Injury
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Observational Study
Major trauma patients and their outcomes - A retrospective observational study of critical care trauma admissions to a trauma unit with special services.
International data describes a changing pattern to trauma over the last decade, with an increasingly comorbid population presenting challenges to trauma management and resources. In Ireland, resource provision and management of trauma is being transformed to deliver a trauma network, in line with international best practice. Our hospital plays a crucial role within this network and is designated a Trauma Unit with Specialist Services (TUSS) to distinguish it from standard trauma units. ⋯ The burden of major trauma in our hospital is considerable and increasing over time. Substantial changes in demographics, injury mechanism and mortality were seen, with outcomes improving over time. This is consistent with international data where trauma systems have been adopted.
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This study sought to examine the relationship between neighborhood disorder and perceptions of gun access. Further, this study focused on determining whether or not antisocial peer affiliation mediates this relationship. ⋯ Affiliation with antisocial peers may be greater in disordered neighborhoods and they may facilitate access to guns for adolescents living in such communities. Mentoring programs for adolescents living in disordered communities may have some capacity for attenuating this relationship.
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Prolonged operative duration is an independent risk factor for surgical complications in numerous subspecialties. However, associations between adverse events and operative duration of hip fracture fixation in older adults have not been well-quantified. This study aims to determine if prolonged operative duration of hip fracture surgery is related to adverse outcomes. We hypothesized that patients with high operative durations experience greater rates of 30-day complications. ⋯ Our study demonstrates that duration of surgery is an independent risk factor for superficial SSI, any SSI, and any complication. Notably, our findings suggest that high operative durations may be most concerning for SSIs in IMN fixation, which is currently the most common choice for hip fracture fixation in the US. However, the rate of any complication is significantly elevated when surgical duration is prolonged, regardless of surgery type.
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Comparative Study
Prediction of mortality among severely injured trauma patients A comparison between TRISS and machine learning-based predictive models.
Given the huge impact of trauma on hospital systems around the world, several attempts have been made to develop predictive models for the outcomes of trauma victims. The most used, and in many studies most accurate predictive model, is the "Trauma Score and Injury Severity Score" (TRISS). Although it has proven to be fairly accurate and is widely used, it has faced criticism for its inability to classify more complex cases. In this study, we aimed to develop machine learning models that better than TRISS could predict mortality among severely injured trauma patients, something that has not been studied using data from a nationwide register before. ⋯ This study showed that all the developed ML-based prediction models were superior to TRISS for the prediction of trauma mortality.