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ABSTRACT: Many injury severity scoring tools have been developed over the past few decades. These tools include the Injury Severity Score (ISS), New ISS (NISS), Trauma and Injury Severity Score (TRISS) and International Classification of Diseases (ICD)-based Injury Severity Score (ICISS). Although many studies have endeavored to determine the ability of these tools to predict the mortality of injured patients, their results have been inconsistent. We conducted a systematic review to summarize the predictive performances of these tools and explore the heterogeneity among studies. We defined a relevant article as any research article that reported the area under the Receiver Operating Characteristic curve as a measure of predictive performance. We conducted an online search using MEDLINE and Embase. We evaluated the quality of each relevant article using a quality assessment questionnaire consisting of 10 questions. The total number of positive answers was reported as the quality score of the study. Meta-analysis was not performed due to the heterogeneity among studies. We identified 64 relevant articles with 157 AUROCs of the tools. The median number of positive answers to the questionnaire was 5, ranging from 2 to 8. Less than half of the relevant studies reported the version of the Abbreviated Injury Scale (AIS) and/or ICD (37.5%). The heterogeneity among the studies could be observed in a broad distribution of crude mortality rates of study data, ranging from 1% to 38%. The NISS was mostly reported to perform better than the ISS when predicting the mortality of blunt trauma patients. The relative performance of the ICSS against the AIS-based tools was inconclusive because of the scarcity of studies. The performance of the ICISS appeared to be unstable because the performance could be altered by the type of formula and survival risk ratios used. In conclusion, high-quality studies were limited. The NISS might perform better in the mortality prediction of blunt injuries than the ISS. Additional studies are required to standardize the derivation of the ICISS and determine the relative performance of the ICISS against the AIS-based tools.
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 09/2012; 20(1):63. · 1.85 Impact Factor
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ABSTRACT: A regional trauma registry (RTR) collects injury data from multiple hospitals in a given region; however, the differences among RTRs have not yet been thoroughly investigated.
The objective of this study was to identify RTRs worldwide and describe the structural differences, inclusion criteria and demographics among RTRs, as well as to investigate the effect of the inclusion criteria on patient demographics.
We included state, national and multinational trauma registries in this study. We searched for RTRs using the MEDLINE database and a general Internet search engine. We abstracted the funding sources, AIS versions, data submission methods, inclusion criteria and patient demographics of each RTR. We selected the following three outcome measures for comparison: the number of case registrations per year per hospital, proportion of cases with an Injury Severity Score (ISS)>15 and crude mortality rate. We compared the outcome measures for RTRs that included 'an ISS>15', 'an admission to the Intensive Care Unit (ICU)' or 'a transferred patient for higher care' with those of RTRs that did not.
We identified 17 RTRs (11 national, 4 state and 2 multinational). Government funding was the most common funding source. The RTRs most frequently used the AIS 98 or AIS 2008. Web-based data submission was the most common. A significantly increased crude mortality rate was seen with 'an admission to the ICU' and 'an ISS>15'.
We identified 17 RTRs, analysed the differences among RTRs and investigated the effect of the inclusion criteria on patient demographics. These findings may be useful when improving or developing RTRs.
Injury 08/2012; 43(11):1924-30. · 1.98 Impact Factor
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ABSTRACT: 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.
The Journal of trauma 12/2011; 71(6):1829-34. · 2.48 Impact Factor
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ABSTRACT: 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.
The Journal of trauma 07/2011; 71(1):56-62. · 2.48 Impact Factor
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Emergency medicine Australasia: EMA 06/2011; 23(3):237-9. · 0.98 Impact Factor
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ABSTRACT: 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.
Annals of advances in automotive medicine 01/2011; 55:255-65.
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ABSTRACT: Mortality from trauma in rural areas is increased compared with the urban environment. We aimed to describe the relationship between trauma deaths and various categories of remoteness in rural areas, in Western Australia (WA).
We used Death Registry data from July 1, 1997 to June 30, 2006. Deaths were allocated to one of the five Remoteness Areas classified by the Accessibility/ Remoteness Index of Australia: Major Cities, Inner Regional, Outer Regional, Remote, and Very Remote. Population data were obtained from the Australian Bureau of Statistics 2001 census.
There were 4,937 deaths (3,543, 71.8% men; mean age 43.4 years +/- 24.3 years). The least number of deaths occurred in Remote WA, and the age at which death occurred decreased as remoteness increased. Falls occur predominantly in the elderly in the major city. Transport injuries are the leading cause of death (43.3%) outside the major city, where self harm is the leading cause of death (31.2%). The relative risk for death in very remote WA compared with the major city is 4.28 (95% CI 3.93-4.68). The standardized age-specific death rates ranged from 24.09 per 100,000 person-years in the major city, to 103.30 per 100,000 person-years in very remote WA.
We have quantified the direct relationship between remoteness and trauma deaths. In particular, the death rate in very remote areas is over four times the rate in major cities. Such data should be useful for the planning of trauma systems in these areas.
The Journal of trauma 09/2008; 67(5):910-4. · 2.48 Impact Factor
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ABSTRACT: As a result of a number of clinical management studies, D-dimer (DD) tests such as VIDAS (BioMérieux Australia P/L-Sydney, NSW) have been recommended to reduce venous thromboembolism (VTE) investigations. Surveillance studies for new tests are recommended. We prospectively assessed VIDAS DD in normal practice.
Consecutive emergency patients and inpatients (IPs) with DD or VTE investigations were prospectively identified. Investigation results and early chart review including predefined factors reducing specificity were documented. A latex DD was also performed. Patients were followed for at least 3 months for recurrent VTE.
Four hundred three patients (emergency, 64%; VTE-positive, 12%; 95% followed up) were analyzed. VIDAS sensitivity was 96% (95% confidence interval 86%-99%), specificity 38% (confidence interval, 34%-44%; negative likelihood ratio, 0.11), and emergency specificity 51%. Latex sensitivity was 76%. Cancer, trauma, recent operations, IP status, and advanced age were associated with markedly reduced specificity. Specificity in older emergency patients (>70 years old) and younger IPs (<70) without comorbidities was 20% to 30%, but sensitivity was maintained at 100%.
VIDAS DD probably maintains adequate sensitivity in normal clinical practice for low- or even intermediate-risk patients. Latex agglutination had poor sensitivity. Specificity is best in younger low-morbidity emergency patients. These findings need validation in larger multicenter surveillance studies.
The American journal of emergency medicine 05/2007; 25(4):464-71. · 1.54 Impact Factor
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ABSTRACT: Objective
To ascertain the nature and extent of telephone advice to the public provided from the emergency department.MethodA postal survey of all emergency departments in Australia (n=147).ResultsAn 88% response rate was achieved. Sixty seven percent of emergency departments provide telephone advice. Seventy five percent of Directors of Emergency Medicine consider telephone advice to be worthwhile. The mean number of calls received each month is 627 per emergency department (range 4–12,500). Only 24% of emergency departments provide training on telephone advice. Fifty nine percent of departments do not document the calls.The general impression was that providing telephone advice was time consuming and distracted emergency department staff from direct patient care. Lack of funding to provide a dedicated service was frequently commented upon.The survey data indicated that there are at least 27.6 calls per 100 emergency department attendances; i.e. for every 100 attendances, there are a further 27.6 occasions of service.Conclusions
The provision of telephone advice from emergency departments is common practice in Australia and appears to be ad hoc. This service has a particular advantage for those who have difficulty accessing medical care. More formalised systems should be established. This would relieve a considerable burden from emergency departments freeing resources for direct patient care.
Emergency Medicine 05/1998; 10(2):117 - 121.
