From 1 January 2013 to 30 June 2014, 58 patients sustained gunshot wounds in the city of Gothenburg. 57 were males and the median age was 26 years. The majority of injuries were musculoskeletal. Ten patients died, of these 4 patients suffered single gunshot wounds to the head, while 6 patients had wounds to mediastinal structures and large abdominal vessels. 90 % of patients presented out-of-hours. The total length of stay for the 47 patients admitted was 316 days. Direct health care costs were calculated to 6.2 MSEK.
Injury severity is most frequently classified using the Abbreviated Injury Scale (AIS) as a basis for the Injury Severity Score (ISS) and the New Injury Severity Score (NISS), which are used for assessment of overall injury severity in the multiply injured patient and in outcome prediction. European trauma registries recommended the AIS 2008 edition, but the levels of inter-rater agreement and reliability of ISS and NISS, associated with its use, have not been reported.
Nineteen Norwegian AIS-certified trauma registry coders were invited to score 50 real, anonymised patient medical records using AIS 2008. Rater agreements for ISS and NISS were analysed using Bland-Altman plots with 95% limits of agreement (LoA). A clinically acceptable LoA range was set at ± 9 units. Reliability was analysed using a two-way mixed model intraclass correlation coefficient (ICC) statistics with corresponding 95% confidence intervals (CI) and hierarchical agglomerative clustering.
Ten coders submitted their coding results. Of their AIS codes, 2189 (61.5%) agreed with a reference standard, 1187 (31.1%) real injuries were missed, and 392 non-existing injuries were recorded. All LoAs were wider than the predefined, clinically acceptable limit of ± 9, for both ISS and NISS. The joint ICC (range) between each rater and the reference standard was 0.51 (0.29,0.86) for ISS and 0.51 (0.27,0.78) for NISS. The joint ICC (range) for inter-rater reliability was 0.49 (0.19,0.85) for ISS and 0.49 (0.16,0.82) for NISS. Univariate linear regression analyses indicated a significant relationship between the number of correctly AIS-coded injuries and total number of cases coded during the rater's career, but no significant relationship between the rater-against-reference ISS and NISS ICC values and total number of cases coded during the rater's career.
Based on AIS 2008, ISS and NISS were not reliable for summarising anatomic injury severity in this study. This result indicates a limitation in their use as benchmarking tools for trauma system performance.
Abdominal injuries occur relatively infrequently during trauma, and they rarely require surgical intervention. In this era of non-operative management of abdominal injuries, surgeons are seldom exposed to these patients. Consequently, surgeons may misinterpret the mechanism of injury, underestimate symptoms and radiologic findings, and delay definite treatment. Here, we determined the incidence, diagnosis, and treatment of traumatic abdominal injuries at our hospital to provide a basis for identifying potential hazards in non-operative management of patients with these injuries in a low trauma volume hospital.
This retrospective study included prehospital and in-hospital assessments of 110 patients that received 147 abdominal injuries from an isolated abdominal trauma (n = 70 patients) or during multiple trauma (n = 40 patients). Patients were primarily treated at the University Hospital of Umeå from January 2000 to December 2009.
The median New Injury Severity Score was 9 (range: 1-57) for 147 abdominal injuries. Most patients (94%) received computed tomography (CT), but only 38% of patients with multiple trauma were diagnosed with CT
To compare the abductor muscle function and trochanteric tenderness in patients operated with hemiarthroplasty using the direct lateral (DL) or posterolateral (PL) approach for displaced femoral neck fracture.
Prospective cohort study.
A secondary teaching hospital.
We enrolled 183 hips operated with hemiarthroplasty for displaced femoral neck fracture using the DL or PL approach.
Preoperatively, we evaluated the Harris hip score (HHS) and European Quality of Life-5 Dimensions (EQ-5D). At 1 year postoperatively, lucid patients were clinically examined to evaluate the Trendelenburg sign, abductor muscle strength with a dynamometer, and trochanteric tenderness with an electronic algometer. The 1-year HHS and EQ-5D were documented.
The primary outcome was the incidence of postoperative Trendelenburg sign, whereas the secondary outcomes included patients' reported limp, abductor muscle strength, trochanteric tenderness, HHS, and EQ-5D.
There were 48 patients (24 in the DL group and 24 in the PL group) who attended the 1-year clinical follow-up. The 2 groups were comparable (P > 0.05). The DL group showed a higher incidence of the Trendelenburg sign (9/24 vs. 1/24, P = 0.02) and limp (12/24 vs. 2/24, P = 0.004). Further analysis with logistic regression showed the surgical approach to be the only factor that resulted in the increment. No differences regarding HHS, EQ-5D, abductor muscle strength, algometer pressure pain threshold, and radiologic measurements were found (P > 0.05).
The incidence of the Trendelenburg sign and limp were significantly higher in the DL approach although this seemed not to influence abductor muscle strength or the incidence of trochanteric tenderness or compromise the clinical outcome.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
In Finland, the severity of road traffic injuries is determined using the International Classification of Diseases, 10th Revision, Finnish Modification (ICD-10-FM) injury codes from Finnish Hospital Discharge data and the automatic conversion tool (ICD-AIS map) developed by the Association for the Advancement of Automotive Medicine (AAAM). The aim of this study was to evaluate the ability of the ICD-AIS map to identify seriously injured patients due to traffic accidents in Finnish injury data by comparing the severity rating generated by an expert and by the ICD-AIS map.
Our data came from the North Kymi Hospital (level 2 trauma center at the time of the study). The data included 574 patients who were injured in traffic accidents during 2 years. The severity rating (Maximum Abbreviated Injury Scale [MAIS] 3+) of each patient was recorded retrospectively by an expert based on information from patient records. In addition, the rating was generated from ICD-10 injury codes by the ICD-AIS map conversion tool. These 2 ratings were compared by road user categories and the strength of agreement was described using Cohen's kappa.
The proportion of seriously injured patients was 10.1% as defined by the expert and 6.6% as generated by the ICD-AIS map; exact agreement was 65.5%. The highest concordance was for pedestrians (exact agreement 100%) and the weakest for moped drivers and motorcyclists (46.7%). Furthermore, the overall strength of agreement of the severity ratings (slightly or seriously injured) between the expert and the ICD-AIS map was good (??=?0.70). Most (65%) of the conversion problems were misclassifications caused by the simplicity of the Finnish ICD-10 injury codes compared to the injury codes used in the ICD-AIS map. In Finland, the injuries are recorded mainly with 4-digit codes and, infrequently, with 5-digit codes, whereas the ICD-AIS map defines up to 6-digit codes.
For this sample of simplified ICD-10-FM codes, the ICD-AIS map underestimated the number of seriously injured patients. The mapping result could be improved if at least open and closed fractures of extremities and visceral contusions and ruptures had separate codes. In addition, there were a few injury codes that should be considered for inclusion in the map.
Purpose: To study the probabilities and permanence of return to work, inability to work and rehabilitation, and to explore the connection between these life situations and later working after a severe occupational injury. Materials and methods: A historical cohort of Finnish workers with a severe occupational injury during 2008 (N?=?11,585) were followed up annually on the outcomes of return to work over a 5-year observation period. We examined transition probabilities from one life situation to another with Markov chain analysis, and applied logistic regression with generalized estimating equations to assess the effect of register-based determinants on return to work. Results: Within the five anniversaries, 85% of the injured were working, 9% were unable to work (fully or partly) and 2% received rehabilitation. Age, gross annual income, type of work, injured body part, injury type and the injured's annual condition subsequent to the work injury were significant determinants of return to work. Conclusions: The probability of return to work decreased with time, but, on average, one-fifth of the injured workers succeeded in return to work after being unable to work on the previous anniversary, which indicates that it is worthwhile to conduct efforts for this target group in order to promote return to work. Implications for Rehabilitation The current life situation of the injured should be taken into account when promoting return to work, as it is a strong predictor of later working after a serious occupational injury. Rehabilitation and return to work programs should start in time due to declining return to work rates as the disability continues. Return to work on a part-time basis could be a good option during the early phases of recovery, since a notable proportion of those partly unable to work on the first anniversary returned later to full-time workers. The probability of recovery is relatively high even for those with long-term disabilities, so the promotion of return to work is highly recommended also for this target group.
INTRODUCTION: This paper analyses the development in the incidence of injuries in day care institutions for children below school age in Denmark 1989-1997. MATERIAL: Data on injuries were collected from the injury register, which covers around 15 per cent of the Danish population. The population data derive from Statistics Denmark. METHOD: Incidence patterns were analysed by means of linear regressions and comparisons of means. RESULTS: Injuries in day care institutions for children below school age have increased sharply during the 1990s. In children aged 1-6, the 3-6-year-olds had a higher incidence and the boys a significantly higher incidence of injury than the girls. DISCUSSION: The increase in injuries is to some extent explained by a higher attendance at day care institutions. The hypothesis that the rising incidence is partly due to an increase in the tendency to seek emergency department treatment in the event of minor injuries cannot be ruled out, as minor injuries almost solely account for the rise.
To compare the incidence and severity of acetabular fractures and associated injuries before and after seatbelt legislation.
A retrospective study.
Two major trauma centres, which are teaching hospitals.
Three hundred and ninety-three patients who sustained acetabular fractures during the 5 years before and 5 years after seatbelt legislation was enacted. Of these, the fractures in 198 patients (50.4%) resulted from a motor vehicle accident.
The number and severity of acetabular fractures and associated injuries.
There has been a significant reduction in the number of acetabular fractures (p = 0.005) since seatbelt use became mandatory, and the complexity of the fractures has decreased. There has also been a marked reduction in associated injuries, such as fractures of other bones, and head, chest and abdominal injuries (p
