• Journal of Trauma and Injury
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• v.37 no.2
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• pp.114-123
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• 2024

Purpose: Appropriate scoring systems can help classify and treat polytrauma patients. This study aimed to validate chest trauma scoring systems in polytrauma patients. Methods: Data from 1,038 polytrauma patients were analyzed. The primary outcomes were one or more complications: pneumonia, chest complications requiring surgery, and mortality. The Thoracic Trauma Severity Score (TTSS), Chest Trauma Score, Rib Fracture Score, and RibScore were compared using receiver operating characteristic (ROC) analysis in patients with or without head trauma. Results: In total, 1,038 patients were divided into two groups: those with complications (822 patients, 79.2%) and those with no complications (216 patients, 20.8%). Sex and body mass index did not significantly differ between the groups. However, age was higher in the complications group (64.1±17.5 years vs. 54.9±17.6 years, P<0.001). The proportion of head trauma patients was higher (58.3% vs. 24.6%, P<0.001) and the Glasgow Coma Scale score was worse (median [interquartile range], 12 [6.5-15] vs. 15 [14-15]; P<0.001) in the complications group. The number of rib fractures, the degree of rib fracture displacement, and the severity of pulmonary contusions were also higher in the complications group. In the area under the ROC curve analysis, the TTSS showed the highest predictive value for the entire group (0.731), head trauma group (0.715), and no head trauma group (0.730), while RibScore had the poorest performance (0.643, 0.622, and 0.622, respectively) Conclusions: Early injury severity detection and grading are crucial for patients with blunt chest trauma. The chest trauma scoring systems introduced to date, including the TTSS, are not acceptable for clinical use, especially in polytrauma patients with traumatic brain injury. Therefore, further revisions and analyses of chest trauma scoring systems are recommended.

• Journal of Trauma and Injury
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• v.19 no.1
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• pp.35-40
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• 2006

Purpose: Injuries are the third leading cause of death in Korea. Isolated chest injury is not uncommon and shows high mortality and morbidity. Several scoring systems are used for triage and stratification for trauma patients, but no standard system is accepted. We aimed to analyze the accuracy of identification of isolated chest injury by using several scoring systems. Methods: We reviewed a total of 75 patients admitted with isolated chest injury between January 2005 and October 2005. Medical records were reviewed by using the Injury Severity Score (ISS), the Revised Trauma Score (RTS), and the Trauma and Injury Severity Score (TRISS). The scoring systems were compared by using statistics methods. Results: The overall predictive accuracy of the TRISS was 12.5%, 12.0% greater than those of the RTS and the ISS. By using the area under the receiver operating characteristic (AUROC) curve, the TRISS showed an excellent discriminative power (AUROC 0.931) compared to the ISS (AUROC 0.926) and the RTS (AUROC 0.872). Conclusion: Compared with the RTS and the ISS, the TRISS is an easily applied tool with excellent prognostic abilities for isolated chest trauma patients. However, the TRISS, the ISS, and the RTS showed high specificity and low sensitivity, so another scoring system is required for triage and stratification of isolated chest injury patients.

• Journal of Chest Surgery
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• v.47 no.6
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• pp.523-528
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• 2014

Background: Numerous statistical models have been developed to accurately predict outcomes in multiple trauma patients. However, such trauma scoring systems reflect the patient's physiological condition, which can only be determined to a limited extent, and are difficult to use when performing a rapid initial assessment. We studied the predictive ability of the systemic inflammatory response syndrome (SIRS) score compared to other scoring systems. Methods: We retrospectively reviewed 229 patients with multiple trauma combined with chest injury from January 2006 to June 2011. A SIRS score was calculated for patients based on their presentation to the emergency room. The patients were divided into two groups: those with an SIRS score of two points or above and those with an SIRS score of one or zero. Then, the outcomes between the two groups were compared. Furthermore, the ability of the SIRS score and other injury severity scoring systems to predict mortality was compared. Results: Hospital death occurred in 12 patients (5.2%). There were no significant differences in the general characteristics of patients, but the trauma severity scores were significantly different between the two groups. The SIRS scores, number of complications, and mortality rate were significantly higher in those with a SIRS score of two or above (p<0.001). In the multivariant analysis, the SIRS score was the only independent factor related to mortality. Conclusion: The SIRS score is easily calculated on admission and may accurately predict mortality in patients with multiple traumas.

• Journal of Trauma and Injury
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• v.34 no.1
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• pp.3-12
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• 2021

Purpose: To evaluate the severity of trauma, many scoring systems and predictive models have been presented. The quick Sequential Organ Failure Assessment (qSOFA) is a simple scoring system based on vital signs, and we expect it to be easier to apply to trauma patients than other trauma assessment tools. Methods: This study was a cross-sectional study of trauma patients who visited the emergency department of Jeju National University Hospital. We excluded patients under the age of 18 years and unknown outcomes. We calculated the qSOFA, the Modified Early Warning Score (mEWS), Revised Trauma Score (RTS), and Injury Severity Score (ISS) based on patients' initial vital signs and assessments performed in the emergency department (ED). The primary outcome was mortality within 14 days of trauma. We analyzed qSOFA scores using multivariate logistic regression analysis and compared the predictive accuracy of these scoring systems using the area under the receiver operating characteristic curve (AUROC). Results: In total, 27,764 patients were analyzed. In the multivariate logistic regression analysis of the qSOFA, the adjusted odds ratios with 95% confidence interval (CI) for mortality relative to a qSOFA score of 0 were 27.82 (13.63-56.79) for a qSOFA score of 1, 373.31 (183.47-759.57) for a qSOFA score of 2, and 494.07 (143.75-1698.15) for a qSOFA score of 3. In the receiver operating characteristic (ROC) curve analysis for the qSOFA, mEWS, ISS, and RTS in predicting the outcomes, for mortality, the AUROC for the qSOFA (AUROC [95% CI]; 0.912 [0.871-0.952]) was significantly greater than those for the ISS (0.700 [0.608-0.793]) and RTS (0.160 [0.108-0.211]). Conclusions: The qSOFA was useful for predicting the prognosis of trauma patients evaluated in the ED.

• Journal of Trauma and Injury
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• v.35 no.1
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• pp.25-33
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• 2022

Purpose: The scoring system for traumatic liver injury (SSTLI) was developed in 2015 to predict mortality in patients with polytraumatic liver injury. This study aimed to validate the SSTLI as a prognostic factor in patients with polytrauma and liver injury through a generalized estimating equation analysis. Methods: The medical records of 521 patients with traumatic liver injury from January 2015 to December 2019 were reviewed. The primary outcome variable was in-hospital mortality. All the risk factors were analyzed using multivariate logistic regression analysis. The SSTLI has five clinical measures (age, Injury Severity Score, serum total bilirubin level, prothrombin time, and creatinine level) chosen based on their predictive power. Each measure is scored as 0-1 (age and Injury Severity Score) or 0-3 (serum total bilirubin level, prothrombin time, and creatinine level). The SSTLI score corresponds to the total points for each item (0-11 points). Results: The areas under the curve of the SSTLI to predict mortality on post-traumatic days 0, 1, 3, and 5 were 0.736, 0.783, 0.830, and 0.824, respectively. A very good to excellent positive correlation was observed between the probability of mortality and the SSTLI score (γ=0.997, P<0.001). A value of 5 points was used as the threshold to distinguish low-risk (<5) from high-risk (≥5) patients. Multivariate analysis using the generalized estimating equation in the logistic regression model indicated that the SSTLI score was an independent predictor of mortality (odds ratio, 1.027; 95% confidence interval, 1.018-1.036; P<0.001). Conclusions: The SSTLI was verified to predict mortality in patients with polytrauma and liver injury. A score of ≥5 on the SSTLI indicated a high-risk of post-traumatic mortality.

• Journal of Trauma and Injury
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• v.26 no.4
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• pp.273-279
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• 2013

Purpose: In patients with splenic trauma, Computed Tomography (CT) scan is helpful in selecting treatment options and evaluating resolution after NOM (Non-Operative Management). The purpose of this study was to suggest a CT based hemoperitoneum (HP) scoring system that can easily be used by clinicians to evaluate the severity of injury and recovery. Methods: A retrospective review of patients with splenic trauma admitted to our hospital between May 2003 and January 2013 was conducted. Patients diagnosed with isolated spleen injury who had a CT scan on admission were included. 1 or 2 points were given according to location and amount of hematoma in the CT image. Using the existing ultrasonography (US) based HP scoring system, the same method was applied to obtain our CT based HP scoring (CBHS) system, which ranges from 0 to 8 points. The CBHS system can be easily used by clinicians for a quick assessment of splenic injury. Results: Of the 39 patients meeting the inclusion criteria, 6 patients were managed operatively and 33 nonoperatively. There was a significant difference in CBHS between the OM (operative management) group and the NOM group.(p=0.03) CBHS showed correlation with Hb (hemoglobin), Hct (hematocrit), spleen injury grade(AAST), and Hounsfield unit of ROI (Region of interest). (p=0.17, p=0.18, p<0.000, p=0.02, respectively) After successful NOM with stabilized Hb level, the amount of hemoperitoneum was scored in the follow-up CT. CBHS demonstrated correlation with decreased spleen injury grade, decreased Hounsfield unit of ROI (Region of interest) (p=0.039, p=0.049, respectively), and also objectively reflected patient recovery. Conclusion: CBHS can be used as an objective and intuitive tool for clinicians in grading the severity of splenic injury by scoring the amount of hemoperitoneum, and in assessing recovery.

• Journal of East-West Nursing Research
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• v.28 no.1
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• pp.10-20
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• 2022

Purpose: We compared the Korean Triage and Acuity Scale (KTAS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) determined the validity of KTAS for classifying trauma patients. Methods: A retrospective chart review of 10,865 trauma patients (aged ≥15 years) who visited a single regional trauma and emergency medical center from January 1, 2016, to December 31, 2020, was conducted. Data were collected from the Korean Trauma Data Bank. Based on KTAS classification, the rates of intensive care unit admission, surgery and intervention, transfusion, emergency room (ER) and hospital mortality, and ER stay time were investigated. Data were analyzed using Chi-square test, Pearson's correlation coefficient, receiver operating characteristic curve, and area under the ROC curve. Results: In the KTAS, severe trauma patients (ISS ≥16) were classified as Level 1 (79.6%), 2 (44.8%), 3 (15.5%), 4 (4.0%) and 5 (7.6%). The following were the predictive powers of KTAS, ISS, and RTS for different parameters: surgery and intervention rate, KTAS (.71), ISS (.70), and RTS (.63); transfusion rate within 4h, KTAS (.82), ISS (.82), and RTS (.74); ER stay time within 90 min, KTAS (.72), ISS (.62), and RTS (.56); and ER mortality, KTAS (.84), ISS (.72), and RTS (.88). These findings were statistically significant (p<.001). The sensitivity and specificity of KTAS for trauma patients were .88 (.87~.90), and .38 (.37~.39), respectively. Conclusion: KTAS is a useful classification system that can predict the clinical outcomes of patients with trauma, and effectively triage acutely ill trauma patients, thus provide appropriate treatment.

• Journal of Trauma and Injury
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• v.37 no.2
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• pp.97-105
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• 2024

Purpose: Massive transfusion protocols (MTPs) implementation improves clinical outcomes of the patient's resuscitation with hemorrhagic trauma. Various predictive scoring system have been used and studied worldwide to improve clinical decision. However, such research has not yet been studied in Korea. This systematic review aimed to assess the predictors of MTPs activation in patients with trauma in Korea. Methods: The PubMed, Embase, Cochrane Library, Research Information Sharing Service databases, KoreaMed, and KMbase were searched from November 2022. All studies conducted in Korea that utilized predictors of MTPs activation in adult patients with trauma were included. Results: Ten articles were eligible for analysis, and the predictors were assessed. Clinical assessments such as systolic and diastolic blood pressure, shock index (SI), prehospital modified SI, modified early warning system (MEWS) and reverse SI multiplied by the Glasgow Coma Scale (rSIG) were used. Laboratory values such as lactate level, fibrinogen degradation product/fibrinogen ratio, and rotational thromboelastometry (ROTEM) were used. Imaging examinations such as pelvic bleeding score were used as predictors of MTPs activation. Conclusions: Our systematic review identified predictors of MTPs activation in patients with trauma in Korea; predictions were performed using tools that requires clinical assessments, laboratory values or imaging examinations only. Among them, ROTEM, rSIG, MEWS, SI, and lactate level showed good effects for predictions of MTPs activation. The application of predictors for MTP's activation should be individualized based on hospital resource and skill set, also should be performed as a clinical decision supporting tools.

• Journal of Trauma and Injury
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• v.35 no.3
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• pp.151-158
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• 2022

Purpose: There is a strong correlation between trauma and pain. Pain increases the rate of depression, posttraumatic stress disorder, and even mortality in trauma patients. Methods: This institution-based, provider-blinded and patient-blinded, observational study was conducted among trauma patients treated at Tikur Anbessa Specialized Hospital. Over the course of 3 months, this study included patients who had no prior pain management at other hospitals before presentation, and who presented within 24 hours of the traumatic event. Results: Of the 74 patients evaluated, none of the patients had their pain level scored. The researcher-provided pain scale showed a severe subjective pain score for 79.7% of the patients and a severe functional activity score for 59.5% of the patients. Analgesia was provided at an average of 55.4 minutes after presentation and all patients received either diclofenac or tramadol. Satisfactory pain reduction after analgesia was 28.8% for patients initially complaining of severe pain, 54.6% for moderate pain, and 66.7% for mild pain, with the difference being statistically significant (P<0.05). Forty percent of patients discharged home received no analgesia after the first dose provided upon presentation. Conclusions: Pain scoring was nonexistent during the course of the study. The poor utilization rate of analgesia combination and opioids led to unsatisfactory pain outcomes in patients evaluated and followed for 24 hours after presentation.

• Journal of Trauma and Injury
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• v.28 no.3
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• pp.134-143
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• 2015

Purpose: Many patients are injured by trauma. And some of them expire due to severity of trauma. Various scoring systems have been introduced in grading severity and predicting mortality of trauma patients. This study is to evaluation the usefulness of factors for determining the severity and predicting the prognosis of the trauma victims. Methods: Data on the patients who visited our Emergency departments from January 2010 to December 2011 were retrospectively reviewed using electronic medical records. The patients were activated severe trauma team calling system. The patients were categorized as survivors and non-survivors. Univariated associations were calculated, and a multiple logistic regression analysis was used to determine variables associated with hospital mortality. Results: Two hundred sixty two(262) patients were enrolled, and the mortality rate was 25.6%. By multivariate analysis, lower respiration rate, lower Glasgow Coma Score, higher International Normalized Ratio and emergency transfusion within 6 hours were expected as severity and prognosis predict factors (each of odds ratio were 24.907, 14.282, 2.667 and 16.144). Conclusion: As predict factors, respiration rate, Glasgow Coma Score, International Normalized Ratio and emergency transfusion, are useful determining the severity and predicting prognosis of trauma victims.