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Related Concept Videos

SBAR II: Application of SBAR01:14

SBAR II: Application of SBAR

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SBAR is an effective communication tool used by healthcare professionals to communicate patient information accurately. SBAR stands for Situation, Background, Assessment, and Recommendation. For a better understanding, an example is given below.
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...
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Related Experiment Video

Updated: Jun 5, 2025

Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
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Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device

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Injury Severity Score Precision for Determining Undertriage in Trauma Consultation Patients: A Retrospective Study.

C Michael Dunham1, Gregory S Huang1, Elisha A Chance2

  • 1Trauma, Critical Care, and General Surgery, Mercy Health, St. Elizabeth Youngstown Hospital, Youngstown, USA.

Cureus
|December 10, 2024
PubMed
Summary

The Injury Severity Score (ISS) has limitations in assessing trauma undertriage. A new method combining intracranial hemorrhage (ICH), Glasgow Coma Scale (GCS), and ISS, with targeted audits, offers a more precise approach for consultation patients.

Keywords:
adverse outcomesconsult patientsglasgow coma scaleinjury severity scoreintracranial hemorrhageprecisionpreexisting medical conditionstrauma centerstrauma mortalityundertriage

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Area of Science:

  • Trauma Surgery
  • Emergency Medicine
  • Public Health

Background:

  • The Injury Severity Score (ISS) is widely used but has limitations in accurately identifying all undertriaged trauma patients.
  • Existing undertriage assessment methods may not adequately differentiate patient risk profiles based on activation status (full, partial, or consultation).

Purpose of the Study:

  • To evaluate the precision of the Injury Severity Score (ISS) in determining trauma undertriage.
  • To compare risk conditions and outcomes between ISS ≥16 patients with different activation statuses.
  • To develop and assess a novel categorization method (ICH-GCS-ISS) for undertriage in trauma consultation patients.

Main Methods:

  • Retrospective analysis of trauma registry data for 2,076 patients, including demographics, ISS, GCS, activation status, and outcomes (death, intensive care, hospital stay).
  • Application of Peng and Cribari methods for undertriage proportion calculation.
  • Targeted electronic medical record audits (EMRA) for detailed clinical information, including intracranial hemorrhage (ICH) status, to refine the ICH-GCS-ISS categorization.

Main Results:

  • Undertriage proportions were 64.2% (Peng) and 21.7% (Cribari).
  • Patients with ISS ≥16 and full/partial activation had significantly higher risks (mortality, longer stays) compared to consultation patients.
  • The novel ICH-GCS-ISS categorization identified an 11.0% undertriage proportion among consultation patients, requiring EMRA in only 12% of cases.

Conclusions:

  • Commingling ISS ≥16 consultation and activation patients for undertriage assessment is inappropriate due to differing risk profiles.
  • The ICH-GCS-ISS categorization method, supplemented by EMRA for specific cases, provides a more accurate assessment of undertriage in trauma consultation patients.
  • The benefit of trauma activation for elderly or comorbid patients with ISS ≥16-adverse outcomes remains uncertain.