Dhoni Ganesh Siva Rama Krishna Moorthy

Introduction: Trauma scoring systems are essential for predicting outcomes in trauma patients, guiding clinical decisions, and optimizing resource allocation. Common systems include the Injury Severity Score (ISS), New ISS (NISS), Revised Trauma Score (RTS), Trauma and ISS (TRISS), Emergency Trauma Score (EMTRAS), and Rapid Emergency Medicine Score (REMS). This study aims to evaluate the predictive accuracy of REMS and EMTRAS in comparison to traditional trauma scoring systems. Methods: This prospective observational study involved 1090 trauma patients admitted to the Department of Emergency Medicine from January 2021 to December 2023. Eligible patients were aged 18 or older with documented trauma. Data collection encompassed demographics, clinical parameters, and trauma severity, assessed using six scoring systems. Outcomes were monitored until patient discharge or death. Results: The cohort consisted of 915 (83.9%) male patients with a mean age of 36.1 years. Road traffic accidents were the leading cause of trauma, 934 (85.6%). Intensive care unit patients exhibited higher ISS and lower RTS scores (P < 0.0001), indicating more severe injuries. Nonsurvivors showed higher ISS and NISS and lower RTS and TRISS scores. EMTRAS demonstrated higher sensitivity and specificity than REMS, while TRISS proved the most effective in predicting trauma outcomes. Conclusions: REMS and EMTRAS had reasonable sensitivity and specificity but were less effective than traditional systems such as ISS, NISS, RTS, and TRISS. TRISS emerged as the most reliable tool for predicting outcomes, supporting its continued use as the gold standard in trauma assessment.

Background and objective ST-segment elevation myocardial infarction (STEMI) is a leading cause of morbidity and mortality globally. Proper risk stratification is critical to guide its early management and forecast outcomes. Although traditional scoring systems such as Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) are commonly employed, more recent indices such as Shock Index (SI), Modified Shock Index (MSI), and Age Shock Index (Age SI), and Myocardial Blush Grade (MBG) provide potentially more straightforward, bedside-usable means for prognostication. This study aimed to evaluate and compare the predictive validity of SI, Age SI, MSI, and MBG with validated risk scores - TIMI and GRACE - in predicting in-hospital and 30-day outcomes in STEMI patients who are undergoing reperfusion therapy. Methods This prospective observational study was conducted from September 2023 to August 2024 at R.L. Jalappa Hospital and RLJ Narayana Hrudayalaya, Kolar. A total of 150 adult STEMI patients treated with thrombolysis or primary percutaneous coronary intervention (PCI) were enrolled. Data were examined using chi-square tests and receiver operating characteristic (ROC) curves. Outcomes were assessed as in-hospital mortality, length of stay in ICU, and 30-day major adverse cardiac events (MACE). Results GRACE score evidenced higher predictive capacity for mortality and MACE over TIMI and shock-based indices. Age SI and MBG indicated encouraging correlation with outcomes, especially when employed in combination with conventional scores. Conclusions GRACE is a potent risk stratification tool for STEMI. Yet, SI-based metrics and MBG may supplement conventional scores, thereby providing fast, bedside assessment to facilitate early intervention and enhance patient outcomes in these patients.

Background: Trauma is one of the leading causes of death in older patients, who experience higher mortality rates even with less severe injuries compared to younger individuals. Many factors affect the outcomes in elderly trauma patients, with polypharmacy being one of the most significant. The Injury Severity Score (ISS) is an anatomical measure used to estimate the outcomes of trauma patients. This study compares the Comorbidity Polypharmacy Score (CPS) with the ISS to evaluate patient outcomes. Aims and Objectives: To assess the relationship between the Comorbidity–Polypharmacy Score (CPS) and injury severity score (ISS) on outcomes in geriatric trauma patients. Materials and Methods: This prospective observational study included 200 individuals aged over 60 years with clinical evidence of trauma who presented to the emergency department and were subsequently hospitalized. ISS and CPS scores were calculated in the Emergency Department and followed up until discharge. Patients were subdivided into two groups: Group A with a CPS of 0 to 7 and Group B with a CPS of more than 7. Results: The mean age of the 200 patients was 66.41 ± 6.89 years, with 148 men and 52 women. In the study, 42 people had a CPS of more than 7, while 158 had a CPS of 0 to 7. Based on the severity of injuries, 95 people were classified as mild ISS, 51 as moderate, 35 as severe, and 19 as very severe. Compared to Group A, Group B patients had prolonged hospital stays despite having lower ISS scores in the mild to moderate ISS groups. However, this association was not observed in patients with severe to very severe ISS in terms of ICU stay or mortality rates. Conclusion: In our population, patients with higher Comorbidity Polypharmacy Scores had prolonged hospital stays in the mild to moderate Injury Severity Score group. However, in patients with severe to very severe Injury Severity Scores, higher CPS did not affect the length of stay or mortality.

Objectives: Modified shock index (MSI) is a simple bedside tool used in the emergency department. There are a few studies suggesting MSI as a good prognostic indicator than shock index in sepsis patients. However, there is not enough research emphasizing the role of MSI in patients with comorbidities. Hence, this study aims to assess the predictive validity of MSI in predicting the prognosis of sepsis patients with and without co-morbidities. Methods: From January to December 2020, a prospective observational study was conducted in a tertiary care teaching hospital. Patients with sepsis diagnosed based on systemic inflammatory response syndrome criteria and quick sequential organ failure assessment (qSOFA) were included. The need for mechanical ventilation and step down from the intensive care unit were outcome variables, MSI was considered as a predictor variable, and co-morbidities as an explanatory variable. Results: Among people with co-morbidities, the MSI value on arrival to the emergency department had fair predictive validity in predicting the need for mechanical ventilation after 24 hours, as indicated by the area under the curve of 0.749 (95% CI: 0.600-0.897; p-value = 0.002) and a sensitivity of 68.75% in predicting mechanical ventilation after 24 hours (MSI ≥ 1.59). Among people without co-morbidities, the MSI value on arrival to the emergency department had fair predictive validity in predicting the need for mechanical ventilation after 24 hours, as indicated by the area under the curve of 0.879 (95% CI: 0.770-0.988; p-value <0.001) and a sensitivity of 83.33% in predicting the need for mechanical ventilation after 24 hours (MSI ≥ 1.67). Conclusion: MSI can be used as an indicator in predicting the prognosis of sepsis patients in the emergency department. A simple bedside calculation of the MSI can indicate the need for mechanical ventilation and step down from the intensive care unit after 24 hours in patients with co-morbidities and without co-morbidities.

Objectives: This study aimed to evaluate the trauma and injury severity score (TRISS), IMPACT (international mission for prognosis and analysis of clinical trials), and CRASH (corticosteroid randomization after significant head injury) prognostic models for prediction of outcome after moderate-to-severe traumatic brain injury (TBI) in the elderly following road traffic accident. Design: This was a prospective observational study. Materials and Methods: This was a prospective observational study on 104 elderly trauma patients who were admitted to tertiary care hospital, over a consecutive period of 18 months from December 2016 to May 2018. On the day of admission, data were collected from each patient to compute the TRISS, IMPACT, and CRASH and outcome evaluation was prospectively done at discharge, 14^th day, and 6-month follow-up. Results: This study included 104 TBI patients with a mean age of 66.75 years and with a mortality rate of 32% and 45%, respectively, at discharge and at the end of 6 months. The predictive accuracies of the TRISS, CRASH (computed tomography), and IMPACT (core, extended, laboratory) were calculated using receiver operator characteristic (ROC) curves for the prediction of mortality. Best cutoff point for predicting mortality in elderly TBI patients using TRISS system was a score of ≤88 (sensitivity 94%, specificity of 80%, and area under ROC curve 0.95), similarly cutoff point under the CRASH at 14 days was score of >35 (100%, 80%, 0.958); for CRASH at 6 months, best cutoff point was at >84 (88%, 88%, 0.959); for IMPACT (core), it was >38 (88%, 93%, 0.976); for IMPACT (extended), it was >27 (91%, 89%, 0.968); and for IMPACT (lab), it was >41 (82%, 100%, 0.954). There were statistical differences among TRISS, CRASH (at 14 days and 6 months), and IMPACT (core, extended, lab) in terms of area under the ROC curve (P < 0.0001). Conclusion: IMPACT (core, extended) models were the strongest predictors of mortality in moderate-to-severe TBI when compared with the TRISS, CRASH, and IMPACT (lab) models.