Purpose: The Injury Severity Score (ISS) is used to predict outcome after trauma. However, it is criticised because of flaws in its calculation of injury severity. The New Injury Severity Score (NISS) was proposed as an alternative. However, studies are conflicted on which is better. We compared both scales in predicting surgery, multiple surgeries, preoperative blood transfusion, hospital stay length and mortality in patients with orthopaedic injuries. Method: A retrospective cohort study that used the hospital's trauma database. Patients’ data were extracted, and the outcome parameters noted. The ISS and NISS were calculated for each patient. The patients were dichotomised into discrepant and non-discrepant if both scores are different or the same, respectively. A receiver operator characteristic (ROC) curve was generated for each outcome parameter, and the area under the curve (AUC) compared between the two scoring systems. Results: Four hundred and forty-seven (447) patients participated in this study. The participants’ average age was 34.78 years (SD = 18.67), mean ISS score was 8.5 (SD = 5.9), while the average NISS was 9.4 (SD = 6.6). The NISS exceeded the ISS (discrepant) in 82 subjects (18.3%), while both scores are the same (non-discrepant) in 365 subjects (81.7%). The NISS outperformed the ISS in predicting multiple surgeries and hospital stay length, while the ISS better predicts mortality rate. Both performed similarly for predicting surgical intervention and blood transfusion. Conclusion: Both scores performed similarly and there is insufficient evidence to replace ISS with NISS.
Introduction posterior urethral injuries can occur in polytrauma settings, and may contribute to morbidity post-trauma. The aim of this study is to determine the occurrence of pelvic fracture urethral injury (PFUI) in adult polytrauma patients who were successfully stabilized and to appraise the nature of associated injuries. Methods the medical records of stabilized polytrauma patients≥ 18 years of age from January 2010 to December 2019 were retrospectively reviewed focusing on those presenting with bony pelvis disruptions. Injuries were categorized using the injury severity scale (ISS) while bony pelvis disruptions were classed according to the Young-Burgess classification. Data on the demography of the patient, mechanism of injury, nature, and severity of injuries, class of pelvic fracture-disruption, and urethral integrity were collected and analyzed accordingly. Results of 111 patients with bony pelvis disruptions, 95 of them had adequate information and were included in our analysis. The mean age of participants was 37.3 ± 11.8 years and most of them were males (87.4%). Blunt pelvic trauma occurred in 96.8%. Lateral compression pelvic injuries were prevalent at 39.0%. In 54.7% of the patients, the injury severity score (ISS) was ≥ 27. At 25.3% and 24.2% respectively, the abdomen and the lower extremities most frequently sustained a grade ≥ 3 injuries (abbreviated injury scale (AIS) ≥3). At a rate of 2.1%, spinal cord injury was the least observed. In the 10 years, there were 6 PFUI among 83 stabilized polytraumatized men with mean ISS of 35.5 ± 8.3. The incidence rate of PFUI was 0.6 per 8.3 pelvic disruptions in men per year. Symphysis pubis disruption or fracture of the pubis or both was consistently seen in all PFUI. Higher ISS significantly relates to PFUI (p <0.001). The mechanism of bony pelvis disruption and the class of bony pelvis injury are determined by the severity and trajectory of the impact apparently relates to PFUI only through fracture-disruption of the pubic symphysis or the pubis. Conclusion about 7.2% of men presenting with traumatic disruption of the bony pelvis in polytrauma setting sustain PFUI. In polytrauma settings, PFUI should be suspected in cases of fracture-disruption of the pubis or symphysis pubis from any mechanism.
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