Factors Impacting Injury Severity Score in Soldiers
In this retrospective study, the medical records of all injured Thai military personnel in MCI April 10, 2010, treated in PMK Hospital, were reviewed. Demographic data of patients and the nature of injuries were obtained from the medical records and PMK trauma registry major data collection form as shown in Additional File 1.
ISS was classified according to the Abbreviated Injury Scale 2005 (AIS 2005) following the guidelines of the Association for the Advancement of Automotive Medicine (AAAM); an international multidisciplinary organization for crash injury control. Injured body regions were classified in six regions as follows: head & neck, face, chest, abdomen, extremities and external body region. Numbers of injuries were recorded according to body regions with the agreement that multiple wounds in one region were counted as one injury, with a described definition in detail as shown in Additional File 2.
Assessment factors, correlated with the ISS in Thai military personnel injured in MCI, require identification of the total number of traumatized population. Employing a sampling group is likely to reduce significant bias.
The traumatized population was categorized by severity of injury into PMK’s major and minor data categories as described below; then included only major data category for analysis because this group represented a high severity of injuries and used proper category to reveal which factors influenced ISS. Finally, major data category for the group, comprising a total of 153 subjects, was sent for analysis.
Inclusion criteria included;
1. Injury in MCI April 10, 2010
2. Criteria diagnosis of PMK Hospital’s major data category included at least one parameter below:
2.1 Injury to more than one body region
2.2 Any skeleton or internal organ injury of the head, neck, chest, abdomen or extremities (including fractured ribs)
2.3 Any loss of consciousness
2.4 ISS ≥ 16
2.5 Death following injury
2.6 Burns (> 20% body surface area or airway burns)
2.7 Undergoing trauma laparoscopy, laparotomy or diagnostic peritoneal lavage
2.8 Being intubated prehospital or in emergency department
2.9 Admission to intensive care unit
2.10 Fracture tibia/fibula above ankle level
Exclusion criteria
1. Criteria diagnosis of PMK Hospital’s minor data category, isolated injury to one body region, specified below:
1.1 Upper limb closed fracture/dislocation at or below level of neck of humerus
1.2 Lower limb closed fracture/dislocation at or below level of the ankle
1.3 Isolated closed fracture of fibula or patella
1.4 Soft tissue injury include partial or complete amputation of a digit
1.5 Isolated tendon injury
1.6 Minor burns (< 20% body surface area)
1.7 Isolated mandibular fracture
1.8 Minor scalp contusion or laceration with no neurological signs
The objective of this study was divided into primary and secondary outcomes. The primary outcome was used to identify factors influencing the ISS regarding Thai military personnel injured in MCI April 10, 2010. Secondary outcome was used to describe the mechanism of injury and distribution of injured body regions.
The Ethics Research Committee of the Royal Thai Army Medical Department approved the study (R089h/53). STROBE guidelines, for reporting observational study, were utilized in the drafting of this report.
Descriptive statistics was used to display characteristics of the injuries, relationship between mechanism of injury and injured body regions. Chi-square test was used to assess significance of coefficient. Multiple logistic regressions were used to calculate the adjusted odds ratio (adjusted OR) of ISS comparing injured body region categories.
Methods
Study Design
In this retrospective study, the medical records of all injured Thai military personnel in MCI April 10, 2010, treated in PMK Hospital, were reviewed. Demographic data of patients and the nature of injuries were obtained from the medical records and PMK trauma registry major data collection form as shown in Additional File 1.
ISS was classified according to the Abbreviated Injury Scale 2005 (AIS 2005) following the guidelines of the Association for the Advancement of Automotive Medicine (AAAM); an international multidisciplinary organization for crash injury control. Injured body regions were classified in six regions as follows: head & neck, face, chest, abdomen, extremities and external body region. Numbers of injuries were recorded according to body regions with the agreement that multiple wounds in one region were counted as one injury, with a described definition in detail as shown in Additional File 2.
Study Patients
Assessment factors, correlated with the ISS in Thai military personnel injured in MCI, require identification of the total number of traumatized population. Employing a sampling group is likely to reduce significant bias.
The traumatized population was categorized by severity of injury into PMK’s major and minor data categories as described below; then included only major data category for analysis because this group represented a high severity of injuries and used proper category to reveal which factors influenced ISS. Finally, major data category for the group, comprising a total of 153 subjects, was sent for analysis.
Inclusion criteria included;
1. Injury in MCI April 10, 2010
2. Criteria diagnosis of PMK Hospital’s major data category included at least one parameter below:
2.1 Injury to more than one body region
2.2 Any skeleton or internal organ injury of the head, neck, chest, abdomen or extremities (including fractured ribs)
2.3 Any loss of consciousness
2.4 ISS ≥ 16
2.5 Death following injury
2.6 Burns (> 20% body surface area or airway burns)
2.7 Undergoing trauma laparoscopy, laparotomy or diagnostic peritoneal lavage
2.8 Being intubated prehospital or in emergency department
2.9 Admission to intensive care unit
2.10 Fracture tibia/fibula above ankle level
Exclusion criteria
1. Criteria diagnosis of PMK Hospital’s minor data category, isolated injury to one body region, specified below:
1.1 Upper limb closed fracture/dislocation at or below level of neck of humerus
1.2 Lower limb closed fracture/dislocation at or below level of the ankle
1.3 Isolated closed fracture of fibula or patella
1.4 Soft tissue injury include partial or complete amputation of a digit
1.5 Isolated tendon injury
1.6 Minor burns (< 20% body surface area)
1.7 Isolated mandibular fracture
1.8 Minor scalp contusion or laceration with no neurological signs
Outcomes
The objective of this study was divided into primary and secondary outcomes. The primary outcome was used to identify factors influencing the ISS regarding Thai military personnel injured in MCI April 10, 2010. Secondary outcome was used to describe the mechanism of injury and distribution of injured body regions.
Ethical Statement
The Ethics Research Committee of the Royal Thai Army Medical Department approved the study (R089h/53). STROBE guidelines, for reporting observational study, were utilized in the drafting of this report.
Statistical Analysis
Descriptive statistics was used to display characteristics of the injuries, relationship between mechanism of injury and injured body regions. Chi-square test was used to assess significance of coefficient. Multiple logistic regressions were used to calculate the adjusted odds ratio (adjusted OR) of ISS comparing injured body region categories.
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