Comparison of current injury scales for survival chance estimation: an evaluation comparing the predictive performance of the ISS, NISS, and AP scores in a Dutch local trauma registration

BACKGROUND: Prediction of survival chances for trauma patients is a basic requirement for evaluation of trauma care. The current methods are the Trauma and Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOT). Scales for scoring injury severity are part of these methods. This study compared three injury scales, the Injury Severity Score (ISS), the New ISS (NISS), and the Anatomic Profile (AP), in three otherwise identical predictive models. METHODS: Records of the Rotterdam Trauma Center were analyzed using logistic regression. The variables used in the models were age (as a linear variable), the corrected Revised Trauma Score (RTS), a denominator for blunt or penetrating trauma, and one of the three injury scales. The original TRISS and ASCOT models also were evaluated. The resulting models were compared in terms of their discriminative power, as indicated by the receiver-operator characteristic (ROC), and calibration (Hosmer-Lemeshow [HL]) for the entire range of injury severity. RESULTS: For this study, 1,102 patients, with an average ISS of 15, met the inclusion criteria. The TRISS and ASCOT models, using original coefficients, showed excellent discriminative power (ROC, 0.94 and 0.96, respectively), but insufficient fits (HL, p = 0.001 and p = 0.03, respectively). The three fitted models also had excellent discriminative abilities (ROC, 0.95, 0.97, and 0.96, respectively). The custom ISS model was unable to fit the entire range of survival chances sufficiently (p = 0.01). Models using the NISS and AP scales provided adequate fits to the actual survival chances of the population (HL, 0.32 and 0.12, respectively). CONCLUSIONS: The AP and NISS scores particularly both managed to outperform the ISS score in correctly predicting survival chances among a Dutch trauma population. Trauma registries stratifying injuries by the ISS score should evaluate the use of the NISS and AP scores.     

A year in Bristol. Heroes and zeros

United Bristol Healthcare trust has a 3m pounds sterling deficit forecast which it is trying to recover. The trust has closed a ward and cheaper deals for some clinical supplies have been found. Directorates may be reorganised to improve decision-making and merge back-office functions.     

Fertility aspects in yearling beef bulls grazing endophyte-infected tall fescue pastures

During a 2-year study, yearling beef bulls were used to determine the effects of grazing on endophyte-infected tall fescue on endocrine profiles, semen quality and fertilisation potential. Bulls were allotted to graze tall fescue pastures infected with Neotyphodium coenophialum (E+; n = 20 per year) or Jesup/MaxQ (Pennington Seed, Atlanta, GA, USA; NTE; n = 10 per year). Bulls were grouped by scrotal circumference (SC), bodyweight (BW), breed composites and age to graze tall fescue pastures from mid-November until the end of June (within each year). Blood samples, BW, SC and rectal temperatures (RT) were collected every 14 days. Semen was collected from bulls every 60 days by electroejaculation and evaluated for motility and morphology. The developmental competence of oocytes fertilised in vitro with semen from respective treatments was determined. Bulls grazing E+ pastures had decreased BW gain (P < 0.01), increased overall RT (P < 0.01) and decreased prolactin (P < 0.01) compared with animals grazing NTE pastures. Neither percentage of normal sperm morphology nor motility differed between bulls grazed on the two pasture types. Semen from E+ bulls demonstrated decreased cleavage rates (P = 0.02) compared with semen from NTE bulls. However, development of cleaved embryos to the eight-cell and blastocyst stages did not differ between the two groups. In conclusion, semen from bulls grazing E+ tall fescue resulted in decreased cleavage rates in vitro, which may lower reproductive performance owing to reduced fertilisation ability.     

How well does fetal ultrasound predict the date of birth in Antigua and Barbuda?

This study was done to determine the accuracy of fetal ultrasound (U.S.) predicting the estimated date of delivery (EDD) in a primarily Afro-Caribbean population in Antigua and Barbuda. A total of 206 women had retrospective review offetal ultrasound tests done between July 1994 and January 1996. The EDD based on last menstrual period (LMP) was calculated for 104 women with dates and compared with EDD calculated from ultrasound test. These were then compared with actual date of birth from maternity records. For women with unreliable menstrual data (102 women), ultrasound EDD was compared with actual date of birth. Ultrasound EDD demonstrated a trend toward being more accurate than menstrual history EDD, being 10.0 +/- 9.4 (mean +/- standard deviation) days off versus 13.3 +/- 15 days, p = 0.057, (n=104), CI: -0.1, 6.73 days. Ultrasound EDD was within ten days of delivery 60% of the time versus 57% for menstrual history EDD. The average error in estimating EDD was + 1.7 days for ultrasound and + 3.7 days for menstrual history. In women without menstrual history data (n=102), the ultrasound EDD was just as accurate in both the second trimester, 11.8 +/- 9.5 versus 11.4 +/- 10.7 days off (not statistically significant) and the third trimester, 10.0 +/- 8.0 versus 8.1 +/- 7.0 days off (not statistically significant). Fetal ultrasound is marginally better at predicting the date of birth compared with menstrual history but the difference does notjustify routine use for that purpose. When menstrual history is unknown, ultrasound EDD is just as accurate as when menstrual history is known, making it a very useful test.     

Surgical benefits conveyed by biopsy site marking system using ultrasound localization

BACKGROUND: With vacuum-assisted biopsy technology all, or most, of a breast lesion may be removed during the initial biopsy; in such cases a metallic marker is often inserted at the site of the biopsy for future localization. The aim of this study was to evaluate the efficacy and impact of the Gel Mark Ultra biopsy site marking system (SenoRx, Aliso Viejo, CA) on the practice of needle localization breast biopsy. METHODS: We retrospectively analyzed the experience of 45 general surgeons across the United States in a variety of practice settings using the Gel Mark Ultra clip. Imaging-guided biopsy technique, localization quality, surgeon confidence, and margin status were assessed and compared against the broad data reported in the literature. RESULTS: A total of 432 records of patients who underwent imaging-guided breast biopsy with placement of Gel Mark Ultra clip were reviewed. Of these, 63 (15%) patients required definitive surgical intervention, for which 41 cases were localized with ultrasound and assessed for margin clearance. Clear margins were achieved in 37 (90%) of the 41 cases. These results are statistically superior (P < .01) to positive margins rates reported in the literature. CONCLUSIONS: The Gel Mark Ultra biopsy site marking system is a new localization device that provides a safe and effective alternative to traditional localization methods with a significant reduction in the percentage of positive margins, as well as advantages in terms of surgical approach, time, and patient comfort.     

Laparoscopic ventral hernia repair: postoperative antibiotics decrease incidence of seroma-related cellulitis

Seroma formation has been documented as a common complication in laparoscopic ventral herniorraphy. However, there are no recent studies documenting the incidence of or protective strategies against seroma-related cellulitis. The purpose of this study was to evaluate 65 laparoscopic ventral herniorraphies and to determine if seroma-related cellulitis can be prevented by the routine use of postoperative prophylactic antibiotics. A retrospective case review of 65 laparoscopic ventral herniorraphies was done at our institution from February 2002 to January 2004. All were performed using either Gore-Tex DualMesh or Bard Composix mesh and performed under the direct supervision of a single surgeon. Twenty patients received only preoperative third-generation cephalosporins or fluoroquinolones. All other patients received either 7 days of postoperative oral cephalosporins or fluoroquinolones in addition to preoperative antibiotics. Sixty-five patients underwent laparoscopic ventral hernia repair. There were 45 patients in the postoperative antibiotic group and 20 patients in the preoperative-only antibiotic group. Twenty-one patients developed seromas. Twelve of these developed cellulitis. The rates of seroma formation were similar in the two groups with 30 per cent in the preoperative only group and 33 per cent in the postoperative antibiotic group. However, 100 per cent of the seromas in the preoperative antibiotic group developed seroma-related cellulitis. Only 40 per cent of seromas in the postoperative antibiotic group developed cellulitis. In addition, two seromas in the preoperative antibiotics-only group progressed to frank mesh infection necessitating operative removal. There were no complications related to antibiotic administration. Laparoscopic ventral hernia repair is a safe and effective procedure. Our seroma rate is 30 per cent and compares equally with prior reported studies. Seroma-related cellulitis is a common problem that can lead to mesh infection, postoperative morbidity, and further need for operative care. The administration of 7 days of postoperative prophylactic antibiotics appears to be a safe and effective means to limit seroma-related cellulitis.     

In vitro fermentation characteristics of a mixture of Raftilose and guar gum by human faecal bacteria

Summary Background The therapeutic effects of indigestible carbohydrates in the human colon are well known. Most fermentation studies have examined only single carbohydrates. Considering the idiosyncratic actions of individual carbohydrates and the dose required, it is unlikely that any one carbohydrate will provide ideal physiological actions without having some undesirable effects. Little is known of how mixing non–digestible carbohydrates affects their fermentation. This necessitates fermentation studies using different carbohydrates in mixtures. Aim of the study The aim of this study was to test the effect of mixing Raftilose™ (R) and guar gum (G) on short chain fatty acid (SCFA) production in in vitro cultures of human faecal bacteria. Method The fermentation of the individual carbohydrates (10 mg/ml) was compared with that of a 50:50 mixture in anaerobic in vitro cultures of human faeces. Results Cultures of R/G mixtures produced significantly more n–butyrate than 100 mg G alone at 8 and 24 hours (p < 0.02). There was no significant difference in the production of n–butyrate between cultures of 100 mg R and the R/G mixture at 8 and 24 hours. R (100 mg) produced a propionic/butyric (p/b) acid ratio of 1.18 compared with 3.88 for 100 mg G, whereas R/G mixture produced a p/b ratio of 2.01. Conclusion The fermentation of R/G mixture was different compared with 100 mg of R or G alone. There was no loss of n–butyrate in the culture containing R/G (50 mg of each) mixture compared with the 100 mg R culture.