Injury
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As part of a study of the early management of severe head injury, the use of the Glasgow Coma Score (GCS), Injury Severity Score (ISS) and TRISS was investigated. These injury scores were compared in correlating with outcome at one year as assessed by the Glasgow Outcome Score (GOS) and mortality. One hundred and thirty-one patients had a severe head injury, as defined by an ISS of 16 or higher, in whom the Abbreviated Injury Score (AIS) for craniocerebral injury was 3 or higher. ⋯ TRISS was slightly better than GCS for predicting outcome based on both GOS and mortality, however this difference was not significant. TRISS identified patients who died that are not considered as severe head injury by GCS. Use of TRISS allows the effects of systemic factors and other injuries to be taken into account when assessing severity of head injury.
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Post-traumatic multiple organ dysfunction syndrome--infection is an uncommon antecedent risk factor.
A pattern of multiple organ dysfunction syndrome (MODS) and risk factors following blunt trauma was identified, based on analyses of clinical data from 3611 patients who were admitted directly to a level I trauma centre and had hospital stays > or = 3 days. Five system dysfunctions were simultaneously associated (P < 0.05) with death (adjusted odds ratio): adult respiratory distress syndrome (ARDS) (4.9), renal failure (6.7), hyperglycaemia (3.6), recurrent acidosis (4.8) and hypoalbuminaemia (1.8). Mortality increased with the number of system dysfunctions. ⋯ Seven admission risk factors were independently associated (P < 0.003) with MODS [adjusted odds ratio]: pre-existing condition (3.4), age > 50 (3.1), Injury Severity Score > or = 25 (6.4), hypotension (2.8), acidaemia (2.2), 24 h blood loss > 1 l (3.7), and major base deficit (1.6). Only 13 per cent with MODS had an infection in the 5 days before or at initiation of MODS. Haemodynamic instability, acidosis, blood loss, pre-existing condition, age and serious injury were risk factors independently related to life-threatening MODS, but infection was an uncommon precursor except in late MODS.(ABSTRACT TRUNCATED AT 250 WORDS)