients with liver injury seen during 24 months in five consecutive decades were reviewed. Initially (1960s), all injuries were explored; currently (2000s), most injuries are observed. The number of patients was 235 (1960s), 228 (1970s), 79 (1980s), 116 (1990s), and 64 (2000s). The greater number in the 1990s reflects the diagnosis of minor, clinically insignificant, blunt injuries after abdominal CAT scan became available. Each injury was categorized by cause, severity (Abbreviated Injury Scale), associated shock, and primary therapy (observe [OBS], operation alone [OR], hepatorrhaphy [SUT], tractotomy [TRACT] with intraparenchymal hemostasis, hepatic dearterialization [HAL], and resection [RESECT]). Packing, used in each decade, was placed in one of the above primary treatment groups. The primary techniques for hemostasis are shown in the text table.Shock and Abbreviated Injury Scale correlated with mortality averaged 16%; 40 of 116 deaths (34%) exsanguinated from hepatic injury. During training, a resident performed an average of 12.0, 12.0, 2.4, 4.0, and 1.3 procedures for hemostasis. Reduced incidence and decreased therapeutic laparotomies for liver injury have created a training vacuum for future trauma surgeons. Surgical residents will need to supplement their clinical experience with solid organ hemostasis by practice on appropriate animal models of injury and cadaver dissections.

  9. The Abbreviation of Personality, or how to Measure 200 Personality Scales with 200 Items

    PubMed Central

    Yarkoni, Tal

    2010-01-01

    Personality researchers have recently advocated the use of very short personality inventories in order to minimize administration time. However, few such inventories are currently available. Here I introduce an automated method that can be used to abbreviate virtually any personality inventory with minimal effort. After validating the method against existing measures in Studies 1 and 2, a new 181-item inventory is generated in Study 3 that accurately recaptures scores on 8 different broadband inventories comprising 203 distinct scales. Collectively, the results validate a powerful new way to improve the efficiency of personality measurement in research settings. PMID:20419061

  10. New scoring system for intra-abdominal injury diagnosis after blunt trauma.

    PubMed

    Shojaee, Majid; Faridaalaee, Gholamreza; Yousefifard, Mahmoud; Yaseri, Mehdi; Arhami Dolatabadi, Ali; Sabzghabaei, Anita; Malekirastekenari, Ali

    2014-01-01

    An accurate scoring system for intra-abdominal injury (IAI) based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagnosis of IAI after blunt trauma. This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma (BAT) admitted to the emergency department (ED) of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient's history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chi-square test and logistic regression were done. Factors with significant relationship with CT scan were imported in multivariate regression models, where a coefficient (β) was given based on the contribution of each of them. Scoring system was developed based on the obtained total β of each factor. Altogether 261 patients (80.1% male) were enrolled (48 cases of IAI). A 24-point blunt abdominal trauma scoring system (BATSS) was developed. Patients were divided into three groups including low (score<8), moderate (8≤score<12) and high risk (score≥12). In high risk group immediate laparotomy should be done, moderate group needs further assessments, and low risk group should be kept under observation. Low risk patients did not show positive CT-scans (specificity 100%). Conversely, all high risk patients had positive CT-scan findings (sensitivity 100%). The receiver operating characteristic curve indicated a close relationship between the results of CT scan and BATSS (sensitivity=99.3%). The present scoring system furnishes a high precision and reproducible diagnostic tool for BAT

  11. Identification of vehicle components associated with severe thoracic injury in motor vehicle crashes: a CIREN and NASS analysis.

    PubMed

    Nirula, R; Pintar, F A

    2008-01-01

    Thoracic trauma secondary to motor vehicle crashes (MVC) continues to be a major cause of morbidity and mortality. Specific vehicle features may increase the risk of severe thoracic injury when striking the occupant. We sought to determine which vehicle contact points were associated with an increased risk of severe thoracic injury in MVC to focus subsequent design modifications necessary to reduce thoracic injury. The National Automotive Sampling System (NASS) databases from 1993 to 2001 and the Crash Injury Research and Engineering Network (CIREN) databases from 1996 to 2004 were analyzed separately using univariate and multivariate logistic regression stratified by restraint use and crash direction. The risk of driver thoracic injury, defined as an abbreviated injury scale (AIS) of score > or =3, was determined as it related to specific points of contact between the vehicle and the driver. The incidence of severe chest injury in NASS and CIREN were 5.5% and 33%, respectively. The steering wheel, door panel, armrest, and seat were identified as contact points associated with an increased risk of severe chest injury. The door panel and arm rest were consistently a frequent cause of severe injury in both the NASS and CIREN data. Several vehicle contact points, including the steering wheel, door panel, armrest and seat are associated with an increased risk of severe thoracic injury when striking the occupant. These elements need to be further investigated to determine which characteristics need to be manipulated in order to reduce thoracic trauma during a crash.

  12. A Comparative Study of Glasgow Coma Scale and Full Outline of Unresponsiveness Scores for Predicting Long-Term Outcome After Brain Injury.

    PubMed

    McNett, Molly M; Amato, Shelly; Philippbar, Sue Ann

    2016-01-01

    The aim of this study was to compare predictive ability of hospital Glasgow Coma Scale (GCS) scores and scores obtained using a novel coma scoring tool (the Full Outline of Unresponsiveness [FOUR] scale) on long-term outcomes among patients with traumatic brain injury. Preliminary research of the FOUR scale suggests that it is comparable with GCS for predicting mortality and functional outcome at hospital discharge. No research has investigated relationships between coma scores and outcome 12 months postinjury. This is a prospective cohort study. Data were gathered on adult patients with traumatic brain injury admitted to urban level I trauma center. GCS and FOUR scores were assigned at 24 and 72 hours and at hospital discharge. Glasgow Outcome Scale scores were assigned at 6 and 12 months. The sample size was n = 107. Mean age was 53.5 (SD = ±21, range = 18-91) years. Spearman correlations were comparable and strongest among discharge GCS and FOUR scores and 12-month outcome (r = .73, p < .000; r = .72, p < .000). Multivariate regression models indicate that age and discharge GCS were the strongest predictors of outcome. Areas under the curve were similar for GCS and FOUR scores, with discharge scores occupying the largest areas. GCS and FOUR scores were comparable in bivariate associations with long-term outcome. Discharge coma scores performed best for both tools, with GCS discharge scores predictive in multivariate models.

  13. Open-access programs for injury categorization using ICD-9 or ICD-10.

    PubMed

    Clark, David E; Black, Adam W; Skavdahl, David H; Hallagan, Lee D

    2018-04-09

    The article introduces Programs for Injury Categorization, using the International Classification of Diseases (ICD) and R statistical software (ICDPIC-R). Starting with ICD-8, methods have been described to map injury diagnosis codes to severity scores, especially the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS). ICDPIC was originally developed for this purpose using Stata, and ICDPIC-R is an open-access update that accepts both ICD-9 and ICD-10 codes. Data were obtained from the National Trauma Data Bank (NTDB), Admission Year 2015. ICDPIC-R derives CDC injury mechanism categories and an approximate ISS ("RISS") from either ICD-9 or ICD-10 codes. For ICD-9-coded cases, RISS is derived similar to the Stata package (with some improvements reflecting user feedback). For ICD-10-coded cases, RISS may be calculated in several ways: The "GEM" methods convert ICD-10 to ICD-9 (using General Equivalence Mapping tables from CMS) and then calculate ISS with options similar to the Stata package; a "ROCmax" method calculates RISS directly from ICD-10 codes, based on diagnosis-specific mortality in the NTDB, maximizing the C-statistic for predicting NTDB mortality while attempting to minimize the difference between RISS and ISS submitted by NTDB registrars (ISSAIS). Findings were validated using data from the National Inpatient Survey (NIS, 2015). NTDB contained 917,865 cases, of which 86,878 had valid ICD-10 injury codes. For a random 100,000 ICD-9-coded cases in NTDB, RISS using the GEM methods was nearly identical to ISS calculated by the Stata version, which has been previously validated. For ICD-10-coded cases in NTDB, categorized ISS using any version of RISS was similar to ISSAIS; for both NTDB and NIS cases, increasing ISS was associated with increasing mortality. Prediction of NTDB mortality was associated with C-statistics of 0.81 for ISSAIS, 0.75 for RISS using the GEM methods, and 0.85 for RISS using the ROCmax method; prediction of NIS mortality

  14. Automatic Word Sense Disambiguation of Acronyms and Abbreviations in Clinical Texts

    ERIC Educational Resources Information Center

    Moon, Sungrim

    2012-01-01

    The use of acronyms and abbreviations is increasing profoundly in the clinical domain in large part due to the greater adoption of electronic health record (EHR) systems and increased electronic documentation within healthcare. A single acronym or abbreviation may have multiple different meanings or senses. Comprehending the proper meaning of an…

  15. Comparing the predictive value of the pelvic ring injury classification systems by Tile and by Young and Burgess.

    PubMed

    Osterhoff, Georg; Scheyerer, Max J; Fritz, Yannick; Bouaicha, Samy; Wanner, Guido A; Simmen, Hans-Peter; Werner, Clément M L

    2014-04-01

    Radiology-based classifications of pelvic ring injuries and their relevance for the prognosis of morbidity and mortality are disputed in the literature. The purpose of this study was to evaluate potential differences between the pelvic ring injury classification systems by Tile and by Young and Burgess with regard to their predictive value on mortality, transfusion/infusion requirement and concomitant injuries. Two-hundred-and-eighty-five consecutive patients with pelvic ring fractures were analyzed for mortality within 30 days after admission, number of blood units and total volume of fluid infused during the first 24h after trauma, the Abbreviated Injury Severity (AIS) scores for head, chest, spine, abdomen and extremities as a function of the Tile and the Young-Burgess classifications. There was no significant relationship between occurrence of death and fracture pattern but a significant relationship between fracture pattern and need for blood units/total fluid volume for Tile (p<.001/p<.001) and Young-Burgess (p<.001/p<.001). In both classifications, open book fractures were associated with more fluid requirement and more severe injuries of the abdomen, spine and extremities (p<.05). When divided into the larger subgroups "partially stable" and "unstable", unstable fractures were associated with a higher mortality rate in the Young-Burgess system (p=.036). In both classifications, patients with unstable fractures required significantly more blood transfusions (p<.001) and total fluid infusion (p<.001) and higher AIS scores. In this first direct comparison of both classifications, we found no clinical relevant differences with regard to their predictive value on mortality, transfusion/infusion requirement and concomitant injuries. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Changing paradigms in the management of 2184 patients with traumatic brain injury.

    PubMed

    Joseph, Bellal; Haider, Ansab A; Pandit, Viraj; Tang, Andrew; Kulvatunyou, Narong; OʼKeeffe, Terence; Rhee, Peter

    2015-09-01

    The aim of this study was to assess the change in trends in the management of traumatic brain injury (TBI) at a level I trauma center and the utilization of resources as a result of this change in management. The management of TBI has been evolving with trends toward management of minimally injured patients with intracranial hemorrhage exclusively by trauma surgeons. A 5-year (2009-2014) prospective database on all patients with TBI (skull fracture/intracranial hemorrhage on head computed tomography) presenting to a level I trauma center was analyzed for patient demographics, injuries, admission physiology, computed tomographic scan results, and hospital outcomes. These records were matched to the institutional registry and hospital financial database. A total of 2184 patients were included with median (interquartile range) Glasgow Coma Scale score of 15 (12-15), and median (interquartile range) head-abbreviated injury scale score of 3 (2-4). The distribution of types and size of intracranial bleeds remained unchanged throughout the study period. The proportion of TBI managed exclusively by trauma surgeons increased significantly over the years from 6.8% to 40.1% (P < 0.001). Proportion of patients who received neurosurgical consultations (P < 0.001) and repeat head computed tomographic scans (P < 0.001), hospital length of stay (P = 0.028), and costs (P < 0.001) decreased significantly over time. The overall mortality rate (18.5%) and rate of intervention (14.1%) remained unchanged. TBI patients can be selectively managed without initially involving neurosurgeons safely in a cost-effective manner, resulting in more effective use of precious resources.

  17. Multicenter Retrospective Cohort Study of "Talk and Die" After Traumatic Brain Injury.

    PubMed

    Shibahashi, Keita; Sugiyama, Kazuhiro; Okura, Yoshihiro; Hoda, Hidenori; Hamabe, Yuichi

    2017-11-01

    Patients who "talk and die" after traumatic brain injury (TBI) are potentially salvageable. The reported incidences and risk factors for the "talk and die" phenomenon are conflicting and do not take into account recent improvements in trauma care. The aim of this study was to determine the incidences of "talk and die" after TBI in a modern trauma care system, as well as associated risk factors. We identified patients who experienced TBI (abbreviated injury scale 3-5) between 2004 and 2015 who talked on admission (i.e., their verbal component on the Glasgow Coma Scale was ≥3 on admission) using a nationwide trauma registry (the Japan Trauma Data Bank). The end point was in-hospital mortality. We compared patients who talked and died with those who talked and survived. During the study period, 236,698 patients were registered in the database. Of the 24,833 patients who were eligible for analysis, 956 (4.0%) patients subsequently died in the hospital. The in-hospital mortality rate significantly decreased over the past 12 years. Older age; male sex; a higher injury severity score; a lower Glasgow Coma Scale score; comorbidities (congestive heart failure, chronic kidney disease, liver cirrhosis, and hematologic disorders); hypotension on arrival; subdural hemorrhage; contusion; and vault fracture were independently associated with higher in-hospital mortality. Even in modern trauma care systems, some patients still talk and die after TBI. We identified certain risk factors in patients with TBI that elicit the requirement for close observation, even if these patients talk after TBI. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. The risk assessment score in acute whiplash injury predicts outcome and reflects biopsychosocial factors.

    PubMed

    Kasch, Helge; Qerama, Erisela; Kongsted, Alice; Bach, Flemming W; Bendix, Tom; Jensen, Troels S

    2011-12-01

    One-year prospective study of 141 acute whiplash patients (WLP) and 40 acute ankle-injured controls. This study investigates a priori determined potential risk factors to develop a risk assessment tool, for which the expediency was examined. The whiplash-associated disorders (WAD) grading system that emerged from The Quebec Task-Force-on-Whiplash has been of limited value for predicting work-related recovery and for explaining biopsychosocial disability after whiplash and new predictive factors, for example, risk criteria that comprehensively differentiate acute WLP in a biopsychosocial manner are needed. Consecutively, 141 acute WLP and 40 ankle-injured recruited from emergency units were examined after 1 week, 1, 3, 6, and 12 months obtaining neck/head visual analog scale score, number of nonpainful complaints, epidemiological, social, psychological data and neurological examination, active neck mobility, and furthermore muscle tenderness and pain response, and strength and duration of neck muscles. Risk factors derived (reduced cervical range of motion, intense neck pain/headache, multiple nonpain complaints) were applied in a risk assessment score and divided into seven risk strata. A receiver operating characteristics curve for the Risk Assessment Score and 1-year work disability showed an area of 0.90. Risk strata and number of sick days showed a log-linear relationship. In stratum 1 full recovery was encountered, but for high-risk patients in stratum 6 only 50% and 7 only 20% had returned to work after 1 year (P < 5.4 × 10). Strength measures, psychophysical pain measurements, and psychological and social data (reported elsewhere) showed significant relation to risk strata. The Risk Assessment score is suggested as a valuable tool for grading WLP early after injury. It has reasonable screening power for encountering work disability and reflects the biopsychosocial nature of whiplash injuries.

  19. Unregulated proliferation of trauma centers undermines cost efficiency of population-based injury control.

    PubMed

    Tepas, Joseph J; Kerwin, Andrew J; Ra, Jin Hee

    2014-03-01

    We evaluated the impact on coverage and regional cost of trauma care produced by the activation of a Level II center with no preceding needs analysis in an established trauma region with a Level I center. Patient deidentified trauma registry data for years 2010, 2011, and 2012 were analyzed to assess the effect on trauma service volume during a period at the midpoint of which the Level II center was activated. Trends for each year were evaluated by patient volume, mechanism, resource use as reflected in a transfer to the intensive care unit (ICU) and ICU stay, patient severity as defined by Injury Severity Score (ISS), and patient injury profile determined by mean body region Abbreviated Injury Scale (AIS) score. Between 2010 and 2011, during which the Level II opened, overall volume at the Level I center dropped by 3.7%, and blunt volume remained unchanged. From 2011 to 2012, overall Level I volume dropped by 9.4%, and blunt injury fell by 14%. Proportions requiring immediate operating room or ICU care did not change. ISS distribution at the Level I center across the years was similar. Head, chest, and abdominal injuries, as assessed by AIS body region, increased slightly in severity and decreased in volume by 25%, 17%, and 18%, respectively. For 2012, the new center publically reported treating 1,100 patients, which, in concert with the Level I decrease, translates to increasing regional trauma center access by 25% while increasing expense of necessary core personnel by 217%. Addition of a second trauma center in a stable region, in which injury incidence was actually decreasing, doubled the cost of personnel, one of the most expensive components of the trauma system and decreased the volume of injuries necessary for training and education. Trauma system expansion must be based on needs assessment, which assures system survival and controls societal cost. Economic & value-based evaluation, level III.

  20. A Factor Analysis of Functional Independence and Functional Assessment Measure Scores Among Focal and Diffuse Brain Injury Patients: The Importance of Bifactor Models.

    PubMed

    Gunn, Sarah; Burgess, Gerald H; Maltby, John

    2018-04-30

    To explore the factor structure of the UK Functional Independence Measure and Functional Assessment Measure (FIM+FAM) among focal and diffuse acquired brain injury patients. Criterion standard. A National Health Service acute acquired brain injury inpatient rehabilitation hospital. Referred sample of N=447 adults admitted for inpatient treatment following an acquired brain injury significant enough to justify intensive inpatient neurorehabilitation INTERVENTION: Not applicable. Functional Independence Measure and Functional Assessment Measure. Exploratory factor analysis suggested a 2-factor structure to FIM+FAM scores, among both focal-proximate and diffuse-proximate acquired brain injury aetiologies. Confirmatory factor analysis suggested a 3-factor bifactor structure presented the best fit of the FIM+FAM score data across both aetiologies. However, across both analyses, a convergence was found towards a general factor, demonstrated by high correlations between factors in the exploratory factor analysis, and by a general factor explaining the majority of the variance in scores on confirmatory factor analysis. Our findings suggested that although factors describing specific functional domains can be derived from FIM+FAM item scores, there is a convergence towards a single factor describing overall functioning. This single factor informs the specific group factors (eg, motor, psychosocial, and communication function) after brain injury. Further research into the comparative value of the general and group factors as evaluative/prognostic measures is indicated. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  1. Cervical spine injuries, mechanisms, stability and AIS scores from vertical loading applied to military environments.

    PubMed

    Yoganandan, Narayan; Pintar, Frank A; Humm, John R; Maiman, Dennis J; Voo, Liming; Merkle, Andrew

    2016-07-01

    The purpose of this study was to determine injuries to osteo-ligamentous structures of cervical column, mechanisms, forces, severities and AIS scores from vertical accelerative loading. Seven human cadaver head-neck complexes (56.9 ± 9.5 years) were aligned based on seated the posture of military soldiers. Army combat helmets were used. Specimens were attached to a vertical accelerator to apply caudo-cephalad g-forces. They were accelerated with increasing insults. Intermittent palpation and radiography were done. A roof structure mimicking military vehicle interior was introduced after a series of tests and experiments were conducted following similar protocols. Upon injury detection, CT and dissection were done. Temporal force responses were extracted, peak forces and times of occurrence were obtained, injury severities were graded, and spine stability was determined. Injuries occurred in tests only when the roof structure was included. Responses were tri-phasic: initial thrust, secondary tensile, tertiary roof contact phases. Peak forces: 1364-4382 N, initial thrust, 165-169 N, secondary tensile, 868-3368 N tertiary helmet-head roof contact phases. Times of attainments: 5.3-9.6, 31.7-42.6, 55.0-70.8 ms. Injuries included fractures and joint disruptions. Multiple injuries occurred in all but one specimen. A majority of injury severities were AIS = 2. Spines were considered unstable in a majority of cases. Spine response was tri-phasic. Injuries occurred in roof contact tests with the helmeted head-neck specimen. Multiplicity and unstable nature of AIS = 2 level injuries, albeit at lower severities, might predispose the spine to long-term accelerated degenerative changes. Clinical protocols should include a careful evaluation of sub-catastrophic injuries in military patients.

  2. Developing Methodologies to Find Abbreviated Laboratory Test Names in Narrative Clinical Documents by Generating High Quality Q-Grams.

    PubMed

    Kim, Kyungmo; Choi, Jinwook

    2017-01-01

    Laboratory test names are used as basic information to diagnose diseases. However, this kind of medical information is usually written in a natural language. To find this information, lexicon based methods have been good solutions but they cannot find terms that do not have abbreviated expressions, such as "neuts" that means "neutrophils". To address this issue, similar word matching can be used; however, it can be disadvantageous because of significant false positives. Moreover, processing time is longer as the size of terms is bigger. Therefore, we suggest a novel q-gram based algorithm, named modified triangular area filtering, to find abbreviated laboratory test terms in clinical documents, minimizing the possibility to impair the lexicons' precision. In addition, we found the terms using the methodology with reasonable processing time. The results show that this method can achieve 92.54 precision, 87.72 recall, 90.06 f1-score in test sets when edit distance threshold(τ) = 3.

  3. Effects of special exercise programs on functional movement screen scores and injury prevention in preprofessional young football players.

    PubMed

    Dinc, Engin; Kilinc, Bekir Eray; Bulat, Muge; Erten, Yunus Turgay; Bayraktar, Bülent

    2017-10-01

    To increase movement capacity and to reduce injury risk in young soccer players by implementing a special functional exercise program based on functional movement screen (FMS) and correctives. 67 young male athletes 14-19 years of age from a Super League Football Club Academy participated in the study. Functional movement patterns were evaluated with FMS assessment protocol. Deep squat, hurdle step, inline lunge, shoulder mobility, active straight leg raise, trunk stability push-up, and rotatory stability were examined in FMS. Considering the FMS scores the number of intervention and control groups were defined as 24 and 43, respectively. Intervention program was composed of 1 hr twice a week sessions in total of 12 weeks with 4 weeks of mobility, 4 weeks of stability, and 4 weeks of integration exercises. At the end of 12-week intervention and control groups were re-evaluated with FMS protocol. Contact and noncontact sports injuries recorded during one season. In intervention group there was statistically significant difference in increase in total FMS scores ( P <0.01), deep squat ( P ≤0.001), hurdle step ( P <0.05), inline lunge ( P <0.01), and trunk stability push-up ( P <0.01). In control group total FMS, deep squat, and trunk stability push-up scores increased with a statistical difference ( P <0.01, P <0.05, P ≤0.01, respectively). The incidence of noncontact injury in control group was higher than intervention group ( P <0.05). Periodic movement screening and proper corrections with functional training is valuable in order to create better movement capacity to build better physical performance and more effective injury prevention.

  4. Genitourinary injuries after traffic accidents: Analysis of a registry of 162,690 victims.

    PubMed

    Terrier, Jean-Etienne; Paparel, Philippe; Gadegbeku, Blandine; Ruffion, Alain; Jenkins, Lawrence C; N'Diaye, Amina

    2017-06-01

    Traffic accidents are the most frequent cause of genitourinary injuries (GUI). Kidney injuries after trauma have been well described. However, there exists a paucity of data on other traumatic GUI after traffic accidents. The objective of this study was to analyze the frequency and type of all GUI, by user category, after traffic accidents. Patient cases were extracted from the trauma registry of the French department of Rhone from 1996 to 2013. We assessed the urogenital injuries presented by each of road user's categories. Severity injuries were coded with the Abbreviated Injury Scale and the Injury Severity Score. Kidney trauma was mapped with the classification of the American Association for the Surgery of Trauma. Multivariate prediction models were used for analysis of data. Of 162,690 victims, 963 presented with GUI (0.59%). 47% were motorcyclists, 22% were in a car, 18% on bicycles, and 9% were pedestrians. The most common organ injury was kidney (41%) followed by testicular (23%). Among the 208 motorists with a GUI, kidney (70%), bladder (10%), and adrenal gland (9%) were the most frequent lesions. Among the 453 motorcyclist victims with GUI, kidney (35%) and testicular (38%) traumas were the most frequent and 62% of injuries involved external genitalia. There were 175 cyclists with GUI, 70% of injuries involved external genitalia; penile traumas (23%) were the most frequent. In total, there were 395 kidney injuries, most being low grade. According to the American Association for the Surgery of Trauma kidney injuries were grade I, 59%; grade II, 11%; grade III, 16%; grade IV, 9%; grade V, 3%; and indeterminate, 2%. GUI is an infrequent trauma after traffic accidents, with kidneys being the most commonly injured. Physicians must maintain a high awareness for external genitalia injuries in motorcyclists and cyclists. Prognostic and epidemiologic study, level III.

  5. Polytrauma Defined by the New Berlin Definition: A Validation Test Based on Propensity-Score Matching Approach.

    PubMed

    Rau, Cheng-Shyuan; Wu, Shao-Chun; Kuo, Pao-Jen; Chen, Yi-Chun; Chien, Peng-Chen; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua

    2017-09-11

    Background: Polytrauma patients are expected to have a higher risk of mortality than that obtained by the summation of expected mortality owing to their individual injuries. This study was designed to investigate the outcome of patients with polytrauma, which was defined using the new Berlin definition, as cases with an Abbreviated Injury Scale (AIS) ≥ 3 for two or more different body regions and one or more additional variables from five physiologic parameters (hypotension [systolic blood pressure ≤ 90 mmHg], unconsciousness [Glasgow Coma Scale score ≤ 8], acidosis [base excess ≤ -6.0], coagulopathy [partial thromboplastin time ≥ 40 s or international normalized ratio ≥ 1.4], and age [≥70 years]). Methods: We retrieved detailed data on 369 polytrauma patients and 1260 non-polytrauma patients with an overall Injury Severity Score (ISS) ≥ 18 who were hospitalized between 1 January 2009 and 31 December 2015 for the treatment of all traumatic injuries, from the Trauma Registry System at a level I trauma center. Patients with burn injury or incomplete registered data were excluded. Categorical data were compared with two-sided Fisher exact or Pearson chi-square tests. The unpaired Student t -test and the Mann-Whitney U -test was used to analyze normally distributed continuous data and non-normally distributed data, respectively. Propensity-score matched cohort in a 1:1 ratio was allocated using the NCSS software with logistic regression to evaluate the effect of polytrauma on patient outcomes. Results: The polytrauma patients had a significantly higher ISS than non-polytrauma patients (median (interquartile range Q1-Q3), 29 (22-36) vs. 24 (20-25), respectively; p < 0.001). Polytrauma patients had a 1.9-fold higher odds of mortality than non-polytrauma patients (95% CI 1.38-2.49; p < 0.001). Compared to non-polytrauma patients, polytrauma patients had a substantially longer hospital length of stay (LOS). In addition, a higher proportion of polytrauma

  6. Osmolar Therapy in Pediatric Traumatic Brain Injury

    PubMed Central

    Bennett, Tellen D.; Statler, Kimberly D.; Korgenski, E. Kent; Bratton, Susan L.

    2011-01-01

    Objectives To describe patterns of use for mannitol and hypertonic saline in children with traumatic brain injury (TBI), to evaluate any potential associations between hypertonic saline and mannitol use and patient demographic, injury, and treatment hospital characteristics, and to determine if the 2003 guidelines for severe pediatric TBI impacted clinical practice regarding osmolar therapy. Design Retrospective cohort study Setting Pediatric Health Information System (PHIS) database, January, 2001 to December, 2008 Patients Children (age < 18 years) with TBI and head/neck Abbreviated Injury Scale (AIS) score ≥ 3 who received mechanical ventilation and intensive care Interventions None Measurements and Main Results The primary outcome was hospital billing for parenteral hypertonic saline and mannitol use, by day of service. Overall, 33% (2,069 of 6,238) of the patients received hypertonic saline and 40% (2,500 of 6,238) received mannitol. Of the 1,854 patients who received hypertonic saline or mannitol for ≥ 2 days in the first week of therapy, 29% did not have ICP monitoring. After adjustment for hospital-level variation, primary insurance payer, and overall injury severity, use of both drugs was independently associated with older patient age, intracranial hemorrhage (other than epidural), skull fracture, and higher head/neck injury severity. Hypertonic saline use increased and mannitol use decreased with publication of the 2003 guidelines, and these trends continued through 2008. Conclusions Hypertonic saline and mannitol are used less in infants than in older children. The patient-level and hospital-level variation in osmolar therapy use and the substantial amount of sustained osmolar therapy without ICP monitoring suggest opportunities to improve the quality of pediatric TBI care. With limited high-quality evidence available, published expert guidelines appear to significantly impact clinical practice in this area. PMID:21926592

  7. An Evaluation of the Euroncap Crash Test Safety Ratings in the Real World

    PubMed Central

    Segui-Gomez, Maria; Lopez-Valdes, Francisco J.; Frampton, Richard

    2007-01-01

    We investigated whether the rating obtained in the EuroNCAP test procedures correlates with injury protection to vehicle occupants in real crashes using data in the UK Cooperative Crash Injury Study (CCIS) database from 1996 to 2005. Multivariate Poisson regression models were developed, using the Abbreviated Injury Scale (AIS) score by body region as the dependent variable and the EuroNCAP score for that particular body region, seat belt use, mass ratio and Equivalent Test Speed (ETS) as independent variables. Our models identified statistically significant relationships between injury severity and safety belt use, mass ratio and ETS. We could not identify any statistically significant relationships between the EuroNCAP body region scores and real injury outcome except for the protection to pelvis-femur-knee in frontal impacts where scoring “green” is significantly better than scoring “yellow” or “red”.

  8. Update of the trauma risk adjustment model of the TraumaRegister DGU™: the Revised Injury Severity Classification, version II.

    PubMed

    Lefering, Rolf; Huber-Wagner, Stefan; Nienaber, Ulrike; Maegele, Marc; Bouillon, Bertil

    2014-09-05

    The TraumaRegister DGU™ (TR-DGU) has used the Revised Injury Severity Classification (RISC) score for outcome adjustment since 2003. In recent years, however, the observed mortality rate has fallen to about 2% below the prognosis, and it was felt that further prognostic factors, like pupil size and reaction, should be included as well. Finally, an increasing number of cases did not receive a RISC prognosis due to the missing values. Therefore, there was a need for an updated model for risk of death prediction in severely injured patients to be developed and validated using the most recent data. The TR-DGU has been collecting data from severely injured patients since 1993. All injuries are coded according to the Abbreviated Injury Scale (AIS, version 2008). Severely injured patients from Europe (ISS ≥ 4) documented between 2010 and 2011 were selected for developing the new score (n = 30,866), and 21,918 patients from 2012 were used for validation. Age and injury codes were required, and transferred patients were excluded. Logistic regression analysis was applied with hospital mortality as the dependent variable. Results were evaluated in terms of discrimination (area under the receiver operating characteristic curve, AUC), precision (observed versus predicted mortality), and calibration (Hosmer-Lemeshow goodness-of-fit statistic). The mean age of the development population was 47.3 years; 71.6% were males, and the average ISS was 19.3 points. Hospital mortality rate was 11.5% in this group. The new RISC II model consists of the following predictors: worst and second-worst injury (AIS severity level), head injury, age, sex, pupil reactivity and size, pre-injury health status, blood pressure, acidosis (base deficit), coagulation, haemoglobin, and cardiopulmonary resuscitation. Missing values are included as a separate category for every variable. In the development and the validation dataset, the new RISC II outperformed the original RISC score, for example AUC in

  9. Preseason Functional Test Scores Are Associated With Future Sports Injury in Female Collegiate Athletes.

    PubMed

    Brumitt, Jason; Heiderscheit, Bryan C; Manske, Robert C; Niemuth, Paul E; Mattocks, Alma; Rauh, Mitchell J

    2018-06-01

    Brumitt, J, Heiderscheit, B, Manske, R, Niemuth, PE, Mattocks, A, and Rauh, MJ. Preseason functional test scores are associated with future sports injury in female collegiate athletes. J Strength Cond Res 32(6): 1692-1701, 2018-Recent prospective cohort studies have reported preseason functional performance test (FPT) measures and associations with future risk of injury; however, the findings associated with these studies have been equivocal. The purpose of this study was to determine the ability of a battery of FPTs as a preseason screening tool to identify female Division III (D III) collegiate athletes who may be at risk for a noncontact time-loss injury to the lower quadrant (LQ = low back and lower extremities). One hundred six female D III athletes were recruited for this study. Athletes performed 3 FPTs: standing long jump (SLJ), single-leg hop (SLH) for distance, and the lower extremity functional test (LEFT). Time-loss sport-related injuries were tracked during the season. Thirty-two (24 initial and 8 subsequent) time-loss LQ injuries were sustained during the study. Ten of the 24 initial injuries occurred at the thigh and knee. At-risk athletes with suboptimal FPT measures (SLJ ≤79% ht; (B) SLH ≤64% ht; LEFT ≥118 seconds) had significantly greater rates of initial (7.2 per 1,000 athletic exposures [AEs]) and total (7.6 per 1,000 AEs) time-loss thigh or knee injuries than the referent group (0.9 per 1,000 AEs; 1.0 per 1,000 AEs, respectively). At-risk athletes were 9 times more likely to experience a thigh or knee injury (odds ratio [OR] = 9.7, confidence interval [CI]: 2.3-39.9; p = 0.002) than athletes in the referent group. At-risk athletes with a history of LQ sports injury and lower off-season training habits had an 18-fold increased risk of a time-loss thigh or knee injury during the season (adjusted OR = 18.7, CI: 3.0-118.1; p = 0.002). This battery of FPTs appears useful as a tool for identifying female D III athletes at risk of an LQ injury

  10. Advantages of using an abbreviated dossier for drug master file applications in Taiwan.

    PubMed

    Sun, I-Chen

    2016-10-01

    In Taiwan, the quality of active pharmaceutical ingredients is recorded in a drug master file (DMF), the applications for which can be submitted in two dossier types, either full (complete technical information) or abbreviated (partially complete technical information with an approved document issued by developed countries). However, the advantages of the abbreviated approach remain unknown. This study compared full and abbreviated dossier profiles and reviewed their outcomes in acceptance rates and deficiencies leading to rejection. Data were collected from new submissions of both dossier types that were completed in 2014 by the Center for Drug Evaluation, Taiwan. The results revealed that the abbreviated applications took shorter review time and had a higher acceptance rate. Among the eligible types of document for abbreviated applications, Certification of Suitability to the Monographs of the European Pharmacopeia (CEP) was the most frequently used. For categorical deficiencies, both dossier types presented the deficiencies in similar sections leading to rejection, namely Manufacture (3.2.S.2), Control of drug substance (3.2.S.4), and Stability (3.2.S.7). In summary, CEP serves a favorable document for the abbreviated DMF application in which it shortens the review time, increases the acceptance rate, and its deficiencies are similar to those of the full DMF application. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. 40 CFR 1042.905 - Symbols, acronyms, and abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... symbols, acronyms, and abbreviations apply to this part: ABTAveraging, banking, and trading. AECDauxiliary.... cylcylinder. disp.displacement. ECAEmission Control Area. EEZExclusive Economic Zone. EPAEnvironmental...

  12. 40 CFR 600.303-77 - Abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Abbreviations. 600.303-77 Section 600.303-77 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) ENERGY POLICY FUEL ECONOMY AND CARBON-RELATED EXHAUST EMISSIONS OF MOTOR VEHICLES Fuel Economy Regulations for 1977 and Later...

  13. 40 CFR 600.003-77 - Abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Abbreviations. 600.003-77 Section 600.003-77 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) ENERGY POLICY FUEL ECONOMY AND CARBON-RELATED EXHAUST EMISSIONS OF MOTOR VEHICLES Fuel Economy Regulations for 1977 and Later...

  14. 40 CFR 600.103-78 - Abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Abbreviations. 600.103-78 Section 600.103-78 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) ENERGY POLICY FUEL ECONOMY AND CARBON-RELATED EXHAUST EMISSIONS OF MOTOR VEHICLES Fuel Economy Regulations for 1978 and Later...

  15. 21 CFR 1002.12 - Abbreviated reports.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Abbreviated reports. 1002.12 Section 1002.12 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) RADIOLOGICAL HEALTH RECORDS AND REPORTS Required Manufacturers' Reports for Listed Electronic Products § 1002...

  16. Correlation between standardized assessment of concussion scores and small-world brain network in mild traumatic brain injury.

    PubMed

    Yan, Yan; Song, Jian; Xu, Guozheng; Yao, Shun; Cao, Chenglong; Li, Chang; Peng, Guibao; Du, Hao

    2017-10-01

    This study investigated the characteristics of the small-world brain network architecture of patients with mild traumatic brain injury (MTBI), and a correlation between brain functional connectivity network properties in the resting-state fMRI and Standardized Assessment of Concussion (SAC) parameters. The neurological conditions of 22 MTBI patients and 17 normal control individuals were evaluated according to the SAC. Resting-state fMRI was performed in all subjects 3 and 7days after injury respectively. After preprocessing the fMRI data, cortex functional regions were marked using AAL90 and Dosenbach160 templates. The small-world network parameters and areas under the integral curves were computed in the range of sparsity from 0.01 to 0.5. Independent-sample t-tests were used to compare these parameters between the MTBI and control group. Significantly different parameters were investigated for correlations with SAC scores; those that correlated were chosen for further curve fitting. The clustering coefficient, the communication efficiency across in local networks, and the strength of connectivity were all higher in MTBI patients relative to control individuals. Parameters in 160 brain regions of the MTBI group significantly correlated with total SAC score and score for attention; the network parameters may be a quadratic function of attention scores of SAC and a cubic function of SAC scores. MTBI patients were characterized by elevated communication efficiency across global brain regions, and in local networks, and strength of mean connectivity. These features may be associated with brain function compensation. The network parameters significantly correlated with SAC total and attention scores. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Predicting patients that require care at a trauma center: analysis of injuries and other factors.

    PubMed

    Schoell, Samantha L; Doud, Andrea N; Weaver, Ashley A; Barnard, Ryan T; Meredith, J Wayne; Stitzel, Joel D; Martin, R Shayn

    2015-04-01

    The detection of occult or unpredictable injuries in motor vehicle crashes (MVCs) is crucial in correctly triaging patients and thus reducing fatalities. The purpose of the study was to develop a metric that indicates the likelihood that an injury sustained in a MVC would require management at a Level I/II trauma centre (TC) versus a non-trauma centre (non-TC). Transfer Scores (TSs) were computed for 240 injuries that comprise the top 95% most frequently occurring injuries in the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) with an Abbreviated Injury Scale (AIS) severity of 2 or greater. A TS for each injury was computed using the proportions of patients involved in a MVC from the National Inpatient Sample (NIS) that were transferred to a TC or managed at a non-TC. Similarly, a TSMAIS that excludes patients with higher severity co-injuries was calculated using the proportion of patients with a maximum AIS (MAIS) equal to the AIS severity of a given injury. The results indicated for injuries of a given AIS severity, body region, and injury type, there were large variations in the TSMAIS. Overall results demonstrated higher TSMAIS values when injuries were internal, haemorrhagic, intracranial or of moderate severity (AIS 3-5). Specifically, injuries to the head possessed a TSMAIS that ranged from 0.000 to 0.889, with head injuries of AIS 3-5 severities being the most likely to be transferred. The analysis indicated that the TSMAIS is not solely correlated with AIS severity and therefore it captures other important aspects of injury such as predictability and trauma system capabilities. The TS and TSMAIS can be useful in advanced automatic crash notification (AACN) research for the detection of highly unpredictable injuries in MVCs that require direct transport to a TC. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. The association of weight percentile and motor vehicle crash injury among 3 to 8 year old children.

    PubMed

    Zonfrillo, Mark R; Nelson, Kyle A; Durbin, Dennis R; Kallan, Michael J

    2010-01-01

    The use of age-appropriate child restraint systems significantly reduces injury and death associated with motor vehicle crashes (MVCs). Pediatric obesity has become a global epidemic. Although recent evidence suggests a possible association between pediatric obesity and MVC-related injury, there are potential misclassifications of body mass index from under-estimated height in younger children. Given this limitation, age- and sex-specific weight percentiles can be used as a proxy of weight status. The specific aim of this study was to determine the association between weight percentile and the risk of significant injury for children 3-8 years in MVCs. This was a cross-sectional study of children aged 3-8 years in MVCs in 16 US states, with data collected via insurance claims records and a telephone survey from 12/1/98-11/30/07. Parent-reported injuries with an abbreviated Injury Scale (AIS) score of 2+ indicated a clinically significant injury. Age- and sex-specific weight percentiles were calculated using pediatric norms. The study sample included 9,327 children aged 3-8 years (weighted to represent 157,878 children), of which 0.96% sustained clinically significant injuries. There was no association between weight percentiles and overall injury when adjusting for restraint type (p=0.71). However, increasing weight percentiles were associated with lower extremity injuries at a level that approached significance (p=0.053). Further research is necessary to describe mechanisms for weight-related differences in injury risk. Parents should continue to properly restrain their children in accordance with published guidelines.

  19. Clinical Trials Network / Building Infrastructure to Accelerate Transfer of Basic Research in Spinal Cord Injury (SCI) to Clinical Practice

    DTIC Science & Technology

    2015-05-01

    Glasgow Coma Scale (GCS) and of associated injuries with the Abbreviated Injury Scale . The American Spinal Injury Association impairment scale (AIS) is...registry protocol includes: the AIS Impairment Scale , and where appropriate, the Functional Independence Measure FIM™, the Spinal Cord Independence...have been achieved with the registry. Enrollment of 762 participants has demonstrated that is feasible to acquire prospective standardized research

  20. 78 FR 13071 - Guidance for Industry: Implementation of an Acceptable Full-Length and Abbreviated Donor History...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-26

    ...] Guidance for Industry: Implementation of an Acceptable Full- Length and Abbreviated Donor History... Full-Length and Abbreviated Donor History Questionnaires and Accompanying Materials for Use in... full-length and abbreviated donor history questionnaires and accompanying materials, version 1.2 dated...

  1. Relationship of the Kaufman Brief Intelligence Test-Second Edition and the Wechsler Abbreviated Scale of Intelligence in children referred for ADHD.

    PubMed

    Raggio, Donald J; Scattone, Dorothy; May, Warren

    2010-04-01

    This study examines the relationship between the Wechsler Abbreviated Scale of Intelligence (WASI) and the Kaufman Brief Intelligence Test-Second Edition (KBIT-2). Increasingly, psychologists are using brief measures of intelligence, but scant information exists regarding their clinical utility in various populations. 44 children referred for evaluation of ADHD were administered the KBIT-2 and WASI in counterbalanced order. Results of this study indicated the WASI to be a more stable measure of ADHD children's intelligence, that the KBIT-2 Vocabulary scores were significantly lower than the WASI Verbal score, and that there was significant variability within participants.

  2. Injury analysis of patients according to impact patterns involved in pedestrian traffic crashes.

    PubMed

    Lee, Hee Young; Youk, Hyun; Ii Lee, Jeong; Kang, Chan Young; Kong, Joon Seok; Sung, Sil; Kang, In Hye; Lee, Jung Hun; Kim, Oh Hyun; Jung, Woo Jin; Lee, Kang Hyun; Youn, Young Han; Park, Jong Chan

    2018-02-28

    In cases of car-to-person pedestrian traffic crashes (PTCs), the principal issue is determining at what point the car collided with the pedestrian. Accordingly, the objective of the present study was to use the medical records of patients injured in PTCs to investigate the characteristics of crash types and the areas and injury severity and to determine whether there are differences in injuries due to the angle, motion, and position at the point of impact. The present study examined 231 PTC patients admitted to the emergency room (ER) between January and December 2014. Electronic medical records from the hospital were used to divide the patient data according to Abbreviated Injury Scale (AIS) codes for injured areas based on sex, age, time of the crash, outcomes after ER treatment, and major symptoms. Among 231 patients, police reports on 67 crash cases, involving 70 people, were obtained with the help of local police departments, and these reports were used to reconstruct details of the actual crash. For statistical analysis, a chi-square test and a one-way analysis of variance calculation were used to compare the Injury Severity Score (ISS) based on groups and stages, with a statistical significance level set to P < .05. With respect to patients who were admitted for PTC, 52.4% were females and 47.6% were males. The frequency of crashes was high in middle-aged and elderly groups, as well as for youths between 10 and 19 years old. With respect to outcomes after ER treatment, discharge to home after symptom improvement was the most common outcome (24.6%). Admissions to the intensive care unit (25.1%) and to the general ward (23.8%) were also high. In terms of major symptoms, the most common injuries were to the head, resulting from a rotatory motion post impact (35.9%), and injuries to the legs, resulting from the impact of a direct collision with an object (25.1%). This study demonstrated that injuries to the chest and abdomen were the most severe in the fender

  3. Defining the "older" crash victim: the relationship between age and serious injury in motor vehicle crashes.

    PubMed

    Newgard, Craig D

    2008-07-01

    Age is often used as a predictor of injury and mortality in motor vehicle crashes (MVCs), however, the age that defines an "older" occupant in terms of injury-risk remains unclear, as do specific injury patterns associated with increasing age. The objective of this study was to evaluate the relationship between age and serious injury (including injury patterns) for occupants involved in MVCs. This was a retrospective cohort study using a national population-based cohort of adult front-seat occupants involved in MVCs and included in the National Automotive Sampling System Crashworthiness Data System database from 1995 to 2006. The primary outcome was serious injury, defined as an abbreviated injury scale (AIS) score >/=3 in any body region. Anatomic injury patterns were also assessed by age. One hundred thousand one hundred and fifty-six adult front-seat occupants were included in the analysis, of which 14,128 (2%) were seriously injured. Age was a strong predictor of serious injury using a variety of different age covariates (categorical, continuous, and polynomial) in multivariable regression models (p<0.0001 for all). There was evidence of a strong non-linear relationship between age and serious injury (p<0.001 for comparison of non-linear to linear representation of age). There was no age that clearly defined an "older" occupant by injury risk, as the odds of injury increased with increasing age across all age groups. The proportion of serious head and extremity injuries gradually increased with increasing age, while serious chest injuries markedly increased after 60 years. Age is a strong predictor of serious injury from motor vehicle trauma, the risk of which increases in non-linear fashion as age increases. There is no specific age that clearly defines an "older" occupant by injury risk.

  4. A sense inventory for clinical abbreviations and acronyms created using clinical notes and medical dictionary resources.

    PubMed

    Moon, Sungrim; Pakhomov, Serguei; Liu, Nathan; Ryan, James O; Melton, Genevieve B

    2014-01-01

    To create a sense inventory of abbreviations and acronyms from clinical texts. The most frequently occurring abbreviations and acronyms from 352,267 dictated clinical notes were used to create a clinical sense inventory. Senses of each abbreviation and acronym were manually annotated from 500 random instances and lexically matched with long forms within the Unified Medical Language System (UMLS V.2011AB), Another Database of Abbreviations in Medline (ADAM), and Stedman's Dictionary, Medical Abbreviations, Acronyms & Symbols, 4th edition (Stedman's). Redundant long forms were merged after they were lexically normalized using Lexical Variant Generation (LVG). The clinical sense inventory was found to have skewed sense distributions, practice-specific senses, and incorrect uses. Of 440 abbreviations and acronyms analyzed in this study, 949 long forms were identified in clinical notes. This set was mapped to 17,359, 5233, and 4879 long forms in UMLS, ADAM, and Stedman's, respectively. After merging long forms, only 2.3% matched across all medical resources. The UMLS, ADAM, and Stedman's covered 5.7%, 8.4%, and 11% of the merged clinical long forms, respectively. The sense inventory of clinical abbreviations and acronyms and anonymized datasets generated from this study are available for public use at http://www.bmhi.umn.edu/ihi/research/nlpie/resources/index.htm ('Sense Inventories', website). Clinical sense inventories of abbreviations and acronyms created using clinical notes and medical dictionary resources demonstrate challenges with term coverage and resource integration. Further work is needed to help with standardizing abbreviations and acronyms in clinical care and biomedicine to facilitate automated processes such as text-mining and information extraction.

  5. Characterization of children hospitalized with traumatic brain injuries after building falls.

    PubMed

    Loftus, Kirsten V; Rhine, Tara; Wade, Shari L; Pomerantz, Wendy J

    2018-04-10

    Unintentional falls cause a substantial proportion of pediatric traumatic brain injury (TBI), with building falls carrying particularly high risk for morbidity and mortality. The cohort of children sustaining building fall-related TBI has not been well-examined. We sought to characterize children hospitalized with building fall-related TBIs and evaluate if specific factors distinguished these children from children hospitalized with TBI due to other fall mechanisms. We secondarily assessed if TBI severity among children injured due to a building fall varied between children from urban versus non-urban areas. This was a secondary analysis of the Pediatric Health Information System (PHIS), an administrative database from pediatric hospitals. We identified children < 15 years old, hospitalized between 2009 and 2014, with an associated TBI-related diagnosis due to a fall as determined by International Classification of Diseases, Clinical Modification, Ninth revision (ICD9-CM) diagnosis codes. Urban versus non-urban status was determined using PHIS-assigned Rural-Urban Commuting Area codes. Injury severity (i.e. Injury Severity Score (ISS) and head Abbreviated Injury Scale (AIS) score) were calculated. Head AIS scores were dichotomized into minor/moderate (1-2) and serious/severe (3-6) for analysis. Frequencies, descriptive statistics, Chi-square analysis, and Mann-Whitney U analysis characterized populations and determined group differences. The study cohort included 23,813 children, of whom 933 (3.9%) fell from buildings. Within the building fall cohort, 707 (75.8%) resided in urban areas, 619 (66.3%) were male, 513 (55.0%) were white, and 528 (56.6%) had government insurance; the mean age was 3.8 years (SD 2.9). There was a larger proportion of children with serious/severe TBI among those injured from building falls relative to other falls (63.4% vs 53.9%, p <  0.01). Among children injured from building falls, those from non-urban areas were more likely to

  6. An Abbreviated Protocol for High-Risk Screening Breast MRI Saves Time and Resources.

    PubMed

    Harvey, Susan C; Di Carlo, Phillip A; Lee, Bonmyong; Obadina, Eniola; Sippo, Dorothy; Mullen, Lisa

    2016-04-01

    To review the ability of an abbreviated, high-risk, screening, breast MRI protocol to detect cancer and save resources. High-risk screening breast MR images were reviewed, from both an abbreviated protocol and a full diagnostic protocol. Differences in cancer detection, scanner utilization, interpretation times, and need for additional imaging were recorded in an integrated data form, and reviewed and compared. A total of 568 MRI cases were reviewed, with the abbreviated and full protocols. No difference was found in the number of cancers detected. Scan times were decreased by 18.8 minutes per case, for a total of 10,678 minutes (178 hours). Interpretation time, on average, was 1.55 minutes for the abbreviated protocol, compared with 6.43 minutes for the full protocol. Review of the full protocol led to a significant change in the final BI-RADS(®) assessment in 12 of 568 (2.1%) cases. Abbreviated MRI is as effective as full-protocol MRI for demonstration of cancers in the high-risk screening setting, with only 12 (2.1%) cases recommended for additional MRI evaluation. The efficiency and resource savings of an abbreviated protocol would be significant, and would allow for opportunities to provide MRI for additional patients, as well as improved radiologist time management and workflow, with the potential to add real-time MRI interpretation or double reading. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  7. An Abbreviated Protocol for High-Risk Screening Breast MRI Saves Time and Resources.

    PubMed

    Harvey, Susan C; Di Carlo, Phillip A; Lee, Bonmyong; Obadina, Eniola; Sippo, Dorothy; Mullen, Lisa

    2016-11-01

    To review the ability of an abbreviated, high-risk, screening, breast MRI protocol to detect cancer and save resources. High-risk screening breast MR images were reviewed, from both an abbreviated protocol and a full diagnostic protocol. Differences in cancer detection, scanner utilization, interpretation times, and need for additional imaging were recorded in an integrated data form, and reviewed and compared. A total of 568 MRI cases were reviewed, with the abbreviated and full protocols. No difference was found in the number of cancers detected. Scan times were decreased by 18.8 minutes per case, for a total of 10,678 minutes (178 hours). Interpretation time, on average, was 1.55 minutes for the abbreviated protocol, compared with 6.43 minutes for the full protocol. Review of the full protocol led to a significant change in the final BI-RADS ® assessment in 12 of 568 (2.1%) cases. Abbreviated MRI is as effective as full-protocol MRI for demonstration of cancers in the high-risk screening setting, with only 12 (2.1 %) cases recommended for additional MRI evaluation. The efficiency and resource savings of an abbreviated protocol would be significant, and would allow for opportunities to provide MRI for additional patients, as well as improved radiologist time management and workflow, with the potential to add real-time MRI interpretation or double reading. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  8. Community integration after burn injuries.

    PubMed

    Esselman, P C; Ptacek, J T; Kowalske, K; Cromes, G F; deLateur, B J; Engrav, L H

    2001-01-01

    Evaluation of community integration is a meaningful outcome criterion after major burn injury. The Community Integration Questionnaire (CIQ) was administered to 463 individuals with major burn injuries. The CIQ results in Total, Home Integration, Social Integration, and Productivity scores. The purposes of this study were to determine change in CIQ scores over time and what burn injury and demographic factors predict CIQ scores. The CIQ scores did not change significantly from 6 to 12 to 24 months postburn injury. Home integration scores were best predicted by sex and living situation; Social Integration scores by marital status; and Productivity scores by functional outcome, burn severity, age, and preburn work factors. The data demonstrate that individuals with burn injuries have significant difficulties with community integration due to burn and nonburn related factors. CIQ scores did not improve over time but improvement may have occurred before the initial 6-month postburn injury follow-up in this study.

  9. Evaluation of novel computerized tomography scoring systems in human traumatic brain injury: An observational, multicenter study

    PubMed Central

    Kivisaari, Riku; Svensson, Mikael; Skrifvars, Markus B.

    2017-01-01

    Background Traumatic brain injury (TBI) is a major contributor to morbidity and mortality. Computerized tomography (CT) scanning of the brain is essential for diagnostic screening of intracranial injuries in need of neurosurgical intervention, but may also provide information concerning patient prognosis and enable baseline risk stratification in clinical trials. Novel CT scoring systems have been developed to improve current prognostic models, including the Stockholm and Helsinki CT scores, but so far have not been extensively validated. The primary aim of this study was to evaluate the Stockholm and Helsinki CT scores for predicting functional outcome, in comparison with the Rotterdam CT score and Marshall CT classification. The secondary aims were to assess which individual components of the CT scores best predict outcome and what additional prognostic value the CT scoring systems contribute to a clinical prognostic model. Methods and findings TBI patients requiring neuro-intensive care and not included in the initial creation of the Stockholm and Helsinki CT scoring systems were retrospectively included from prospectively collected data at the Karolinska University Hospital (n = 720 from 1 January 2005 to 31 December 2014) and Helsinki University Hospital (n = 395 from 1 January 2013 to 31 December 2014), totaling 1,115 patients. The Marshall CT classification and the Rotterdam, Stockholm, and Helsinki CT scores were assessed using the admission CT scans. Known outcome predictors at admission were acquired (age, pupil responsiveness, admission Glasgow Coma Scale, glucose level, and hemoglobin level) and used in univariate, and multivariable, regression models to predict long-term functional outcome (dichotomizations of the Glasgow Outcome Scale [GOS]). In total, 478 patients (43%) had an unfavorable outcome (GOS 1–3). In the combined cohort, overall prognostic performance was more accurate for the Stockholm CT score (Nagelkerke’s pseudo-R2 range 0.24–0

  10. Audit on the Use of Dangerous Abbreviations, Symbols, and Dose Designations in Paper Compared to Electronic Medication Orders: A Multicenter Study.

    PubMed

    Cheung, Stephanie; Hoi, Sannifer; Fernandes, Olavo; Huh, Jin; Kynicos, Sara; Murphy, Laura; Lowe, Donna

    2018-04-01

    Dangerous abbreviations on the Institute for Safe Medication Practices Canada's "Do Not Use" list have resulted in medication errors leading to harm. Data comparing rates of use of dangerous abbreviations in paper and electronic medication orders are limited. To compare rates of use of dangerous abbreviations from the "Do Not Use" list, in paper and electronic medication orders. Secondary objectives include determining the proportion of patients at risk for medication errors due to dangerous abbreviations and the most commonly used dangerous abbreviations. One-day cross-sectional audits of medication orders were conducted at a 6-site hospital network in Toronto, Canada, between December 2013 and January 2014. Proportions of paper and electronic medication orders containing dangerous abbreviation(s) were compared using a χ 2 test. The proportion of patients with at least 1 medication order containing dangerous abbreviation(s) and the top 5 dangerous abbreviations used were described. Overall, 255 patient charts were reviewed. The proportions of paper and electronic medication orders containing dangerous abbreviation(s) were 172/714 (24.1%) and 9/2207 (0.4%), respectively ( P < 0.001). Almost one-third of patients had medication order(s) containing dangerous abbreviation(s). The proportions of patients with at least 1 medication order during the audit period containing dangerous abbreviation(s) for patients with paper only, electronic only, or a hybrid of paper and electronic medication orders were 50.5%, 5%, and 47.2%, respectively. Those most commonly used were "D/C", drug name abbreviations, "OD," "cc," and "U." Electronic medication orders have significantly lower rates of dangerous abbreviation use compared to paper medication orders.

  11. Validation of the Retinal Detachment after Open Globe Injury (RD-OGI) Score as an Effective Tool for Predicting Retinal Detachment.

    PubMed

    Brodowska, Katarzyna; Stryjewski, Tomasz P; Papavasileiou, Evangelia; Chee, Yewlin E; Eliott, Dean

    2017-05-01

    The Retinal Detachment after Open Globe Injury (RD-OGI) Score is a clinical prediction model that was developed at the Massachusetts Eye and Ear Infirmary to predict the risk of retinal detachment (RD) after open globe injury (OGI). This study sought to validate the RD-OGI Score in an independent cohort of patients. Retrospective cohort study. The predictive value of the RD-OGI Score was evaluated by comparing the original RD-OGI Scores of 893 eyes with OGI that presented between 1999 and 2011 (the derivation cohort) with 184 eyes with OGI that presented from January 1, 2012, to January 31, 2014 (the validation cohort). Three risk classes (low, moderate, and high) were created and logistic regression was undertaken to evaluate the optimal predictive value of the RD-OGI Score. A Kaplan-Meier survival analysis evaluated survival experience between the risk classes. Time to RD. At 1 year after OGI, 255 eyes (29%) in the derivation cohort and 66 eyes (36%) in the validation cohort were diagnosed with an RD. At 1 year, the low risk class (RD-OGI Scores 0-2) had a 3% detachment rate in the derivation cohort and a 0% detachment rate in the validation cohort, the moderate risk class (RD-OGI Scores 2.5-4.5) had a 29% detachment rate in the derivation cohort and a 35% detachment rate in the validation cohort, and the high risk class (RD-OGI scores 5-7.5) had a 73% detachment rate in the derivation cohort and an 86% detachment rate in the validation cohort. Regression modeling revealed the RD-OGI to be highly discriminative, especially 30 days after injury, with an area under the receiver operating characteristic curve of 0.939 in the validation cohort. Survival experience was significantly different depending upon the risk class (P < 0.0001, log-rank chi-square). The RD-OGI Score can reliably predict the future risk of developing an RD based on clinical variables that are present at the time of the initial evaluation after OGI. Copyright © 2017 American Academy of

  12. An Approach to the Derivation of the Cost of UK Vehicle Crash Injuries

    PubMed Central

    Morris, Andrew; Welsh, Ruth; Barnes, Jo; Chambers-Smith, Dawn

    2006-01-01

    An approach to costing of road crash injury has been developed using data from a ‘Willingness-to-pay’ survey mapped to injuries listed in the Abbreviated Injury Scale 1998 Revision. The costs derived have been applied to a database of real-world crash injuries that have been collected as part of the UK Cooperative Crash Injury Study (CCIS). The approach has been developed in order to determine future research priorities in vehicle passive safety. When all injuries in all crash-types are examined, the results highlight the cost of ‘Whiplash’ in the UK. When more serious injuries are considered, specifically those at AIS 2+, the cost of head injuries becomes evident in both frontal and side impacts. PMID:16968643

  13. A Summary Score for the Framingham Heart Study Neuropsychological Battery

    PubMed Central

    Downer, Brian; Fardo, David W.; Schmitt, Frederick A.

    2015-01-01

    Objective To calculate three summary scores of the Framingham Heart Study neuropsychological battery and determine which score best differentiates between subjects classified as having normal cognition, test-based impaired learning and memory, test-based multidomain impairment, and dementia. Method The final sample included 2,503 participants. Three summary scores were assessed: (a) composite score that provided equal weight to each subtest, (b) composite score that provided equal weight to each cognitive domain assessed by the neuropsychological battery, and (c) abbreviated score comprised of subtests for learning and memory. Receiver operating characteristic analysis was used to determine which summary score best differentiated between the four cognitive states. Results The summary score that provided equal weight to each subtest best differentiated between the four cognitive states. Discussion A summary score that provides equal weight to each subtest is an efficient way to utilize all of the cognitive data collected by a neuropsychological battery. PMID:25804903

  14. A Summary Score for the Framingham Heart Study Neuropsychological Battery.

    PubMed

    Downer, Brian; Fardo, David W; Schmitt, Frederick A

    2015-10-01

    To calculate three summary scores of the Framingham Heart Study neuropsychological battery and determine which score best differentiates between subjects classified as having normal cognition, test-based impaired learning and memory, test-based multidomain impairment, and dementia. The final sample included 2,503 participants. Three summary scores were assessed: (a) composite score that provided equal weight to each subtest, (b) composite score that provided equal weight to each cognitive domain assessed by the neuropsychological battery, and (c) abbreviated score comprised of subtests for learning and memory. Receiver operating characteristic analysis was used to determine which summary score best differentiated between the four cognitive states. The summary score that provided equal weight to each subtest best differentiated between the four cognitive states. A summary score that provides equal weight to each subtest is an efficient way to utilize all of the cognitive data collected by a neuropsychological battery. © The Author(s) 2015.

  15. A sense inventory for clinical abbreviations and acronyms created using clinical notes and medical dictionary resources

    PubMed Central

    Moon, Sungrim; Pakhomov, Serguei; Liu, Nathan; Ryan, James O; Melton, Genevieve B

    2014-01-01

    Objective To create a sense inventory of abbreviations and acronyms from clinical texts. Methods The most frequently occurring abbreviations and acronyms from 352 267 dictated clinical notes were used to create a clinical sense inventory. Senses of each abbreviation and acronym were manually annotated from 500 random instances and lexically matched with long forms within the Unified Medical Language System (UMLS V.2011AB), Another Database of Abbreviations in Medline (ADAM), and Stedman's Dictionary, Medical Abbreviations, Acronyms & Symbols, 4th edition (Stedman's). Redundant long forms were merged after they were lexically normalized using Lexical Variant Generation (LVG). Results The clinical sense inventory was found to have skewed sense distributions, practice-specific senses, and incorrect uses. Of 440 abbreviations and acronyms analyzed in this study, 949 long forms were identified in clinical notes. This set was mapped to 17 359, 5233, and 4879 long forms in UMLS, ADAM, and Stedman's, respectively. After merging long forms, only 2.3% matched across all medical resources. The UMLS, ADAM, and Stedman's covered 5.7%, 8.4%, and 11% of the merged clinical long forms, respectively. The sense inventory of clinical abbreviations and acronyms and anonymized datasets generated from this study are available for public use at http://www.bmhi.umn.edu/ihi/research/nlpie/resources/index.htm (‘Sense Inventories’, website). Conclusions Clinical sense inventories of abbreviations and acronyms created using clinical notes and medical dictionary resources demonstrate challenges with term coverage and resource integration. Further work is needed to help with standardizing abbreviations and acronyms in clinical care and biomedicine to facilitate automated processes such as text-mining and information extraction. PMID:23813539

  16. Is there still a role for the lung injury score in the era of the Berlin definition ARDS?

    PubMed Central

    2014-01-01

    Background The Lung Injury Score (LIS) remains a commonly utilized measure of lung injury severity though the additive value of LIS to predict ARDS outcomes over the recent Berlin definition of ARDS, which incorporates severity, is not known. Methods We tested the association of LIS (in which scores range from 0 to 4, with higher scores indicating more severe lung injury) and its four components calculated on the day of ARDS diagnosis with ARDS morbidity and mortality in a large, multi-ICU cohort of patients with Berlin-defined ARDS. Receiver Operator Characteristic (ROC) curves were generated to compare the predictive validity of LIS for mortality to Berlin stages of severity (mild, moderate and severe). Results In 550 ARDS patients, a one-point increase in LIS was associated with 58% increased odds of in-hospital death (95% CI 14 to 219%, P = 0.006), a 7% reduction in ventilator-free days (95% CI 2 to 13%, P = 0.01), and, among patients surviving hospitalization, a 25% increase in days of mechanical ventilation (95% CI 9 to 43%, P = 0.001) and a 16% increase (95% CI 2 to 31%, P = 0.02) in the number of ICU days. However, the mean LIS was only 0.2 points higher (95% CI 0.1 to 0.3) among those who died compared to those who lived. Berlin stages of severity were highly correlated with LIS (Spearman’s rho 0.72, P < 0.0001) and were also significantly associated with ARDS mortality and similar morbidity measures. The predictive validity of LIS for mortality was similar to Berlin stages of severity with an area under the curve of 0.58 compared to 0.60, respectively (P-value 0.49). Conclusions In a large, multi-ICU cohort of patients with ARDS, both LIS and the Berlin definition severity stages were associated with increased in-hospital morbidity and mortality. However, predictive validity of both scores was marginal, and there was no additive value of LIS over Berlin. Although neither LIS nor the Berlin definition were designed to prognosticate

  17. Abbreviated Combined MR Protocol: A New Faster Strategy for Characterizing Breast Lesions.

    PubMed

    Moschetta, Marco; Telegrafo, Michele; Rella, Leonarda; Stabile Ianora, Amato Antonio; Angelelli, Giuseppe

    2016-06-01

    The use of an abbreviated magnetic resonance (MR) protocol has been recently proposed for cancer screening. The aim of our study is to evaluate the diagnostic accuracy of an abbreviated MR protocol combining short TI inversion recovery (STIR), turbo-spin-echo (TSE)-T2 sequences, a pre-contrast T1, and a single intermediate (3 minutes after contrast injection) post-contrast T1 sequence for characterizing breast lesions. A total of 470 patients underwent breast MR examination for screening, problem solving, or preoperative staging. Two experienced radiologists evaluated both standard and abbreviated protocols in consensus. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for both protocols were calculated (with the histological findings and 6-month ultrasound follow-up as the reference standard) and compared with the McNemar test. The post-processing and interpretation times for the MR images were compared with the paired t test. In 177 of 470 (38%) patients, the MR sequences detected 185 breast lesions. Standard and abbreviated protocols obtained sensitivity, specificity, diagnostic accuracy, PPV, and NPV values respectively of 92%, 92%, 92%, 68%, and 98% and of 89%, 91%, 91%, 64%, and 98% with no statistically significant difference (P < .0001). The mean post-processing and interpretation time were, respectively, 7 ± 1 minutes and 6 ± 3.2 minutes for the standard protocol and 1 ± 1.2 minutes and 2 ± 1.2 minutes for the abbreviated protocol, with a statistically significant difference (P < .01). An abbreviated combined MR protocol represents a time-saving tool for radiologists and patients with the same diagnostic potential as the standard protocol in patients undergoing breast MRI for screening, problem solving, or preoperative staging. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. A novel abbreviation standard for organobromine, organochlorine and organophosphorus flame retardants and some characteristics of the chemicals

    PubMed Central

    Bergman, Åke; Rydén, Andreas; Law, Robin J.; de Boer, Jacob; Covaci, Adrian; Alaee, Mehran; Birnbaum, Linda; Petreas, Myrto; Rose, Martin; Sakai, Shinichi; Van den Eede, Nele; van der Veen, Ike

    2012-01-01

    Ever since the interest in organic environmental contaminants first emerged 50 years ago, there has been a need to present discussion of such chemicals and their transformation products using simple abbreviations so as to avoid the repetitive use of long chemical names. As the number of chemicals of concern has increased, the number of abbreviations has also increased dramatically, sometimes resulting in the use of different abbreviations for the same chemical. In this article, we propose abbreviations for flame retardants (FRs) substituted with bromine or chlorine atoms or including a functional group containing phosphorus, i.e. BFRs, CFRs and PFRs, respectively. Due to the large number of halogenated and organophosphorus FRs, it has become increasingly important to develop a strategy for abbreviating the chemical names of FRs. In this paper, a two step procedure is proposed for deriving practical abbreviations (PRABs) for the chemicals discussed. In the first step, structural abbreviations (STABs) are developed using specific STAB criteria based on the FR structure. However, since several of the derived STABs are complicated and long, we propose instead the use of PRABs. These are, commonly, an extract of the most essential part of the STAB, while also considering abbreviations previously used in the literature. We indicate how these can be used to develop an abbreviation that can be generally accepted by scientists and other professionals involved in FR related work. Tables with PRABs and STABs for BFRs, CFRs and PFRs are presented, including CAS (Chemical Abstract Service) numbers, notes of abbreviations that have been used previously, CA (Chemical Abstract) name, common names and trade names, as well as some fundamental physico-chemical constants. PMID:22982223

  19. Psychometric properties of the abbreviated version of the Scale to Assess Unawareness in Mental Disorder in schizophrenia

    PubMed Central

    2013-01-01

    Background The Scale to Assess Unawareness in Mental Disorder (SUMD) is widely used in clinical trials and epidemiological studies but more rarely in clinical practice because of its length (74 items). In clinical practice, it is necessary to provide shorter instruments. The aim of this study was to investigate the validity and reliability of the abbreviated version of the SUMD. Methods Design: We used data from four cross-sectional studies conducted in several psychiatric hospitals in France. Inclusion criteria: a diagnosis of schizophrenia based on DSM-IV criteria. Data collection: socio-demographic and clinical data (including duration of illness, Positive and Negative Syndrome Scale, and the Calgary Depression Scale); quality of life; SUMD. Statistical analysis: confirmatory factor analyses, item-dimension correlations, Cronbach’s alpha coefficients, Rasch statistics, relationships between the SUMD and other parameters. We tested two different scoring models and considered the response ‘not applicable’ as ‘0’ or as missing data. Results Five hundred and thirty-one patients participated in this study. The 3-factor structure of the SUMD (awareness of the disease, consequences and need for treatment; awareness of positive symptoms; and awareness of negative symptoms) was confirmed using LISREL confirmatory factor analysis for the two models. Internal item consistency and reliability were satisfactory for all dimensions. External validity testing revealed that dimension scores correlated significantly with all PANSS scores, especially with the G12 item (lack of judgement and awareness). Significant associations with age, disease duration, education level, and living arrangements showed good discriminant validity. Conclusion The abbreviated version of the SUMD appears to be a valid and reliable instrument for measuring insight in patients with schizophrenia and may be used by clinicians to accurately assess insight in clinical settings. PMID:24053640

  20. Review of gunshot injuries in cats and dogs and utility of a triage scoring system to predict short-term outcome: 37 cases (2003-2008).

    PubMed

    Olsen, Lisa E; Streeter, Elizabeth M; DeCook, Rhonda R

    2014-10-15

    To describe the signalment, wound characteristics, and treatment of gunshot injuries in cats and dogs in urban and rural environments, and to evaluate the utility of the animal trauma triage (ATT) score as an early predictor of survival to discharge from the hospital. Retrospective case series. 29 dogs and 8 cats. Medical records of cats and dogs evaluated for gunshot wounds from 2003 and 2008 at a private urban referral practice in Cedar Rapids, Iowa, and an urban veterinary teaching hospital in Ames, Iowa, were reviewed. Information collected included signalment, chief reason for evaluation, circumstance of the injury, general physical examination findings, wound characteristics, treatments provided, cost of care, survival to discharge from the hospital (yes vs no), and duration of hospital stay. For each animal, ATT scores were calculated and evaluated as a prognostic tool. 37 animals met study inclusion criteria. Animals with higher ATT scores had a greater likelihood of poor outcome following gunshot injury. Animals with higher ATT scores, classified as low (< 4.5) or high (> 4.5), were found to have a longer duration of stay, classified as zero (0 days), short (1 to 3 days), or long (> 3 days). Young male dogs generally considered working breeds were overrepresented (29/37 [78.4%]). A preference for low-velocity, low-kinetic-energy firearms was identified (19/37 [52%]). The most numerous wounds were those inflicted to the limbs (12/37 [32.4%]), during low-visibility hours or hunting excursions. Calculated ATT scores on admission were higher in animals requiring blood products or surgical procedures and in nonsurvivors. Results of the present study suggested that regional preferences in breed ownership and firearm choice are responsible for variation in gunshot injury characteristics and management in animals sustaining injuries in rural and urban settings in Iowa. In cats and dogs, calculation of an ATT score may provide a useful predictor of the need for

  1. Early or delayed stabilization in severely injured patients with spinal fractures? Current surgical objectivity according to the Trauma Registry of DGU: treatment of spine injuries in polytrauma patients.

    PubMed

    Bliemel, Christopher; Lefering, Rolf; Buecking, Benjamin; Frink, Michael; Struewer, Johannes; Krueger, Antonio; Ruchholtz, Steffen; Frangen, Thomas Manfred

    2014-02-01

    Because of a lack of evidence, the appropriate timing of surgical stabilization of thoracic and lumbar spine injuries in severely injured patients is still controversial. Data of a large international trauma register were analyzed to investigate the medical care situation of unstable spinal column fractures in patients with multiple injuries, so as to examine the outcome related to timing of surgical stabilization. Data sets of the Trauma Registry of German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie [DGU]) (1993-2010) were analyzed. The Trauma Registry of DGU is a prospective, multicenter register that provides information on severely injured patients. All patients with an Injury Severity Score (ISS) of 16 or greater caused by blunt trauma, subsequent treatment of 7 days or more, 16 years or older, and thoracic or lumbar spine injuries (spine Abbreviated Injury Scale [AIS] score ≥ 2) were included in our analysis. Patients with relevant spine injuries classified as having a spine AIS score of 3 or greater were further analyzed in terms of whether they got early (<72 hours) or late (>72 hours) surgical treatment due to unstable spinal column fractures. Of 24,974 patients, 8,994 (36.0%) had documented spinal injuries (spine AIS score ≥ 2). A total of 1,309 patients who sustained relevant thoracic spine injuries (spine AIS score ≥ 3) and 994 patients who experienced lumbar spine trauma and classified as having spine AIS score of 3 or greater were more precisely analyzed. Of these, 68.2% and 71.0%, respectively, received an early thoracic or lumbar spine fixation. With an increase in spinal injury severity, an increase in early stabilization in the thoracic and lumbar spine was seen. In the group of patients with early surgical stabilization, significantly shorter hospital stays, shorter intensive care unit stays, fewer days on mechanical ventilation, and lower rates of sepsis were seen. In the case that additional body regions were affected, for

  2. 40 CFR 1060.805 - What symbols, acronyms, and abbreviations does this part use?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 33 2011-07-01 2011-07-01 false What symbols, acronyms, and... AND STATIONARY EQUIPMENT Definitions and Other Reference Information § 1060.805 What symbols, acronyms, and abbreviations does this part use? The following symbols, acronyms, and abbreviations apply to this...

  3. 40 CFR 59.685 - What symbols, acronyms, and abbreviations does this subpart use?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 5 2011-07-01 2011-07-01 false What symbols, acronyms, and... Containers Definitions and Other Reference Information § 59.685 What symbols, acronyms, and abbreviations does this subpart use? The following symbols, acronyms, and abbreviations apply to this subpart...

  4. Pulmonary Contusion in Mechanically Ventilated Subjects After Severe Trauma.

    PubMed

    Dhar, Sakshi Mathur; Breite, Matthew D; Barnes, Stephen L; Quick, Jacob A

    2018-03-13

    Pulmonary contusions are thought to worsen outcomes. We aimed to evaluate the effects of pulmonary contusion on mechanically ventilated trauma subjects with severe thoracic injuries and hypothesized that contusion would not increase morbidity. We conducted a single-center, retrospective review of 163 severely injured trauma subjects (injury severity score ≥ 15) with severe thoracic injury (chest abbreviated injury score ≥ 3), who required mechanical ventilation for >24 h at a verified Level 1 trauma center. Subject data were analyzed for those with radiographic documentation of pulmonary contusion and those without. Statistical analysis was performed to determine the effects of coexisting pulmonary contusion in severe thoracic trauma. Pulmonary contusion was present in 91 subjects (55.8%), whereas 72 (44.2%) did not have pulmonary contusions. Mean chest abbreviated injury score (3.54 vs 3.47, P = .53) and mean injury severity score (32.6 vs 30.2, P = .12) were similar. There was no difference in mortality (11 [12.1%] vs 9 [12.5%], P > .99) or length of stay (16.29 d vs 17.29 d, P = .60). Frequency of ventilator-associated pneumonia was comparable (43 [47.3%] vs 32 [44.4%], P = .75). Subjects with contusions were more likely to grow methicillin-sensitive Staphylococcus aureus in culture (33 vs 10, P = .004) as opposed to Pseudomonas aeruginosa in culture (6 vs 13, P = .003). Overall, no significant differences were noted in mortality, length of stay, or pneumonia rates between severely injured trauma subjects with and without pulmonary contusions. Copyright © 2018 by Daedalus Enterprises.

  5. Reversal of coagulopathy in critically ill patients with traumatic brain injury: recombinant factor VIIa is more cost-effective than plasma.

    PubMed

    Stein, Deborah M; Dutton, Richard P; Kramer, Mary E; Scalea, Thomas M

    2009-01-01

    Traumatic brain injury (TBI) is the leading cause of death and disability after trauma. Coagulopathy is common in this patient population and requires rapid reversal to allow for safe neurosurgical intervention and prevent worsening of the primary injury. Typically reversal of coagulopathy is accomplished with the use of plasma. Recombinant factor VIIa (rFVIIa; NovoSeven, Novo Nordisk, Bagsvaerd, Denmark) has become increasingly used "off-label" in patients with neurosurgical emergencies to rapidly reverse coagulopathy. We hypothesized that the use of rFVIIa in this patient population would prove to be cost-effective as well as demonstrate clinical benefit. The trauma registry at the R Adams Cowley Shock Trauma Center was used to identify all coagulopatic trauma patients admitted between January 2002 and December 2007 with relatively isolated TBI (head Abbreviated Injury Scale score of >or=4). The medical records of patients were reviewed and demographics, injury-specific data, medications administered, laboratory values, blood product utilization, neurosurgical procedures, length of stay (LOS), discharge disposition, and outcome data were abstracted. Patients who received rFVIIa for reversal of coagulopathy were compared against those who did not receive rFVIIa. t Tests were used to compare differences between continuous variables, and chi2 analysis was used to compare categorical variables. A p value of <0.05 was considered significant for all statistical tests. During a 6-year period, there were 179 patients who met inclusion criteria. One hundred eleven patients (62.0%) were treated with conventional therapy alone whereas 68 (38.0%) received rFVIIa. Baseline characteristics between the two groups were similar except that Injury Severity Score and admission International normalized ratio were higher in the rFVIIa group and the rFVIIa group had a higher percentage of patients with head Abbreviated Injury Scale score of 5 injuries, patients who underwent

  6. Is trauma in Switzerland any different? epidemiology and patterns of injury in major trauma - a 5-year review from a Swiss trauma centre.

    PubMed

    Heim, C; Bosisio, F; Roth, A; Bloch, J; Borens, O; Daniel, R T; Denys, A; Oddo, M; Pasquier, M; Schmidt, S; Schoettker, P; Zingg, T; Wasserfallen, J B

    2014-01-01

    Switzerland, the country with the highest health expenditure per capita, is lacking data on trauma care and system planning. Recently, 12 trauma centres were designated to be reassessed through a future national trauma registry by 2015. Lausanne University Hospital launched the first Swiss trauma registry in 2008, which contains the largest database on trauma activity nationwide. Prospective analysis of data from consecutively admitted shock room patients from 1 January 2008 to 31 December 2012. Shock room admission is based on physiology and mechanism of injury, assessed by prehospital physicians. Management follows a surgeon-led multidisciplinary approach. Injuries are coded by Association for the Advancement of Automotive Medicine (AAAM) certified coders. Over the 5 years, 1,599 trauma patients were admitted, predominantly males with a median age of 41.4 years and median injury severity score (ISS) of 13. Rate of ISS >15 was 42%. Principal mechanisms of injury were road traffic (40.4%) and falls (34.4%), with 91.5% blunt trauma. Principal patterns were brain (64.4%), chest (59.8%) and extremity/pelvic girdle (52.9%) injuries. Severe (abbreviated injury scale [AIS] score ≥ 3) orthopaedic injuries, defined as extremity and spine injuries together, accounted for 67.1%. Overall, 29.1% underwent immediate intervention, mainly by orthopaedics (27.3%), neurosurgeons (26.3 %) and visceral surgeons (13.9%); 43.8% underwent a surgical intervention within the first 24 hours and 59.1% during their hospitalisation. In-hospital mortality for patients with ISS >15 was 26.2%. This is the first 5-year report on trauma in Switzerland. Trauma workload was similar to other European countries. Despite high levels of healthcare, mortality exceeds published rates by >50%. Regardless of the importance of a multidisciplinary approach, trauma remains a surgical disease and needs dedicated surgical resources.

  7. Injury risk to restrained children exposed to deployed first- and second-generation air bags in frontal crashes.

    PubMed

    Arbogast, Kristy B; Durbin, Dennis R; Kallan, Michael J; Elliott, Michael R; Winston, Flaura K

    2005-04-01

    To estimate the risk of serious nonfatal injuries in frontal crashes among belted children seated in the right front seat of vehicles in which second-generation passenger air bags deployed compared with that of belted children seated in the right front seat of vehicles in which first-generation passenger air bags deployed. We enrolled a probability sample of 1781 seat belt-restrained occupants aged 3 through 15 years seated in the right front seat, exposed to deployed passenger air bags in frontal crashes involving insured vehicles in 3 large US regions, between December 1, 1998, and November 30, 2002. A telephone interview was conducted with the driver of the vehicle using a previously validated instrument. The study sample was weighted according to each subject's probability of selection, with analyses conducted on the weighted sample. Main Outcome Measure Risk of serious injury (Abbreviated Injury Scale score of > or =2 injuries and facial lacerations). The risk of serious injury for restrained children in the right front seat exposed to deployed second-generation passenger air bags was 9.9%, compared with 14.9% for similar children exposed to deployed first-generation passenger air bags (adjusted odds ratio, 0.59; 95% confidence interval, 0.36-0.97). This study provides evidence based on field data that the risk of injury to children exposed to deploying second-generation passenger air bags is reduced compared with earlier designs.

  8. Advanced clinical interpretation of the Delis-Kaplan Executive Function System: multivariate base rates of low scores.

    PubMed

    Karr, Justin E; Garcia-Barrera, Mauricio A; Holdnack, James A; Iverson, Grant L

    2018-01-01

    Multivariate base rates allow for the simultaneous statistical interpretation of multiple test scores, quantifying the normal frequency of low scores on a test battery. This study provides multivariate base rates for the Delis-Kaplan Executive Function System (D-KEFS). The D-KEFS consists of 9 tests with 16 Total Achievement scores (i.e. primary indicators of executive function ability). Stratified by education and intelligence, multivariate base rates were derived for the full D-KEFS and an abbreviated four-test battery (i.e. Trail Making, Color-Word Interference, Verbal Fluency, and Tower Test) using the adult portion of the normative sample (ages 16-89). Multivariate base rates are provided for the full and four-test D-KEFS batteries, calculated using five low score cutoffs (i.e. ≤25th, 16th, 9th, 5th, and 2nd percentiles). Low scores occurred commonly among the D-KEFS normative sample, with 82.6 and 71.8% of participants obtaining at least one score ≤16th percentile for the full and four-test batteries, respectively. Intelligence and education were inversely related to low score frequency. The base rates provided herein allow clinicians to interpret multiple D-KEFS scores simultaneously for the full D-KEFS and an abbreviated battery of commonly administered tests. The use of these base rates will support clinicians when differentiating between normal variations in cognitive performance and true executive function deficits.

  9. A Genomic Score Prognostic of Outcome in Trauma Patients

    PubMed Central

    Warren, H Shaw; Elson, Constance M; Hayden, Douglas L; Schoenfeld, David A; Cobb, J Perren; Maier, Ronald V; Moldawer, Lyle L; Moore, Ernest E; Harbrecht, Brian G; Pelak, Kimberly; Cuschieri, Joseph; Herndon, David N; Jeschke, Marc G; Finnerty, Celeste C; Brownstein, Bernard H; Hennessy, Laura; Mason, Philip H; Tompkins, Ronald G

    2009-01-01

    Traumatic injuries frequently lead to infection, organ failure, and death. Health care providers rely on several injury scoring systems to quantify the extent of injury and to help predict clinical outcome. Physiological, anatomical, and clinical laboratory analytic scoring systems (Acute Physiology and Chronic Health Evaluation [APACHE], Injury Severity Score [ISS]) are utilized, with limited success, to predict outcome following injury. The recent development of techniques for measuring the expression level of all of a person’s genes simultaneously may make it possible to develop an injury scoring system based on the degree of gene activation. We hypothesized that a peripheral blood leukocyte gene expression score could predict outcome, including multiple organ failure, following severe blunt trauma. To test such a scoring system, we measured gene expression of peripheral blood leukocytes from patients within 12 h of traumatic injury. cRNA derived from whole blood leukocytes obtained within 12 h of injury provided gene expression data for the entire genome that were used to create a composite gene expression score for each patient. Total blood leukocytes were chosen because they are active during inflammation, which is reflective of poor outcome. The gene expression score combines the activation levels of all the genes into a single number which compares the patient’s gene expression to the average gene expression in uninjured volunteers. Expression profiles from healthy volunteers were averaged to create a reference gene expression profile which was used to compute a difference from reference (DFR) score for each patient. This score described the overall genomic response of patients within the first 12 h following severe blunt trauma. Regression models were used to compare the association of the DFR, APACHE, and ISS scores with outcome. We hypothesized that patients with a total gene response more different from uninjured volunteers would tend to have poorer

  10. Polytrauma Defined by the New Berlin Definition: A Validation Test Based on Propensity-Score Matching Approach

    PubMed Central

    Rau, Cheng-Shyuan; Wu, Shao-Chun; Kuo, Pao-Jen; Chen, Yi-Chun; Chien, Peng-Chen; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua

    2017-01-01

    Background: Polytrauma patients are expected to have a higher risk of mortality than that obtained by the summation of expected mortality owing to their individual injuries. This study was designed to investigate the outcome of patients with polytrauma, which was defined using the new Berlin definition, as cases with an Abbreviated Injury Scale (AIS) ≥ 3 for two or more different body regions and one or more additional variables from five physiologic parameters (hypotension [systolic blood pressure ≤ 90 mmHg], unconsciousness [Glasgow Coma Scale score ≤ 8], acidosis [base excess ≤ −6.0], coagulopathy [partial thromboplastin time ≥ 40 s or international normalized ratio ≥ 1.4], and age [≥70 years]). Methods: We retrieved detailed data on 369 polytrauma patients and 1260 non-polytrauma patients with an overall Injury Severity Score (ISS) ≥ 18 who were hospitalized between 1 January 2009 and 31 December 2015 for the treatment of all traumatic injuries, from the Trauma Registry System at a level I trauma center. Patients with burn injury or incomplete registered data were excluded. Categorical data were compared with two-sided Fisher exact or Pearson chi-square tests. The unpaired Student t-test and the Mann–Whitney U-test was used to analyze normally distributed continuous data and non-normally distributed data, respectively. Propensity-score matched cohort in a 1:1 ratio was allocated using the NCSS software with logistic regression to evaluate the effect of polytrauma on patient outcomes. Results: The polytrauma patients had a significantly higher ISS than non-polytrauma patients (median (interquartile range Q1–Q3), 29 (22–36) vs. 24 (20–25), respectively; p < 0.001). Polytrauma patients had a 1.9-fold higher odds of mortality than non-polytrauma patients (95% CI 1.38–2.49; p < 0.001). Compared to non-polytrauma patients, polytrauma patients had a substantially longer hospital length of stay (LOS). In addition, a higher proportion of

  11. 40 CFR 1048.805 - What symbols, acronyms, and abbreviations does this part use?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 33 2011-07-01 2011-07-01 false What symbols, acronyms, and... ENGINES Definitions and Other Reference Information § 1048.805 What symbols, acronyms, and abbreviations does this part use? The following symbols, acronyms, and abbreviations apply to this part: °Cdegrees...

  12. 40 CFR 1054.805 - What symbols, acronyms, and abbreviations does this part use?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false What symbols, acronyms, and... ENGINES AND EQUIPMENT Definitions and Other Reference Information § 1054.805 What symbols, acronyms, and abbreviations does this part use? The following symbols, acronyms, and abbreviations apply to this part...

  13. 40 CFR 1054.805 - What symbols, acronyms, and abbreviations does this part use?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 33 2011-07-01 2011-07-01 false What symbols, acronyms, and... ENGINES AND EQUIPMENT Definitions and Other Reference Information § 1054.805 What symbols, acronyms, and abbreviations does this part use? The following symbols, acronyms, and abbreviations apply to this part...

  14. 40 CFR 1068.35 - What symbols, acronyms, and abbreviations does this part use?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 33 2011-07-01 2011-07-01 false What symbols, acronyms, and... and Miscellaneous Provisions § 1068.35 What symbols, acronyms, and abbreviations does this part use? The following symbols, acronyms, and abbreviations apply to this part: $U.S. dollars. CFRCode of...

  15. First CT findings and improvement in GOS and GOSE scores 6 and 12 months after severe traumatic brain injury.

    PubMed

    Corral, Luisa; Herrero, José Ignacio; Monfort, José Luis; Ventura, José Luis; Javierre, Casimiro F; Juncadella, Montserrat; García-Huete, Lucía; Bartolomé, Carlos; Gabarrós, Andreu

    2009-05-01

    To analyse the association between individual initial computerized tomography (CT) scan characteristics and Glasgow Outcome Scale (GOS) and Extended Glasgow Outcome Scale (GOSE) improvement between 6 months and 1 year. Two hundred and twenty-four adult patients with severe traumatic brain injury and Glasgow Coma Scale (GCS) score of 8 or less who were admitted to an intensive care unit were studied. GOS and GOSE scores were obtained 6 and 12 months after injury in 203 subjects. Patients were predominantly male (84%) and median age was 35 years. Traumatic Coma Data Bank (TCDB) CT classification was associated with GOS/GOSE improvement between 6 months and 1 year, with diffuse injury type I, type II and evacuated mass improving more than diffuse injury type III, type IV and non-evacuated mass; for GOS 43/155 (28%) vs 3/48 (6%) (chi(2) = 9.66, p < 0.01) and for GOSE 71/155 (46%) vs 7/48 (15%) (chi(2) = 15.1, p < 0.01). CT individual abnormalities were not associated with GOS/GOSE improvement, with the exception of subarachnoid haemorrhage, which showed a negative association with GOSE improvement (chi(2) = 4.08, p < 0.05). TCDB CT scan classification and subarachnoid haemorrhage were associated with GOS/GOSE improvement from 6-12 months, but individual CT abnormalities were not associated.

  16. [Prehospital assessment of injury type and severity in severely injured patients by emergency physicians : An analysis of the TraumaRegister DGU®].

    PubMed

    Esmer, E; Derst, P; Lefering, R; Schulz, M; Siekmann, H; Delank, K-S

    2017-05-01

    Prehospital assessment of injury type and severity by emergency medical services physicians impacts treatment including appropriate destination hospital selection, especially in (potentially) life-threatening cases. Injuries which are underestimated or overlooked by the emergency physician can delay adequate therapy and thus significantly influence the overall outcome. The current study used data from the TraumaRegister DGU® to evaluate the reliability of prehospital injury assessments made by emergency physicians. Data of 30,777 patients from the TraumaRegister DGU® between 1993 and 2009 were retrospectively evaluated. Using the abbreviated injury scale (AIS), subjective prehospital assessments of injury severity by emergency physicians were correlated with objectively identified injuries diagnosed after admission to hospital. For this evaluation, prehospital injury assessments rated moderate or severe by the emergency physician as well as injuries diagnosed in hospital with an AIS score ≥3 points were deemed relevant. The 30,777 patients with an injury severity score (ISS) ≥ 9 suffered a total of 202,496 injuries and of these 26 % (51,839 out of 202,496) were considered relevant with an AIS ≥3 points. The most frequent relevant injuries were to the head (47 %) and chest (46 %). Of the 51,839 relevant injuries, the prehospital assessment by the emergency physician was accurate for 71 % and in 29 % of the cases relevant injuries were underestimated. Relevant injuries were unrecognized or underestimated in prehospital assessments for almost 1 out of every 7 cases of head trauma, almost 1 out of every 3 thoracic trauma and almost 1 out of every 2 abdominal and pelvic trauma. The assessment of injury severity by emergency medical services physicians based on physical examination at the scene of the trauma is not very reliable. Thus, mechanisms of injury and overall presentation as well as identifiable injuries and vital parameters should be

  17. Factors influencing pediatric Injury Severity Score and Glasgow Coma Scale in pediatric automobile crashes: results from the Crash Injury Research Engineering Network.

    PubMed

    Ehrlich, Peter F; Brown, J Kristine; Sochor, Mark R; Wang, Stewart C; Eichelberger, Martin E

    2006-11-01

    Motor vehicle crashes account for more than 50% of pediatric injuries. Triage of pediatric patients to appropriate centers can be based on the crash/injury characteristics. Pediatric motor vehicle crash/injury characteristics can be determined from an in vitro laboratory using child crash dummies. However, to date, no detailed data with respect to outcomes and crash mechanism have been presented with a pediatric in vivo model. The Crash Injury Research Engineering Network is comprised of 10 level 1 trauma centers. Crashes were examined with regard to age, crash severity (DeltaV), crash direction, restraint use, and airbag deployment. Multiple logistic regression analysis was performed with Injury Severity Score (ISS) and Glasgow Coma Scale (GCS) as outcomes. Standard age groupings (0-4, 5-9, 10-14, and 15-18) were used. The database is biases toward a survivor population with few fatalities. Four hundred sixty-one motor vehicle crashes with 2500 injuries were analyzed (242 boys, 219 girls). Irrespective of age, DeltaV > 30 mph resulted in increased ISS and decreased GCS (eg, for 0-4 years, DeltaV < 30: ISS = 10, GCS = 13.5 vs DeltaV > 30: ISS = 19.5, GCS = 10.6; P < .007, < .002, respectively). Controlling for DeltaV, children in lateral crashes had increased ISS and decreased GCS versus those in frontal crashes. Airbag deployment was protective for children 15 to 18 years old and resulted in a lower ISS and higher GCS (odds ratio, 2.1; 95% confidence interval, 0.9-4.6). Front-seat passengers suffered more severe (ISS > 15) injuries than did backseat passengers (odds ratio, 1.7; 95% confidence interval, 0.7-3.4). A trend was noted for children younger than 12 years sitting in the front seat to have increased ISS and decreased GCS with airbag deployment but was limited by case number. A reproducible pattern of increased ISS and lower GCS characterized by high severity, lateral crashes in children was noted. Further analysis of the specific injuries as a function and

  18. An abbreviated Faecal Incontinence Quality of Life Scale for Chinese-speaking population with colorectal cancer after surgery: cultural adaptation and item reduction.

    PubMed

    Hsu, L-F; Hung, C-L; Kuo, L-J; Tsai, P-S

    2017-09-01

    No instrument is available to assess the impact of faecal incontinence (FI) of quality of life for Chinese-speaking population. The purpose of the study was to adapt the Faecal Incontinence Quality of Life Scale (FIQL) for patients with colorectal cancer, assess the factor structure and reduce the items for brevity. A sample of 120 participants were enrolled. Internal consistency, test-retest reliability, and convergent and contrasted-groups validity were assessed. Construct validity was analysed using an exploratory and confirmatory factor analyses (CFA). The internal consistency (Cronbach's α of the total scale and four subscales = 0.98 and 0.97, 0.96, 0.92, 0.82 respectively), test-retest reliability (intraclass correlation coefficients ≥.98 for all scales with p < .001) and significant correlations of all scales with selected subscales of the Medical Outcomes Study 36-Item Short-Form Health Survey and the Wexner scale suggested satisfactory reliability and validity. The severe FI group (with a Wexner score ≥9) scored significantly lower on the scale than the less severe FI group (with a Wexner score <9) did (p < .001). The CFA supported a two-factor structure and demonstrated an excellent model fit of the 15-item abbreviated version of the FIQL-Chinese. The FIQL-Chinese has satisfactory validity and reliability and the abbreviated version may be more practical and applicable. © 2016 John Wiley & Sons Ltd.

  19. The Head Injury Retrieval Trial (HIRT): a single-centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics only

    PubMed Central

    Garner, Alan A; Mann, Kristy P; Fearnside, Michael; Poynter, Elwyn; Gebski, Val

    2015-01-01

    Background Advanced prehospital interventions for severe brain injury remains controversial. No previous randomised trial has been conducted to evaluate additional physician intervention compared with paramedic only care. Methods Participants in this prospective, randomised controlled trial were adult patients with blunt trauma with either a scene GCS score <9 (original definition), or GCS<13 and an Abbreviated Injury Scale score for the head region ≥3 (modified definition). Patients were randomised to either standard ground paramedic treatment or standard treatment plus a physician arriving by helicopter. Patients were evaluated by 30-day mortality and 6-month Glasgow Outcome Scale (GOS) scores. Due to high non-compliance rates, both intention-to-treat and as-treated analyses were preplanned. Results 375 patients met the original definition, of which 197 was allocated to physician care. Differences in the 6-month GOS scores were not significant on intention-to-treat analysis (OR 1.11, 95% CI 0.74 to 1.66, p=0.62) nor was the 30-day mortality (OR 0.91, 95% CI 0.60 to 1.38, p=0.66). As-treated analysis showed a 16% reduction in 30-day mortality in those receiving additional physician care; 60/195 (29%) versus 81/180 (45%), p<0.01, Number needed to treat =6. 338 patients met the modified definition, of which 182 were allocated to physician care. The 6-month GOS scores were not significantly different on intention-to-treat analysis (OR 1.14, 95% CI 0.73 to 1.75, p=0.56) nor was the 30-day mortality (OR 1.05, 95% CI 0.66 to 1.66, p=0.84). As-treated analyses were also not significantly different. Conclusions This trial suggests a potential mortality reduction in patients with blunt trauma with GCS<9 receiving additional physician care (original definition only). Confirmatory studies which also address non-compliance issues are needed. Trial registration number NCT00112398. PMID:25795741

  20. Predicted Unfavorable Neurologic Outcome Is Overestimated by the Marshall Computed Tomography Score, Corticosteroid Randomization After Significant Head Injury (CRASH), and International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) Models in Patients with Severe Traumatic Brain Injury Managed with Early Decompressive Craniectomy.

    PubMed

    Charry, Jose D; Tejada, Jorman H; Pinzon, Miguel A; Tejada, Wilson A; Ochoa, Juan D; Falla, Manuel; Tovar, Jesus H; Cuellar-Bahamón, Ana M; Solano, Juan P

    2017-05-01

    Traumatic brain injury (TBI) is of public health interest and produces significant mortality and disability in Colombia. Calculators and prognostic models have been developed to establish neurologic outcomes. We tested prognostic models (the Marshall computed tomography [CT] score, International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT), and Corticosteroid Randomization After Significant Head Injury) for 14-day mortality, 6-month mortality, and 6-month outcome in patients with TBI at a university hospital in Colombia. A 127-patient cohort with TBI was treated in a regional trauma center in Colombia over 2 years and bivariate and multivariate analyses were used. Discriminatory power of the models, their accuracy, and precision was assessed by both logistic regression and area under the receiver operating characteristic curve (AUC). Shapiro-Wilk, χ 2 , and Wilcoxon test were used to compare real outcomes in the cohort against predicted outcomes. The group's median age was 33 years, and 84.25% were male. The injury severity score median was 25, and median Glasgow Coma Scale motor score was 3. Six-month mortality was 29.13%. Six-month unfavorable outcome was 37%. Mortality prediction by Marshall CT score was 52.8%, P = 0.104 (AUC 0.585; 95% confidence interval [CI] 0 0.489-0.681), the mortality prediction by CRASH prognosis calculator was 59.9%, P < 0.001 (AUC 0.706; 95% CI 0.590-0.821), and the unfavorable outcome prediction by IMPACT was 77%, P < 0.048 (AUC 0.670; 95% CI 0.575-0.763). In a university hospital in Colombia, the Marshall CT score, IMPACT, and Corticosteroid Randomization After Significant Head Injury models overestimated the adverse neurologic outcome in patients with severe head trauma. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Injury patterns among various age and gender groups of trauma patients in southern Iran: A cross-sectional study.

    PubMed

    Bolandparvaz, Shahram; Yadollahi, Mahnaz; Abbasi, Hamid Reza; Anvar, Mehrdad

    2017-10-01

    Administrative data from trauma referral centers are useful sources while studying epidemiologic aspects of injuries. We aimed to provide a hospital-based view of injuries in Shiraz considering victims' age and gender, using administrative data from trauma research center.A cross-sectional registry-based study of adult trauma patients (age ≥15 years) sustaining injury through traffic accidents, violence, and unintentional incidents was conducted. Information was retrieved from 3 hospital administrative databases. Data on demographics, injury mechanisms, injured body regions, and injury descriptions; outcomes of hospitalization; and development of nosocomial infections were recorded. Injury Severity Score (ISS) was calculated by crosswalking from ICD-10 (International Classification of Diseases) injury diagnosis codes to AIS-98 (Abbreviated Injury Scale) severity codes. Patients were compared based on age groups and gender differences.A total of 47,295 trauma patients with a median age of 30 (interquartile range: 24-44 years) were studied, of whom 73.1% were male and the remaining 26.9% were female (M/F = 2.7:1.0). The most common injury mechanisms in the male group were car and motorcycle accidents whereas females were mostly victims of falls and pedestrian accidents (P < .01). As age increased, a shift from transportation-related to unintentionally caused injuries occurred. Overall, young men had their most severe injuries on head, whereas elderly women suffered more severe extremity injuries. Injury severity was similar between men and women; however, elderly had a significantly higher ISS. Although incidence of nosocomial infections was independent of victims' age and gender, elderly men had a significantly higher mortality rate.Based on administrative data from our trauma center, male gender and age >65 years are associated with increased risk of injury incidence, prolonged hospitalizations, and in-hospital death following trauma. Development of a

  2. What are the differences in injury patterns of young and elderly traffic accident fatalities considering death on scene and death in hospital?

    PubMed

    Heinrich, Daniela; Holzmann, Christopher; Wagner, Anja; Fischer, Anja; Pfeifer, Roman; Graw, Matthias; Schick, Sylvia

    2017-07-01

    Older traffic participants have higher risks of injury than the population up to 65 years in case of comparable road traffic accidents and further, higher mortality rates at comparable injury severities. Rib fractures as risk factors are currently discussed. However, death on scene is associated with hardly survivable injuries and might not be a matter of neither rib fractures nor age. As 60% of traffic accident fatalities are estimated to die on scene, they are not captured in hospital-based trauma registries and injury patterns remain unknown. Our database comprises 309 road traffic fatalities, autopsied at the Institute of Legal Medicine Munich in 2004 and 2005. Injuries are coded according to Abbreviated Injury Scale, AIS© 2005 update 2008 [1]. Data used for this analysis are age, sex, site of death, site of accident, traffic participation mode, measures of injury severity, and rib fractures. The injury patterns of elderly, aged 65+ years, are compared to the younger ones divided by their site of death. Elderly with death on scene more often show serious thorax injuries and pelvic fractures than the younger. Some hints point towards older fatalities showing less frequently serious abdominal injuries. In hospital, elderly fatalities show lower Injury Severity Scores (ISSs) compared to the younger. The number of rib fractures is significantly higher for the elderly but is not the reason for death. Results show that young and old fatalities have different injury patterns and reveal first hints towards the need to analyze death on scene more in-depth.

  3. 40 CFR 87.2 - Acronyms and abbreviations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 20 2011-07-01 2011-07-01 false Acronyms and abbreviations. 87.2 Section 87.2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONTROL OF AIR POLLUTION FROM AIRCRAFT AND AIRCRAFT ENGINES General Provisions § 87.2 Acronyms and...

  4. 7 CFR 1755.900 - Abbreviations and Definitions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... to §§ 1755.901 and 1755.902: (a) Abbreviations. (1) ADSSAll dielectric self-supporting; (2...) Dielectric cable means a cable which has neither metallic members nor other electrically conductive materials... means any fiber made of dielectric material that guides light. (24) Optical point discontinuities means...

  5. 7 CFR 1755.900 - Abbreviations and Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... to §§ 1755.901 and 1755.902: (a) Abbreviations. (1) ADSSAll dielectric self-supporting; (2...) Dielectric cable means a cable which has neither metallic members nor other electrically conductive materials... means any fiber made of dielectric material that guides light. (24) Optical point discontinuities means...

  6. Risk of thoracic injury from direct steering wheel impact in frontal crashes.

    PubMed

    Chen, Rong; Gabler, Hampton C

    2014-06-01

    The combination of airbag and seat belt is considered to be the most effective vehicle safety system. However, despite the widespread availability of airbags and a belt use rate of more than 85%, US drivers involved in crashes continue to be at risk of serious thoracic injury. The objective of this study was to determine the influence of steering wheel deformation on driver injury risk in frontal automobile crash. The analysis is based on cases extracted from the National Automotive Sampling System Crashworthiness Data System database for case years 1993 to 2011. The approach was to compare the adjusted odds of frontal crash injury experienced by drivers in vehicles with and without steering wheel deformation. Among frontal crash cases with belted drivers, observable steering wheel deformation occurred in less than 4% of all cases but accounted for 30% of belted drivers with serious (Abbreviated Injury Scale [AIS] score, 3+) thoracic injuries. Similarly, steering wheel deformation occurred in approximately 13% of unbelted drivers but accounted for 60% of unbelted drivers with serious thoracic injuries. Belted drivers in frontal crashes with steering wheel deformation were found to have two times greater odds of serious thoracic injury. Unbelted drivers were found to have four times greater odds of serious thoracic injury in crashes with steering wheel deformation. In frontal crashes, steering wheel deformation was more likely to occur in unbelted drivers than belted drivers, as well as higher severity crashes and with heavier drivers. The results of the present study show that airbag deployment and seat belt restraint do not completely eliminate the possibility of steering wheel contact. Even with the most advanced restraint systems, there remains an opportunity for further reduction in thoracic injury by continued enhancement to the seat belt and airbag systems. Furthermore, the results showed that steering wheel deformation is an indicator of potential serious

  7. Injury patterns among various age and gender groups of trauma patients in southern Iran

    PubMed Central

    Bolandparvaz, Shahram; Yadollahi, Mahnaz; Abbasi, Hamid Reza; Anvar, Mehrdad

    2017-01-01

    Abstract Administrative data from trauma referral centers are useful sources while studying epidemiologic aspects of injuries. We aimed to provide a hospital-based view of injuries in Shiraz considering victims’ age and gender, using administrative data from trauma research center. A cross-sectional registry-based study of adult trauma patients (age ≥15 years) sustaining injury through traffic accidents, violence, and unintentional incidents was conducted. Information was retrieved from 3 hospital administrative databases. Data on demographics, injury mechanisms, injured body regions, and injury descriptions; outcomes of hospitalization; and development of nosocomial infections were recorded. Injury Severity Score (ISS) was calculated by crosswalking from ICD-10 (International Classification of Diseases) injury diagnosis codes to AIS-98 (Abbreviated Injury Scale) severity codes. Patients were compared based on age groups and gender differences. A total of 47,295 trauma patients with a median age of 30 (interquartile range: 24–44 years) were studied, of whom 73.1% were male and the remaining 26.9% were female (M/F = 2.7:1.0). The most common injury mechanisms in the male group were car and motorcycle accidents whereas females were mostly victims of falls and pedestrian accidents (P < .01). As age increased, a shift from transportation-related to unintentionally caused injuries occurred. Overall, young men had their most severe injuries on head, whereas elderly women suffered more severe extremity injuries. Injury severity was similar between men and women; however, elderly had a significantly higher ISS. Although incidence of nosocomial infections was independent of victims’ age and gender, elderly men had a significantly higher mortality rate. Based on administrative data from our trauma center, male gender and age >65 years are associated with increased risk of injury incidence, prolonged hospitalizations, and in-hospital death following trauma

  8. The current status of road user injuries among the elderly in Germany: a medical and technical accident analysis.

    PubMed

    Richter, Martinus; Pape, Hans-Christoph; Otte, Dietmar; Krettek, Christian

    2005-03-01

    The incidence and treatment of injuries involving the elderly road user are of increasing importance for all fields of trauma care to ensure the best possible outcomes. Traffic accident reports were analyzed through technical and medical investigation for the involvement of elderly citizens. In 12,309 documented traffic accidents between 1985 and 1998, 1,843 elderly citizens (65 years and older) were involved, 1,260 of which were reported to have been injured. The mean Injury Severity Score among the injured elderly citizens was 7.3. Of the injured elderly road users, 39.5% were car occupants, 27.4% were bicyclists, 29.6% were pedestrians, 1.8% were truck occupants, and 1.7% were motorcyclists. Of the elderly road users in cars, 53% were not injured, in contrast to only 1.1% of the bicyclists and 0.8% of the pedestrians. Serious or severe injuries (Maximum Abbreviated Injury Scale, >/=2] occurred for 36.5% of the injured elderly road users as car occupants (unrestrained, 58%; restrained, 34%), 57.4% as bicyclists, and 65.4% as pedestrians A high rate of motor injuries is associated with vehicle accidents and increased levels of severity among the elderly population. This finding is especially evident for elder pedestrians and bicyclists. Also of note, the elderly even appear to be at risk for sustaining an increased level of injury severity when they are restrained or belt protected.

  9. 78 FR 26785 - Guidance for Industry: Implementation of an Acceptable Abbreviated Donor History Questionnaire...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-08

    ...] Guidance for Industry: Implementation of an Acceptable Abbreviated Donor History Questionnaire and... Abbreviated Donor History Questionnaire and Accompanying Materials for Use in Screening Frequent Donors of... history questionnaire and accompanying materials (aDHQ documents), version 1.3 dated December 2012...

  10. The Changing Pattern and Implications of Multiple Organ Failure (MOF) After Blunt Injury With Hemorrhagic Shock

    PubMed Central

    Minei, Joseph P.; Cuschieri, Joseph; Sperry, Jason; Moore, Ernest E.; West, Michael A.; Harbrecht, Brian G.; O’Keefe, Grant E.; Cohen, Mitchell J.; Moldawer, Lyle L.; Tompkins, Ronald G.; Maier, Ronald V.

    2012-01-01

    Objective To describe the incidence of post-injury multiple organ failure (MOF) and its relationship to nosocomial infection and mortality in trauma centers employing evidence-based standard operating procedures (SOPs). Design Prospective cohort study wherein SOPs were developed and implemented to optimize post-injury care. Setting Seven U.S. Level I trauma centers. Patients Severely injured patients (> 16 years old) with a blunt mechanism, systolic hypotension (< 90 mmHg) and/or base deficit (> 6 meq/L), need for blood transfusion within the first 12 hrs, and an abbreviated injury score (AIS) ≥ two excluding brain injury were eligible for inclusion. Measurements and Main Results 1,002 patients were enrolled and 916 met inclusion criteria. Daily markers of organ dysfunction were prospectively recorded for all patients while receiving intensive care. Overall, 29% of patients developed MOF. Development of MOF was early (median time of two days), short - lived, and predicted an increased incidence of NI, whereas, persistence of MOF predicted mortality. However, surprisingly, NI did not increase subsequent MOF and there was no evidence of a “second-hit” induced late onset MOF. Conclusions MOF remains common after severe injury. Contrary to current paradigms, the onset is only early, and not bimodal, nor is it associated with a “second-hit” induced late onset. MOF is associated with subsequent NI and increased mortality. SOP-driven interventions may be associated with a decrease in late MOF and morbidity. PMID:22020243

  11. Physiologic, demographic and mechanistic factors predicting New Injury Severity Score (NISS) in motor vehicle accident victims.

    PubMed

    Staff, T; Eken, T; Wik, L; Røislien, J; Søvik, S

    2014-01-01

    Current literature on motor vehicle accidents (MVAs) has few reports regarding field factors that predict the degree of injury. Also, studies of mechanistic factors rarely consider concurrent predictive effects of on-scene patient physiology. The New Injury Severity Score (NISS) has previously been found to correlate with mortality, need for ICU admission, length of hospital stay, and functional recovery after trauma. To potentially increase future precision of trauma triage, we assessed how the NISS is associated with physiologic, demographic and mechanistic variables from the accident site. Using mixed-model linear regression analyses, we explored the association between NISS and pre-hospital Glasgow Coma Scale (GCS) score, Revised Trauma Score (RTS) categories of respiratory rate (RR) and systolic blood pressure (SBP), gender, age, subject position in the vehicle, seatbelt use, airbag deployment, and the estimated squared change in vehicle velocity on impact ((Δv)(2)). Missing values were handled with multiple imputation. We included 190 accidents with 353 dead or injured subjects (mean NISS 17, median NISS 8, IQR 1-27). For the 307 subjects in front-impact MVAs, the mean increase in NISS was -2.58 per GCS point, -2.52 per RR category level, -2.77 per SBP category level, -1.08 for male gender, 0.18 per year of age, 4.98 for driver vs. rear passengers, 4.83 for no seatbelt use, 13.52 for indeterminable seatbelt use, 5.07 for no airbag deployment, and 0.0003 per (km/h)(2) velocity change (all p<0.002). This study in victims of MVAs demonstrated that injury severity (NISS) was concurrently and independently predicted by poor pre-hospital physiologic status, increasing age and female gender, and several mechanistic measures of localised and generalised trauma energy. Our findings underscore the need for precise information from the site of trauma, to reduce undertriage, target diagnostic efforts, and anticipate need for high-level care and rehabilitative resources

  12. Expanding pedestrian injury risk to the body region level: how to model passive safety systems in pedestrian injury risk functions.

    PubMed

    Niebuhr, Tobias; Junge, Mirko; Achmus, Stefanie

    2015-01-01

    Assessment of the effectiveness of advanced driver assistance systems (ADAS) plays a crucial role in accident research. A common way to evaluate the effectiveness of new systems is to determine the potentials for injury severity reduction. Because injury risk functions describe the probability of an injury of a given severity conditional on a technical accident severity (closing speed, delta V, barrier equivalent speed, etc.), they are predestined for such evaluations. Recent work has stated an approach on how to model the pedestrian injury risk in pedestrian-to-passenger car accidents as a family of functions. This approach gave explicit and easily interpretable formulae for the injury risk conditional on the closing speed of the car. These results are extended to injury risk functions for pedestrian body regions. Starting with a double-checked German In-depth Accident Study (GIDAS) pedestrian-to-car accident data set (N = 444) and a functional-anatomical definition of the body regions, investigations on the influence of specific body regions on the overall injury severity will be presented. As the measure of injury severity, the ISSx, a rescaled version of the well-known Injury Severity Score (ISS), was used. Though traditional ISS is computed by summation of the squares of the 3 most severe injured body regions, ISSx is computed by the summation of the exponentials of the Abbreviated Injury Scale (AIS) severities of the 3 most severely injured body regions. The exponentials used are scaled to fit the ISS range of values between 0 and 75. Three body regions (head/face/neck, thorax, hip/legs) clearly dominated abdominal and upper extremity injuries; that is, the latter 2 body regions had no influence at all on the overall injury risk over the range of technical accident severities. Thus, the ISSx is well described by use of the injury codes from the same body regions for any pedestrian injury severity. As a mathematical consequence, the ISSx becomes explicitly

  13. Executive Functioning of Combat Mild Traumatic Brain Injury.

    PubMed

    Gaines, Katy D; Soper, Henry V; Berenji, Gholam R

    2016-01-01

    This study investigates neuropsychological deficits in recently deployed veterans with mild traumatic brain injury (mTBI). Veterans discharged from 2007 to 2012 were recruited from Veterans Affairs clinics. Independent groups of participants with mTBI (n = 57) and those without TBI (n = 57) were administered the Beck Depression Inventory-II, Combat Exposure Scale, Word Memory Test, and the Self-Awareness of Deficits Interview. Neuropsychological instruments included the Rey-Osterrieth Complex Figure Test, Letter and Category Fluency, Trail-Making Test-Parts A and B, Christiansen H-abbreviated, Soper Neuropsychology Screen, Wechsler Memory Scale subtests Logical Memory I and II, and the Street Completion Test. The mTBI group performed significantly worse on all of the executive and nonexecutive measurements with the exception of Category Fluency, after controlling for age, depression effort, and combat exposure. Depression and combat exposure were greater for the mTBI group. The mTBI group scored poorer on effort, but only the Multiple Choice subtest was significant. The mTBI group had good awareness of their deficits.

  14. Injury severity in ice skating: an epidemiologic analysis using a standardised injury classification system.

    PubMed

    Ostermann, Roman C; Hofbauer, Marcus; Tiefenböck, Thomas M; Pumberger, Matthias; Tiefenböck, Michael; Platzer, Patrick; Aldrian, Silke

    2015-01-01

    Although injuries sustained during ice skating have been reported to be more serious than other forms of skating, the potential injury risks are often underestimated by skating participants. The purpose of this study was to give a descriptive overview of injury patterns occurring during ice skating. Special emphasis was put on injury severity by using a standardised injury classification system. Over a six month period, all patients treated with ice-skating-related injuries at Europe's largest hospital were included. Patient demographics were collected and all injuries categorised according to the Abbreviated Injury Scale (AIS) 2005. A descriptive statistic and logistic regression analysis was performed. Three hundred and forty-one patients (134 M, 207 F) were included in this study. Statistical analysis revealed that age had a significant influence on injury severity. People > 50 years had a higher risk of sustaining a more severe injury according to the AIS compared with younger skaters. Furthermore, the risk of head injury was significantly lower for people aged between 18 and 50 years than for people < 18 years (p = 0.0007) and significantly higher for people > 50 years than for people aged between 18 and 50 years (p = 0.04). The severity of ice-skating injuries is associated with the patient's age, showing more severe injuries in older patients. Awareness should be raised among the public and physicians about the risks associated with this activity in order to promote further educational interventions and the use of protective gear.

  15. 21 CFR 314.150 - Withdrawal of approval of an application or abbreviated application.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on Applications and Abbreviated Applications § 314.150 Withdrawal of approval of an... abbreviated application for a new drug on a finding that there is an imminent hazard to the public health. FDA...

  16. 21 CFR 314.150 - Withdrawal of approval of an application or abbreviated application.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on Applications and Abbreviated Applications § 314.150 Withdrawal of approval of an... abbreviated application for a new drug on a finding that there is an imminent hazard to the public health. FDA...

  17. 21 CFR 314.150 - Withdrawal of approval of an application or abbreviated application.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on Applications and Abbreviated Applications § 314.150 Withdrawal of approval of an... abbreviated application for a new drug on a finding that there is an imminent hazard to the public health. FDA...

  18. 21 CFR 314.150 - Withdrawal of approval of an application or abbreviated application.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on Applications and Abbreviated Applications § 314.150 Withdrawal of approval of an... abbreviated application for a new drug on a finding that there is an imminent hazard to the public health. FDA...

  19. 21 CFR 314.150 - Withdrawal of approval of an application or abbreviated application.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on Applications and Abbreviated Applications § 314.150 Withdrawal of approval of an... abbreviated application for a new drug on a finding that there is an imminent hazard to the public health. FDA...

  20. 7 CFR 4274.302 - Definitions and abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Definitions and abbreviations. 4274.302 Section 4274.302 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE DIRECT AND INSURED LOANMAKING Intermediary Relending Program (IRP) § 4274.302...

  1. Change in KOOS and WOMAC Scores in a Young Athletic Population With and Without Anterior Cruciate Ligament Injury.

    PubMed

    Antosh, Ivan J; Svoboda, Steven J; Peck, Karen Y; Garcia, E'Stephan J; Cameron, Kenneth L

    2018-06-01

    Several studies have examined changes in patient-reported outcome measures (PROMs) after anterior cruciate ligament (ACL) injury, but no studies to date have prospectively evaluated changes from preinjury baseline through injury and follow-up among ACL-injured patients compared to the baseline and follow-up changes of uninjured patients. To examine changes in PROMs over time from preinjury baseline to at least 2 years after ACL reconstruction and to compare these changes with those of an uninjured control group having similar physical activity requirements. Cohort study; Level of evidence, 2. The authors conducted a prospective cohort study with a nested case-control analysis at a US service academy. All incoming first year students were recruited to participate in this study. Consenting participants completed a baseline questionnaire that included the KOOS (Knee injury and Osteoarthritis Outcome Score), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and MARS (Marx Activity Rating Scale). Participants who sustained a subsequent ACL injury completed assessments at the time of surgery and at 6, 12, and 24 months after surgery. Healthy participants were recruited to repeat the baseline assessments within 1 year of graduation. Inter- and intragroup differences at these time points were evaluated with dependent and independent t tests, respectively. We also compared these results with established minimum clinically important difference (MCID) values. Of 1268 first year students entering the academy, 1005 with no previous injuries consented to participate in this study (82% male, mean ± SD age 19 ± 1 years). Of those enrolled, 30 suffered an ACL injury and met the inclusion criteria for this study. Ninety uninjured control students who met the inclusion criteria completed follow-up assessments. There were statistically significant differences across all KOOS and WOMAC subscales between ACL-injured group and uninjured group at the time of the

  2. Central diabetes insipidus in pediatric severe traumatic brain injury.

    PubMed

    Alharfi, Ibrahim M; Stewart, Tanya Charyk; Foster, Jennifer; Morrison, Gavin C; Fraser, Douglas D

    2013-02-01

    To determine the occurrence rate of central diabetes insipidus in pediatric patients with severe traumatic brain injury and to describe the clinical, injury, biochemical, imaging, and intervention variables associated with mortality. Retrospective chart and imaging review. Children's Hospital, level 1 trauma center. Severely injured (Injury Severity Score ≥ 12) pediatric trauma patients (>1 month and <18 yr) with severe traumatic brain injury (presedation Glasgow Coma Scale ≤ 8 and head Maximum Abbreviated Injury Scale ≥ 4) that developed acute central diabetes insipidus between January 2000 and December 2011. Of 818 severely injured trauma patients, 180 had severe traumatic brain injury with an overall mortality rate of 27.2%. Thirty-two of the severe traumatic brain injury patients developed acute central diabetes insipidus that responded to desamino-8-D-arginine vasopressin and/or vasopressin infusion, providing an occurrence rate of 18%. At the time of central diabetes insipidus diagnosis, median urine output and serum sodium were 6.8 ml/kg/hr (interquartile range = 5-11) and 154 mmol/L (interquartile range = 149-159), respectively. The mortality rate of central diabetes insipidus patients was 87.5%, with 71.4% declared brain dead after central diabetes insipidus diagnosis. Early central diabetes insipidus onset, within the first 2 days of severe traumatic brain injury, was strongly associated with mortality (p < 0.001), as were a lower presedation Glasgow Coma Scale (p = 0.03), a lower motor Glasgow Coma Scale (p = 0.01), an occurrence of fixed pupils (p = 0.04), and a prolonged partial thromboplastin time (p = 0.04). Cerebral edema on the initial computed tomography, obtained in the first 24 hrs after injury, was the only imaging finding associated with death (p = 0.002). Survivors of central diabetes insipidus were more likely to have intracranial pressure monitoring (p = 0.03), have thiopental administered to induce coma (p = 0.04) and have received a

  3. MSFC Space Station Program Commonly Used Acronyms and Abbreviations Listing

    NASA Technical Reports Server (NTRS)

    Gates, Thomas G.

    1988-01-01

    The Marshall Space Flight Center maintains an active history program to assure that the foundation of the Center's history is captured and preserved for current and future generations. As part of that overall effort, the Center began a project in 1987 to capture historical information and documentation on the Marshall Center's roles regarding Space Shuttle and Space Station. This document is MSFC Space Station Program Commonly Used Acronyms and Abbreviations Listing. It contains acronyms and abbreviations used in Space Station documentation and in the Historian Annotated Bibliography of Space Station Program. The information may be used by the researcher as a reference tool.

  4. Thoracic irrigation prevents retained hemothorax: A prospective propensity scored analysis.

    PubMed

    Kugler, Nathan W; Carver, Thomas W; Milia, David; Paul, Jasmeet S

    2017-12-01

    Thoracic trauma resulting in hemothorax (HTx) is typically managed with thoracostomy tube (TT) placement; however, up to 20% of patients develop retained HTx which may necessitate further intervention for definitive management. Although optimal management of retained HTx has been extensively researched, little is known about prevention of this complication. We hypothesized that thoracic irrigation at the time of TT placement would significantly decrease the rate of retained HTx necessitating secondary intervention. A prospective, comparative study of patients with traumatic HTx who underwent bedside TT placement was conducted. The control group consisted of patients who underwent standard TT placement, whereas the irrigation group underwent standard TT placement with immediate irrigation using 1 L of warmed sterile 0.9% saline. Patients who underwent emergency thoracotomy, those with TTs removed within 24 hours, or those who died within 30 days of discharge were excluded. The primary end point was secondary intervention defined by additional TT placement or operative management for retained HTx. A propensity-matched analysis was performed with scores estimated using a logistic regression model based on age, sex, mechanism of injury, Abbreviated Injury Scale chest score, and TT size. In over a 30-month period, a total of 296 patients underwent TT placement for the management of traumatic HTx. Patients were predominantly male (79.6%) at a median age of 40 years and were evenly split between blunt (48.8%) and penetrating (51.2%) mechanisms. Sixty (20%) patients underwent thoracic irrigation at time of initial TT placement. The secondary intervention rate was significantly lower within the study group (5.6% vs. 21.8%; OR, 0.16; p < 0.001). No significant differences in TT duration, ventilator days, or length of stay were noted between the irrigation and control cohort. Thoracic irrigation at the time of initial TT placement for traumatic HTx significantly reduced the

  5. Association between weight and risk of crash-related injuries for children in child restraints.

    PubMed

    Zonfrillo, Mark R; Elliott, Michael R; Flannagan, Carol A; Durbin, Dennis R

    2011-12-01

    To determine the association between weight and the risk of injury in motor vehicle crashes (MVCs) for children 1 through 8 years of age who were using child restraints. This was a cross-sectional study of children 1 to 8 years of age in MVCs, in which cases from the National Automotive Sampling System Crashworthiness Data System were used. Abbreviated Injury Scale scores of ≥2 indicated clinically significant injuries. The National Automotive Sampling System Crashworthiness Data System study sample included 650 children 1 to 5 years of age in forward-facing child restraints who weighed 20 to 65 lb and 344 children 3 to 8 years of age in belt-positioning booster seats who weighed 30 to 100 lb. With adjustment for seating position, type of vehicle, direction of impact, crash severity, and vehicle model year, there was no association between absolute weight and clinically significant injuries in either age group (odds ratio: 1.17 [95% confidence interval: 0.96-1.42] for children 1-5 years of age in forward-facing child restraints and 1.22 [95% confidence interval: 0.96-1.55] for children 3-8 years of age in belt-positioning booster seats). The risk of clinically significant injuries was not associated with weight across a broad weight range in this sample of children in MVCs who were using child restraint systems. Parents should continue to restrain their children according to current recommendations from the American Academy of Pediatrics and the National Highway Traffic Safety Administration.

  6. Are prehospital deaths from trauma and accidental injury preventable? A direct historical comparison to assess what has changed in two decades.

    PubMed

    Oliver, G J; Walter, D P; Redmond, A D

    2017-05-01

    In 1994, Hussain and Redmond revealed that up to 39% of prehospital deaths from accidental injury might have been preventable had basic first aid care been given. Since then there have been significant advances in trauma systems and care. The exclusion of prehospital deaths from the analysis of trauma registries, giv en the high rate of those, is a major limitation in prehospital research on preventable death. We have repeated the 1994 study to identify any changes over the years and potential developments to improve patient outcomes. We examined the full Coroner's inquest files for prehospital deaths from trauma and accidental injury over a three-year period in Cheshire. Injuries were scored using the Abbreviated-Injury-Scale (AIS-1990) and Injury Severity Score (ISS), and probability of survival estimated using Bull's probits to match the original protocol. One hundred and thirty-four deaths met our inclusion criteria; 79% were male, average age at death was 53.6 years. Sixty-two were found dead (FD), fifty-eight died at scene (DAS) and fourteen were dead on arrival at hospital (DOA). The predominant mechanism of injury was fall (39%). The median ISS was 29 with 58 deaths (43%) having probability of survival of >50%. Post-mortem evidence of head injury was present in 102 (76%) deaths. A bystander was on scene or present immediately after injury in 45% of cases and prior to the Emergency Medical Services (EMS) in 96%. In 93% of cases a bystander made the call for assistance, in those DAS or DOA, bystander intervention of any kind was 43%. The number of potentially preventable prehospital deaths remains high and unchanged. First aid intervention of any kind is infrequent. There is a potentially missed window of opportunity for bystander intervention prior to the arrival of the ambulance service, with simple first-aid manoeuvres to open the airway, preventing hypoxic brain injury and cardiac arrest. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All

  7. 32 CFR 516.3 - Explanation of abbreviations and terms.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Glossary contains explanations of abbreviations and terms. (b) The masculine gender has been used throughout this regulation for simplicity and consistency. Any reference to the masculine gender is intended...

  8. 32 CFR 516.3 - Explanation of abbreviations and terms.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Glossary contains explanations of abbreviations and terms. (b) The masculine gender has been used throughout this regulation for simplicity and consistency. Any reference to the masculine gender is intended...

  9. 32 CFR 516.3 - Explanation of abbreviations and terms.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Glossary contains explanations of abbreviations and terms. (b) The masculine gender has been used throughout this regulation for simplicity and consistency. Any reference to the masculine gender is intended...

  10. 32 CFR 516.3 - Explanation of abbreviations and terms.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Glossary contains explanations of abbreviations and terms. (b) The masculine gender has been used throughout this regulation for simplicity and consistency. Any reference to the masculine gender is intended...

  11. Comparison of the serious injury pattern of adult bicyclists, between South-West Netherlands and the State of Victoria, Australia 2001-2009.

    PubMed

    Yilmaz, Pinar; Gabbe, Belinda J; McDermott, Francis T; Van Lieshout, Esther M M; Rood, Pleunie P M; Mulligan, Terrence M; Patka, Peter; Cameron, Peter A

    2013-06-01

    Head injury is the leading cause of death and long term disability from bicycle injuries and may be prevented by helmet wearing. We compared the pattern of injury in major trauma victims resulting from bicyclist injury admitted to hospitals in the State of Victoria, Australia and South-West Netherlands, with respective high and low prevalence of helmet use among bicyclists. A cohort of bicycle injured patients with serious injury (defined as Injury Severity Score>15) in South-West Netherlands, was compared to a cohort of serious injured bicyclists in the State of Victoria, Australia. Additionally, the cohorts of patients with serious injury admitted to a Dutch level 1 trauma centre in Rotterdam, the Netherlands and an Australian level 1 trauma centre in Melbourne, Australia were compared. Both cohorts included patients admitted between July 2001 and June 2009. Primary outcome was in-hospital mortality and secondary outcome was prevalence of severe injury per body region. Outcome was compared using univariate analysis and mortality outcomes were also calculated using multivariable logistic regression models. A total of 219 cases in South-West Netherlands and 500 cases in Victoria were analyzed. Further analyses comparing the major trauma centres in each region, showed the percentage of bicycle-related death was higher in the Dutch population than in the Australian (n=45 (24%) vs n=13(7%); P<0.001). After adjusting for age, mechanism of injury, GCS and head injury severity in both hospitals, there was no significant difference in mortality (adjusted odds ratio 1.4; 95% confidence interval=0.6, 3.5). Patients in Netherlands trauma centre suffered from more serious head injuries (Abbreviated Injury Scale≥3) than patients in the Australian trauma centre (n=165 (88.2%) vs n=121 (62.4%); P<0.001). The other body regions demonstrated significant differences in the AIS scores with significantly more serious injuries (AIS≥3) of the chest, abdominal and extremities

  12. Contemporary New Zealand coefficients for the Trauma Injury Severity Score: TRISS(NZ).

    PubMed

    Schluter, Philip J; Cameron, Cate M; Davey, Tamzyn M; Civil, Ian; Orchard, Jodie; Dansey, Rangi; Hamill, James; Naylor, Helen; James, Carolyn; Dorrian, Jenny; Christey, Grant; Pollard, Cliff; McClure, Rod J

    2009-09-11

    To develop local contemporary coefficients for the Trauma Injury Severity Score in New Zealand, TRISS(NZ), and to evaluate their performance at predicting survival against the original TRISS coefficients. Retrospective cohort study of adults who sustained a serious traumatic injury, and who survived until presentation at Auckland City, Middlemore, Waikato, or North Shore Hospitals between 2002 and 2006. Coefficients were estimated using ordinary and multilevel mixed-effects logistic regression models. 1735 eligible patients were identified, 1672 (96%) injured from a blunt mechanism and 63 (4%) from a penetrating mechanism. For blunt mechanism trauma, 1250 (75%) were male and average age was 38 years (range: 15-94 years). TRISS information was available for 1565 patients of whom 204 (13%) died. Area under the Receiver Operating Characteristic (ROC) curves was 0.901 (95%CI: 0.879-0.923) for the TRISS(NZ) model and 0.890 (95% CI: 0.866-0.913) for TRISS (P<0.001). Insufficient data were available to determine coefficients for penetrating mechanism TRISS(NZ) models. Both TRISS models accurately predicted survival for blunt mechanism trauma. However, TRISS(NZ) coefficients were statistically superior to TRISS coefficients. A strong case exists for replacing TRISS coefficients in the New Zealand benchmarking software with these updated TRISS(NZ) estimates.

  13. Association of contact loading in diffuse axonal injuries from motor vehicle crashes.

    PubMed

    Yoganandan, Narayan; Gennarelli, Thomas A; Zhang, Jiangyue; Pintar, Frank A; Takhounts, Erik; Ridella, Stephen A

    2009-02-01

    Although studies have been conducted to analyze brain injuries from motor vehicle crashes, the association of head contact has not been fully established. This study examined the association in occupants sustaining diffuse axonal injuries (DAIs). The 1997 to 2006 motor vehicle Crash Injury Research Engineering Network database was used. All crash modes and all changes in velocity were included; ejections and rollovers were excluded; injuries to front and rear seat occupants with and without restraint use were considered. DAI were coded in the database using Abbreviated Injury Scale 1990. Loss of consciousness was included and head contact was based on medical- and crash-related data. Sixty-seven occupants with varying ages were coded with DAI. Forty-one adult occupants (mean, 33 years of age, 171-cm tall, 71-kg weight; 30 drivers, 11 passengers) were analyzed. Mean change in velocity was 41.2 km/h and Glasgow Coma Scale score was 4. There were 33 lateral, 6 frontal, and 2 rear crashes with 32 survivors and 9 were fatalities. Two occupants in the same crash did not sustain DAI. Although skull fractures and scalp injuries occurred in some impacts, head contact was identified in all frontal, rear, and far side, and all but one nearside crashes. Using a large sample size of occupants sustaining DAI in 1991 to 2006 model year vehicles, DAI occurred more frequently in side than frontal crashes, is most commonly associated with impact load transfer, and is not always accompanied by skull fractures. The association of head contact in >95% of cases underscores the importance of evaluating crash-related variables and medical information for trauma analysis. It would be prudent to include contact loading in addition to angular kinematics in the analysis and characterization of DAI.

  14. 21 CFR 314.101 - Filing an application and receiving an abbreviated new drug application.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on Applications and Abbreviated Applications § 314.101 Filing an application and receiving an abbreviated new drug application. (a)(1) Within 60 days after FDA receives an...

  15. 21 CFR 314.101 - Filing an application and receiving an abbreviated new drug application.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on Applications and Abbreviated Applications § 314.101 Filing an application and receiving an abbreviated new drug application. (a)(1) Within 60 days after FDA receives an...

  16. 21 CFR 314.101 - Filing an application and receiving an abbreviated new drug application.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on Applications and Abbreviated Applications § 314.101 Filing an application and receiving an abbreviated new drug application. (a)(1) Within 60 days after FDA receives an...

  17. 21 CFR 314.101 - Filing an application and receiving an abbreviated new drug application.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on Applications and Abbreviated Applications § 314.101 Filing an application and receiving an abbreviated new drug application. (a)(1) Within 60 days after FDA receives an...

  18. 21 CFR 314.101 - Filing an application and receiving an abbreviated new drug application.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on Applications and Abbreviated Applications § 314.101 Filing an application and receiving an abbreviated new drug application. (a)(1) Within 60 days after FDA receives an...

  19. Abbreviations and acronyms

    NASA Technical Reports Server (NTRS)

    1994-01-01

    This booklet provides a partial list of acronyms, abbreviations, and other short word forms, including their definitions, used in documents at the Goddard Space Flight Center (GSFC). This list does not preclude the use of other short forms of less general usage, as long as these short forms are identified the first time they appear in a document and are defined in a glossary in the document in which they are used. This document supplements information in the GSFC Scientific and Technical Information Handbook (GHB 2200.2/April 1989). It is not intended to contain all short word forms used in GSFC documents; however, it was compiled of actual short forms used in recent GSFC documents. The entries are listed first, alphabetically by the short form, and then again alphabetically by definition.

  20. Agricultural Farm-Related Injuries in Bangladesh and Convenient Design of Working Hand Tools.

    PubMed

    Parvez, M S; Shahriar, M M

    2018-01-01

    Injuries during cultivation of land are the significant causes of recession for an agricultural country like Bangladesh. Thousands of tools are used in agricultural farm having much probability of getting injury at their workplaces. For the injury prevention, proper hand tool designs need to be recommended with ergonomic evaluations. This paper represents the main causes of agricultural injuries among the Bangladeshi farmers. Effective interventions had been discussed in this paper to reduce the rate of injury. This study was carried out in the Panchagarh district of Bangladesh. Data on 434 agricultural injuries were collected and recorded. About 67% injuries of all incidents were due to hand tools, and the remaining 33% were due to machinery or other sources. Though most of the injuries were not serious, about 22% injuries were greater than or equal to AIS 2 (Abbreviated Injury Scale). The practical implication of this study is to design ergonomically fit agricultural hand tools for Bangladeshi farmers in order to avoid their injuries.

  1. The increasing incidence of severe pelvic injury in motor vehicle collisions.

    PubMed

    Inaba, Kenji; Sharkey, Philip W; Stephen, David J G; Redelmeier, Donald A; Brenneman, Frederick D

    2004-08-01

    Pelvic fractures constitute a major cause of death and residual disability in motor vehicle collisions (MVC). To date there has been poor documentation of the epidemiology of severe pelvic injuries. A detailed retrospective examination of all abbreviated injury score (AIS) > or = 4 pelvic fractures sustained in occupants of MVCs seen at this lead trauma hospital over the last 12 years and in the province of Ontario over the last 6 years was completed. The regional trauma centre registry and provincial database were used to obtain demographics, injuries, course in hospital and crash data on patients sustaining AIS > or = 4 pelvic injuries between May 1988 and April 2000. Data was analysed for drivers (D), front (FP) and rear (RP) passengers in 4-year blocks. Means (S.D.) with t-test for continuous and chi2 for categorical data were used for analysis. AIS > or = 4 pelvic fractures increased significantly in D and FP over 12 years and in RP over the last 8 years. Similar significant increases were seen throughout the province over the last 6 years. No significant change in age, sex, ISS or referral patterns was seen. Lateral impact collisions also increased over the study duration. Occupants with pelvic injury compared to all MVC survivors ISS > or = 16 during the same study period had a higher ISS (P < 0.001), utilised more blood in 24h and in total (P < 0.001) and died more frequently (P < 0.001). However, significantly fewer required ICU support (P < 0.01) which may reflect the associated injuries. Patients with pelvic fractures had significantly fewer head and chest injuries as well as fewer face and neck injuries. They did have significantly more injuries in the region of the pelvis including lumbar and sacral spine fractures, genitourinary, liver, spleen and lower extremity blood vessel, nerve and bone injuries. This study documented an increasing incidence of severe pelvic injury resulting from MVCs. This may be related to an associated increase in the

  2. 40 CFR 96.303 - Measurements, abbreviations, and acronyms.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Measurements, abbreviations, and acronyms. 96.303 Section 96.303 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... IMPLEMENTATION PLANS CAIR NOX Ozone Season Trading Program General Provisions § 96.303 Measurements...

  3. 48 CFR 3402.101-70 - Abbreviations and acronyms.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 7 2011-10-01 2011-10-01 false Abbreviations and acronyms. 3402.101-70 Section 3402.101-70 Federal Acquisition Regulations System DEPARTMENT OF EDUCATION... acronyms. CAO—Chief Acquisition Officer. CO—Contracting Officer. COR—Contracting Officer's Representative...

  4. Test Review: Review of the Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II)

    ERIC Educational Resources Information Center

    McCrimmon, Adam W.; Smith, Amanda D.

    2013-01-01

    The Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II; Wechsler, 2011), published by Pearson, is a newly updated abbreviated measure of cognitive intelligence designed for individuals 6 to 90 years of age. Primarily used in clinical, psychoeducational, and research settings, the WASI-II was developed to quickly and accurately…

  5. 76 FR 71601 - Record of Decision, Long Walk National Historic Trail Feasibility Study/Abbreviated Final...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-18

    ... National Historic Trail Feasibility Study/Abbreviated Final Environmental Impact Statement, National Trails... Decision on the Abbreviated Final Environmental Impact Statement for the Long Walk National Historic Trail... Final Environmental Impact Statement for the Long Walk National Historic Trail Feasibility Study...

  6. Simplifying the use of prognostic information in traumatic brain injury. Part 1: The GCS-Pupils score: an extended index of clinical severity.

    PubMed

    Brennan, Paul M; Murray, Gordon D; Teasdale, Graham M

    2018-06-01

    OBJECTIVE Glasgow Coma Scale (GCS) scores and pupil responses are key indicators of the severity of traumatic brain damage. The aim of this study was to determine what information would be gained by combining these indicators into a single index and to explore the merits of different ways of achieving this. METHODS Information about early GCS scores, pupil responses, late outcomes on the Glasgow Outcome Scale, and mortality were obtained at the individual patient level by reviewing data from the CRASH (Corticosteroid Randomisation After Significant Head Injury; n = 9,045) study and the IMPACT (International Mission for Prognosis and Clinical Trials in TBI; n = 6855) database. These data were combined into a pooled data set for the main analysis. Methods of combining the Glasgow Coma Scale and pupil response data varied in complexity from using a simple arithmetic score (GCS score [range 3-15] minus the number of nonreacting pupils [0, 1, or 2]), which we call the GCS-Pupils score (GCS-P; range 1-15), to treating each factor as a separate categorical variable. The content of information about patient outcome in each of these models was evaluated using Nagelkerke's R 2 . RESULTS Separately, the GCS score and pupil response were each related to outcome. Adding information about the pupil response to the GCS score increased the information yield. The performance of the simple GCS-P was similar to the performance of more complex methods of evaluating traumatic brain damage. The relationship between decreases in the GCS-P and deteriorating outcome was seen across the complete range of possible scores. The additional 2 lowest points offered by the GCS-Pupils scale (GCS-P 1 and 2) extended the information about injury severity from a mortality rate of 51% and an unfavorable outcome rate of 70% at GCS score 3 to a mortality rate of 74% and an unfavorable outcome rate of 90% at GCS-P 1. The paradoxical finding that GCS score 4 was associated with a worse outcome than GCS

  7. Comparison of the injury severity and medical history of disease-related versus trauma-related bicyclist fatalities.

    PubMed

    Hitosugi, Masahito; Koseki, Takeshi; Miyama, Genta; Furukawa, Satoshi; Morita, Satomu

    2016-01-01

    The objective of this study was to clarify the relationship between injury severity and mechanism of death in bicycle fatalities resulting from trauma compared with those resulting from disease, to propose effective measures to prevent fatal bicyclist accidents. Autopsy and accident records were reviewed for bicyclist fatalities who had undergone forensic autopsy at the Dokkyo Medical University School of Medicine between September 1999 and March 2014. Victims' health histories, blood alcohol levels, causes of death, mechanisms of injury, Abbreviated Injury Scale (AIS) scores and Injury Severity Scores (ISSs) were determined. Fifty-five bicyclists (43 male and 12 female) with a mean age of 62.5±17.3 years were included in this study. Sixteen victims had driven under the influence of alcohol (mean blood concentration of 1.8±0.7 mg/ml). Mean ISS was 32.4 and the chest had the highest mean AIS score (2.6), followed by the head (2.1) and the neck (1.8). Thirty-nine victims (70.9%) had died of trauma and 16 had died of disease. The disease-death victims had significantly higher prevalence of having diabetes mellitus, hyperlipidemia, hypertension, heart disease or cerebrovascular diseases (50.0% vs. 22.2%, p=0.03) and a lower rate of drunk driving (6.3% vs. 41.0%, p=0.01) than the trauma-death group. All victims who were affected by disease, and 33.3% of trauma-death victims, had fallen on the road without a vehicle collision (p<0.001). The mean ISS of the trauma-death group was significantly higher than that of the disease-death group (44.0 vs. 4.2, p<0.001). Except for facial injuries, the AIS scores were significantly higher in trauma-death victims than in the disease-death group (p<0.005). To effectively reduce bicyclist fatalities, the authors strongly advocate efforts that will increase compliance with drunk driving prohibitions. For victims of fatal bicycle accidents with a medical history of diseases, a forensic autopsy should be performed to establish a

  8. 24 CFR 58.2 - Terms, abbreviations and definitions.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 false Terms, abbreviations and definitions. 58.2 Section 58.2 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development ENVIRONMENTAL REVIEW PROCEDURES FOR ENTITIES ASSUMING HUD ENVIRONMENTAL...

  9. 24 CFR 58.2 - Terms, abbreviations and definitions.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Terms, abbreviations and definitions. 58.2 Section 58.2 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development ENVIRONMENTAL REVIEW PROCEDURES FOR ENTITIES ASSUMING HUD ENVIRONMENTAL...

  10. 24 CFR 58.2 - Terms, abbreviations and definitions.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Terms, abbreviations and definitions. 58.2 Section 58.2 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development ENVIRONMENTAL REVIEW PROCEDURES FOR ENTITIES ASSUMING HUD ENVIRONMENTAL...

  11. 24 CFR 58.2 - Terms, abbreviations and definitions.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 false Terms, abbreviations and definitions. 58.2 Section 58.2 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development ENVIRONMENTAL REVIEW PROCEDURES FOR ENTITIES ASSUMING HUD ENVIRONMENTAL...

  12. 24 CFR 58.2 - Terms, abbreviations and definitions.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 1 2014-04-01 2014-04-01 false Terms, abbreviations and definitions. 58.2 Section 58.2 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development ENVIRONMENTAL REVIEW PROCEDURES FOR ENTITIES ASSUMING HUD ENVIRONMENTAL...

  13. Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: a pilot study.

    PubMed

    Fortney, Luke; Luchterhand, Charlene; Zakletskaia, Larissa; Zgierska, Aleksandra; Rakel, David

    2013-01-01

    Burnout, attrition, and low work satisfaction of primary care physicians are growing concerns and can have a negative influence on health care. Interventions for clinicians that improve work-life balance are few and poorly understood. We undertook this study as a first step in investigating whether an abbreviated mindfulness intervention could increase job satisfaction, quality of life, and compassion among primary care clinicians. A total of 30 primary care clinicians participated in an abbreviated mindfulness course. We used a single-sample, pre-post design. At 4 points in time (baseline, and 1 day, 8 weeks, and 9 months postintervention), participants completed a set of online measures assessing burnout, anxiety, stress, resilience, and compassion. We used a linear mixed-effects model analysis to assess changes in outcome measures. Participants had improvements compared with baseline at all 3 follow-up time points. At 9 months postintervention, they had significantly better scores (1) on all Maslach Burnout Inventory burnout subscales-Emotional Exhaustion (P =.009), Depersonalization (P = .005), and Personal Accomplishment (P <.001); (2) on the Depression (P =.001), Anxiety (P =.006), and Stress (P = .002) subscales of the Depression Anxiety Stress Scales-21; and (3) for perceived stress (P = .002) assessed with the Perceived Stress Scale. There were no significant changes on the 14-item Resilience Scale and the Santa Clara Brief Compassion Scale. In this uncontrolled pilot study, participating in an abbreviated mindfulness training course adapted for primary care clinicians was associated with reductions in indicators of job burnout, depression, anxiety, and stress. Modified mindfulness training may be a time-efficient tool to help support clinician health and well-being, which may have implications for patient care.

  14. Can a Boxer Engine Reduce Leg Injuries Among Motorcyclists? Analysis of Injury Distributions in Crashes Involving Different Motorcycles Fitted with Antilock Brakes (ABS).

    PubMed

    Rizzi, Matteo

    2015-01-01

    Several studies have shown that motorcycle antilock braking systems (ABS) reduce crashes and injuries. However, it has been suggested that the improved stability provided by ABS would make upright crashes more frequent, thus changing the injury distributions among motorcyclists and increasing the risk of leg injuries. The overall motorcycle design can vary across different categories and manufacturers. For instance, some motorcycles are equipped with boxer-twin engines; that is, with protruding cylinder heads. A previous study based on a limited material has suggested that these could provide some leg protection; therefore, the aim of this research was to analyze injury distributions in crashes involving ABS-equipped motorcycles with boxer-twin engines compared to similar ABS-equipped motorcycles with other engine configurations. Swedish hospital and police records from 2003-2014 were used. Crashes involving ABS-equipped motorcycles with boxer-twin engines (n = 55) were compared with similar ABS-equipped motorcycles with other engines configurations (n = 127). The distributions of Abbreviated Injury Scale (AIS) 1+ and AIS 2+ were compared. Each subject's injury scores were also converted to the risk for permanent medical impairment (RPMI), which shows the risk of different levels of permanent medical impairment given the severity and location and of injuries. To compare injury severity, the mean RPMI 1+ and RPMI 10+ were analyzed for each body region and in overall for each group of motorcyclists. It was found that AIS 1+, AIS 2+, and PMI 1+ leg injuries were reduced by approximately 50% among riders with boxer engines. These results were statistically significant. The number of injuries to the upper body did not increase; the mean RPMI to the head and upper body were similar across the 2 groups, suggesting that the severity of injuries did not increase either. Indications were found suggesting that the overall mean RPMI 1+ was lower among riders with boxer engines

  15. Acute Kidney Injury Enhances Outcome Prediction Ability of Sequential Organ Failure Assessment Score in Critically Ill Patients

    PubMed Central

    Chang, Chih-Hsiang; Fan, Pei-Chun; Chang, Ming-Yang; Tian, Ya-Chung; Hung, Cheng-Chieh; Fang, Ji-Tseng; Yang, Chih-Wei; Chen, Yung-Chang

    2014-01-01

    Introduction Acute kidney injury (AKI) is a common and serious complication in intensive care unit (ICU) patients and also often part of a multiple organ failure syndrome. The sequential organ failure assessment (SOFA) score is an excellent tool for assessing the extent of organ dysfunction in critically ill patients. This study aimed to evaluate the outcome prediction ability of SOFA and Acute Physiology and Chronic Health Evaluation (APACHE) III score in ICU patients with AKI. Methods A total of 543 critically ill patients were admitted to the medical ICU of a tertiary-care hospital from July 2007 to June 2008. Demographic, clinical and laboratory variables were prospectively recorded for post hoc analysis as predictors of survival on the first day of ICU admission. Results One hundred and eighty-seven (34.4%) patients presented with AKI on the first day of ICU admission based on the risk of renal failure, injury to kidney, failure of kidney function, loss of kidney function, and end-stage renal failure (RIFLE) classification. Major causes of the ICU admissions involved respiratory failure (58%). Overall in-ICU mortality was 37.9% and the hospital mortality was 44.7%. The predictive accuracy for ICU mortality of SOFA (areas under the receiver operating characteristic curves: 0.815±0.032) was as good as APACHE III in the AKI group. However, cumulative survival rates at 6-month follow-up following hospital discharge differed significantly (p<0.001) for SOFA score ≤10 vs. ≥11 in these ICU patients with AKI. Conclusions For patients coexisting with AKI admitted to ICU, this work recommends application of SOFA by physicians to assess ICU mortality because of its practicality and low cost. A SOFA score of ≥ “11” on ICU day 1 should be considered an indicator of negative short-term outcome. PMID:25279844

  16. Traumatic Brain Injury among Older Adults at Level I and II Trauma Centers

    PubMed Central

    Cuthbert, Jeffrey P.; Whyte, John; Corrigan, John D.; Faul, Mark; Harrison-Felix, Cynthia

    2013-01-01

    Abstract Individuals 65 years of age and over have the highest rates of traumatic brain injury (TBI)-related hospitalizations and deaths, and older adults (defined variably across studies) have particularly poor outcomes after TBI. The factors predicting these outcomes remain poorly understood, and age-specific care guidelines for TBI do not exist. This study provides an overview of TBI in older adults using data from the National Trauma Data Bank (NTDB) gathered between 2007 and 2010, evaluates age group-specific trends in rates of TBI over time using U.S. Census data, and examines whether routinely collected information is able to predict hospital discharge status among older adults with TBI in the NTDB. Results showed a 20–25% increase in trauma center admissions for TBI among the oldest age groups (those >=75 years), relative to the general population, between 2007 and 2010. Older adults (>=65 years) with TBI tended to be white females who have incurred an injury from a fall resulting in a “severe” Abbreviated Injury Scale (AIS) score of the head. Older adults had more in-hospital procedures, such as neuroimaging and neurosurgery, tended to experience longer hospital stays, and were more likely to require continued medical care than younger adults. Older age, injury severity, and hypotension increased the odds of in-hospital death. The public health burden of TBI among older adults will likely increase as the Baby Boom generation ages. Improved primary and secondary prevention of TBI in this cohort is needed. PMID:23962046

  17. 77 FR 12877 - Record of Decision for the General Management Plan/Abbreviated Final Environmental Impact...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-02

    ... Decision for the General Management Plan/Abbreviated Final Environmental Impact Statement for New River... Abbreviated Final Environmental Impact Statement for the General Management Plan for New River Gorge National... Record of Decision can be downloaded from the NPS Planning, Environment and Public Comment (PEPC) Web...

  18. The Effect of Armed Forces Qualification Test Score on Mental Health Outcome Following Mild Traumatic Brain Injury

    DTIC Science & Technology

    2012-04-04

    Brain reserve and dementia: a systematic review . Psychol Med 2006;36:441–54. 39. Valenzuela MJ: Brain reserve and the prevention of dementia. Curr Opin...Forces Qualification Test (AFQT) score. A retrospective review was conducted to identify those with postinjury mental health disorders (ICD-9-CM codes...studies suggest the relationship between intelligence and mental health outcome may be more robust in those with MTBI, because the injury itself may

  19. Validating the Injury Severity Score (ISS) in different populations: ISS predicts mortality better among Hispanics and females.

    PubMed

    Bolorunduro, O B; Villegas, C; Oyetunji, T A; Haut, E R; Stevens, K A; Chang, D C; Cornwell, E E; Efron, D T; Haider, A H

    2011-03-01

    The Injury Severity Score (ISS) is the most commonly used measure of injury severity. The score has been shown to have excellent predictive capability for trauma mortality and has been validated in multiple data sets. However, the score has never been tested to see if its discriminatory ability is affected by differences in race and gender. This study is aimed at validating the ISS in men and women and in three different race/ethnic groups using a nationwide database. Retrospective analysis of patients age 18-64 y in the National Trauma Data Bank 7.0 with blunt trauma was performed. ISS was categorized as mild (<9,) moderate (9-15), severe (16-25), and profound (>25). Logistic regression was done to measure the relative odds of mortality associated with a change in ISS categories. The discriminatory ability was compared using the receiver operating characteristics curves (ROC). A P value testing the equality of the ROC curves was calculated. Age stratified analyses were also conducted. A total of 872,102 patients had complete data for the analysis on ethnicity, while 763,549 patients were included in the gender analysis. The overall mortality rate was 3.7%. ROC in Whites was 0.8617, in Blacks 0.8586, and in Hispanics 0.8869. Hispanics have a statistically significant higher ROC (P value < 0.001). Similar results were observed within each age category. ROC curves were also significantly higher in females than in males. The ISS possesses excellent discriminatory ability in all populations as indicated by the high ROCs. Copyright © 2011 Elsevier Inc. All rights reserved.

  20. Self-reported previous knee injury and low knee function increase knee injury risk in adolescent female football.

    PubMed

    Clausen, M B; Tang, L; Zebis, M K; Krustrup, P; Hölmich, P; Wedderkopp, N; Andersen, L L; Christensen, K B; Møller, M; Thorborg, K

    2016-08-01

    Knee injuries are common in adolescent female football. Self-reported previous knee injury and low Knee injury and Osteoarthritis Outcome Score (KOOS) are proposed to predict future knee injuries, but evidence regarding this in adolescent female football is scarce. The aim of this study was to investigate self-reported previous knee injury and low KOOS subscale score as risk factors for future knee injuries in adolescent female football. A sample of 326 adolescent female football players, aged 15-18, without knee injury at baseline, were included. Data on self-reported previous knee injury and KOOS questionnaires were collected at baseline. Time-loss knee injuries and football exposures were reported weekly by answers to standardized text-message questions, followed by injury telephone interviews. A priori, self-reported previous knee injury and low KOOS subscale scores (< 80 points) were chosen as independent variables in the risk factor analyses. The study showed that self-reported previous knee injury significantly increased the risk of time-loss knee injury [relative risk (RR): 3.65, 95% confidence (CI) 1.73-7.68; P < 0.001]. Risk of time-loss knee injury was also significantly increased in players with low KOOS subscale scores (< 80 points) in Activities of Daily Living (RR: 5.0), Sport/Recreational (RR: 2.2) and Quality of Life (RR: 3.0) (P < 0.05). In conclusion, self-reported previous knee injury and low scores in three KOOS subscales significantly increase the risk of future time-loss knee injury in adolescent female football. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. Intra- and Extra-Cranial Injury Burden as Drivers of Impaired Cerebrovascular Reactivity in Traumatic Brain Injury.

    PubMed

    Zeiler, Frederick Adam; Donnelly, Joseph; Nourallah, Basil; Thelin, Eric Peter; Calviello, Leanne; Smieleweski, Peter; Czosnyka, Marek; Ercole, Ari; Menon, David

    2018-02-12

    Impaired cerebrovascular reactivity has been associated with outcome following traumatic brain injury (TBI), but it is unknown how it is affected by trauma severity. Thus, we aimed to explore the relationship between intra-cranial (IC) and extra-cranial (EC) injury burden and cerebrovascular reactivity in TBI patients. We retrospectively included critically ill TBI patients. IC injury burden included detailed lesion and computerized tomography (CT) scoring (ie. Marshall, Rotterdam, Helsinki and Stockholm Scores) on admission. EC injury burden were characterized using the injury severity score (ISS) and APACHE II score. Pressure reactivity index (PRx), pulse amplitude index (PAx) and RAC were used to assess autoregulation/cerebrovascular reactivity. We used univariate and multi-variate logistic regression techniques to explore relationships between IC and EC injury burden and autoregulation indices. A total of 358 patients were assessed. ISS and all IC CT scoring systems were poor predictors of impaired cerebrovascular reactivity. Only subdural hematomas and thickness of SAH (p<0.05, respectively) were consistently associated with dysfunctional cerebrovascular reactivity. High age (p<0.01 for all) and admission APACHE II scores (p<0.05 for all) were the two variables strongest associated with abnormal cerebrovascular reactivity. In summary, diffuse IC injury markers (thickness of SAH and the presence of a SDH) and APACHE II were most associated with dysfunction in cerebrovascular reactivity after TBI. Standard CT scoring systems and evidence of macroscopic parenchymal damage are poor predictors, implicating potentially both microscopic injury patterns and host response as drivers of dysfunctional cerebrovascular reactivity. Age remains a major variable associated with cerebrovascular reactivity.

  2. Albumin administration is associated with acute kidney injury in cardiac surgery: a propensity score analysis.

    PubMed

    Frenette, Anne Julie; Bouchard, Josée; Bernier, Pascaline; Charbonneau, Annie; Nguyen, Long Thanh; Rioux, Jean-Philippe; Troyanov, Stéphan; Williamson, David R

    2014-11-14

    The risk of acute kidney injury (AKI) with the use of albumin-containing fluids compared to starches in the surgical intensive care setting remains uncertain. We evaluated the adjusted risk of AKI associated with colloids following cardiac surgery. We performed a retrospective cohort study of patients undergoing on-pump cardiac surgery in a tertiary care center from 2008 to 2010. We assessed crystalloid and colloid administration until 36 hours after surgery. AKI was defined by the RIFLE (risk, injury, failure, loss and end-stage kidney disease) risk and Acute Kidney Injury Network (AKIN) stage 1 serum creatinine criterion within 96 hours after surgery. Our cohort included 984 patients with a baseline glomerular filtration rate of 72 ± 19 ml/min/1.73 m(2). Twenty-three percent had a reduced left ventricular ejection fraction (LVEF), thirty-one percent were diabetics and twenty-three percent underwent heart valve surgery. The incidence of AKI was 5.3% based on RIFLE risk and 12.0% based on the AKIN criterion. AKI was associated with a reduced LVEF, diuretic use, anemia, heart valve surgery, duration of extracorporeal circulation, hemodynamic instability and the use of albumin, pentastarch 10% and transfusions. There was an important dose-dependent AKI risk associated with the administration of albumin, which also paralleled a higher prevalence of concomitant risk factors for AKI. To address any indication bias, we derived a propensity score predicting the likelihood to receive albumin and matched 141 cases to 141 controls with a similar risk profile. In this analysis, albumin was associated with an increased AKI risk (RIFLE risk: 12% versus 5%, P = 0.03; AKIN stage 1: 28% versus 13%, P = 0.002). We repeated this methodology in patients without postoperative hemodynamic instability and still identified an association between the use of albumin and AKI. Albumin administration was associated with a dose-dependent risk of AKI and remained significant using a propensity

  3. The Impact of Seat belts and Airbags on High Grade Renal Injuries and Nephrectomy Rates in Motor Vehicle Collisions

    PubMed Central

    Bjurlin, Marc A; Fantus, Richard J.; Mellett, Michele M.; Fantus, Richard J.; Villines, Dana

    2015-01-01

    Purpose Motor vehicle collisions (MVCs) are the most common cause of blunt genitourinary trauma. We compared renal injuries with no protective device to those with seat belts and/or airbags utilizing the National Trauma Data Bank (NTDB). Our primary endpoint was a reduction in high-grade renal injuries (grades III-V) with a secondary endpoint of reduction in nephrectomy rate. Materials and Methods The NTDB research datasets, admission year 2010, 2011, and 2012, were queried for MVC occupants with renal injury. Subjects were stratified by protective device and airbag deployment. Abbreviated Injury Score was converted to American Association for the Surgery of Trauma renal injury grade and nephrectomy rates were evaluated. Intergroup comparisons were analyzed for renal injury grades, nephrectomy, length of stay, and mortality with chi-square or one-way ANOVA. Protective device relative risk reduction was determined. Results A review of 466,028 MVCs revealed 3,846 renal injuries. Injured occupants without a protective device had a higher rate of high grade renal injury (45.1%) compared to those with seat belts (39.9%, p=0.008), airbags (42.3%, p=0.317), and seat belts with airbags (34.7%, p<0.001). Seat belts (20.0%, p<0.001), airbags (10.5% p<0.001), and seat belts with airbags (13.3%, p<0.001) reduced the rate of nephrectomy compared to no protective device (56.2%). The combination of seatbelts and airbags also reduced total hospital length of stay (p<0.001) and ICU days (p=0.005). Relative risk reduction of high-grade renal injuries (23.1%) and nephrectomy (39.9%) were highest for combined protective devices. Conclusions Occupants of MVCs with protective devices have reduced rates of high-grade renal injury and nephrectomy. Reduction appears most pronounced with the combination of seat belts and airbags. PMID:24846798

  4. Associations between damage location and five main body region injuries of MAIS 3-6 injured occupants.

    PubMed

    Tang, Youming; Cao, Libo; Kan, Steven

    2014-05-08

    To examine the damage location distribution of five main body region injuries of maximum abbreviated injury score (MAIS) 3-6 injured occupants for nearside struck vehicle in front-to-side impact crashes. MAIS 3-6 injured occupants information was extracted from the US-National Automotive Sampling System/Crashworthiness Data System in the year 2007; it included the head/face/neck, chest, pelvis, upper extremity and lower extremity. Struck vehicle collision damage was classified in a three-dimensional system according to the J224 Collision Deformation Classification of SAE Surface Vehicle Standard. Nearside occupants seated directly adjacent to the struck side of the vehicle with MAIS 3-6 injured, in light truck vehicles-passenger cars (LTV-PC) side impact crashes. Distribution of MAIS 3-6 injured occupants by body regions and specific location of damage (lateral direction, horizontal direction and vertical direction) were examined. Injury risk ratio was also assessed. The lateral crush zone contributed to MAIS 3-6 injured occupants (n=705) and 50th centile injury risks when extended into zone 3. When the crush extended to zone 4, the injury risk ratio of MAIS 3-6 injured occupants approached 81%. The horizontal crush zones contributing to the highest injury risk ratio of MAIS 3-6 occupants were zones 'D' and 'Y', and the injury risk ratios were 25.4% and 36.9%, respectively. In contrast, the lowest injury risk ratio was 5.67% caused by zone 'B'. The vertical crush zone which contributed to the highest injury risk ratio of MAIS 3-6 occupants was zone 'E', whose injury risk ratio was 58%. In contrast, the lowest injury risk ratio was 0.14% caused by zone 'G+M'. The highest injury risk ratio of MAIS 3-6 injured occupants caused by crush intrusion between 40 and 60 cm in LTV-PC nearside impact collisions and the damage region of the struck vehicle was in the zones 'E' and 'Y'.

  5. Analysis of Shahid Rajaee hospital administrative data on injuries resulting from car accidents in Shiraz, Iran: 2011-2014 data.

    PubMed

    Yadollahi, Mahnaz; Ghiassee, Aida; Anvar, Mehrdad; Ghaem, Hale; Farahmand, Mohammad

    2017-02-01

    The administrative data from trauma centers could serve as potential sources of invaluable information while studying epidemiologic features of car accidents. In this cross-sectional analysis of Shahid Rajaee hospital administrative data, we aimed to evaluate patients injured in car accidents in terms of age, gender, injury severity, injured body regions and hospitalization outcome in the recent four years (2011-2014). The hospital registry was accessed at Shiraz Trauma Research Center (Shiraz, Iran) and the admission's unit data were merged with the information gathered upon discharge. A total number of 27,222 car accident patients aged over 15 years with International Classification of Diseases 10th revision (ICD-10) external causes of injury codes (V40.9-V49.9) were analyzed. Injury severity score and injured body regions were determined based on converting ICD-10 injury codes to Abbreviated Injury Scale (AIS-98) severity codes using a domestically developed electronic algorithm. A binary logistic regression model was applied to the data to examine the contribution of all independent variables to in-hospital mortality. Men accounted for 68.9% of the injuries and the male to female ratio was 2.2:1. The age of the studied population was (34 ± 15) years, with more than 77.2% of the population located in the 15-45 years old age group. Head and neck was the most commonly injured body region (39.0%) followed by extremities (27.2%). Injury severity score (ISS) was calculated for 13,152 (48.3%) patients, of whom, 80.9% had severity scores less than 9. There were 332 patients (1.2%) admitted to the intensive care units and 422 in-hospital fatalities (1.5%) were recorded during the study period. Age above 65 years [OR = 7.4, 95% CI (5.0-10.9)], ISS above 16 [OR = 9.1, 95% CI (5.5-14.9)], sustaining a thoracic injury [OR = 7.4, 95% CI (4.6-11.9)] and head injury [OR = 4.9, 95% CI (3.1-7.6)] were the most important independent predictors of death following car

  6. Survival time estimation using Injury Severity Score (ISS) in homicide cases.

    PubMed

    Cros, Jérôme; Alvarez, Jean-Claude; Sbidian, Emilie; Charlier, Philippe; de la Grandmaison, Geoffroy Lorin

    2013-12-10

    The aim of our study was to assess the value of ISS to estimate survival time in a retrospective study of all homicidal deaths in the Western suburbs of Paris between 1994 and 2008. Stab wounds were the most common cause of death. Survival time between assault and death, determined in 107 cases out of 511 homicide cases, ranged from 0 min to 25 days (mean 39 h). There was an overall significant association between the survival time and the ISS score. ISS and survival time were strongly associated with male victims and a clear trend was seen with women. Regarding the type of wounds, a trend was seen with gunshot wounds and blunt injuries, but not with stab wounds. There was no influence of blood toxicological results and resuscitation attempts. Overall, ISS was a good predictor of a survival under 30 min. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  7. Youth motorcycle-related brain injury by state helmet law type: United States, 2005-2007.

    PubMed

    Weiss, Harold; Agimi, Yll; Steiner, Claudia

    2010-12-01

    Twenty-seven states have youth-specific helmet laws even though such laws have been shown to decrease helmet use and increase youth mortality compared with all-age (universal) laws. Our goal was to quantify the impact of age-specific helmet laws on youth under age 20 hospitalized with traumatic brain injury (TBI). Our cross-sectional ecological group analysis compared TBI proportions among US states with different helmet laws. We examined the following null hypothesis: If age-specific helmet laws are as effective as universal laws, there will be no difference in the proportion of hospitalized young motorcycle riders with TBI in the respective states. The data are derived from the 2005 to 2007 State Inpatient Databases of the Healthcare Cost and Utilization Project. We examined data for 17 states with universal laws, 6 states with laws for ages <21, and 12 states with laws for children younger than 18 (9287 motorcycle injury discharges). In states with a <21 law, serious TBI among youth was 38% higher than in universal-law states. Motorcycle riders aged 12 to 17 in 18 helmet-law states had a higher proportion of serious/severe TBI and higher average Abbreviated Injury Scores for head-region injuries than riders from universal-law states. States with youth-specific laws had an increased risk of TBI that required hospitalization, serious and severe TBI, TBI-related disability, and in-hospital death among the youth they are supposed to protect. The only method known to keep motorcycle-helmet use high among youth is to adopt or maintain universal helmet laws.

  8. Prospective observational study with an abbreviated protocol in the management of blunt renal injury in children.

    PubMed

    Graziano, Kathleen D; Juang, David; Notrica, David; Grandsoult, Victoria L; Acosta, Juan; Sharp, Susan W; Murphy, J Patrick; St Peter, Shawn D

    2014-01-01

    There are no published management schemes for blunt renal injuries. We are conducting a 2-center prospective observational study with a fixed management scheme. Children with CT proven renal injuries were enrolled with permission. Ambulation is allowed when able regardless of grade. Discharge occurs when tolerating a diet and pain is controlled regardless of hematuria. Urinalysis occurs at follow up in 2-4weeks and repeated as indicated. Between 9/2008 and 9/2012, 70 patients were enrolled. Mean age was 11.8years (3-17), and 70% were male. The mean grade of injury was 2.8±1.1 [1-5]. One nephrectomy (1.4%) was performed for a grade 5 injury. Other renal interventions included an embolization for the hilar bleed and one cystotomy for a clot. Mean LOS was 2.9days±2.4days. In patients without other major injury, LOS was 1.9±1.7days (0.4-8days). There were 5 (7%) readmissions: 3 for pain, 1 for hematuria, and 1 for a bladder clot. 58 patients (83%) gave urinalysis samples at initial follow up (med 18days), where 31 (53%) were positive for blood. Children with blunt renal injury may benefit from management without strict bedrest guidelines. Hematuria appears to have little influence on recovery. © 2014.

  9. Interactive Hangman Teaches Amino Acid Structures and Abbreviations

    ERIC Educational Resources Information Center

    Pennington, Britney O.; Sears, Duane; Clegg, Dennis O.

    2014-01-01

    We developed an interactive exercise to teach students how to draw the structures of the 20 standard amino acids and to identify the one-letter abbreviations by modifying the familiar game of "Hangman." Amino acid structures were used to represent single letters throughout the game. To provide additional practice in identifying…

  10. Performance of International Classification of Diseases-based injury severity measures used to predict in-hospital mortality: A systematic review and meta-analysis.

    PubMed

    Gagné, Mathieu; Moore, Lynne; Beaudoin, Claudia; Batomen Kuimi, Brice Lionel; Sirois, Marie-Josée

    2016-03-01

    The International Classification of Diseases (ICD) is the main classification system used for population-based injury surveillance activities but does not contain information on injury severity. ICD-based injury severity measures can be empirically derived or mapped, but no single approach has been formally recommended. This study aimed to compare the performance of ICD-based injury severity measures to predict in-hospital mortality among injury-related admissions. A systematic review and a meta-analysis were conducted. MEDLINE, EMBASE, and Global Health databases were searched from their inception through September 2014. Observational studies that assessed the performance of ICD-based injury severity measures to predict in-hospital mortality and reported discriminative ability using the area under a receiver operating characteristic curve (AUC) were included. Metrics of model performance were extracted. Pooled AUC were estimated under random-effects models. Twenty-two eligible studies reported 72 assessments of discrimination on ICD-based injury severity measures. Reported AUC ranged from 0.681 to 0.958. Of the 72 assessments, 46 showed excellent (0.80 ≤ AUC < 0.90) and 6 outstanding (AUC ≥ 0.90) discriminative ability. Pooled AUC for ICD-based Injury Severity Score (ICISS) based on the product of traditional survival proportions was significantly higher than measures based on ICD mapped to Abbreviated Injury Scale (AIS) scores (0.863 vs. 0.825 for ICDMAP-ISS [p = 0.005] and ICDMAP-NISS [p = 0.016]). Similar results were observed when studies were stratified by the type of data used (trauma registry or hospital discharge) or the provenance of survival proportions (internally or externally derived). However, among studies published after 2003 the Trauma Mortality Prediction Model based on ICD-9 codes (TMPM-9) demonstrated superior discriminative ability than ICISS using the product of traditional survival proportions (0.850 vs. 0.802, p = 0.002). Models

  11. Relatively short diagnostic delays (<8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience.

    PubMed

    Fakhry, S M; Brownstein, M; Watts, D D; Baker, C C; Oller, D

    2000-03-01

    Blunt small bowel injury (SBI) is uncommon, and its timely diagnosis may be difficult. The impact of operative delays on morbidity and mortality has been unclear. The purpose of this study was to determine the relationship of diagnostic delays to morbidity and mortality in blunt SBI. Patients with blunt SBI with perforation were identified from the registries of eight trauma centers (1989-1997). Patients with duodenal injuries were excluded. Data were extracted by individual chart review. Patients were classified as multi-trauma (group 1) or near-isolated SBI (group 2 with Abbreviated Injury Scale score < 2 for other body areas). Time to operation and its impact on mortality and morbidity was determined for each patient. A total of 198 patients met inclusion criteria: 66.2% were male, mean age was 35.2 years (range, 1-90 years) and mean Injury Severity Score was 16.7 (range, 9-47). 100 patients had multiple injuries (group 1). There were 21 deaths (10.6%) with 9 (4.5%) attributable to delay in operation for SBI. In patients with near-isolated SBI, the incidence of mortality increased with time to operative intervention (within 8 hours: 2%; 8-16 hours: 9.1%; 16-24 hours: 16.7%; greater than 24 hours: 30.8%, p = 0.009) as did the incidence of complications. Delays as short as 8 hours 5 minutes and 11 hours 15 minutes were associated with mortality attributable to SBI. The rates of delay in diagnosis were not significantly associated with age, gender, intoxication, transfer status, or presence of associated injuries. Delays in the diagnosis of SBI are directly responsible for almost half the deaths in this series. Even relatively brief delays (as little as 8 hours) result in morbidity and mortality directly attributable to "missed" SBI. Further investigation into the prompt diagnosis of this injury is needed.

  12. Injury severity of pedestrians, bicyclists and motorcyclists resulting from crashes with reversing cars.

    PubMed

    Decker, Sebastian; Otte, Dietmar; Cruz, Dana Leslie; Müller, Christian Walter; Omar, Mohamed; Krettek, Christian; Brand, Stephan

    2016-09-01

    Pedestrians, bicyclists and motorcyclists can suffer serious injury in road traffic crashes. To date, no studies examine the injury severity within this vulnerable cohort following collisions with reversing cars. Our institution prospectively maintains a database including medical and technical information regarding traffic accidents in our area, including urban and suburban regions. In a retrospective review of this database, the authors describe the injury severity of pedestrians, bicyclists and motorcyclists following traffic crashes involving reversing cars. Injury severity was described using the abbreviated injury scale (AIS) as well as the maximum abbreviated injury scale (MAIS). This study included 234 crashes occurring between 1999 and 2012. The lower extremity was injured most often while also suffering more severe injuries with a median AIS of 1 compared to 0 in all other documented body regions. The upper extremity was injured second most often. AIS ranging from 4 to 6 were infrequent. AIS 3 however, was documented for the legs in 4.3% of patients. MAIS 0, 1, 2, 3, 5 and 9 were found in 1, 164, 46, 14, 1, and 8 patients in the study cohort, respectively. Pedestrians and motorcyclists were seriously injured in 9.1% and 9.6% of cases, respectively. In contrast, no bicyclists suffered serious injuries. As to the zone of impact, most collisions occurred at the rear center of the vehicle (35%) followed by rear left (26%), rear right (20%), side rear (11%), side center (4%) and side front (3%). 204 (87.2%) collisions occurred during the day, 19 (8.1%) at night and 11 (4.7%) at twilight. Speed was similar in crashes involving pedestrians, bicyclists and motorcyclists, being as high as 7.0±3.6, 7.0±4.0 and 7.9±4.2km/h respectively. This is the first study that analyzes injury severity among these vulnerable road users following collisions with reversing vehicles. The majority of collisions occur at low impact speed during the day. Most injuries resulting

  13. A Confirmatory Factor Analysis of the Structure of Abbreviated Math Anxiety Scale

    PubMed Central

    Farrokhi, Farahman

    2011-01-01

    Objective The aim of this study is to explore the confirmatory factor analysis results of the Persian adaptation of Abbreviated Math Anxiety Scale (AMAS), proposed by Hopko, Mahadevan, Bare & Hunt. Method The validity and reliability assessments of the scale were performed on 298 college students chosen randomly from Tabriz University in Iran. The confirmatory factor analysis (CFA) was carried out to determine the factor structures of the Persian version of AMAS. Results As expected, the two-factor solution provided a better fit to the data than a single factor. Moreover, multi-group analyses showed that this two-factor structure was invariant across sex. Hence, AMAS provides an equally valid measure for use among college students. Conclusions Brief AMAS demonstrates adequate reliability and validity. The AMAS scores can be used to compare symptoms of math anxiety between male and female students. The study both expands and adds support to the existing body of math anxiety literature. PMID:22952521

  14. The Effect of Concussion or Mild Traumatic Brain Injury on School Grades, National Examination Scores, and School Attendance: A Systematic Review.

    PubMed

    Rozbacher, Adrian; Selci, Erin; Leiter, Jeff; Ellis, Michael; Russell, Kelly

    2017-07-15

    Concussion often results in symptoms, including difficulty concentrating, focusing, and remembering, that are typically managed with cognitive and physical rest. Often, the school environment is not conducive to cognitive rest and may lead to worsening or prolonged symptoms that can contribute to impaired academic performance. The objective of the review was to identify and summarize literature concerning the effects of concussion or mild traumatic brain injury (mTBI) on academic outcomes. MEDLINE, Embase, Scopus, and CINAHL were searched until June 1, 2016. Studies must have been primary literature examining students enrolled in primary, secondary, or post-secondary education, have received a physician diagnosis of concussion or mTBI, and have post-injury academic outcomes assessed in numeric or alphabet grade/grade point average (GPA), school attendance records, or national examination scores. Data were extracted and checked by a second reviewer for accuracy and completeness. Nine studies were included. Among four studies that examined grades, one found a significant difference in pre- and post-grades only in the subject Afrikaans. Three examined national test scores and no significant differences were found between cases and controls. Four examined school absenteeism and found that students who developed post-concussion syndrome missed significantly more school days and took longer to return to school than students with extremity injuries. Although mTBI or concussion is associated with missed school, the results demonstrate minimal impact on school grades and national examination scores at a group level. Further research is needed to identify risk factors for impaired school functioning following mTBI and concussion in individual patients.

  15. Abbreviated Mindfulness Intervention for Job Satisfaction, Quality of Life, and Compassion in Primary Care Clinicians: A Pilot Study

    PubMed Central

    Fortney, Luke; Luchterhand, Charlene; Zakletskaia, Larissa; Zgierska, Aleksandra; Rakel, David

    2013-01-01

    PURPOSE Burnout, attrition, and low work satisfaction of primary care physicians are growing concerns and can have a negative influence on health care. Interventions for clinicians that improve work-life balance are few and poorly understood. We undertook this study as a first step in investigating whether an abbreviated mindfulness intervention could increase job satisfaction, quality of life, and compassion among primary care clinicians. METHODS A total of 30 primary care clinicians participated in an abbreviated mindfulness course. We used a single-sample, pre-post design. At 4 points in time (baseline, and 1 day, 8 weeks, and 9 months postintervention), participants completed a set of online measures assessing burnout, anxiety, stress, resilience, and compassion. We used a linear mixed-effects model analysis to assess changes in outcome measures. RESULTS Participants had improvements compared with baseline at all 3 follow-up time points. At 9 months postintervention, they had significantly better scores (1) on all Maslach Burnout Inventory burnout subscales—Emotional Exhaustion (P =.009), Depersonalization (P = .005), and Personal Accomplishment (P <.001); (2) on the Depression (P =.001), Anxiety (P =.006), and Stress (P = .002) subscales of the Depression Anxiety Stress Scales-21; and (3) for perceived stress (P = .002) assessed with the Perceived Stress Scale. There were no significant changes on the 14-item Resilience Scale and the Santa Clara Brief Compassion Scale. CONCLUSIONS In this uncontrolled pilot study, participating in an abbreviated mindfulness training course adapted for primary care clinicians was associated with reductions in indicators of job burnout, depression, anxiety, and stress. Modified mindfulness training may be a time-efficient tool to help support clinician health and well-being, which may have implications for patient care. PMID:24019272

  16. 32 CFR Appendix B to Part 806 - Abbreviations and Acronyms

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... FORCE FREEDOM OF INFORMATION ACT PROGRAM Pt. 806, App. B Appendix B to Part 806—Abbreviations and... IG—Inspector General IMPAC—International Merchant Purchase Authority Card LOA—Letters of Offer and...

  17. 32 CFR Appendix B to Part 806 - Abbreviations and Acronyms

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... FORCE FREEDOM OF INFORMATION ACT PROGRAM Pt. 806, App. B Appendix B to Part 806—Abbreviations and... IG—Inspector General IMPAC—International Merchant Purchase Authority Card LOA—Letters of Offer and...

  18. Social anxiety in the general population: introducing abbreviated versions of SIAS and SPS.

    PubMed

    Kupper, Nina; Denollet, Johan

    2012-01-01

    Social anxiety is characterized by the experience of stress, discomfort and fear in social situations, and is associated with substantial personal and societal burden. Two questionnaires exist that assess the aspects of social anxiety, i.e. social interaction anxiety (SIAS) and social phobia (SPS). There is no agreement in literature on the dimensionality of social anxiety. Further, the length of a questionnaire may negatively affect response rates and participation at follow-up occasions. To explore the structure of social anxiety in the general population, and to examine psychosocial and sociodemographic correlates. Our second aim was to construct abbreviated versions of SIAS and SPS that can be easily used and with minimal burden. A total of 1598 adults from the general Dutch population completed a survey asking information on social anxiety, mood and demographics. Exploratory and confirmatory factor analyses as well as reliability analysis with item-total statistics were performed. Confirmatory factor analysis revealed a 3-factor structure for social phobia, and a 2-factor structure for the SIAS, with the second factor containing both reversely scored items. The abbreviated versions of SPS (11 items) and SIAS (10 items) show excellent discriminant and construct validity (Cronbach's α=.90 and .92), while specificity analysis showed that gender, marital status and educational level (SIAS(10): p<.0005; SPS(11): p<.0005) are important determinants of social anxiety. In the general population, social interaction anxiety and social phobia are two aspects of a higher-order factor of social anxiety. Social anxiety is validly captured by the short versions of SPS and SIAS, reducing the questionnaire burden for participants in epidemiological and biobehavioral research. Copyright © 2011 Elsevier B.V. All rights reserved.

  19. 40 CFR 96.203 - Measurements, abbreviations, and acronyms.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... PROGRAMS (CONTINUED) NOX BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS FOR STATE IMPLEMENTATION PLANS CAIR SO2 Trading Program General Provisions § 96.203 Measurements, abbreviations, and...—nitrogen oxides O2—oxygen ppm—parts per million scfh—standard cubic feet per hour SO2—sulfur dioxide yr...

  20. Pattern and spectrum of tornado injury and its geographical information system distribution in Yancheng, China: a cross-sectional study.

    PubMed

    Deng, Qiangyu; Lv, Yipeng; Xue, Chen; Kang, Peng; Dong, Junqiang; Zhang, Lulu

    2018-06-22

    Few studies of tornado injuries have considered differences related to damage levels and Enhanced-Fujita (EF) scale ratings. This study aimed to evaluate the pattern, spectrum and geographical distribution of injuries related to the Yancheng tornado and provide guidelines for effective emergency medical strategies. The study was conducted at three hospitals which treated patients with injuries related to the tornado in Yancheng, China. We obtained the records of 451 patients with tornado-related injuries. Of these, 401 valid trauma medical records were included; 50 other records were excluded for insufficient information. Informed consent was obtained from all patients by telephone. We analysed patients' injury sites and types and used the abbreviated injury scale (AIS) to standardise injury severity. Geographical information system and non-parametric tests were used to analyse the effects of geographical factors on casualties. Women, middle-aged/elderly individuals (age>45 years) and children/adolescents (<18 years) accounted for 51.62%, 77.30% and 12.47% of injured patients, respectively. This caused a dumbbell-shaped age distribution. Head (46.63%), body surface (39.90%) and lower-limb (29.43%) injuries were common, as were soft-tissue injuries (90.77%), fractures (38.90%) and organ damage (19.70%). Minor injuries (AIS=1) were common (60.85%), whereas critical/fatal injuries (AIS≥5) were very rare (2.50%). Although the densities of injury varied among damage levels and EF ratings for different areas, area-wise differences in injury severity (AIS scores) were not significant (p>0.05). We recommend the use of helmets to prevent head injuries caused by tornadoes and suggest prioritising the treatment of high-risk head and multiple-organ injuries. Additionally, medical rescuers should follow the 'same quality and different quantity' principle: the injured in all affected areas should receive equal attention, but numbers of medical personnel should be allocated

  1. Knee Injury and Osteoarthritis Outcome Score (KOOS): systematic review and meta-analysis of measurement properties.

    PubMed

    Collins, N J; Prinsen, C A C; Christensen, R; Bartels, E M; Terwee, C B; Roos, E M

    2016-08-01

    To conduct a systematic review and meta-analysis to synthesize evidence regarding measurement properties of the Knee injury and Osteoarthritis Outcome Score (KOOS). A comprehensive literature search identified 37 eligible papers evaluating KOOS measurement properties in participants with knee injuries and/or osteoarthritis (OA). Methodological quality was evaluated using the COSMIN checklist. Where possible, meta-analysis of extracted data was conducted for all studies and stratified by age and knee condition; otherwise narrative synthesis was performed. KOOS has adequate internal consistency, test-retest reliability and construct validity in young and old adults with knee injuries and/or OA. The ADL subscale has better content validity for older patients and Sport/Rec for younger patients with knee injuries, while the Pain subscale is more relevant for painful knee conditions. The five-factor structure of the original KOOS is unclear. There is some evidence that the KOOS subscales demonstrate sufficient unidimensionality, but this requires confirmation. Although measurement error requires further evaluation, the minimal detectable change for KOOS subscales ranges from 14.3 to 19.6 for younger individuals, and ≥20 for older individuals. Evidence of responsiveness comes from larger effect sizes following surgical (especially total knee replacement) than non-surgical interventions. KOOS demonstrates adequate content validity, internal consistency, test-retest reliability, construct validity and responsiveness for age- and condition-relevant subscales. Structural validity, cross-cultural validity and measurement error require further evaluation, as well as construct validity of KOOS Physical function Short form. Suggested order of subscales for different knee conditions can be applied in hierarchical testing of endpoints in clinical trials. PROSPERO (CRD42011001603). Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All

  2. 24 CFR 91.235 - Special case; abbreviated consolidated plan.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Special case; abbreviated consolidated plan. 91.235 Section 91.235 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development CONSOLIDATED SUBMISSIONS FOR COMMUNITY PLANNING AND DEVELOPMENT PROGRAMS...

  3. 24 CFR 91.235 - Special case; abbreviated consolidated plan.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 false Special case; abbreviated consolidated plan. 91.235 Section 91.235 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development CONSOLIDATED SUBMISSIONS FOR COMMUNITY PLANNING AND DEVELOPMENT PROGRAMS...

  4. 24 CFR 91.235 - Special case; abbreviated consolidated plan.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 1 2014-04-01 2014-04-01 false Special case; abbreviated consolidated plan. 91.235 Section 91.235 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development CONSOLIDATED SUBMISSIONS FOR COMMUNITY PLANNING AND DEVELOPMENT PROGRAMS...

  5. 24 CFR 91.235 - Special case; abbreviated consolidated plan.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Special case; abbreviated consolidated plan. 91.235 Section 91.235 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development CONSOLIDATED SUBMISSIONS FOR COMMUNITY PLANNING AND DEVELOPMENT PROGRAMS...

  6. 24 CFR 91.235 - Special case; abbreviated consolidated plan.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 false Special case; abbreviated consolidated plan. 91.235 Section 91.235 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development CONSOLIDATED SUBMISSIONS FOR COMMUNITY PLANNING AND DEVELOPMENT PROGRAMS...

  7. Test-retest reliability at the item level and total score level of the Norwegian version of the Spinal Cord Injury Falls Concern Scale (SCI-FCS).

    PubMed

    Roaldsen, Kirsti Skavberg; Måøy, Åsa Blad; Jørgensen, Vivien; Stanghelle, Johan Kvalvik

    2016-05-01

    Translation of the Spinal Cord Injury Falls Concern Scale (SCI-FCS), and investigation of test-retest reliability on item-level and total-score-level. Translation, adaptation and test-retest study. A specialized rehabilitation setting in Norway. Fifty-four wheelchair users with a spinal cord injury. The median age of the cohort was 49 years, and the median number of years after injury was 13. Interventions/measurements: The SCI-FCS was translated and back-translated according to guidelines. Individuals answered the SCI-FCS twice over the course of one week. We investigated item-level test-retest reliability using Svensson's rank-based statistical method for disagreement analysis of paired ordinal data. For relative reliability, we analyzed the total-score-level test-retest reliability with intraclass correlation coefficients (ICC2.1), the standard error of measurement (SEM), and the smallest detectable change (SDC) for absolute reliability/measurement-error assessment and Cronbach's alpha for internal consistency. All items showed satisfactory percentage agreement (≥69%) between test and retest. There were small but non-negligible systematic disagreements among three items; we recovered an 11-13% higher chance for a lower second score. There was no disagreement due to random variance. The test-retest agreement (ICC2.1) was excellent (0.83). The SEM was 2.6 (12%), and the SDC was 7.1 (32%). The Cronbach's alpha was high (0.88). The Norwegian SCI-FCS is highly reliable for wheelchair users with chronic spinal cord injuries.

  8. Evaluation of Military Trauma System Practices Related to Complications After Injury

    DTIC Science & Technology

    2012-01-01

    and ventilator- associated pneumonia (VAP).3Y5 This current analysis illustrates three key examples of trauma system PI initiatives related to...the Abbreviated Injury Scale (AIS) body re- gion of 7 (upper extremity) or 8 (lower extremity). Compartment syndrome patients were identified in the...queried met the inclusion criteria for the VAP evaluation study. Of the total study popu- lation, 1.7% of patients (n = 107) acquired VAP, whereas

  9. Haemophilia Joint Health Score in healthy adults playing sports.

    PubMed

    Sluiter, D; Foppen, W; de Kleijn, P; Fischer, K

    2014-03-01

    To evaluate outcome of prophylactic clotting factor replacement in children with haemophilia, the Haemophilia Joint Health Score (HJHS) was developed aiming at scoring early joint changes in children aged 4-18. The HJHS has been used for adults on long-term prophylaxis but interpretation of small changes remains difficult. Some changes in these patients may be due to sports-related injuries. Evaluation of HJHS score in healthy adults playing sports could improve the interpretation of this score in haemophilic patients. The aim of this study was to evaluate the HJHS scores in a cohort of young, healthy men participating in sports. Concomitant with a project collecting MRI images of ankles and knees in normal young adults, HJHS scores were assessed in 30 healthy men aged 18-26, participating in sports one to three times per week. One physiotherapist assessed their clinical function using the HJHS 2.1. History of joint injuries was documented. MRI images were scored by a single radiologist, using the International Prophylaxis Study Group additive MRI score. Median age of the study group was 24.3 years (range 19.0-26.4) and median frequency of sports activities was three times per week (range 1-4). Six joints (five knees, one ankle) had a history of sports-related injury. The median overall HJHS score was 0 out of 124 (range 0-3), with 60% of subjects showing no abnormalities on HJHS. All joints were normal on MRI. These results suggest that frequent sports participation and related injuries are not related with abnormalities in HJHS scores. © 2013 John Wiley & Sons Ltd.

  10. Determinants and outcomes of nonoperative management for blunt traumatic aortic injuries.

    PubMed

    Sandhu, Harleen K; Leonard, Samuel D; Perlick, Alexa; Saqib, Naveed U; Miller, Charles C; Charlton-Ouw, Kristofer M; Safi, Hazim J; Azizzadeh, Ali

    2018-02-01

    The natural history and parameters for successful nonoperative management of blunt traumatic aortic injuries (BTAIs) involving the descending aorta are poorly understood. We examined our experience with nonoperative BTAI treatment (anti-impulse, blood pressure) and evaluated for determinants of successful outcomes. We performed a review of our institutional prospective trauma registry database for all BTAI patients from 1999 to 2015. Computed tomography angiography was used to classify aortic injuries on the basis of severity: grade I, intimal tear; grade II, intramural hematoma; grade III, aortic pseudoaneurysm; and grade IV, free rupture. Grade IV injuries were excluded from nonoperative management. Baseline characteristics, clinical outcomes, and follow-up lesion resolution were compared within the medically managed cohort and between surgical and nonoperative groups using univariate and multivariable analysis. Among 338 BTAI patients admitted between 1999 and 2015, 67 BTAI patients were managed nonoperatively; 26 (54%) had grade I BTAI, 22 (46%) had grade II, and 2 (4%) had grade III. Both grade III injuries required a late thoracic endovascular aortic repair after initial medical management and were excluded from analysis. In all, 48 were managed with initial medical therapy, and the remaining 19 died on admission or before definitive treatment. Among the 48 medically managed, the median age was 34 years, and 14 (29%) were female. Six of the 48 (12%) were transferred from other facilities. There was no significant difference in baseline characteristics or early outcomes between BTAI grades. Median injury resolution time was 39 days for grade I and 62 days for grade II (P = .03). Compared with a surgical cohort, BTAI grade and Abbreviated Injury Scale score for the chest were the only significant determinants of propensity to operate. Based on these limited data, it appears that patients with minimal aortic injuries (grades I and II) may be managed

  11. Arterial injuries after penetrating brain injury in civilians: risk factors on admission head computed tomography.

    PubMed

    Bodanapally, Uttam K; Saksobhavivat, Nitima; Shanmuganathan, Kathirkamanathan; Aarabi, Bizhan; Roy, Ashis K

    2015-01-01

    The object of this study was to determine the specific CT findings of the injury profile in penetrating brain injury (PBI) that are risk factors related to intracranial arterial injuries. The authors retrospectively evaluated admission head CTs and accompanying digital subtraction angiography (DSA) studies from patients with penetrating trauma to the head in the period between January 2005 and December 2012. Two authors reviewed the CT images to determine the presence or absence of 30 injury profile variables and quantified selected variables. The CT characteristics in patients with and without arterial injuries were compared using univariate analysis, multivariate analysis, and receiver operating characteristic (ROC) curve analysis to determine the respective risk factors, independent predictors, and optimal threshold values for the continuous variables. Fifty-five patients were eligible for study inclusion. The risk factors for an intracranial arterial injury on univariate analysis were an entry wound over the frontobasal-temporal regions, a bihemispheric wound trajectory, a wound trajectory in proximity to the circle of Willis (COW), a subarachnoid hemorrhage (SAH), a higher SAH score, an intraventricular hemorrhage (IVH), and a higher IVH score. A trajectory in proximity to the COW was the best predictor of injury (OR 6.8 and p = 0.005 for all penetrating brain injuries [PBIs]; OR 13.3 and p = 0.001 for gunshot wounds [GSWs]). Significant quantitative variables were higher SAH and IVH scores. An SAH score of 3 (area under the ROC curve [AUC] for all PBIs 0.72; AUC for GSWs 0.71) and an IVH score of 3 (AUC for all PBIs 0.65; AUC for GSWs 0.65) could be used as threshold values to suggest an arterial injury. The risk factors identified may help radiologists suggest the possibility of arterial injury and prioritize neurointerventional consultation and potential DSA studies.

  12. FUNCTIONAL HOP TESTS AND TUCK JUMP ASSESSMENT SCORES BETWEEN FEMALE DIVISION I COLLEGIATE ATHLETES PARTICIPATING IN HIGH VERSUS LOW ACL INJURY PRONE SPORTS: A CROSS SECTIONAL ANALYSIS

    PubMed Central

    Hoog, Philipp; Warren, Meghan; Smith, Craig A.

    2016-01-01

    Background Although functional tests including the single leg hop (SLH), triple hop (TH), cross over hop (COH) for distance, and the tuck jump assessment (TJA) are used for return to play (RTP) criteria for post anterior cruciate ligament (ACL) injury, sport-specific baseline measurements are limited. Purpose The purpose of this study was to examine differences in SLH, TH, and COH distance and limb symmetry index (LSI), as well as total scores, number of jumps, and individual flaws of the TJA in 97 injury-free Division I (DI) collegiate female student athletes participating in ACL injury prone vs. non ACL injury prone sports. The hypothesis was that significant mean differences and asymmetries (LSI) would exist between the two groups in SLH, TH, COH and TJA. Study Design Cross sectional. Methods Due to research suggesting inherent ACL injury risk associated with specific sport involvement, participants were grouped into high (HR, n=57) and low (LR, n=40) ACL injury risk based on participating in a sport with high or low ACL injury rates. The HR group was composed of athletes participating in soccer, basketball, and volleyball, while the LR group athletes participated in diving, cross country, and track and field. Participants performed all standard functional tests (SFT) and side-to-side differences for each participant as well as between group differences were assessed for the hop tests. The LSI, a ratio frequently used to gauge athletes’ readiness for RTP post injury, was also assessed for between group differences. The TJA was compared between the groups on individual flaws, overall scores, and number of jumps performed. Results No between group differences for hop distances were found, with medium to large effect sizes for SLH, TH, and COH. The HR group had a higher TJA score, number of jumps, and higher proportion of the flaw of ‘foot placement not shoulder width apart’. Conclusion Although most SFT's showed no significant differences between athlete

  13. Characterization of the occult nature of injury for frequently occurring motor vehicle crash injuries.

    PubMed

    Schoell, Samantha L; Doud, Andrea N; Weaver, Ashley A; Talton, Jennifer W; Barnard, Ryan T; Winslow, James E; Stitzel, Joel D

    2017-01-01

    Occult injuries are not easily detected and can be potentially life-threatening. The purpose of this study was to quantify the perceived occultness of the most frequent motor vehicle crash injuries according to emergency medical services (EMS) professionals. An electronic survey was distributed to 1,125 EMS professionals who were asked to quantify the likelihood that first responders would miss symptoms related to a particular injury on a 5-point Likert scale. The Occult Score for each injury was computed from the average of all the survey responses and normalized to be a continuous metric ranging from 0 to 1 where 0 is a non-occult (highly apparent on initial presentation) injury and 1 is an occult (unapparent on initial presentation) injury. Overall, 110,671 survey responses were collected. The Occult Score ranged from 0 to 1 with a mean, median, and standard deviation of 0.443, 0.450, and 0.233, respectively. When comparing the Occult Score of an injury to its corresponding AIS severity, there was no relationship between the metrics. When stratifying by body region, injury type, and AIS severity, it was evident that AIS 2-4 abdominal injuries with lacerations, hemorrhage, or contusions were perceived as the most occult injuries. Timely triage is key to reduce the morbidity and mortality associated with occult injuries. The Occult Score developed in this study to describe the predictability of an injury in a motor vehicle crash will be used as part of a larger effort, including incorporation into an advanced automatic crash notification (AACN) algorithm to detect crash conditions associated with a patient's need for prompt treatment at a trauma center. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Prevalence and Risk Factors for Early Seizure in Patients with Traumatic Brain Injury: Analysis from National Trauma Data Bank.

    PubMed

    Majidi, Shahram; Makke, Yamane; Ewida, Amr; Sianati, Bahareh; Qureshi, Adnan I; Koubeissi, Mohamad Z

    2017-08-01

    Traumatic brain injury (TBI) is a well-known risk factor for seizures. We aimed to identify the frequency and risk factors for seizure occurrence during hospitalization for TBI. We used ICD-9-CM codes to identify patients 18 years of age or older from the National Trauma Data Bank who were admitted with TBI. We also used ICD-9-CM codes to identify the subset who had seizures during hospitalization. Patient demographics, comorbidities, Glasgow Coma Scale (GCS) score, Injury Severity Score Abbreviated Injury Scale (ISSAIS), in-hospital complications, and discharge disposition were compared in the seizure group (SG) and no-seizure group (NSG). A total of 1559 patients had in-hospital seizures, comprising 0.4% of all patients admitted with TBI. The mean age of SG was 3 years older than NSG [51 vs. 48; p < 0.0001]. African-American ethnicity (20 vs. 12%, p < 0.0001) and moderate TBI (8 vs. 4%, p < 0.0001) were more common in SG. History of alcohol dependence was more common in the SG (25 vs. 11%, p < 0.0001). Fall was the most common mechanism of injury in SG (56 vs. 36% in NSG; p < 0.0001). Subdural hematoma was more common in SG (31 vs. 21%, p < 0.0001). SG had higher rates of pneumonia, ARDS, acute kidney injury, and increased ICP. The average length of hospital stay was significantly higher in SG (10 vs. 6 days, p < 0.0001), and these patients had higher rate of discharge to nursing facility (32 vs. 25%, p < 0.0001). In-hospital seizures occur in 0.4% of all TBI patients. Although infrequent, seizure occurrence is associated with higher rates of hospital complications such as pneumonia and ARDS and is an independent predictor of longer hospital stay and worse hospital outcome.

  15. 32 CFR 651.3 - Explanation of abbreviations and terms.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Explanation of abbreviations and terms. 651.3 Section 651.3 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) ENVIRONMENTAL QUALITY ENVIRONMENTAL ANALYSIS OF ARMY ACTIONS (AR 200-2) Introduction § 651.3 Explanation of...

  16. 27 CFR 19.726 - Authorized abbreviations to identify spirits.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... records: Kinds of spirits Abbreviations Alcohol A Brandy BR Bourbon Whisky BW Canadian Whisky CNW Completely Denatured Alcohol CDA Corn Whisky CW Grain Spirits GS Irish Whisky IW Light Whisky LW Malt Whisky MW Neutral Spirits NS Neutral Spirits Grain NSG Rye Whisky RW Scotch Whisky SW Specially Denatured...

  17. Development of a Middle-Age and Geriatric Trauma Mortality Risk Score A Tool to Guide Palliative Care Consultations.

    PubMed

    Konda, Sanjit R; Seymour, Rachel; Manoli, Arthur; Gales, Jordan; Karunakar, Madhav A

    2016-11-01

    This study aimed to develop a tool to quantify risk of inpatient mortality among geriatric and middleaged trauma patients. This study sought to demonstrate the ability of the novel risk score in the early identification of high risk trauma patients for resource-sparing interventions, including referral to palliative medicine. This retrospective cohort study utilized data from a single level 1 trauma center. Regression analysis was used to create a novel risk of inpatient mortality score. A total of 2,387 low energy and 1,201 high-energy middle-aged (range: 55 to 64 years of age) and geriatric (65 years of age or odler) trauma patients comprised the study cohort. Model validation was performed using 37,474 lowenergy and 97,034 high-energy patients from the National Trauma Databank (NTDB). Potential hospital cost reduction was calculated for early referral of high risk trauma patients to palliative medicine services in comparison to no palliative medicine referral. Factors predictive of inpatient mortality among the study and validation patient cohorts included; age, Glasgow Coma Scale, and Abbreviated Injury Scale for the head and neck and chest. Within the validation cohort, the novel mortality risk score demonstrated greater predictive capacity than existing trauma scores [STTGMALE-AUROC: 0.83 vs. TRISS 0.80, (p < 0.01), STTGMAHE-AUROC: 0.86 vs. TRISS 0.85, (p < 0.01)]. Our model demonstrated early palliative medicine evaluation could produce $1,083,082 in net hospital savings per year. This novel risk score for older trauma patients has shown fidelity in prediction of inpatient mortality; in the study and validation cohorts. This tool may be used for early intervention in the care of patients at high risk of mortality and resource expenditure.

  18. The injury severity score or the new injury severity score for predicting mortality, intensive care unit admission and length of hospital stay: experience from a university hospital in a developing country.

    PubMed

    Tamim, Hala; Al Hazzouri, Adina Zeki; Mahfoud, Ziad; Atoui, Maria; El-Chemaly, Souheil

    2008-01-01

    Limited research has been performed to compare the predictive abilities of the injury severity score (ISS) and the new ISS (NISS) in the developing world. From January 2001 until January 2003 all trauma patients admitted to the American University of Beirut Medical Centre were enrolled. The statistical performance of the ISS/NISS in predicting mortality, admission to the intensive care unit (ICU) and length of hospital stay (LOS dichotomised as <10 or > or =10 days) was evaluated using receiver operating characteristic and the Hosmer-Lemeshow calibration statistic. A total of 891 consecutive patients were enrolled. The ISS and NISS were equivalent in predicting survival, and both performed better in patients younger than 65 years of age. However, the ISS predicted ICU admission and LOS better than the NISS. However, these predictive abilities were lower for the geriatric trauma patients aged 65 years and above compared to the other age groups. There are conflicting results in the literature about the abilities of ISS and NISS to predict mortality. However, this is the first study to report that ISS has a superior ability in predicting both LOS and ICU admission. The scoring of trauma severity may need to be individualised to different countries and trauma systems.

  19. Patient and Community-Level Socio-Demographic Characteristics Associated with Emergency Department Visits for Childhood Injury; A Retrospective Analysis of Data from the Pediatric Emergency Care Applied Research Network (PECARN) Core Data Project 2004–2008

    PubMed Central

    Macy, Michelle L.; Zonfrillo, Mark R.; Cook, Lawrence J.; Funai, Tomohiko; Goldstick, Jason; Stanley, Rachel M.; Chamberlain, James M.; Cunningham, Rebecca M.; Lipton, Robert; Alpern, Elizabeth R.

    2015-01-01

    Objective To examine pediatric emergency department (ED) visits over 5 years, trends in injury severity, and associations between injury-related ED visit outcome and patient and community-level socio-demographic characteristics. Study design Retrospective analysis of administrative data provided to the Pediatric Emergency Care Applied Research Network Core Data Project, 2004–2008. Home addresses were geocoded to determine census block group and associated socio-demographic characteristics. Maximum Abbreviated Injury Scale severity and Severity Classification System scores were calculated. Generalized estimating equations were used to test for associations between socio-demographic characteristics and admission or transfer among injury-related ED visits. Results Overall ED visits and injury-related visits increased from 2004 to 2008 at study sites. Of 2,833,676 successfully geocoded visits, 700,821 (24.7%) were injury-related. The proportion of higher severity injury-related visits remained consistent. Nearly 10% of injury-related visits resulted in admission or transfer each year. After adjusting for age, sex, payer, and injury severity, odds of admission or transfer were lower among minority children and children from areas with moderate and high prevalence of poverty. Conclusions Pediatric injury-related ED visits to included sites increased over the study period while injury severity, anticipated resource utilization, and visit outcomes remained stable, with low rates of admission or transfer. Socio-demographic differences in injury-related visits and ED disposition were apparent. ED-based injury surveillance is essential to understand disparities, inform targets for prevention programs, and reduce the overall burden of childhood injuries. PMID:26141551

  20. Lower limb and associated injuries in frontal-impact road traffic collisions.

    PubMed

    Ammori, Mohannad B; Eid, Hani O; Abu-Zidan, Fikri M

    2016-03-01

    To study the relationship between severity of injury of the lower limb and severity of injury of the head, thoracic, and abdominal regions in frontal-impact road traffic collisions. Consecutive hospitalised trauma patients who were involved in a frontal road traffic collision were prospectively studied over 18 months. Patients with at least one Abbreviated Injury Scale (AIS) ≥3 or AIS 2 injuries within two AIS body regions were included. Patients were divided into two groups depending on the severity of injury to the head, chest or abdomen. Low severity group had an AIS < 2 and high severity group had an AIS ≥ 2. Backward likelihood logistic regression models were used to define significant factors affecting the severity of head, chest or abdominal injuries. Eighty-five patients were studied. The backward likelihood logistic regression model defining independent factors affecting severity of head injuries was highly significant (p =0.01, nagelkerke r square = 0.1) severity of lower limb injuries was the only significant factor (p=0.013) having a negative correlation with head injury (Odds ratio of 0.64 (95% CI: 0.45-0.91). Occupants who sustain a greater severity of injury to the lower limb in a frontal-impact collision are likely to be spared from a greater severity of head injury.

  1. REASSESSING MECHANISM AS A PREDICTOR OF PEDIATRIC INJURY MORTALITY

    PubMed Central

    Beck, Haley; Mittal, Sushil; Madigan, David; Burd, Randall S.

    2015-01-01

    Background The use of mechanism of injury as a predictor of injury outcome presents practical challenges because this variable may be missing or inaccurate in many databases. The purpose of this study was to determine the importance of mechanism of injury as a predictor of mortality among injured children. Methods The records of children (<15 years old) sustaining a blunt injury were obtained from the National Trauma Data Bank. Models predicting injury mortality were developed using mechanism of injury and injury coding using either Abbreviated Injury Scale post-dot values (low-dimensional injury coding) or injury ICD-9 codes and their two-way interactions (high-dimensional injury coding). Model performance with and without inclusion of mechanism of injury was compared for both coding schemes, and the relative importance of mechanism of injury as a variable in each model type was evaluated. Results Among 62,569 records, a mortality rate of 0.9% was observed. Inclusion of mechanism of injury improved model performance when using low-dimensional injury coding but was associated with no improvement when using high-dimensional injury coding. Mechanism of injury contributed to 28% of model variance when using low-dimensional injury coding and <1% when high-dimensional injury coding was used. Conclusions Although mechanism of injury may be an important predictor of injury mortality among children sustaining blunt trauma, its importance as a predictor of mortality depends on approach used for injury coding. Mechanism of injury is not an essential predictor of outcome after injury when coding schemes are used that better characterize injuries sustained after blunt pediatric trauma. PMID:26197948

  2. ADVANCIS Score Predicts Acute Kidney Injury After Percutaneous Coronary Intervention for Acute Coronary Syndrome.

    PubMed

    Fan, Pei-Chun; Chen, Tien-Hsing; Lee, Cheng-Chia; Tsai, Tsung-Yu; Chen, Yung-Chang; Chang, Chih-Hsiang

    2018-01-01

    Acute kidney injury (AKI), a common and crucial complication of acute coronary syndrome (ACS) after receiving percutaneous coronary intervention (PCI), is associated with increased mortality and adverse outcomes. This study aimed to develop and validate a risk prediction model for incident AKI after PCI for ACS. We included 82,186 patients admitted for ACS and receiving PCI between 1997 and 2011 from the Taiwan National Health Insurance Research Database and randomly divided them into a training cohort (n = 57,630) and validation cohort (n = 24,656) for risk model development and validation, respectively. Risk factor analysis revealed that age, diabetes mellitus, ventilator use, prior AKI, number of intervened vessels, chronic kidney disease (CKD), intra-aortic balloon pump (IABP) use, cardiogenic shock, female sex, prior stroke, peripheral arterial disease, hypertension, and heart failure were significant risk factors for incident AKI after PCI for ACS. The reduced model, ADVANCIS, comprised 8 clinical parameters (age, diabetes mellitus, ventilator use, prior AKI, number of intervened vessels, CKD, IABP use, cardiogenic shock), with a score scale ranging from 0 to 22, and performed comparably with the full model (area under the receiver operating characteristic curve, 87.4% vs 87.9%). An ADVANCIS score of ≥6 was associated with higher in-hospital mortality risk. In conclusion, the ADVANCIS score is a novel, simple, robust tool for predicting the risk of incident AKI after PCI for ACS, and it can aid in risk stratification to monitor patient care.

  3. The utility of the additive EuroSCORE, RIFLE and AKIN staging scores in the prediction and diagnosis of acute kidney injury after cardiac surgery.

    PubMed

    Duthie, Fiona A I; McGeehan, Paul; Hill, Sharleen; Phelps, Richard; Kluth, David C; Zamvar, Vipin; Hughes, Jeremy; Ferenbach, David A

    2014-01-01

    Acute kidney injury (AKI) following cardiac surgery is a complication associated with high rates of morbidity and mortality. We compared staging systems for the diagnosis of AKI after cardiac surgery, and assessed pre-operative factors predictive of post-operative AKI. Clinical data, surgical risk scores, procedure and clinical outcome were obtained on all 4,651 patients undergoing cardiac surgery to the Royal Infirmary of Edinburgh between April 2006 and March 2011, of whom 4,572 had sufficient measurements of creatinine before and after surgery to permit inclusion and analysis. The presence of AKI was assessed using the AKIN and RIFLE criteria. By AKIN criteria, 12.4% of the studied population developed AKI versus 6.5% by RIFLE criteria. Any post-operation AKI was associated with increased mortality from 2.2 to 13.5% (relative risk 7.0, p < 0.001), and increased inpatient stay from a median of 7 (IQR 4) to 9 (IQR 11) days (p < 0.05). Patients identified by AKIN, but not RIFLE, had a mean peak creatinine rise of 34% from baseline and had a significantly lower mortality compared to RIFLE-'Risk' AKI (mortality 6.1 vs. 9.7%; p < 0.05). Pre-operative creatinine, diabetes, NYHA Class IV dyspnoea and EuroSCORE-1 (a surgical risk score) all predicted subsequent AKI on multivariate analysis. EuroSCORE-1 outperformed any single demographic factor in predicting post-operative AKI risk, equating to an 8% increase in relative risk for each additional point. AKI after cardiac surgery is associated with delayed discharge and high mortality rates. The AKIN and RIFLE criteria identify patients at a range of AKI severity levels suitable for trial recruitment. The utility of EuroSCORE as a risk stratification tool to identify high AKI-risk subjects for prospective intervention merits further study.

  4. Quantification method analysis of the relationship between occupant injury and environmental factors in traffic accidents.

    PubMed

    Ju, Yong Han; Sohn, So Young

    2011-01-01

    Injury analysis following a vehicle crash is one of the most important research areas. However, most injury analyses have focused on one-dimensional injury variables, such as the AIS (Abbreviated Injury Scale) or the IIS (Injury Impairment Scale), at a time in relation to various traffic accident factors. However, these studies cannot reflect the various injury phenomena that appear simultaneously. In this paper, we apply quantification method II to the NASS (National Automotive Sampling System) CDS (Crashworthiness Data System) to find the relationship between the categorical injury phenomena, such as the injury scale, injury position, and injury type, and the various traffic accident condition factors, such as speed, collision direction, vehicle type, and seat position. Our empirical analysis indicated the importance of safety devices, such as restraint equipment and airbags. In addition, we found that narrow impact, ejection, air bag deployment, and higher speed are associated with more severe than minor injury to the thigh, ankle, and leg in terms of dislocation, abrasion, or laceration. Copyright © 2010 Elsevier Ltd. All rights reserved.

  5. Effects of Patient Pre-Injury and Injury Characteristics on Acute Rehabilitation Outcomes for Traumatic Brain Injury

    PubMed Central

    Corrigan, John D.; Horn, Susan D.; Barrett, Ryan S.; Smout, Randall J.; Bogner, Jennifer; Hammond, Flora M.; Brandstater, Murray E.; Majercik, Sarah

    2015-01-01

    Objective To examine associations of patient and injury characteristics with outcomes at inpatient rehabilitation discharge and 9 months post-discharge for patients with traumatic brain injury (TBI) Design Prospective, longitudinal observational study Setting 10 inpatient rehabilitation centers (9 US, 1 Canada) Participants Consecutive patients (n=2130) enrolled between 2008 and 2011, admitted for inpatient rehabilitation after index TBI injury, and divided into 5 subgroups based on rehabilitation admission FIM Cognitive score Interventions Not applicable Main Outcome Measures Rehabilitation length of stay, discharge to home, and FIM at discharge and 9 months post-discharge. Results Severity indices increased explained variation in outcomes beyond that accounted for by patient characteristics. FIM Motor scores were generally the most predictable. Higher functioning subgroups had more predictable outcomes then subgroups with lower cognitive function at admission. Age at injury, time from injury to rehabilitation admission, and functional independence at rehabilitation admission were the most consistent predictors across all outcomes and subgroups. Conclusions Findings from previous studies of the relationships among patient and injury characteristics and rehabilitation outcomes were largely replicated. Discharge outcomes were most strongly associated with injury severity characteristics; while predictors of functional independence at 9 months post-discharge included both patient and injury characteristics. PMID:26212398

  6. Occupant and Crash Characteristics in Thoracic and Lumbar Spine Injuries Resulting From Motor Vehicle Collisions

    PubMed Central

    Rao, Raj D.; Berry, Chirag; Yoganandan, Narayan; Agarwal, Arnav

    2016-01-01

    Background context Motor vehicle collisions (MVC) are a leading cause of thoracic and lumbar (T and L) spine injuries. Mechanisms of injury in vehicular crashes that result in thoracic and lumbar fractures and the spectrum of injury in these occupants have not been extensively studied in the literature. Purpose The objective was to investigate the patterns of T and L spine injury following MVC; correlate these patterns with restraint use, crash characteristics and demographic variables; and study the associations of these injuries with general injury morbidity and fatality. Study design/Setting Retrospective study of a prospectively gathered database. Patient sample Six hundred and thirty-one occupants with T and L (T1-L5) spine injuries from 4572 occupants included in the Crash Injury Research and Engineering Network (CIREN) database between 1996 and 2011. Outcome measures No clinical outcome measures were evaluated in this study. Methods The CIREN database includes moderate to severely injured occupants from MVC involving vehicles manufactured recently. Demographic, injury and crash data from each patient was analyzed for correlations between pattern of T and L spine injury, associated extra-spinal injuries and overall injury severity score (ISS), type and use of seat belts, and other crash characteristics. T and L spine injury pattern was categorized using a modified Denis classification, to include extension injuries as a separate entity. Results T and L spine injuries were identified in 631 of 4572 vehicle occupants, of whom 299 sustained major injuries (including 21 extension injuries) and 332 sustained minor injuries. Flexion-distraction injuries were more prevalent in children and young adults, and extension injuries in older adults (mean age 65.7 years). Occupants with extension injuries had a mean BMI of 36.0 and a fatality rate of 23.8%, much higher than the fatality rate for the entire cohort (10.9%). The most frequent extra-spinal injuries (Abbreviated

  7. Traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity.

    PubMed

    Susman, Mark; DiRusso, Stephen M; Sullivan, Thomas; Risucci, Donald; Nealon, Peter; Cuff, Sara; Haider, Adil; Benzil, Deborah

    2002-08-01

    The purpose of this study was to compare data obtained from a statewide data set for elderly patients (age > 64 years) that presented with traumatic brain injury with data from nonelderly patients (age > 15 and < 65 years) with similar injuries. The New York State Trauma Registry from January 1994 through December 1995, from trauma centers and community hospitals excluding New York City (45,982 patients), was examined. Head-injured patients were identified by International Classification of Diseases, Ninth Revision diagnosis codes. A relative head injury severity scale (RHISS) was constructed on the basis of groups of these codes (range, 0 = none to 3 = severe). Comparisons were made with nonelderly patients for mortality, Glasgow Coma Scale (GCS) score at admission and discharge, Injury Severity Score, New Injury Severity Score, and RHISS. Outcome was assessed by a Functional Independence Measure score in three major domains: expression, locomotion, and feeding. Data were analyzed by the chi2 test and Mann-Whitney U test, with p < 0.05 considered significant. There were 11,772 patients with International Classification of Diseases, Ninth Revision diagnosis of head injury, of which 3,244 (27%) were elderly. There were more male subjects in the nonelderly population (78% male subjects) compared with the elderly population (50% men). Mortality was 24.0% in the elderly population compared with 12.8% in the nonelderly population (risk ratio, 2.2; 95% confidence interval, 1.99-2.43). The elderly nonsurvivors were statistically older, and mortality rate increased with age. Stratified by GCS score, there was a higher percentage of nonsurvivors in the elderly population, even in the group with only moderately depressed GCS score (GCS score of 13-15; risk ratio, 7.8; 95% confidence interval, 6.1-9.9 for elderly vs. nonelderly). Functional outcome in all three domains was significantly worse in the elderly survivors compared with the nonelderly survivors. Elderly traumatic

  8. Intrarater and interrater reliability and validity in the assessment of the mechanism of injury and integrity of the posterior ligamentous complex: a novel injury severity scoring system for thoracolumbar injuries. Invited submission from the Joint Section Meeting On Disorders of the Spine and Peripheral Nerves, March 2005.

    PubMed

    Harrop, James S; Vaccaro, Alexander R; Hurlbert, R John; Wilsey, Jared T; Baron, Eli M; Shaffrey, Christopher I; Fisher, Charles G; Dvorak, Marcel F; Oner, F C; Wood, Kirkham B; Anand, Neel; Anderson, D Greg; Lim, Moe R; Lee, Joon Y; Bono, Christopher M; Arnold, Paul M; Rampersaud, Y Raja; Fehlings, Michael G

    2006-02-01

    A new classification and treatment algorithm for thoracolumbar injuries was recently introduced by Vaccaro and colleagues in 2005. A thoracolumbar injury severity scale (TLISS) was proposed for grading and guiding treatment for these injuries. The scale is based on the following: 1) the mechanism of injury; 2) the integrity of the posterior ligamentous complex (PLC); and 3) the patient's neurological status. The reliability and validity of assessing injury mechanism and the integrity of the PLC was assessed. Forty-eight spine surgeons, consisting of neurosurgeons and orthopedic surgeons, reviewed 56 clinical thoracolumbar injury case histories. Each was classified and scored to determine treatment recommendations according to a novel classification system. After 3 months the case histories were reordered and the physicians repeated the exercise. Validity of this classification was good among reviewers; the vast majority (> 90%) agreed with the system's treatment recommendations. Surgeons were unclear as to a cogent description of PLC disruption and fracture mechanism. The TLISS demonstrated acceptable reliability in terms of intra- and interobserver agreement on the algorithm's treatment recommendations. Replacing injury mechanism with a description of injury morphology and better definition of PLC injury will improve inter- and intraobserver reliability of this injury classification system.

  9. 32 CFR Appendix F to Subpart M of... - Abbreviations

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 3 2011-07-01 2009-07-01 true Abbreviations F Appendix F to Subpart M of Part 552 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY MILITARY RESERVATIONS..., Yakima Training Center, and Camp Bonneville Pt. 552, Subpt. M, App. F Appendix F to Subpart M of Part 552...

  10. 32 CFR Appendix F to Subpart M of... - Abbreviations

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Abbreviations F Appendix F to Subpart M of Part 552 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY MILITARY RESERVATIONS..., Yakima Training Center, and Camp Bonneville Pt. 552, Subpt. M, App. F Appendix F to Subpart M of Part 552...

  11. 48 CFR 302.7000 - Common HHSAR acronyms and abbreviations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... acronyms and abbreviations. (a) The HHSAR cites numerous acquisition-related and organizational acronyms...-3(b)(3). CDC Centers for Disease Control and Prevention 301.270(b). CFR Code of Federal Regulations....1300(c). PSC Program Support Center (in OS) 301.270(b). R&D research and development 301.607-72(b). RFI...

  12. An SEM Assessment of the Internal Structure and Predictive Validity of the Abbreviated Early Adolescent HOME Inventory.

    PubMed

    Green, Samuel B; Pennar, Amy L; Bradley, Robert H

    2018-05-01

    The Home Observation for Measurement of the Environment (HOME) Inventory is designed to assess the quality and quantity of support, stimulation, and structure provided to children in the home environment. HOME has been widely used for research and applied purposes. We focused on an abbreviated version of the Early Adolescent HOME (EA-HOME-A) that was administered to 15-year-old adolescents and their parents ( N = 958) as part of the NICHD (National Institute of Child Health and Human Development) Study of Early Child Care and Youth Development. Our study had two objectives. First, we hypothesized and tested a bifactor model that specified a general factor in support of the use of the HOME total score and group factors for subsets of items in support of the content domain scores. Second, we applied structural equation modeling to relate the EA-HOME-A factors to outcome factors assessing maladaptive behaviors, autonomy, self-control, and cognitive-academic performance. The results supported the construct validity of the EA-HOME-A with respect to its internal structure as well as its correlates.

  13. Crash characteristics and injury patterns of restrained front seat occupants in far-side impacts.

    PubMed

    Yoganandan, Narayan; Arun, Mike W J; Halloway, Dale E; Pintar, Frank A; Maiman, Dennis J; Szabo, Aniko; Rudd, Rodney W

    2014-01-01

    The study was conducted to determine the association between vehicle-, crash-, and demographic-related factors and injuries to front seat far-side occupants in modern environments. Field data were obtained from the NASS-CDS database for the years 2009-2012. Inclusion factors included the following: adult restrained front outboard-seated occupants, no ejection or rollovers, and vehicle model years less than 10 years old at the time of crash. Far-side crashes were determined by using collision deformation classification. Injuries were scored using the Abbreviated Injury Scale (AIS). Injuries (MAIS 2+, MAIS 3+, M denotes maximum score) were examined based on demographics, change in velocity, vehicle type, direction of force, extent zone, collision partner, and presence of another occupant in the front seat. Only weighted data were used in the analysis. Injuries to the head and face, thorax, abdomen, pelvis, and upper and lower extremity regions were studied. Odds ratios and upper and lower confidence intervals were estimated from multivariate analysis. Out of 519,195 far-side occupants, 17,715 were MAIS 2+ and 4,387 were MAIS 3+ level injured occupants. The mean age, stature, total body mass, and body mass index (BMI) were 40.7 years, 1.7 m, 77.2 kg, and 26.8 kg/m2, respectively. Of occupants with MAIS 2+ injuries, 51% had head and 19% had thorax injuries. Of occupants with MAIS 3+ injuries, 50% had head and 69% had thorax injuries. The cumulative distribution of changes in velocities at the 50th percentile for the struck vehicle for all occupants and occupants with MAIS 2+ and MAIS 3+ injuries were 19, 34, and 42 km/h, respectively. Furthermore, 73% of MAIS 2+ injuries and 86% of MAIS 3+ injuries occurred at a change in velocity of 24 km/h or greater. Odds of sustaining MAIS 2+ and MAIS 3+ injuries increased with each unit increase in change in velocity, stature, and age, with one exception. Odds of sustaining injuries were higher with the presence of an occupant in

  14. 21 CFR 314.94 - Content and format of an abbreviated application.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... SERVICES (CONTINUED) DRUGS FOR HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG Abbreviated... that FDA can process, review, and archive. FDA will periodically issue guidance on how to provide the...

  15. Epidemiology of moderate-to-severe penetrating versus closed traumatic brain injury in the Iraq and Afghanistan wars.

    PubMed

    Orman, Jean A; Geyer, Dennis; Jones, John; Schneider, Eric B; Grafman, Jordan; Pugh, Mary Jo; Dubose, Joseph

    2012-12-01

    US combat operations in Iraq and Afghanistan have resulted in a greater proportion of service members with head and neck wounds caused by explosions compared with that of previous wars. Although penetrating traumatic brain injury (TBI) is frequently associated with these wounds, the epidemiology of penetrating TBI from these conflicts has not been well described. The Joint Theater Trauma Registry was queried for January 2003 through December 2010 to identify all patients with moderate-to-severe brain injury with a maximum Abbreviated Injury Scale (AIS) score of the head of 3 or greater and a diagnosis of penetrating or closed TBI in accordance with the Department of Defense Traumatic Brain Injury Surveillance definition. The epidemiology of these injuries was examined, including demographics, TBI severity, overall injury severity, and surgical interventions provided. A total of 1,255 TBI patients (774 penetrating, 481 closed) meeting criteria were identified. Penetrating brain injuries were more severe, more likely to be battle related, and less likely to be isolated injuries than a group of moderate-to-severe closed TBIs within the same range of anatomic injury severity. During the 5-year period of the Iraq war with the largest numbers of TBIs (2004-2008), the numbers of penetrating TBIs exceeded closed TBIs by a ratio of 2:1. During the 3-year period of the Afghanistan war with the greatest numbers of TBIs (2008-2010), the ratio of penetrating to closed TBIs was substantially lower, approximately 1.3:1. This study represents the first comprehensive report on the epidemiology of moderate-to-severe penetrating and closed TBIs resulting from the wars in Iraq and Afghanistan using Joint Theater Trauma Registry data. With the maturing theater of conflicts, penetrating TBIs were substantially less predominant compared with closed TBIs. While this finding may reflect changes in the use of protective measures and tactics or improvements in diagnosis of closed TBIs

  16. 21 CFR 314.160 - Approval of an application or abbreviated application for which approval was previously refused...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on Applications and Abbreviated... of an applicant, FDA may, on the basis of new data, approve an application or abbreviated application which it had previously refused, suspended, or withdrawn approval. FDA will publish a notice in the...

  17. 21 CFR 314.160 - Approval of an application or abbreviated application for which approval was previously refused...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on Applications and Abbreviated... of an applicant, FDA may, on the basis of new data, approve an application or abbreviated application which it had previously refused, suspended, or withdrawn approval. FDA will publish a notice in the...

  18. 21 CFR 314.160 - Approval of an application or abbreviated application for which approval was previously refused...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on Applications and Abbreviated... of an applicant, FDA may, on the basis of new data, approve an application or abbreviated application which it had previously refused, suspended, or withdrawn approval. FDA will publish a notice in the...

  19. 21 CFR 314.160 - Approval of an application or abbreviated application for which approval was previously refused...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on Applications and Abbreviated... of an applicant, FDA may, on the basis of new data, approve an application or abbreviated application which it had previously refused, suspended, or withdrawn approval. FDA will publish a notice in the...

  20. 21 CFR 314.160 - Approval of an application or abbreviated application for which approval was previously refused...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on Applications and Abbreviated... of an applicant, FDA may, on the basis of new data, approve an application or abbreviated application which it had previously refused, suspended, or withdrawn approval. FDA will publish a notice in the...