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Introduction: A regionalized trauma system must be tailored to the trauma epidemiology and the trauma care resources of the population it serves. Pediatric trauma system in Singapore differs from others because of its geographic compactness and relatively low incidence of severe trauma. The scarcity of polytrauma highlights the need of a reliable screening system to identify injured children who necessitate urgent transport to emergency department (ED) with pediatric resuscitation capacity as well as activation of trauma team upon their arrival. In this study, the validity of Pediatric Trauma Score (PTS), Glasgow Come Scale (GCS), and respiratory rate (RR) in identifying pediatric patients with major trauma and receipt of resuscitation is evaluated., Patients and Methods: After obtaining Institutional Review Board approval, a retrospective analysis was performed using data obtained from our trauma registry between January 2011 and December 2012. Information pertaining to the demographics, causative mechanism, and injury description, resuscitation, admitting disciplines, surgical intervention, and outcome were analyzed. The sensitivity and specificity of PTS, GCS, and RR to predict outcomes of interest are calculated., Results: A total of 92 patients were recruited. From the 92 patients, 26 sustained major trauma, and 21 patients received ED resuscitation. The mean age was 4 years 9 months. Sensitivity and specificity of PTS ≤ 8, GCS ≤ 10, and abnormal RR for predicting major trauma were 61.5, 77.3; 26.9, 100; and 53.8, 60.6%; respectively. When the reliability to identify patients received ED resuscitation was evaluated the sensitivity and specificity of PTS ≤ 8, GCS ≤ 10, and abnormal RR were 90.5, 83.1; 28.6, 98.6; and 76.2, 66.2%; respectively., Conclusion: The parameters of PTS need to be further refined to improve its accuracy and minimize the undertriage rate. If a combined physiologic and anatomic scoring system such as PTS is used, other physiologic parameters such as GCS and RR may become redundant. The evaluation of the validity of PTS, GCS, and RR in predicting pediatric major trauma indicated poor reliability., (Georg Thieme Verlag KG Stuttgart · New York.)

Background/aims: Pancreatic injury from blunt trauma is infrequent. The aim of the present study was to evaluate a simplified approach of management of pancreatic trauma injuries requiring immediate surgery consisting of either drainage in complex situation or pancreatectomy in the other cases., Methodology: From January 1986 to December 2006, 40 pancreatic traumas requiring immediate surgery were performed. Mechanism of trauma, clinical and laboratories findings were noted upon admission, classification of pancreatic injury according to Lucas' classification were considered. Fifteen (100%) drainages were performed for stage I (n=15), 60% splenopancreatectomies and 40% drainage was achieved for stage II (n=18), 3 Pancreaticoduonectomies and 2 exclusion of duodenum with drainage and 2 packing were performed for stage IV (n=7)., Results: There were 30 men and 10 women with mean age of 29+/-13 years (15-65). Thirty-eight patients had multiple trauma. Overall, mortality and global morbidity rate were 17% and 65% respectively, and the rates increased with Lucas' pancreatic trauma stage., Conclusions: Distal pancreatectomy is indicated for distal injuries with duct involvement, and complex procedures such as pancreaticoduodenectomy should be performed in hemodynamically stable patients.

For more than 30 years various scoring systems have been used as a method to asses the injury severity of multi-system trauma. They have been used as a tool for triage, for emergency-room quality management, for educational reasons or, nowadays, in order to evaluate the cost effectiveness of either a complete hospital or a single department. This review provides the knowledge to score multi-system traumatized patients after their first treatment in the emergency-room. It shows advantages, disadvantages, and limitations of various traumascores which includes knowledge about the used parameters, the type of validation, the medical system in their country of origin, and of course their mathematical background. Relevant examples like physiological trauma scores (GCS, RTS, MEES), anatomic, injury pattern based scores (ISS, NISS, ICISS), biological aspects, mixed scoring systems (PTS, TRISS, ASCOT) and future developments ("Rixen-pattern", RISC) are illustrated. These scores are explained in detail and discussed as to their practicability.

For the hemodynamically unstable patient with pelvic fracture a target focussed and rapid diagnostic and therapy is mandatory. After hemorrhage control at crash site the direct transport in a trauma center follows. Primary therapy in the emergency room sometimes includes stabilization by a pelvic clamp or an external fixator. If the patient is still hemodynamically unstable the life threatening bleeding is packed. After that simple internal osteosynthesis is allowed. The presented article shows the possible options of the therapy. The main message is: hemorrhage control is not possible without stabilization of the pelvic ring.

Background/aims: The liver is the most common injured intraabdominal organ after trauma. This retrospective study was designed to analyze the results of the surgical treatment of 244 cases of liver trauma operated between 1973 and 2001., Methodology: Two hundred and seventeen of the cases were male and 27 were female. Mean age of the patients was 29.6. Blunt injuries were responsible for liver trauma in 53.6% of the patients. According to the American Association for the Surgery of Trauma classification we evaluated the patients to two groups. The first one was Group A, minor hepatic injuries, which consisted of grade I, grade II and grade III injuries, and the second one was Group B, major hepatic injuries, which consisted of grade IV, grade V and grade VI injuries. There were 238 cases in Group A and 6 cases in Group B. Primary suturing of the hepatic rupture was performed in 187 of 238 cases in group A. Liver injuries of the other 50 cases did not require suturing so that we drained the suprahepatic and infrahepatic spaces during laparotomy. The remaining case in group A had resectional debridement and hemostasis. On the other hand we performed regular or irregular hepatic resection in all group B patients., Results: Overall mortality rate was 16.3%. The mortality rate was higher in group B than group A (66.6% and 15.1%, respectively). The mortality rate was also higher in the blunt abdominal trauma cases than penetrating injuries (25.9% and 5.3% consecutively)., Conclusions: We concluded that the injury grade and the type of trauma influence the mortality rate. Careful clinical assessment and close radiological monitoring of the patients with minor hepatic injuries, may prevent unnecessary laparotomies.

For therapeutic recommendations three different kinds of scores are essential: 1. The severity scores for trauma; 2. Severity scores for mangled extremities; 3. Intensive care scores. The severity of polytrauma patients is measurable by the AIS, ISS, RTS, PTS and TRISS which is a combination of RTS, ISS, age, and mechanism of injury. For mangled extremities there are also different scores available: MESI (Mangled Extremity Syndrome Index) and MESS (Mangled Extremity Severity Score). The aim of these scores is to assist in the indication with regard to amputate or to save the extremity. These scoring indices can be used to evaluate the severity of a systemic inflammatory reaction syndrome with respect to multiple organ failure. All scores are dynamic values which are variable with improvement of therapy.

In a prospective study (400 patients, intensive care stay > 18 h) the following data were documented daily: Clinical sepsis, a modified sepsis score, Apache II-score, number of organ failure, Elastase-concentrations and injury severity score (ISS > or = 20 = polytrauma). On admission day a prognostic assessment for early diagnosis of septic complications during intensive care could be demonstrated by a combination of the modified sepsis score and the number of organ failures and the presence of polytrauma. All other parameters did not have any predictive value.

Trauma Score Systems attempt to summarize the severity of injury in a single value. They provide a better classification of trauma patients and translate different severities of injury in a common language. They enable thereby comparisons between hospitals or trauma systems. Young doctors can control their clinical judgement with scoring systems and will gain experience. Scoring systems therefore increase safety and can help in decision making. As accuracy of scoring systems is never 100% individual decisions can never rely on scores only. Glasgow Coma Scale, Revised Trauma Score, Injury Severity Score and TRISS are the most often used international scores for severely injured patients. Their sensitivity and specificity, validity, reliability and practicability have been studied and proved in many trials. The role of these scoring systems for quality management purposes in the treatment of severe trauma is actually studied with the Trauma Registry of the German Society for Trauma Surgery.

Aim: The study aimed at detecting relations between the quality and duration of prehospital care in the case of traumatic patients and the duration of artificial respiration and ICU stay times., Design: 94 traumatic patients, admitted to the intensive care unit, were subdivided into groups according to the type of trauma. The mean time of prehospital care, injury severity score, the Apache II at the admission to the clinic and the discharge to the ICU, intraoperative replacement of blood and clinical care times were calculated., Result: In the group of all patients, times of the ICU-stay were correlated to the ISS and the Apache II of the hospital admission. In the group with multiple fractures, a positive correlation to the prehospital care times was found., Discussion: Quality and duration of the prehospital care were identified as factors, influencing the time of the ICU stay. Optimizing these factors will be helpful in respect of economic considerations.

Trauma scores are used in emergency medicine to classify the severity of injuries. Score systems are applied in science and epidemiological investigations in emergency and intensive care. Moreover, trauma scores are intended to support the decisions in triage and predict the prognosis of mortality. Scores are based on anatomicmorphological or physiological parameters by which the intensity of injury is graded and valued. Commonly used scores are the Injury Severity Score (ISS) and the Revised Trauma Score (RTS). The Glasgow Coma Scale (GCS) is a system that is used worldwide to classify neurologic deficiencies after injury of the brain. Trauma scores have a good prognostic potential by comparing large data bases of different patient groups. Individual prognosis of mortality by trauma scores in the routine of emergency medicine are rapid classification of the injury after trauma and early identification of critically ill patients. Score systems can support decisions and the training of emergency staff. Future studies should go into the grade of rehabilitation and the quality of life after trauma as a -possibly score-aided-prognostic parameter.

The TRISS method offers an approach to evaluate outcome of injured patients. Thereby it provides a tool for quality assurance and for comparison for different populations of trauma patients. The calculations are explained using some instructive examples.

After a short view of literature demands of treatment of multiple seriously injured patients, some ideas to optimize their attending are discussed. A practicable method of prognostication for critical injured patients is presented in 40 cases. It could be reached a real rating, nobody who survived was classified in the group with unfavourable prognosis. Existing problems of gradation are explained.