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  • Trauma is caused by a wide variety of risks e.g. fall ,agricultural related injuries, fire arm injuries, poisoning, burns, drowning, intentional self-harm (suicides), assault, fall of object, natural and man-made disasters.
  • retrospective analysis of a prospectively maintained database from Injury surveillance and Trauma registry forms maintained at JPN Apex Trauma Center, AIIMS
  • To calculate an ISS, take the highest AIS severity code in each of the three most severely injured ISS body regions, square each AIS code and add the three squared numbers for an ISS
  • Triss

    1. 1. Pattern of Injury severity and Probability of survival of RED Triaged Patients in an Apex Level 1 Trauma Centre Sonia Chauhan (Trauma Nurse Coordinator) J P N Apex Trauma Center,AIIMS [email_address]
    2. 2. Background <ul><li>Injury and trauma represent a major health problem worldwide. </li></ul><ul><li>Trauma is caused by a wide variety of risks </li></ul><ul><li>Our study looks at the pattern of Injury severity and Probability of survival of RED Triaged Patients in a Apex Level 1 Trauma Centre </li></ul>
    3. 3. Objective <ul><li>To study the epidemiology, Pattern of Injury severity and Probability of survival of RED Triaged Patients in a Level 1 Trauma Centre. </li></ul>
    4. 4. METHODOLOGY <ul><li>Study design- Qualitative retrospective study </li></ul><ul><li>Performance centre - ED of JPN Apex Trauma Centre, AIIMS. </li></ul><ul><li>Study duration - January to July 2011 </li></ul><ul><li>Study Group - The number of patients Triaged as Red (severe injuries with compromised A, B, C or D) </li></ul>
    5. 5. METHODOLOGY <ul><li>Study Tool: Prospectively maintained database from Injury surveillance and Trauma registry forms </li></ul><ul><li>Pattern of injury was assessed using Trauma Registry Forms </li></ul><ul><li>Injury severity Score (ISS),New Injury severity Score (NISS) were calculated using AIS manual. </li></ul><ul><li>Trauma Related Injury severity Score (TRISS),New Trauma Related Injury severity Score (NTRISS) were calculated using TRISS calculator ( ) </li></ul><ul><li>Data were compiled and analyzed using SPSS version 16. </li></ul>
    6. 6. Definitions <ul><li>Abbreviated Injury Scale : </li></ul><ul><li>A n anatomically based consensus-derived global severity scoring system that classifies each injury in every body region (head and neck including cervical spine, face ,chest , Abdomen with pelvic contents ,extremities, external) </li></ul><ul><li>according to its relative severity on a six point ordinal scale: 1 Minor, 2 Moderate, 3 Serious, 4 Severe, 5 Critical, 6 Maximal (currently untreatable). </li></ul>
    7. 7. <ul><li>Injury severity Score (ISS ) : </li></ul><ul><li>The ISS is based upon the AIS. </li></ul><ul><li>ISS = A^2 + B^2 + C^2 </li></ul><ul><li>where A, B, C are the AIS scores of the three most injured ISS body regions. </li></ul><ul><li>Major trauma:ISS > 15 </li></ul>
    8. 8. <ul><li>New Injury severity Score (NISS ) : The New ISS (NISS ) is defined as the sum of the squares of the AIS of each of the patient’s three most severe AIS injuries, regardless of the body region in which they occur </li></ul><ul><li>NISS better predicts survival and is easier to calculate than ISS* </li></ul><ul><li>* Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974; 14: 187–196 </li></ul>
    9. 9. <ul><li>Trauma Related Injury Severity Score(TRISS) - TRISS determines the probability of survival (Ps) of a patient from the ISS and RTS using the following formulae: </li></ul><ul><li>Ps = 1/(1+e ^-b) </li></ul><ul><li>Where 'b' is calculated from: </li></ul><ul><li>b=b0+b1(RTS)+b2(ISS)+b3(Age index) </li></ul><ul><li>New Trauma Related Injury Severity Score(NTRISS) </li></ul><ul><li>TRISS or NTRISS> 0.5 probabaly survive* </li></ul><ul><li>* Boyd CR, Tolson MA, Copes WS: &quot;Evaluating Trauma Care: The TRISS Method&quot;, J Trauma 27:370-378;1987 </li></ul>
    10. 10. <ul><li>Revised Trauma Score : </li></ul><ul><li>The Revised Trauma Score is made up of a combination of results from three categories : GCS, Systolic Blood Pressure, and respiratory rate </li></ul>
    11. 12. Result <ul><li>Total No. of Registrations =7247 </li></ul><ul><li>Red Triaged Patients = 1744 ( 24.06%) </li></ul><ul><li>Male / female = 1486/ 258 </li></ul>
    12. 13. Age distribution Age Group No. Of Patients 0-10 279 11-20 225 21-30 542 31-40 295 41-50 221 51-60 92 61-70 63 > 70 27
    13. 14. Mechanism of injury (n= 1744) <ul><li>Non trauma=3 </li></ul>
    14. 15. Mode of Injury (n= 1741)
    15. 16. <ul><li>We analysed ISS,NISS,RTS, and TRISS and NTRISS (for probability of survival) for 340 patients. </li></ul>
    16. 17. Final outcome
    17. 18. More Severe Injuries In The Non-survivor Group . Survival Group(235) Average ISS 8.52 Average NISS 10.37 Non Survival group (105): Average ISS 21.55 Average NISS 21.67
    18. 19. Non survival :ED death <ul><li>Average ISS =22.89 </li></ul><ul><li>Average NISS =26.97 </li></ul><ul><li>Means </li></ul><ul><li>More severe injury than in-hospital death patients </li></ul>
    19. 20. Probability of survival <ul><li>Survivor group : </li></ul><ul><li>patients with TRISS/ NTRISS <0.5 =Nil </li></ul><ul><li>No unexpected survivors in Red Triaged patients. </li></ul>
    20. 21. <ul><li>Non Survivor group : </li></ul><ul><li>patients with TRISS/ NTRISS >0.5= 30/34 (in hospital),53/51 (ED deaths) </li></ul><ul><li>signifying preventable deaths </li></ul>
    21. 22. The cause of Injury in the preventable deaths
    22. 23. Review of literature <ul><li>N.G.Biligen et al studied ‘ The usefulness of trauma scores in determining the life threatening condition of trauma victims for writing medical-legal reports’ and concluded that Trauma scores can be used for making more objective, standardized, and accurate judgment on whether the injury was a life threatening one or not which was similar to our results.* </li></ul><ul><li>* Emergency Medicine Emerg Med J 2005;22:783-787 doi:10.1136/emj.2004.019711 </li></ul>
    23. 24. Conclusion: <ul><li>The non-survivor group had higher avg. ISS and NISS as compared to survivor group; moreover the ED death group had a higher avg. ISS and NISS within the non-survivor group. </li></ul><ul><li>The mortality rates of severely injured patients are very high and can be attributed primarily to the lack of systems approach and absence of Pre-hospital care which delays the transfer of the patients to the hospital. </li></ul>
    24. 25. THANK YOU