The injury severity score--importance and uses.
ABSTRACT The development and attributes of the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) are reviewed. The ISS was proved to be an excellent method for retrospective comparison of overall injury data between populations differing in time or space. Its strengths, purpose, and appropriate uses are emphasized, together with specific comments on statistical analyses and combined scales of anatomic and physiologic injury.
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ABSTRACT: Hospital readmission is a significant contributor to increasing health care use related to caring for older trauma patients. This study was undertaken with the following aims: determine the proportion of older adult trauma patients who experience unplanned readmission, as well as risk factors for these readmissions and identify the most common readmission diagnoses among these patients. We conducted a retrospective cohort study of trauma patients age 55 years and older who survived their hospitalization at a statewide trauma center between 2009 and 2010. Linking 3 statewide databases, nonelective readmission rates were calculated for 30 days, 6 months, and 1 year after index discharge. Competing risk regression was used to determine risk factors for readmission and account for the competing risk of dying without first being readmitted. Subhazard ratios (SHR) are reported, indicating the relative risk of readmission by 30 days, 6 months, and 1 year. The cumulative readmission rates for the 14,536 participants were 7.9%, 18.9%, and 25.2% at 30 days, 6 months, and 1 year, respectively. In multivariable models, the strongest risk factors for readmission at 1 year (based on magnitude of SHR) were severe head injury (adjusted SHR = 1.47; 95% CI, 1.24-1.73) and disposition to a skilled nursing facility (SHR = 1.54; 95% CI, 1.39-1.71). The diagnoses most commonly associated with readmission were atrial fibrillation, anemia, and congestive heart failure. In this statewide study, unplanned readmissions after older adult trauma occurred frequently up to 1 year after discharge, particularly for patients who sustained severe head trauma and who could not be discharged home independently. Examining common readmission diagnoses might inform the development of interventions to prevent unplanned readmissions. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.Journal of the American College of Surgeons 11/2014; 220(3). DOI:10.1016/j.jamcollsurg.2014.11.012 · 4.45 Impact Factor
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ABSTRACT: Justificación y objetivos investigar si el Índice de Gravedad de la Lesión (Injury Severity Score [ISS]) y la Escala Abreviada de Lesiones (Abbreviated Injury Score [AIS]) están correlacionados con la calidad de vida a largo plazo en pacientes con traumatismo grave. Métodos pacientes que sufrieron lesiones entre 2005 y 2007, con un ISS ≥ 15, fueron encuestados 16-24 meses después de las lesiones. Se usó el Cuestionario de Evaluación de la Salud-Índice de Incapacidad (Health Assessment Questionnaire-Disability Index [HAQ-DI]) para medir el estado funcional, y el modelo abreviado del cuestionario con 12 ítems (Short Form-12 [SF-12]) para medir el estado de salud dividido en 2 componentes: el índice de salud física (Physical Component Summary [PCS]) y el índice de salud mental (Mental Component Summary [MCS]). Los resultados de los cuestionarios fueron comparados con los componentes del ISS y del AIS. Los resultados del SF-12 fueron comparados con los valores esperados en la población general. Resultados setenta y cuatro pacientes rellenaron los cuestionarios (tasa de respuesta de un 28%). Las puntuaciones medias fueron: PCS 42,6 ± 13,3; MCS 49,4 ± 1,4; HAQ-DI 0,5 ± 0,7. Se registró una correlación con HAQ-DI y PCS (rho de Spearman: −0,83; p < 0,05) y ninguna correlación entre HAQ-DI y MCS o entre MCS y PCS (rho de Spearman = −0,21; y 0,01, respectivamente). Las puntuaciones cutáneo-externas y extremidades-pélvicas de la AIS se correlacionaron con el PCS (rho de Spearman: −0,39 y −0,34; p < 0,05) y con el HAQ-DI (rho de Spearman: 0,31 y 0,23; p < 0,05). La condición física en comparación con la población normal fue peor, excepto para los grupos con edades entre 65-74 y 55-64 años. Conclusiones los pacientes con fracturas pélvicas y de extremidades son más propensos a presentar una incapacidad a largo plazo. La gravedad de las lesiones externas influyó en la discapacidad a largo plazo.03/2014; 64(2):134–139. DOI:10.1016/j.bjanes.2013.03.008
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ABSTRACT: Escherichia coli is the most common colonizing and infecting organism isolated from United States service members injured during deployment. Our objective was to evaluate phenotypic and genotypic changes of infecting and colonizing E. coli over time and across facilities to better understand transmission patterns. E. coli isolates were collected via surveillance cultures and infection workups from U.S. military personnel injured during deployment (June 2009-May 2011). Isolates underwent antimicrobial susceptibility testing, pulsed-field gel electrophoresis, and multiplex PCR for phylotyping to determine resistance profiles and clonality. A total of 343 colonizing and 136 infecting E. coli isolates were analyzed, of which 197 (57%) and 109 (80%) isolates were extended-spectrum β-lactamase (ESBL)-producing, respectively. Phylo-group A was predominant among both colonizing (38%) and infecting isolates (43%). Although 188 unique pulsed-field types (PFTs) were identified among the colonizing isolates and 54 PFTs from the infecting isolates, there was a lack of PFT overlap between study years, combat zones, and military treatment facilities. On a per subject basis, 26% and 32% of patients with serial colonizing isolates and 10% and 21% with serial infecting isolates acquired changes in their phylo-group and PFT profiles over time. Production of ESBL remained high over time and across facilities with no substantial changes in antimicrobial susceptibilities. Overall, our results demonstrated an array of genotypic and phenotypic differences for the isolates without large clonal clusters; however, the same PFTs were occasionally observed among both colonizing and infecting isolates, suggesting that the source of infections may be endogenous host organisms.Journal of Clinical Microbiology 08/2014; 58(11). DOI:10.1128/JCM.00821-14 · 4.23 Impact Factor