Cristiane de Alencar Domingues

Mapping injuries in traffic accident victims: a literature review

O objetivo do estudo foi identificar as regioes corporeas mais atingidas em vitimas de acidentes de transporte e mapear a gravidade das lesoes e do trauma. Foi realizada revisao sistematica da literatura, utilizando-se descritores relacionados aos acidentes de trânsito, acidentes de transporte, ferimentos e lesoes, totalizando 248 artigos. As bases eletronicas pesquisadas foram LILACS, MEDLINE e PAHO, entre 1990 e dezembro de 2006. Essa revisao destacou uma serie de estudos conclusivos sobre as regioes corporeas mais frequentes e aquelas de maior gravidade atingidas nesses eventos e apontou lacunas de conhecimento na literatura nacional. Acredita-se que esses achados possam ser de grande valia para as equipes nos cenarios de pre-hospitalar e intra-hospitalar e apontem caminhos na direcao de novas pesquisas.The objective of this study was to identify the body regions most affected in traffic accident victims and to map the trauma and severity of the lesions. A systematic literature review using key words related to traffic accidents, transportation accidents, wounds and injuries found a total of 248 articles. The electronic bases LILACS, MEDLINE, and PAHO were surveyed between the years 1990 and December 2006. This review emphasized a series of conclusive studies about the most frequent body regions involved and the major injuries occurring in these situations. It also indicated information gaps in the Brazilian literature. We believe that these findings are valuable for pre-hospital and intra-hospital teams and point the way to new investigations.

Ten years of new injury severity score (NISS): is it a possible change?

The article is a bibliographic review which intends to present the actual range of researches comparing the Injury Severity Score (ISS) and the New Injury Severity Score (NISS). Databases were searched using the keyword NISS, with 42 articles, 23 of which didn’t compare the two indexes. Most part of the 19 selected articles showed that NISS has been more accurate in predicting the outcomes (dependent variables) than ISS, moreover in severe and specific trauma. Studies with populations between 1,000 and 10,000 resulted in NISS-favorable results, whereas studies with populations larger than 10,000 or smaller than 1,000 showed either NISS-favorable results or no difference between the two groups. However, there were no studies showing ISS-favorable results. These results and the easier calculation of NISS lead to a future replacement of ISS by NISS.

Severity of trauma victims admitted in intensive care units: comparative study among different indexes

This study compared the performance of the Injury Severity Score (ISS) with the New Injury Severity Score (NISS) and also the Simplified Acute Physiology Score II (SAPS II) with the Logistic Organ Dysfunction System (LODS) in trauma victims, in order to predict mortality and length of stay in Intensive Care Units (ICU), besides identifying which indexes have been the most effective to estimate these results. A retrospective analysis was done in the records of 185 victims admitted in ICU between June and December 2006. None of the four indexes properly discriminated the patients according to length of stay at the ICU. The ISS and the NISS did not show a good discriminating capacity in case of death, but the SAPS II and the LODS presented good performance to estimate mortality at the ICU. Results pointed towards the use of SAPS II and LODS when trauma victims are admitted in an ICU.3Este estudo objetivou comparar em vitimas de trauma o desempenho do Injury Severity Score (ISS), perante o New Injury Severity Score (NISS) e, tambem, do Simplified Acute Physiology Score II (SAPS II), perante o Logistic Organ Dysfunction System (LODS) para predizer a mortalidade e o tempo de permanencia em unidades de terapia intensiva (UTI), alem de identificar quais indices foram os mais efetivos para estimar esses desfechos. Foi realizada analise retrospectiva dos prontuarios de 185 vitimas, admitidas em UTI, entre junho e dezembro de 2006. Os quatro indices nao descriminaram adequadamente os pacientes segundo tempo de permanencia na UTI. ISS e NISS nao mostraram boa capacidade discriminatoria para ocorrencia de obito, diferente do SAPS II e LODS que apresentaram melhor performance para estimar a mortalidade em UTI. Resultados apontaram para o uso do SAPS II e do LODS quando vitimas de trauma sao internadas em UTI.

Nursing Workload in Intensive Care Unit Trauma Patients: Analysis of Associated Factors

Background From the perspective of nurses, trauma patients in the Intensive Care Unit (ICU) demand a high degree of nursing workload due to hemodynamic instability and the severity of trauma injuries. This study aims to identify the factors related to the high nursing workload required for trauma victims admitted to the ICU. Methods This is a prospective, cross-sectional study using descriptive and correlation analyses, conducted with 200 trauma patients admitted to an ICU in the city of São Paulo, Brazil. The nursing workload was measured using the Nursing Activities Score (NAS). The distribution of the NAS values into tertiles led to the identification of two research groups: medium/low workload and high workload. The Chi-square, Fishers exact, Mann-Whitney and multiple logistic regression tests were utilized for the analyses. Findings The majority of patients were male (82.0%) and suffered blunt trauma (94.5%), with traffic accidents (57.5%) and falls (31.0%) being prevalent. The mean age was 40.7 years (±18.6) and the mean NAS was 71.3% (±16.9). Patient gender, the presence of pulmonary failure, the number of injured body regions and the risk of death according to the Simplified Acute Physiology Score II were factors associated with a high degree of nursing workload in the first 24 hours following admission to the ICU. Conclusion Workload demand was higher in male patients with physiological instability and multiple severe trauma injuries who developed pulmonary failure.

The role of the New Trauma and Injury Severity Score (NTRISS) for survival prediction

The objective of this study was to verify if replacing the Injury Severity Score (ISS) by the New Injury Severity Score (NISS) in the original Trauma and Injury Severity Score (TRISS) form would improve the survival rate estimation. This retrospective study was performed in a level I trauma center during one year. ROC curve was used to identify the best indicator (TRISS or NTRISS) for survival probability prediction. Participants were 533 victims, with a mean age of 38±16 years. There was predominance of motor vehicle accidents (61.9%). External injuries were more frequent (63.0%), followed by head/neck injuries (55.5%). Survival rate was 76.9%. There is predominance of ISS scores ranging from 9-15 (40.0%), and NISS scores ranging from 16-24 (25.5%). Survival probability equal to or greater than 75.0% was obtained for 83.4% of the victims according to TRISS, and for 78.4% according to NTRISS. The new version (NTRISS) is better than TRISS for survival prediction in trauma patients.

Mapeamento das lesões em vítimas de acidentes de trânsito: revisão sistemática da literatura

O objetivo do estudo foi identificar as regioes corporeas mais atingidas em vitimas de acidentes de transporte e mapear a gravidade das lesoes e do trauma. Foi realizada revisao sistematica da literatura, utilizando-se descritores relacionados aos acidentes de trânsito, acidentes de transporte, ferimentos e lesoes, totalizando 248 artigos. As bases eletronicas pesquisadas foram LILACS, MEDLINE e PAHO, entre 1990 e dezembro de 2006. Essa revisao destacou uma serie de estudos conclusivos sobre as regioes corporeas mais frequentes e aquelas de maior gravidade atingidas nesses eventos e apontou lacunas de conhecimento na literatura nacional. Acredita-se que esses achados possam ser de grande valia para as equipes nos cenarios de pre-hospitalar e intra-hospitalar e apontem caminhos na direcao de novas pesquisas.The objective of this study was to identify the body regions most affected in traffic accident victims and to map the trauma and severity of the lesions. A systematic literature review using key words related to traffic accidents, transportation accidents, wounds and injuries found a total of 248 articles. The electronic bases LILACS, MEDLINE, and PAHO were surveyed between the years 1990 and December 2006. This review emphasized a series of conclusive studies about the most frequent body regions involved and the major injuries occurring in these situations. It also indicated information gaps in the Brazilian literature. We believe that these findings are valuable for pre-hospital and intra-hospital teams and point the way to new investigations.

Desempenho dos ajustes do Trauma and Injury Severity Score (TRISS): revisão integrativa

Objective Identify studies that made adjustments to the equation of Trauma and Injury Severity Score (TRISS) and compared the discriminatory ability of both modified and original equations. Method An integrative review of studies published between 1990 and 2014 using the following databases: LILACS, MEDLINE, PubMed and SciELO, based on searches using the term “TRISS”. Results 32 studies were included in this review. Of 67 adjustments to TRISS equations identified, 35 (52.2%) resulted in improved accuracy of this index in the prediction of survival probability for trauma patients. Adjustments of TRISS coefficients to study population were frequent, but did not always improve the predictive ability of the analyzed models. Replacement of physiological variables of the Revised Trauma Score (RTS) and changes in the Injury Severity Score (ISS) in the original equation presented varied performance. An alteration to the method of age inclusion in the equation, and the insertion of gender, comorbidities and trauma mechanism, presented a tendency towards improved performance of the TRISS. Conclusion Different proposals of adjustments to the TRISS were identified in this review and indicated, in particular, RTS fragilities in the original model and the need to change the method of age inclusion in the equation to improve the predictive ability of this index.

Performance of Trauma and Injury Severity Score(TRISS) adjustments: an integrative review

Objective Identify studies that made adjustments to the equation of Trauma and Injury Severity Score (TRISS) and compared the discriminatory ability of both modified and original equations. Method An integrative review of studies published between 1990 and 2014 using the following databases: LILACS, MEDLINE, PubMed and SciELO, based on searches using the term “TRISS”. Results 32 studies were included in this review. Of 67 adjustments to TRISS equations identified, 35 (52.2%) resulted in improved accuracy of this index in the prediction of survival probability for trauma patients. Adjustments of TRISS coefficients to study population were frequent, but did not always improve the predictive ability of the analyzed models. Replacement of physiological variables of the Revised Trauma Score (RTS) and changes in the Injury Severity Score (ISS) in the original equation presented varied performance. An alteration to the method of age inclusion in the equation, and the insertion of gender, comorbidities and trauma mechanism, presented a tendency towards improved performance of the TRISS. Conclusion Different proposals of adjustments to the TRISS were identified in this review and indicated, in particular, RTS fragilities in the original model and the need to change the method of age inclusion in the equation to improve the predictive ability of this index.

Dez anos de new injury severity score (NISS): possível mudança?

The article is a bibliographic review which intends to present the actual range of researches comparing the Injury Severity Score (ISS) and the New Injury Severity Score (NISS). Databases were searched using the keyword NISS, with 42 articles, 23 of which didn’t compare the two indexes. Most part of the 19 selected articles showed that NISS has been more accurate in predicting the outcomes (dependent variables) than ISS, moreover in severe and specific trauma. Studies with populations between 1,000 and 10,000 resulted in NISS-favorable results, whereas studies with populations larger than 10,000 or smaller than 1,000 showed either NISS-favorable results or no difference between the two groups. However, there were no studies showing ISS-favorable results. These results and the easier calculation of NISS lead to a future replacement of ISS by NISS.

New Trauma and Injury Severity Score (TRISS) adjustments for survival prediction

BackgroundThe objective of this study is to propose three new adjustments to the Trauma and Injury Severity Score (TRISS) equation and compare their performances with the original TRISS as well as this index with coefficients adjusted for the study population.MethodsThis multicenter, retrospective study evaluated trauma victims admitted to two hospitals in São Paulo-Brazil and San Diego-EUA between January 1st, 2006, and December 31st, 2010. The proposed models included a New Trauma and Injury Severity Score (NTRISS)-like model that included Best Motor Response (BMR), systolic blood pressure (SBP), New Injury Severity Score (NISS), and age variables; a TRISS peripheral oxygen saturation (SpO2) model that included Glasgow Coma Scale (GCS), SBP, SpO2, Injury Severity Score, and age variables; and a NTRISS-like SpO2 model that included BMR, SBP, SpO2, NISS, and age variables. All equations were adjusted for blunt and penetrating trauma coefficients. The model coefficients were established by logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of the models.ResultsThe original TRISS (area under the curve (AUC) = 0.90), TRISS with adjusted coefficients (AUC = 0.89), and the new proposals (NTRISS-like, TRISS SpO2, and NTRISS-like SpO2) showed no difference in performance (AUC = 0.89, 0.89, and 0.90, respectively).ConclusionsThe new models demonstrated good accuracy and similar performance to the original TRISS and TRISS adjusted for coefficients in the study population; therefore, the new proposals may be useful for the assessments of quality of care in trauma patients using variables that are routinely measured and recorded.