Frequency, causes and pattern of abdominal trauma: A 4-year descriptive analysis.

The frequency, characteristics, and effect on outcome of abdominal and pelvic injuries (API) caused by road traffic accidents are not well known. We studied them in a well-defined geographical area in France. The medical data of all hospitalized victims of road traffic accidents that occurred over a 3-year period were recorded. Injuries were coded according to the Abbreviated Injury Scale (AIS). The Injury Severity Score (ISS) was calculated. Continuous and qualitative variables were described by means and standard deviations or medians and percentages, respectively. Proportions and means were compared using the χ2 and Student tests, respectively. Of 6,977 victims of road traffic accidents, 2,009 were hospitalized (mean ISS=7.9). API were present in 9.3% (n=186) of all hospitalized victims and in 32.2% (n=82) of the most severely injured (ISS≥16, n=255) hospitalized victims. The most frequently seriously injured abdominopelvic organs (AIS≥3) were the spleen, the retroperitoneal organs, and the liver. The mean ISS and the mortality rate were significantly higher for victims with API than those without API (17.5 vs. 6.9, P<0.001; 9.7% vs. 1.9%, P<0.001). In multivariate analysis, the presence of severe API increased the mortality rate by a factor of 2.5. In this study, API were present in one third of the most severely injured victims of road traffic accidents and were a significant factor of gravity and mortality. This study, conducted in France where there is no National Trauma Registry, underlined the need for establishing such registry.

Objective To study the relationship between the fractured scapular location, the number of fractured scapular regions and the distribution and severity of associated injuries in patients with multiple trauma. Methods One hundred and fifteen consecutive patients with fractured scapula were retrospectively studied between August 2006 and March 2008. There were 96 males and 19 female with an average age of 37.9 years. Mechanism of injury, associated injuries, abbreviated injury soore (AIS) for each part, injury severity score (ISS), and the location and the number of anatomic scapular regions involved in each fracture were studied. Patients were divided into single-region fracture (SRF) group and multiple-region fracture (MRF) group. Furthermore, the SRF group was subdivided into three groups according to their anatomic location: 1) the muscle covered part, 2) the apophyseal part and 3) the glenoid part. Computer tomography and plain radiographs was used for fracture classification in all patients. Results Most scapular fractures were a part of severe multiple trauma, with mean ISS 14.0 among them 42 cases (36.5%) were greater than 16. Road traffic accident was the most common cause for scapular fracture. Ninety-eight patients (85.2%) sustained associated injury. The most frequent part involved was chest(85/115, 73.9%). ISS and AIS for the chest injuries were higher in patients with multiple scapular fractures or scapular fractures in muscle covered part. Conclusion Scapular fractures are usually caused by directly high energy trauma, accompanied by associated injuries. The most frequent region was chest injury. MRF may serve as an external skeletal marker of severe chest injury. Key words: Shoulder fractures; Scapula; Wounds and injuries; Thorax

BACKGROUND: Craniofacial injuries contribute substantially to morbidity after blunt trauma, with orbital fractures seen in approximately 10–25% of all traumatic facial fractures. Orbital blow-out fractures occur when an orbital wall is fractured with an intact orbital rim, and usually occurs after significant blunt trauma from an object larger than the orbital aperture. The aim of this study is to determine the impact of age, injury severity, and mechanism of injury on orbital blow-out fracture patterns. METHODS: We retrospectively reviewed all patients admitted to a regional Level 2 Trauma Center, who sustained blunt orbital fractures, over an 11-year period, from January 2006 to December 2016. We excluded all patients who had orbital rim fractures and all penetrating trauma. Only patients who had a computed tomography scan of their face on presentation were included. There were 825 patients who met inclusion criteria. Individual charts were reviewed for demographics, length-of-stay(LOS), mechanism of injury(MOI), injury severity score(ISS), and mortality. Individual facial CT scans were reviewed along with the formal radiologist report to determine fracture locations. Statistical significance was set at a p value ≤0.05. This study was approved by our Institutional Review Board. RESULTS: Our cohort consisted of 825 patients, with 42 mortalities (5.1%). The mean age was 40.4 years old (range 1–97) and there was an approximate 4:1 male:female ratio. The mean LOS was 5.4 days (range 0–78) and the mean ISS was 14.7(range 1–50). The most common MOI was motor vehicle collisions(MVC) in 211 patients, followed by assault, ground-level mechanical falls, All-Terrain Vehicle(ATV) accidents, motorcycle collisions(MCC), and other mechanisms in 171, 151, 112, 53, and 127 patients, respectively. Overall, the most common orbital blow-out fracture involved the orbital floor in 567 patients (68.7%), followed by the lateral, medial, superior(roof), and posterior walls in 310(37.6%), 183(22.2%), 160(19.3%), and 16(1.8%) patients, respectively. The most common fracture pattern combination was orbital floor and lateral wall fractures in 202 patients (24.5%). The mean number of orbital blow-out fractures per patient in the entire cohort was 1.50. Orbital floor fractures remained the most common blow-out fracture in all age groups, accounting for 72.4% in pediatrics (1–17 years old), 66.4% in adults (18–64 years), and 77.7% in the elderly (age ≥65 years). Patients with ISS <15 were significantly more likely to have an orbital floor fracture when compared to patients with ISS ≥15, with fractures present in 81.1% and 56.9% of patients, respectively(p<0.05). MCC resulted in the highest mean number of orbital blow-out fractures per patient (1.83), which was significantly higher than other mechanisms(p<0.05). Patients who had ground-level mechanical falls were most likely to have orbital floor blow-out fractures (90.0%) compared with other mechanisms(p<0.05). CONCLUSION: Orbital blow-out fractures are a common injury after significant blunt craniofacial trauma. The orbital floor is most frequently involved, and patients who have mechanical falls seem particularly prone to this injury. Patients with lower ISS in our cohort likely had more concentrated craniofacial injuries, explaining their worse fracture patterns. MCC appears to confer the greatest craniofacial trauma with the most severe orbital blow-out fracture patterns. Age did not independently predict fracture patterns.

PurposeThis study aimed to identify the prevalence and predictors of spinal injuries that are suitable for immobilization.MethodsRetrospective cohort study drawing from the multi-center database of the TraumaRegister DGU®, spinal injury patients ≥ 16 years of age who scored ≥ 3 on the Abbreviated Injury Scale (AIS) between 2009 and 2016 were enrolled.ResultsThe mean age of the 145,833 patients enrolled was 52.7 ± 21.1 years. The hospital mortality rate was 13.9%, and the mean injury severity score (ISS) was 21.8 ± 11.8. Seventy percent of patients had no spine injury, 25.9% scored 2–3 on the AIS, and 4.1% scored 4–6 on the AIS. Among patients with isolated traumatic brain injury (TBI), 26.8% had spinal injuries with an AIS score of 4–6. Among patients with multi-system trauma and TBI, 44.7% had spinal injuries that scored 4–6 on the AIS. Regression analysis predicted a serious spine injury (SI; AIS 3–6) with a prevalence of 10.6% and cervical spine injury (CSI; AIS 3–6) with a prevalence of 5.1%. Blunt trauma was a predictor for SI and CSI (OR 4.066 and OR 3.640, respectively; both p < 0.001) and fall > 3 m for SI (OR 2.243; p < 0.001) but not CSI (OR 0.636; p < 0.001). Pre-hospital shock was predictive for SI and CSI (OR 1.87 and OR 2.342, respectively; both p < 0.001), and diminished or absent motor response was also predictive for SI (OR 3.171) and CSI (OR 7.462; both p < 0.001). Patients over 65 years of age were more frequently affected by CSI.ConclusionsIn addition to the clinical symptoms of pain, we identify ‘4S’ [spill (fall) > 3 m, seniority (age > 65 years), seriously injured, skull/traumatic brain injury] as an indication for increased attention for CSIs or indication for spinal motion restriction.

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

With the dramatic growth in the very old population and their concomitant heightened exposure to traumatic injury, the trauma burden among this patient population is estimated to be exponentially increasing. To determine the clinical outcomes and predictors of in-hospital and 1-year mortality in nonagenarian and centenarian trauma patients (NCTPs). All patients 90 years or older admitted to a level 1 academic trauma center between January 1, 2006, and December 31, 2010, with a primary diagnosis of trauma were included. Standard trauma registry data variables were supplemented by systematic medical record review. Cumulative mortality rates at 1, 3, 6, and 12 months after discharge were investigated using the Social Security Death Index. Univariate and multivariable analyses were performed to identify the predictors of in-hospital and 1-year postdischarge cumulative mortalities. Length of hospital stay, in-hospital mortality, and cumulative mortalities at 1, 3, 6, and 12 months after discharge. Four hundred seventy-four NCTPs were included; 71.7% were female, and a fall was the predominant mechanism of injury (96.4%). The mean patient age was 93 years, the mean Injury Severity Score was 12, and the mean number of comorbidities per patient was 4.4. The in-hospital mortality was 9.5% but cumulatively escalated at 1, 3, 6, and 12 months after discharge to 18.5%, 26.4%, 31.3%, and 40.5%, respectively. Independent predictors of in-hospital mortality were the Injury Severity Score (odds ratio [OR], 1.09; 95% CI, 1.02-1.16; P = .01), mechanical ventilation (OR, 6.23; 95% CI, 1.42-27.27; P = .02), and cervical spine injury (OR, 4.37; 95% CI, 1.41-13.50; P = .01). Independent predictors of cumulative 1-year mortality were head injury (OR, 2.65; 95% CI, 1.24-5.67; P = .03) and length of hospital stay (OR, 1.06; 95% CI, 1.02-1.11; P = .005). Cumulative 1-year mortality in NCTPs with a head injury was 51.1% and increased to 73.2% if the Injury Severity Score was 25 or higher and to 78.7% if mechanical ventilation was required. Most NCTPs required rehabilitation; only 8.9% were discharged to home. Despite low in-hospital mortality, the cumulative mortality rate among NCTPs at 1 year after discharge is significant, particularly in the presence of head injury, spine injury, mechanical ventilation, high injury severity, or prolonged length of hospital stay. These considerations can help guide clinical decisions and family discussions.

This study aimed to describe the determinants of the severity and type of injuries sustained by children hurt in off-road vehicle (ORV) accidents. This was a retrospective clinical study for which data were obtained from the trauma database at the Children's Hospital at Westmead covering the 10-year period between January 1, 1998, and December 31, 2007. Data points collected included age, sex, Injury Severity Score (ISS), body region injured, type of vehicle, accident setting, mechanism of injury, estimated speed, position of the rider, use of a helmet and/or protective clothing, and hospital length of stay. The study end points were determinants of injury severity and type. Statistical analysis of the collected data was done with the standard statistical software package, SPSS. A total of 288 children (242 male [84%] and 46 female [16%] patients) presented for ORV-related trauma. Helmets significantly diminished the chance of sustaining a head injury occasioning a skull fracture. Jumping was associated with increased ISS and a higher chance of sustaining an abdominal and/or thoracic injury. Older children were more likely to sustain pelvic and spinal injures, be injured while traveling at high speed, and be injured while going over a jump. Mean ISS was significantly lower if trauma was sustained while riding a mini motorcyle in any setting and any ORV at home. Further research (prospective, federal, and multi-institutional) is needed with a view to optimizing training schedules, rules, regulations, and licensing requirements for pediatric ORV riders.

ObjectiveThe Finnish national Traffic Safety Strategy 2022–2026 seeks to halve the number of road fatalities and serious injuries from 2020 to 2030. The strategy states that better information on bicycle crashes is needed for safety promotion. The aim of this study was to describe the demographics, injury characteristics, alcohol involvement, and helmet use of severely injured cyclists and to compare single bicycle crashes (falling alone or hitting a fixed object) to collisions. Material and methodsWe identified all bicycle crashes between 2006 and 2021 from the Helsinki Trauma Registry (HTR). Variables analysed were basic patient demographics, Abbreviated Injury Scale (AIS) codes, AIS 3+ injuries, injured body regions, patient Injury Severity Score (ISS) and New Injury Severity Score (NISS), 30-day in-hospital mortality, ICU length of stay, injury mechanism, alcohol use by the injured cyclists, and helmet use. ResultsOf the 325 severe (NISS >15) cycling injury patients in the HTR, 53.5 % were injured in single crashes and 46.5 % in collisions with a moving object. Most (71.4 %) patients were men and mean age of all patients was 54.1 years (SD 16.7). Alcohol was detected in 23.1 % of cases and more often in single crashes (32.8 %) than in collisions (11.9 %). Less than a third (29.2 %) of all cyclists wore a helmet; those who wore a helmet had fewer serious (AIS 3+) head injuries than those who did not. Cyclists injured in collisions had higher ISS and NISS scores than those injured in single crashes. Serious (AIS 3+) injuries in extremities or in pelvic girdle were more common in collisions than in single crashes. ConclusionsAmong severely injured cyclists, single bicycle crashes were more common; alcohol was more often detected in single bicycle crashes than in collisions. Overall injury severity was higher in collisions than in single crashes. Helmet users had less AIS 3+ head injuries than non-users. Attention should be focused on preventing alcohol-related cycling injuries, promoting use of bicycle helmets, and more precise and comprehensive documentation of bicycle crashes in health care units.

BackgroundThoracic trauma is the third most common cause of death after abdominal injury and head trauma in polytrauma patients. The purpose of this study was to investigate epidemiological data, treatment and outcome of polytrauma patients with blunt chest trauma in order to help improve management, prevent complications and decrease polytrauma patients’ mortality.MethodsIn this retrospective study we included all polytrauma patients with blunt chest trauma admitted to our tertiary care center emergency department for a 2-year period, from June 2012 until May 2014. Data collection included details of treatment and outcome. Patients with chest trauma and Injury Severity Score (ISS) ≥18 and Abbreviated Injury Scale (AIS) >2 in more than one body region were included.ResultsA total of 110 polytrauma patients with blunt chest injury were evaluated. 82 of them were males and median age was 48.5 years. Car accidents, falls from a height and motorbike accidents were the most common causes (>75%) for blunt chest trauma. Rib fractures, pneumothorax and pulmonary contusion were the most common chest injuries. Most patients (64.5%) sustained a serious chest injury (AISthorax 3), 19.1% a severe chest injury (AISthorax 4) and 15.5% a moderate chest injury (AISthorax 2). 90% of patients with blunt chest trauma were treated conservatively. Chest tube insertion was indicated in 54.5% of patients. The need for chest tube was significantly higher among the AISthorax 4 group in comparison to the AIS groups 3 and 2 (p < 0.001). Also, admission to the ICU was directly related to the severity of the AISthorax (p < 0.001). The severity of chest trauma did not correlate with ICU length of stay, intubation days, complications or mortality.ConclusionAlthough 84.5% of patients suffered from serious or even severe chest injury, neither in the conservative nor in the surgically treated group a significant impact of injury severity on ICU stay, intubation days, complications or mortality was observed. AISthorax was only related to the rate of chest tube insertions and ICU admission. Management with early chest tube insertion when necessary, pain control and chest physiotherapy resulted in good outcome in the majority of patients.

BackgroundThoracic and extremity injuries are common in polytraumatized patients. The clavicle limits the upper thoracic cage and connects the body and upper extremities. It is easy to examine and is visible on standard emergency room radiographs. We hypothesize that clavicular fracture in polytrauma patients indicates the presence of further injuries of the upper extremities, head, neck and thorax.Material and methodsRetrospective study including patients admitted between 2008 and 2012 to a level-I trauma center. Inclusion criteria: ISS > 16, two or more injured body regions, clavicular fracture. Control group: patients admitted in 2011, ISS > 16, two or more injured body regions, no clavicular fracture. Patient information was obtained from the patients’ charts; evaluation of radiographic findings was performed; scoring was based on the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) AIS/ISS; data were analyzed using Pearson’s correlation and the Mann–Whitney U-test in SPSS (version 11.5.1); graphs were drawn using EXCEL®.ResultsThirty-four patients with clavicular fracture (C+) and 40 without (C-) were included; the mean ISS was 25 (range 16–57), m = 70%, f = 30%; age 43.3 years (range 9–88); clavicular fractures were positively correlated with severe thoracic (p = 0.011, OR 4.5: KI 1.3–15.3), external (p < 0.001, OR 9.2: KI 2.7–30.9) and upper extremity injuries (p < 0.001, OR 33.2: KI 6.9–16.04 resp. p = 0.004, OR 12.5: KI 1.5–102.9). C + showed a lower head/neck AIS (p = 0.033), higher thorax AIS (p = 0.04), arm/shoulder AIS (p = 0.001) and external AIS (0.003) than C-. Mean hospital stay and ICU treatment time were longer in the C + group (p = 0.001 and p = 0.025 respectively).ConclusionA clavicular fracture can be diagnosed easily and may be used as a pointer for further thoracic and upper extremity injuries in polytrauma patients that might have been otherwise missed. Special attention should be paid on second and tertiary survey.

A study on correlation of pedestrian head injuries with physical parameters using in-depth traffic accident data and mathematical models

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 may be a more appropriate definition of severe injury in children. Pattern of injury is important, as only head and chest injury drive mortality in single-system-injured children. These findings should be considered in benchmarking and performance improvement efforts. Epidemiologic study, level III.

to study the correlation of trauma mechanism with frequency and severity of injuries in blunt trauma patients. retrospective analysis of trauma registry in a 15-month period was carried out. Trauma mechanism was classified into six types: occupants of four-wheeled vehicles involved in road traffic accidents (AUTO), pedestrians struck by road vehicles (PED), motorcyclists involved in road traffic accidents (MOTO), falls from height (FALL), physical assault with blunt instruments (ASSA) and falls on same level (FSL). Injuries with AIS>2 were considered severe. One-way ANOVA, Students t and Chi-square tests were used for statistical analysis, considering p<0.05 significant. trauma mechanism was classified by group for 3639 cases, comprising 337 (9.3%) AUTO, 855 (23.5%) PED, 924 (25.4%) MOTO, 455 (12.5%) FALL, 424 (11.7%) ASSA and 644 (17.7%) FSL. There was significant difference among groups when comparing the Revised Trauma Score (RTS), the Injury Severity Score (ISS) and the Abbreviated Injury Scale (AIS) of the head, thorax, abdomen and extremities (p<0.001). Severe injuries in the head and in the extremities were more frequent in PED patients (p<0.001). Severe injuries to the chest were more frequent in AUTO (p<0.001). Abdominal injuries were less frequent in FSL (p=0.004). Complex fractures of the pelvis and spine were more frequent in FALL (p<0.001). Lethality was greater in PED, followed by FALL and AUTO (p<0.001). trauma mechanism analysis predicted frequency and severity of injuries in blunt trauma patients.

The aim of this study was to evaluate the demographics, mechanisms, pattern, injury severity, and the outcome (ie, length of intensive care unit [ICU] stay, length of mechanical ventilation, total length of stay, mortality) in multiple-injured children based on a review from the German trauma registry study ("Traumaregister") of the German Society of Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie e.V.). One hundred three German trauma centers took part in the German trauma registry study from January 1997 to December 2003. Five hundred seventeen children (aged 0-15 years) with multiple injuries and an Injury Severity Score of more than 15 in comparison to 11,025 adults were included. Sex, age, and mechanisms and pattern of injury were assessed. The mechanisms of trauma and the anatomical distribution of severe injury (Abbreviated Injury Scale of 3 or more) were analyzed. The Injury Severity Score, the Revised Trauma Score, and the Trauma Score Injury Severity Score were calculated to estimate the severity of injury and mortality. The predominant sex was male. Most cases were caused by traffic-related accidents. Head injuries were most common in children, and severe thoracic injuries increased with age. Mean length of ICU treatment, mechanical ventilation, and total length of stay were shorter in children than in adults. A total of 22.6% of the children aged 0 to 5 years died in the hospital in comparison with in-hospital mortality rate of 13.7% in the 6- to 10-, 20.3% in the 11- to 15-, and 17.0% in the 16- to 55-year-old patients. There were differences between multiple-injured children and adults concerning injury mechanisms and pattern of injuries. Adults needed a longer mechanical ventilation and a longer ICU therapy. Most deaths could be seen in the youngest patients aged 0 to 5 years.

Background: Traffic accidents have been a bleeding wound due to developing technology and increasing number of vehicles. Improvement in socio-economic level has led to an increase in number of vehicles and traffic accidents with injury and death increase accordingly. High costs appear by tests and treatments as well as further health problems and loss of labour power in traffic accidents. The aim of this study was to evaluate the trauma scores, clinical outcomes and hospital cost of patients presenting to the emergency department with road traffic accidents.&#x0D; Methods: Patients information; hospital automation system, forensic records and patient files were recorded. Cost information was received in hospital automation system. Hospital costs include examinations and treatments that have been performed since the first visit of the patients. According to the data obtained from the patients files, GCS (Glasgow Coma Scale), AIS(Abbreviated Injury Scale) and ISS(Injury Severity Score) scores of each patient were calculated separately. All variables were tested for conformity to normal distribution, Kolmogorov Smirnov test and compliance with parametric test criteria. The data obtained by the study carried out within the scope of clinical research are statistically nonparametric. For this reason, Kruskal-Wallis H tests were used for statistical evaluation of associated variables according to dependency status. Spearman rank correlation in non-parametric data and Pearson correlation in parametric data were used as correlation methods. The results were evaluated for a significance level of P &lt; .05.&#x0D; Results: The average cost of traffic accidents was found to be 247.38 Turkish Lira.The average cost of motor vehicle accidents was 246.53 Turkish Lira.The average cost of extra vehicular traffic accident was 235.3 Turkish Lira. Cost average was 265.9 Turkish Lira.The effect of clinical outcomes on the cost was found statistically significant. There was a statistically significant effect of GCS, AIS, ISS trauma scores on the cost. AIS and ISS and the cost was moderately significant and a positive correlation was found.&#x0D; Conclusion: Frequency of the traffic accidents, higher hospitalization rates and higher medical expenses have made the traffic accidents a significant public health problem economically We believe that community education should be increased in order to reduce traffic accidents in terms of health as well as the national economy.