Predicting lethal outcome risks in patients with craniomaxillofacial trauma and polytrauma by the ISS and NISS
DOI:
https://doi.org/10.30978/GS-2022-2-13Keywords:
mortality, craniomaxillofacial trauma, ISS, NISS, Le FortAbstract
Multiple papers reveal no reliable difference between early and delayed maxillofacial injuries treatment in postoperative complications in patients with craniomaxillofacial trauma and polytrauma. A choice factor of the treatment tactics is the lethal outcome risk, as well as the lethal outcome prognosis. In order to objectivize the severity of trauma authors suggested the assessment scores which represent patient’s condition severity in points and provide lethal outcome risk estimation, — Injury Severity Score (ISS) and New Injury Severity Score (NISS), each with advantages and disadvantages of prognosing the lethal outcome. Though, the data on its preciseness and informativeness regarding patients with combined craniomaxillofacial trauma are limited, and the results, obtained from various authors, seem to be controversial.
Objective — to identify and compare the threshold (critical) values of the ISS and NISS assessment scales which predict the lethal outcome risks in patients with craniomaxillofacial trauma and polytrauma.
Materials and methods. During 2016 — 2019 years 503 patients were treated due to maxillofacial traumas and associated injuries. Patients age ranged from 18 till 91 years, (average age — 30.5 years). There was a male predominance in the sample (84.3 %). Facial bone fractures occurred in 70 % of cases (352 patients). Mainly after assaults (44 %), falls (20 %) and motor‑vehicle accidents (16 %). The other etiological factors included occupational traumas (0.5 %), sport traumas (1 %) and unknown aetiology traumas. The study evaluated patients with facial and concomitant injuries, who received multidisciplinary treatment in a specialized trauma hospital. Values of Injury Severity Score and New Injury Severity Score were statistically analyzed to evaluate effectiveness in prognosing lethal outcome risks.
Results. Mortality in the sample was 3 % (15 patients). With the optimum cut‑off value of ISS > 24, lethal outcome prognosis model sensitivity yields 93.3 %, specificity — 91.4 %. With the optimum cut‑off value NISS > 36, the lethal outcome prognosis sensitivity yields 86.7 %, its specificity 92.4 %.
Conclusions. ISS and NISS demonstrate similar effectiveness in prognosing lethal outcome risks. The difference of area under the curve of both trauma severity estimation methods is not statistically significant (р = 0.651). Both indicators could be used in daily practice in specialized hospitals to assess the patient’s condition and determine priority of treatment steps.
References
Riska EB, von Bonsdorff H, Hakkinen S, Jaroma H, Kiviluoto O, Paavilainen T. Primary operative fixation of long bone fractures in patients with multiple injuries. J Trauma. 1977;17:111-21.
Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Am. 1989;71:336-34.
Rotondo MF, Schwab CW, McGonigal MD, et al. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993;35:375-82; discussion 382-37.
Scalea TM, Boswell SA, Scott JD, Mitchell KA, Kramer ME, Pollak AN. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics. J Trauma. 2000;48:613-21; discussion 621-61.
Kluter T, Lippross S, Oestern S, Weuster M, Seekamp A. Operative treatment strategies for multiple trauma patients: early total care versus damage control. Chirurg. 2013;84:759-76.
Manson P. Management of facial fractures. Perspect Plast Surg 2.1, 1988.
Gruss JS. Complex craniomaxillofacial trauma: evolving concepts in management. A trauma unit’s experience — 1989. Fraser B. Gurd lecture. J Trauma. 1990;30:377-38.
Rothweiler R, Bayer J, Zwingmann J, et al. Outcome and complications after treatment of facial fractures at different times in polytrauma patients. J Craniomaxillofac Surg. 2018 Feb;46(2):283-7. doi: 10.1016/j.jcms.2017.11.027. Epub 2017 Dec 8. PMID: 29292128.
Shumynskyi I, Gurianov V, Kaniura O, Kopchak A. Prediction of mortality in severely injured patients with facial bone fractures. Oral Maxillofac Surg. 2021 Jun 8. doi: 10.1007/s10006-021-00967-7. Epub ahead of print. Erratum in: Oral Maxillofac Surg. 2021 Aug 11. PMID: 34100159.
Eid HO, Abu-Zidan FM. New Injury Severity Score is a better predictor of mortality for blunt trauma patients than the Injury Severity Score. World J Surg. 2015 Jan;39(1):165-71. doi: 10.1007/s00268-014-2745-2. PMID: 25189444.
Cook A, Weddle J, Baker S, et al. A comparison of the Injury Severity Score and the Trauma Mortality Prediction Model. J Trauma Acute Care Surg. 2014 Jan;76(1):47-52; discussion 52-3. doi: 10.1097/TA.0b013e3182ab0d5d. PMID: 24368356.
Kilgo PD, Osler TM, Meredith W. The worst injury predicts mortality outcome the best: rethinking the role of multiple injuries in trauma outcome scoring. J Trauma. 2003 Oct;55(4):599-606; discussion 606-7. doi: 10.1097/01.TA.0000085721.47738.BD. PMID: 14566109.
Deng Q, Tang B, Xue C, et al. Comparison of the ability to predict mortality between the Injury Severity Score and the New Injury Severity Score: A meta-analysis. Int J Environ Res Public Health. 2016 Aug 16;13(8):825. doi: 10.3390/ijerph13080825. PMID: 27537902. PMCID: PMC4997511.
Loftis KL, Price J, Gillich PJ. Evolution of the Abbreviated Injury Scale: 1990-2015. Traffic Inj Prev. 2018;19(sup2):S109-S113. doi: 10.1080/15389588.2018.1512747. PMID: 30543458.
Galvagno SM Jr, Nahmias JT, Young DA. Advanced trauma life support® Update 2019: Management and applications for adults and special populations. Anesthesiol Clin. 2019 Mar;37(1):13-32. doi: 10.1016/j.anclin.2018.09.009.
Farrell MS, Emery B, Caplan R, Getchell J, Cipolle M, Bradley KM. Outcomes with advanced versus basic life support in blunt trauma. Am J Surg. 2020 Sep;220(3):783-6. doi: 10.1016/j.amjsurg.2020.01.012.
Galvagno SM Jr, Nahmias JT, Young DA. Advanced trauma life support® Update 2019: Management and applications for adults and special populations. Anesthesiol Clin. 2019 Mar;37(1):13-32. doi: 10.1016/j.anclin.2018.09.009.
Lavoie A, Moore L, LeSage N, Liberman M, Sampalis JS. The New Injury Severity Score: a more accurate predictor of in-hospital mortality than the Injury Severity Score. J Trauma. 2004 Jun;56(6):1312-20. doi: 10.1097/01.ta.0000075342.36072.ef.
Jamulitrat S, Sangkerd P, Thongpiyapoom S, Na Narong M. A comparison of mortality predictive abilities between NISS and ISS in trauma patients. J Med Assoc Thai. 2001 Oct;84(10):1416-21.
Mica L, Rufibach K, Keel M, Trentz O. The risk of early mortality of polytrauma patients associated to ISS, NISS, APACHE II values and prothrombin time. J Trauma Manag Outcomes. 2013 May 24;7:6. doi: 10.1186/1752-2897-7-6.
Jahangiri M, Mani K, Yates MT, Nowell J. The EXCEL Trial: The surgeons’ perspective. Eur Cardiol. 2020 Nov 9;15:e67. doi: 10.15420/ecr.2020.34.
Petrie A, Sabin C. Medical Statistics at a Glance. 2nd ed. Blackwell Publishing; 2005. 157 p.
Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013 Mar;48(3):452-8. doi: 10.1038/bmt.2012.244.
Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974 Mar;14(3):187-96. PMID: 4814394.
Beverland DE, Rutherford WH. An assessment of the validity of the injury severity score when applied to gunshot wounds. Injury. 1983 Jul;15(1):19-22. doi: 10.1016/0020-1383(83)90156-0. PMID: 6885141.
Semmlow JL, Cone R. Utility of the injury severity score: a confirmation. Health Serv Res. 1976 Spring;11(1):45-52. PMID: 965234. PMCID: PMC1071893.
Bull JP. Measures of severity of injury. Injury. 1978 Feb;9(3):184-7. doi: 10.1016/0020-1383(78)90004-9. PMID: 624568.
Wong TH, Krishnaswamy G, Nadkarni NV, et al. Combining the new injury severity score with an anatomical polytrauma injury variable predicts mortality better than the new injury severity score and the injury severity score: a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2016 Mar 8;24:25. doi: 10.1186/s13049-016-0215-6. PMID: 26955863. PMCID: PMC4784376.
Arajarvi E, Lindqvist C, Santavirta S, Tolonen J, Kiviluoto O. Maxillofacial trauma in fatally injured victims of motor vehicle accidents. Br J Oral Maxillofac Surg. 1986 Aug;24(4):251-7. doi: 10.1016/0266-4356(86)90089-6.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Authors
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
