AIS 2005 vs. AIS 1998—A double-coding exercise to identify issues for trauma data
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The co-ordination of the interdisciplinary care of the multi trauma patient by the Trauma Service staff has promoted a collaborative approach to the management of the multiply injured patient. doi: 10.1016/j.injury.2009.03.037 Prevalence of Patient Controlled Analgesia (PCA) in multiple trauma: A seven-year restrospective analysis of prospective data at a level 1 metropolitan trauma centre Stuart Tan, Amit Rana, Thomas Nau South Eastern Sydney and Illawarra Area Health Services, Sydney, Australia Background: Acute pain control formulates a key component in polytrauma management. Patient Controlled Analgesia (PCA) has been utilised in the last decade. Very little literature is available to date on the prevalence, usage and role of PCA in multiple trauma. Aim: To study the prevalence and pattern of usage of PCA in polytrauma patients Method: A retrospective analysis of prospectively collected data on polytrauma patients admitted to a Level 1 Trauma Centre over a period of seven years was undertaken. Detailed analysis of demographic data, injury severity, injury pattern and types of analgesia were performed in a cohort of patients on PCA. Results: A total of 8599 patients were admitted to a Level 1 Trauma Centre over a period of seven years. Oral analgesics remain by far the most prevalent (n = 3195) type of analgesia used in our trauma inpatient population, followed by parenteral opiates (n = 987), PCA (n = 822) and opiate infusion (n = 573). Epidural analgesia was used in a very small number of patients (n = 4). Out of the total 8,599 patients, 822 patients received PCA during their hospitalisa- tion. 75.3% of PCA patients were males. The mean age of the PCA inpatients was 41.9 years. 35.6% of PCA patients have severe polytrauma with an Injury Severity Score(ISS) greater than 15. Extremities injuries (n = 633), soft tissues injuries (n = 508) and chest injuries (n = 429) were the most prevalent injuries in polytrauma receiving PCA. PCA alone was used in more than half (n = 446) of trauma patients. Conclusion: Pattern of PCA use is around 10% in polytrauma patients. Injury Severity Scores is not a good indicator of PCA usage. PCA alone was an adequate mode of analgesia in more than half of trauma patients. PCA is commonly used in injuries involving extremities, soft tissues and chest. The prevalence of epidural analgesia is extremely low. There is a scope for further increased use of PCA in acute pain management in trauma patients. Further research is required to evaluate the role of PCA in polytrauma with mild head injury. doi: 10.1016/j.injury.2009.03.038 Health outcomes of delayed union and non-union of diaphyseal fractures Wei-Han Tay a , Martin Richardson a , Russell Gruen a , Richard de Steiger b a Department of Surgery, University of Melbourne, Australia b Epworth Hospital, Melbourne, Australia Background: Delayed union and nonunion are complications of fracture healing that remain problematic to treat. They are potentially chronic conditions associated with pain and with functional and psychosocial disability. Although studies have investigated the patient-reported outcomes of different treat- ments of delayed fracture healing, the overall health outcomes of delayed union and nonunion have yet to be documented. This study aims to compare the differences in health outcomes of patients with delayed fracture healing (delayed union and nonunion) and those with union of diaphyseal fractures treated at two major metropolitan trauma centres in Victoria. Methods: 872 fractures of the clavicle, humerus, radius, ulna, femur, tibia and fibula in 695 adult patients followed up by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) were included in the study; 95 fractures in 66 patients were excluded. Hospital medical records were reviewed to identify the healing outcome of each fracture. Prospectively gathered VOTOR health outcome measurements, including the Short Form 12-Item Health Survey (SF-12), at 6 and 12 months post injury were then compared to each fracture outcome. Results: Response rate for the SF-12 was 65.5% at 12 months post injury. 16.7% of fractures demonstrated evidence of delayed healing. The most frequently affected bones in this group were the tibia (41.1%), femur (28.1%) and clavicle (17.8%), while the most common mechanisms of injury were motorcycle (34.9%) and motor vehicle (27.4%) accident. The median SF-12 Physical and Mental Component Summary scores at 12 months post injury for the tibia, femur and clavicle were lower in the delayed fracture healing group compared to the fracture union group. Conclusion: Delayed union and nonunion are common complica- tions of fracture healing post trauma, often requiring further surgical intervention. Patients with delayed healing of diaphyseal fractures generally have reduced physical and mental health at 12 months post injury compared to patients with successful primary fracture union. However, these preliminary results need to be validated with further analyses, including accounting for con- founding variables and testing for statistical significance. doi: 10.1016/j.injury.2009.03.039 AIS 2005 vs. AIS 1998—A double-coding exercise to identify issues for trauma data Cameron Palmer Royal Children’s Hospital, Melbourne, Australia Background: The 2005 version of the Abbreviated Injury Scale (AIS05) potentially represents a significant change in injury spectrum classification, due to a substantial increase in the number of codes used, and alterations to the agreed severity of a number of injury types when compared to the previous version (AIS98). While a significant proportion of trauma registries around the world are moving to adopt AIS05, its effect on patient classification in existing registries, and the optimum method of comparing existing data collections with new AIS05 collections are largely unknown. Objectives: To assess the potential impact of adopting the AIS05 codeset in an established trauma system, and to identify issues associated with this change. Methods: A current subset of consecutive major trauma patients admitted to the Royal Children’s Hospital Melbourne and The Alfred Hospital were double-coded using both AIS98 and AIS05. Resulting codesets were assessed for concordance in codes used, injury severity and calculated injury severity scores. Results: 602 injuries sustained by 109 patients were compared. Individual injury severities, and patient injury severity scores differed markedly between codesets. Discrepancies in data consistency were more common in head and chest injuries. Data mapped to a different codeset performed better in comparisons than raw AIS98 and AIS05 codesets. Conclusions: It is felt that this review contributes significantly to our knowledge of AIS codeset change impact on established trauma registries, and validates the concept of code mapping between AIS versions. The effect of AIS05 on major trauma definition and patient numbers will be discussed. doi: 10.1016/j.injury.2009.03.040 Abstracts / Injury Extra 40 (2009) 139–146 145
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Transcript of AIS 2005 vs. AIS 1998—A double-coding exercise to identify issues for trauma data
Abstracts / Injury Extra 40 (2009) 139–146 145
The co-ordination of the interdisciplinary care of the multi traumapatient by the Trauma Service staff has promoted a collaborativeapproach to the management of the multiply injured patient.
doi: 10.1016/j.injury.2009.03.037
Prevalence of Patient Controlled Analgesia (PCA) in multipletrauma: A seven-year restrospective analysis of prospectivedata at a level 1 metropolitan trauma centre
Stuart Tan, Amit Rana, Thomas NauSouth Eastern Sydney and Illawarra Area Health Services, Sydney,
Australia
Background: Acute pain control formulates a key component inpolytrauma management. Patient Controlled Analgesia (PCA) hasbeen utilised in the last decade. Very little literature is available todate on the prevalence, usage and role of PCA in multiple trauma.Aim: To study the prevalence and pattern of usage of PCA inpolytrauma patientsMethod: A retrospective analysis of prospectively collected data onpolytrauma patients admitted to a Level 1 Trauma Centre over aperiod of seven years was undertaken. Detailed analysis ofdemographic data, injury severity, injury pattern and types ofanalgesia were performed in a cohort of patients on PCA.Results: A total of 8599 patients were admitted to a Level 1 TraumaCentre over a period of seven years. Oral analgesics remain by farthe most prevalent (n = 3195) type of analgesia used in our traumainpatient population, followed by parenteral opiates (n = 987), PCA(n = 822) and opiate infusion (n = 573). Epidural analgesia wasused in a very small number of patients (n = 4). Out of the total8,599 patients, 822 patients received PCA during their hospitalisa-tion. 75.3% of PCA patients were males. The mean age of the PCAinpatients was 41.9 years. 35.6% of PCA patients have severepolytrauma with an Injury Severity Score(ISS) greater than 15.Extremities injuries (n = 633), soft tissues injuries (n = 508) andchest injuries (n = 429) were the most prevalent injuries inpolytrauma receiving PCA. PCA alone was used in more than half(n = 446) of trauma patients.Conclusion: Pattern of PCA use is around 10% in polytraumapatients. Injury Severity Scores is not a good indicator of PCA usage.PCA alone was an adequate mode of analgesia in more than half oftrauma patients. PCA is commonly used in injuries involvingextremities, soft tissues and chest. The prevalence of epiduralanalgesia is extremely low. There is a scope for further increaseduse of PCA in acute pain management in trauma patients. Furtherresearch is required to evaluate the role of PCA in polytrauma withmild head injury.
doi: 10.1016/j.injury.2009.03.038
Health outcomes of delayed union and non-union of diaphysealfractures
Wei-Han Tay a, Martin Richardson a, Russell Gruen a, Richard deSteiger b
a Department of Surgery, University of Melbourne, Australiab Epworth Hospital, Melbourne, Australia
Background: Delayed union and nonunion are complications offracture healing that remain problematic to treat. They arepotentially chronic conditions associated with pain and withfunctional and psychosocial disability. Although studies haveinvestigated the patient-reported outcomes of different treat-ments of delayed fracture healing, the overall health outcomes ofdelayed union and nonunion have yet to be documented. Thisstudy aims to compare the differences in health outcomes ofpatients with delayed fracture healing (delayed union and
nonunion) and those with union of diaphyseal fractures treatedat two major metropolitan trauma centres in Victoria.Methods: 872 fractures of the clavicle, humerus, radius, ulna,femur, tibia and fibula in 695 adult patients followed up by theVictorian Orthopaedic Trauma Outcomes Registry (VOTOR) wereincluded in the study; 95 fractures in 66 patients were excluded.Hospital medical records were reviewed to identify the healingoutcome of each fracture. Prospectively gathered VOTOR healthoutcome measurements, including the Short Form 12-Item HealthSurvey (SF-12), at 6 and 12 months post injury were thencompared to each fracture outcome.Results: Response rate for the SF-12 was 65.5% at 12 months postinjury. 16.7% of fractures demonstrated evidence of delayedhealing. The most frequently affected bones in this group werethe tibia (41.1%), femur (28.1%) and clavicle (17.8%), while the mostcommon mechanisms of injury were motorcycle (34.9%) andmotor vehicle (27.4%) accident. The median SF-12 Physical andMental Component Summary scores at 12 months post injury forthe tibia, femur and clavicle were lower in the delayed fracturehealing group compared to the fracture union group.Conclusion: Delayed union and nonunion are common complica-tions of fracture healing post trauma, often requiring furthersurgical intervention. Patients with delayed healing of diaphysealfractures generally have reduced physical and mental health at 12months post injury compared to patients with successful primaryfracture union. However, these preliminary results need to bevalidated with further analyses, including accounting for con-founding variables and testing for statistical significance.
doi: 10.1016/j.injury.2009.03.039
AIS 2005 vs. AIS 1998—A double-coding exercise to identifyissues for trauma data
Cameron PalmerRoyal Children’s Hospital, Melbourne, Australia
Background: The 2005 version of the Abbreviated Injury Scale(AIS05) potentially represents a significant change in injuryspectrum classification, due to a substantial increase in the numberof codes used, and alterations to the agreed severity of a number ofinjury types when compared to the previous version (AIS98). While asignificant proportion of trauma registries around the world aremoving to adopt AIS05, its effect on patient classification in existingregistries, and the optimum method of comparing existing datacollections with new AIS05 collections are largely unknown.Objectives: To assess the potential impact of adopting the AIS05codeset in an established trauma system, and to identify issuesassociated with this change.Methods: A current subset of consecutive major trauma patientsadmitted to the Royal Children’s Hospital Melbourne and TheAlfred Hospital were double-coded using both AIS98 and AIS05.Resulting codesets were assessed for concordance in codes used,injury severity and calculated injury severity scores.Results: 602 injuries sustained by 109 patients were compared.Individual injury severities, and patient injury severity scoresdiffered markedly between codesets. Discrepancies in dataconsistency were more common in head and chest injuries. Datamapped to a different codeset performed better in comparisonsthan raw AIS98 and AIS05 codesets.Conclusions: It is felt that this review contributes significantly toour knowledge of AIS codeset change impact on establishedtrauma registries, and validates the concept of code mappingbetween AIS versions. The effect of AIS05 on major traumadefinition and patient numbers will be discussed.
doi: 10.1016/j.injury.2009.03.040
