Sind spezielle Scores für Schwerverbrannte nötig?

Zusammenfassung Ein Vergleich der Mortalit?ts- und Sepsis-Vorhersage zwischen speziellen Verbrennungs-Scores und allgemeinen Intensiv-Scores stand im Mittelpunkt dieser retrospektiven Untersuchung. Hierbei wurden bei 51 Schwerverbrannten der ,,Abbreviated Burn Severity Index`` (ABSI) und der ,,Baltimore Sepsis Scale`` (BSS) als spezielle Verbrennungs-Scores auf der einen Seite sowie die allgemeinen Intensiv-Scores ,,Mortality Prediction Model`` (MPM II), ,,Simplified Acute Physiology Score`` (SAPS II), APACHE II (ApII), ,,Hannover Intensiv Score`` (HIS) und der Sepsis-Score nach Elebute und Stoner (ES) auf der anderen Seite erhoben. Am Tag 1 und 3 wurde für alle Scores aus der Sensitivit?t und Spezifit?t eine ,,Receiver Operating Characteristic – ROC`` erstellt und die Fl?che unter dem Graphen als Gütekriterium der Scores berechnet (ROC-Wert: max. 1,0; min. 0,5). Weiterhin wurden die Score-Werte von Patienten mit und ohne septischen Verlauf an den Tagen 1, 2, 3, 5, 7, 10, 14, 21 und 28 auf einen statistischen Unterschied (Mann-Whitney-U-Test) geprüft. Ergebnisse: Bezüglich der Mortalit?tsvorhersage zeigten ABSI, BSS sowie die allgemeinen Scores HIS, ApII und ES ROC-Werte von über 0,8 und eine absolute Korrektheit von über 75%. Der MPM II und der SAPS II schnitten deutlich schlechter ab. Für die Sepsisvorhersage zeigten alle Systeme ROC-Werte zwischen 0,6 und 0,7. Obwohl die ROC-Werte am Tag 3 gegenüber dem ersten Behandlungstag teilweise anstiegen, so blieben insgesamt doch die ROC-Werte, die absolute Richtigkeit und der positiv pr?diktive Wert hinter den Ergebnissen der Mortalit?tsvorhersage zurück. Die Unterscheidungskraft der Scores zwischen Patienten mit und ohne septischen Verlauf war am deutlichsten und frühesten mit Hilfe von BSS und HIS m?glich. Bereits am 2. Behandlungstag zeigte sich ein signi-fikanter Unterschied im Mann-Whitney-U-Test. Schlu?folgerung: Spe-zielle Verbrennungs-Scores bieten hinsichtlich einer Mortalit?tsvorhersage keine entscheidenden Vorteile gegenüber allgemeinen Intensiv-Scores. Die Vorhersage einer Sepsis scheint hingegen mit keinem der untersuchten Systeme m?glich. Ein Sepsis-Monitoring ist sowohl mit dem speziellen Verbrennungs-Score BSS als auch mit den allgemeinen Systemen m?glich. Die vorliegende Arbeit liefert einen Hinweis auf eine m?gliche Vereinfachung der immer verwirrenderen Vielfalt von Score-Systemen. Eine Reduktion würde jedoch wesentlich zur allgemeinen Akzeptanz beitragen. Eingegangen: 12. September 1996 Akzeptiert: 4. Oktober 1996     

Direct Measurement of ATP7B Peptides Is Highly Effective in the Diagnosis of Wilson Disease

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Predicting neurosurgical clearance in the polytrauma patient with concomitant traumatic brain injury

The goal of this study is to develop a model based on previously used prognostic predictors in traumatic brain injury (TBI) patients with polytrauma, which will facilitate the decision-making of whether to clear these patients for non-cranial surgery. Data of eligible patients was obtained from a trauma database at a Level I trauma and academic tertiary referral center in the United States. The number of days seen by the neurosurgical service prior to clearance, injury severity score (ISS), post-trauma day 0 (PTD 0) of Glasgow Coma Score (GCS), intracranial pressure (ICP) score and computed tomography (CT) score, as well as the changes in GCS, ICP score and CT score between PTD 0 and day of clearance were the variables used in developing the model. The Neurosurgical Clearance Model (NCM) was developed using data from 50 patients included in the study. Patients were cleared by neurosurgeons 1.6 days later than it would appear possible based on a retrospective review of the patients’ clinical conditions. A single model equation was developed, the ultimate result of which is a clearance probability value. The best cutoff clearance probability value was found to be 0.584 (or 58.4%) using Receiver Operator Characteristic curve analysis. Our data suggests that neurosurgeons are risk-averse in clearing polytrauma patients for non-cranial surgery. This pilot NCM, if reproduced and validated by other groups and in larger prospective studies, may become a useful tool to assist clinicians in this often-difficult decision-making process.     

Epidemiology and Clinical Patterns of Ocular Trauma at a Level 1 Trauma Center in Korea

BackgroundTo evaluate the patterns of distribution and clinical manifestations of ocular injuries referred to the level 1 trauma center of Pusan National University Hospital (PNUH) in Korea.MethodsWe analyzed 254 of 4,287 patients who were referred to the Department of Ophthalmology at the level 1 trauma center of the PNUH, from January 2016 through December 2018. Data on the incidence of ocular injuries, sex, age, monthly and seasonal distribution, day and time of injury, side of injury, cause, residence of patients, referral time to an ophthalmologist and subsequent examination time, final visual acuity (VA), and complications were obtained from medical records and retrospectively reviewed. The patients were grouped according to their main diagnosis using the Birmingham Eye Trauma Terminology System (BETTS) and Ocular Trauma Score (OTS).ResultsThe incidence of ocular injuries with major trauma was higher in men (n = 207, 81.5%), the median age at time of injury was 54 years, and Pusan recorded the most cases. The incidences of ocular injury were 1.47/100,000, 1.57/100,000, 1.48/100,000 in 2016, 2017 and 2018, respectively. The most common cause was by a motorbike accident, followed by a pedestrian traffic accident and falls. According to the BETTS classification, open-globe injuries represented 4% of cases, closed-globe injuries represented 12.6%, and other injuries represented 83.1%. Open-globe injuries were significantly associated with low final VA (P = 0.01). In the OTS, 79.4% of patients received 4 or 5 points and 13.7% of patients received 1 or 2 points. The patients who received 1 or 2 points in the OTS score showed final VA below hand movement (P < 0.001), except for two patients. Lid laceration and low initial VA were highly correlated with poor final VA (P < 0.001).ConclusionThis is the first study on the epidemiology and clinical manifestations in trauma patients with ocular injuries at a level 1 trauma center. The incidences of ocular injuries with major trauma were about 1.47–1.57/100,000. BETTS, OTS, lid laceration and initial VA were associated with final VA. We expect our study to provide a basis of data for the evaluation, prevention, and management of ocular injuries in patients with systemic trauma.     

The Model for End-Stage Liver Disease Score-Based System Predicts Short Term Mortality Better Than the Current Child-Turcotte-Pugh Score-Based Allocation System during Waiting for Deceased Liver Transplantation

To adopt the model for end-stage liver disease (MELD) score-based system in Korea, the feasibility should be evaluated by analysis of Korean database. The aim of this study was to investigate the feasibility of the MELD score-based system compared with the current Child-Turcotte-Pugh (CTP) based-system and to suggest adequate cut-off to stratify waiting list mortality among Korean population. We included 788 adult patients listed in waiting list in Seoul National University Hospital from January 2008 to May 2011. The short-term survival until 6 months after registration was evaluated. Two hundred forty six (31.2%) patients underwent live donor liver transplantation and 353 (44.8%) patients were still waiting and 121 (15.4%) patients were dropped out due to death. Significant difference was observed when MELD score 24 and 31 were used as cut-off. Three-months survival of Status 2A was 70.2%. However, in Status 2A patients whose MELD score less than 24 (n=82), 86.6% of patients survived until 6 month. Furthermore, patients with high MELD score (≥31) among Status 2B group showed poorer survival rate (45.8%, 3-month) than Status 2A group. In conclusion, MELD score-based system can predict short term mortality better and select more number of high risk patients in Korean population.