List Archives

Tue Oct 21 23:49:54 BST 2008

Dr Smith & Pret

Didn´t the New ISS addressed that problem (blunt vs penetrating)? in the NISS you take the 3 worst AIS injuries irrespective of the body area, so the results better reflect the average penetrating injury (stab, most GSW), we've been using it with our trauma registry, but I thought all registries were already using NISS instead of ISS, is this true?

--- On Tue, 10/21/08, Robert F. Smith <rfsmithmd at comcast.net> wrote:

> From: Robert F. Smith <rfsmithmd at comcast.net>
> Subject: RE: Trauma outcomes
> To: "'Trauma & Critical Care mailing list'" <trauma-list at trauma.org>
> Date: Tuesday, October 21, 2008, 4:52 PM
> Pret,
> 
> In a nutshell, the problem with ISS and TRISS type scoring
> systems for
> penetrating trauma is that they do not take into account
> multiple injuries
> in the same body area. GSW victims often suffer multiple
> severe abdominal
> organ injuries but only one of these may be coded to
> contribute to the
> overall score.
> 
> There isn't supposed to be any "mapping". But
> since Dr. Ellen Mackenzie
> developed the program that maps ECD-9 codes which the
> financial clerks
> generate, into "matching" AIS codes, nearly
> everyone does that. Which is
> another huge problem. AIS coding is supposed to be done
> independently by
> specially trained coders.
> 
> Lastly, I uh, don't know how much validation there is
> before data is
> submitted to the NTDB. That alone would be a fascinating
> project.
> 
> Rob
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Bjorn, Pret
> Sent: Tuesday, October 21, 2008 11:26 AM
> To: Trauma &amp; Critical Care mailing list
> Subject: RE: Trauma outcomes
> 
> This is thought-provoking stuff.
> 
> Honestly -- and it embarrasses me a little to admit this --
> I would have
> assumed that blunt vs. penetrating mechanism would at least
> subtly
> affect the inter-rater reliability of AIS, and thus ISS.  
> 
> It's as simple as observing that penetrating injury is
> typically its own
> triage criterion.  Sophisticates understand that this
> relates more
> specifically to the operative odds than the objective
> severity; but is
> it unfair to wonder if there's some subsequent,
> subconscious rounding-up
> for penetrating injuries?
> 
> Bob, maybe you could dumb down the science enough that I
> might at least
> understand: where AIS/ISS is mapped to diagnosis codes (as
> opposed to
> direct grading by clinicians), what methods are used to
> reconcile
> various blunt injuries to their closest penetrating
> cohorts?
> 
> Pret
> 
> 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Robert
> Waddell II
> Sent: Tuesday, October 21, 2008 10:38 AM
> To: Trauma &amp; Critical Care mailing list
> Subject: Re: Trauma outcomes
> 
> 
> Disclosure: I work with Dr. Sacco.
> 
> If you look at the ISS and TRISS's research from the
> analytical  
> investigator's view the "two different
> diseases" are not that  
> different relative to the patient's physiological
> perspective.  What  
> Dr. Sacco has shown in various tools and what most Trauma
> Centers are  
> using, at variable importance, is the body's response
> to injury, not  
> necessarily the mechanism of injury.  I do not believe he
> has ever  
> looked at race or insurance, but if you evaluate the
> medical  
> priorities of both groups I believe they can most likely be
> compared.
> 
> Take care,
> 
> Bob
> 
> Robert K. Waddell II
> The Sacco Triage Method (STM)
> 
> Wyoming office
> 1302 East 5th Avenue
> Cheyenne, Wyoming 82001
> 
> 307 920 2020
> 
> bwaddell at sharpthinkers.com
> www.sharpthinkers.com
> 
> On Oct 21, 2008, at 8:03 AM, Robert F. Smith wrote:
> 
> > It's hard to comment intelligently on this without
> reading the  
> > methodology
> > which I haven't been able to do yet.
> "Controlling for severity of  
> > injury"
> > covers a lot of water. You can match ISS score with
> GSW patients and  
> > MVC
> > patients but you're really comparing two different
> diseases.
> >
> > Rob
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org 
> > ]
> > On Behalf Of Stephen Richey
> > Sent: Tuesday, October 21, 2008 9:56 AM
> > To: Trauma &amp, Critical Care mailing list
> > Subject: Re: Trauma outcomes
> >
> > It's not simply passing the buck if the actual
> cause of the problem is
> > something in the social networks in which these
> patients operate.   
> > If it is
> > not an issue of insufficient access to care (read as:
> lack of  
> > insurance) and
> > many (most?) trauma centers are located in areas with
> high minority
> > populations so it is not a matter of lack of hospitals
> capable of  
> > handling
> > these patients close by, then the options are either
> something  
> > drastically
> > different in the way the bodies of a black man or a
> Latino responds  
> > to being
> > injured versus someone of Caucasian extraction or
> there is something  
> > social
> > going on here that is hindering the patient from
> receiving the care  
> > they
> > need.
> >
> > I was simply putting forth possible issues that need
> to be  
> > addressed, even
> > if they are proven to be noncontributory to the
> problem and then  
> > dismissed.
> > Nothing more, nothing less than an academic exercise.
> >
> > On Tue, Oct 21, 2008 at 9:48 AM, Bjorn, Pret
> <pbjorn at emh.org> wrote:
> >
> >> I forget: what's Latin for "First, blame
> the victim?"
> >>
> >> Pret Bjorn, RN
> >> Bangor, ME USA
> >>
> >> -----Original Message-----
> >> From: trauma-list-bounces at trauma.org
> >> [mailto:trauma-list-bounces at trauma.org] On Behalf
> Of Stephen Richey
> >> Sent: Tuesday, October 21, 2008 6:48 AM
> >> To: Trauma &amp, Critical Care mailing list
> >> Subject: Re: Trauma outcomes
> >>
> >>
> >> I wonder how much of a factor delays in access to
> care because of
> >> cultural
> >> attitudes plays in this. While working on
> ambulances was told  
> >> numerous
> >> times
> >> by African Americans and Hispanics (especially
> men) things to the  
> >> effect
> >> of
> >> "I ain't going to no ****ing hospital
> b***h! I's tough". Granted,  
> >> I've
> >> been
> >> told the same thing (although worded
> differently....you haven't been
> >> cussed
> >> out until you've been told to go to hell by a
> Cajun) by every ethnic
> >> group
> >> I've treated and by women, but I still wonder-
> given that men  
> >> engage as
> >> a
> >> group in more risky activities than women in
> general- how many of
> >> those additional fatalities were caused as much by
> their own  
> >> machismo or
> >> the
> >> disregard of their "associates" for the
> severity of the injuries as  
> >> by
> >> the
> >> injuries themselves.
> >>
> >> Also, I wonder what role the language barrier
> between Hispanics and
> >> non-Hispanics might take in the much higher rate
> of mortality.  The  
> >> same
> >> degree of curiosity exists for things like
> differences in the use
> >> of standard injury prevention measures such as
> seatbelts, helmets,  
> >> etc.
> >> I've also wondered how the "ghetto
> lean" a lot of urban youth set  
> >> their
> >> driver's seats to have affects the frequency
> and severity of injury  
> >> in
> >> the
> >> event of a car accident....
> >>
> >> Just my two cents worth of rambling....I could be
> completely missing
> >> something here as I am about half awake....
> >>
> >> On Tue, Oct 21, 2008 at 6:31 AM, Robert F. Smith
> >> <rfsmithmd at comcast.net>wrote:
> >>
> >>> Dr. Haider appears to have written several
> articles using trauma  
> >>> data
> >> to
> >>> look at outcomes in different populations.
> Several are co-authored
> >> with Dr.
> >>> Eddie Cornwell. This article does not yet
> appear on the  Pub Med
> >> website.
> >>>
> >>> Rob Smith
> >>>
> >>> Patterns: Race and Health Coverage Affect
> Survival
> >>> By NICHOLAS BAKALAR
> >>>
> >>> Whether you survive after a serious accident
> may depend on your race
> >> and
> >>> your health insurance, a new study concludes.
> >>>
> >>> Researchers examined the records of more than
> 310,000 trauma  
> >>> patients
> >> whose
> >>> cases were entered in a national databank that
> includes  
> >>> information on
> >>> race,
> >>> age, severity and type of injury, insurance
> status, and mortality.
> >>>
> >>> After controlling for severity of injury and
> other factors, they  
> >>> found
> >> that
> >>> compared with whites, African-Americans had a
> 17 percent increased
> >> risk of
> >>> death and Hispanics a 47 percent increased
> risk.
> >>>
> >>> When they looked at patients with health
> insurance, they found a
> >> greater
> >>> disparity. Insured African-Americans had a 20
> percent increased  
> >>> death
> >> risk
> >>> compared with insured whites, and Hispanics a
> 51 percent increased
> >> risk.
> >>> The
> >>> study appears in the October issue of The
> Archives of Surgery.
> >>>
> >>> "This study refutes the notion that
> racial disparities in trauma  
> >>> care
> >> are
> >>> merely a reflection of insurance status,"
> said the lead author, Dr.
> >> Adil H.
> >>> Haider, an assistant professor of surgery at
> Johns Hopkins. "Both
> >> insurance
> >>> and race are independent predictors of
> mortality after trauma. And  
> >>> of
> >> the
> >>> two, insurance is the more important
> predictor."
> >>>
> >>> The authors acknowledge that the study was
> retrospective and based  
> >>> on
> >>> records that did not give complete medical
> information on each
> >> patient.
> >>> Also, people with insurance may be generally
> healthier and have an
> >>> increased
> >>> ability to survive traumatic injury.
> >>>
> >>>
> >>> --
> >>> trauma-list : TRAUMA.ORG
> <http://trauma.org/> <http://trauma.org/>
> >>> To change your settings or unsubscribe visit:
> >>> http://www.trauma.org/index.php?/community/
> >>>
> >>
> >>
> >>
> >> --
> >> Stephen L. Richey, CRT
> >> Aviation Injury Research Project Leader
> >> Saginaw Valley State University
> >> Work E-mail: slrichey at svsu.edu
> >> Home Office Phone: 248-366-4452
> >>
> >> "It is the characteristic excellence of the
> strong man that he can  
> >> bring
> >> momentous issues to the fore and make a decision
> about them. The weak
> >> are
> >> always forced to decide between alternatives they
> have not chosen
> >> themselves."- Dietrich Bonhoeffer
> >> --
> >> trauma-list : TRAUMA.ORG
> <http://trauma.org/>
> >> To change your settings or unsubscribe visit:
> >> http://www.trauma.org/index.php?/community/
> >>
> >>
> >> --
> >> trauma-list : TRAUMA.ORG
> <http://trauma.org/>
> >> To change your settings or unsubscribe visit:
> >> http://www.trauma.org/index.php?/community/
> >>
> >
> >
> >
> > -- 
> > Stephen L. Richey, CRT
> > Aviation Injury Research Project Leader
> > Saginaw Valley State University
> > Work E-mail: slrichey at svsu.edu
> > Home Office Phone: 248-366-4452
> >
> > "It is the characteristic excellence of the
> strong man that he can  
> > bring
> > momentous issues to the fore and make a decision about
> them. The  
> > weak are
> > always forced to decide between alternatives they have
> not chosen
> > themselves."- Dietrich Bonhoeffer
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/

List Archives

For your convenience, find the Trauma List Archive Below

Trauma outcomes