RT Book, Section
A1 Moore, Lynne
A1 Champion, Howard R.
A2 Feliciano, David V.
A2 Mattox, Kenneth L.
A2 Moore, Ernest E.
SR Print(0)
ID 1175130432
T1 Injury Severity Scoring, Modeling, and Outcomes Research
T2 Trauma, 9e
YR 2020
FD 2020
PB McGraw Hill
PP New York, NY
SN 9781260143348
LK accesssurgery.mhmedical.com/content.aspx?aid=1175130432
RD 2024/04/19
AB KEY  POINTSCollecting  reliable,  accurate,  and  timely  data  on  injury  care  is  central  to  injury  research  and  surveillance.Injury  severity  score  (ISS)  selection  should  be  based  on  a  clear  sense  of  what  one  wants  to  measure  and  why  and  on  a  good  understand  of  the  score’s  strengths  and  limitations.Combination  injury  severity  models  attempt  to  combine  the  three  concepts  of  risk:  (1)  preinjury  physiologic  reserve  (eg,  age,  comorbidities);  (2)  physiologic  status  of  the  injured  patient  (eg,  Glasgow  Coma  Scale  [GCS]);  and  (3)  anatomic  injury  severity  (eg,  ISS).  The  optimal  injury  severity  model  will  depend  on  the  data  available,  the  study  population,  the  exposure  of  interest,  and,  in  particular,  the  outcome  under  evaluation.Injury  outcomes  research  aims  to  improve  our  understanding  of  the  determinants  of  optimal  injury  outcomes  with  the  ultimate  goal  of  reducing  the  societal  burden  of  injury.  Scientific  ethics  require  a  demonstration  that  addressing  the  research  question  will  sigadvance  current  knowledge.Researchers  are  increasingly  looking  to  assess  outcomes  that  are  important  to  patients.  For  hemorrhagic  shock,  that  may  be  mortality,  but  for  brain,  spinal  cord,  and  orthopedic  injuries,  function  in  daily  activities  and  quality  of  life  are  more  likely  to  be  meaningful.Outcomes  research  must  be  based  on  a  comprehensive,  integrated,  and  end-of-grant  knowledge-translation  strategy.  Practitioners,  policymakers,  decision  makers,  and  patient/family  advocates  should  be  involved  in  all  phases  of  research  projects,  and  results  should  be  distributed  to  all  stakeholders,  not  just  in  the  form  of  scientific  articles  but  as  policy  briefs,  clinical  guides,  and  decision  rules.  We  should  also  work  to  strengthen  international  collaborations  to  pool  resources,  avoid  duplicating  research  projects,  and  generate  results  with  maximum  impact.To  improve  our  understanding  of  the  complex  associations  underlying  the  burden  of  injury,  we  need  to  improve  the  quality  and  coverage  of  injury  data;  employ  more  sophisticated  analytical  methods;  improve  the  knowledge  translation-to-action  cycle  of  research  results;  look  toward  comparing  outcomes  across  health  care  systems  in  high-,  middle-,  and  low-income  countries;  and  adapt  our  methods  to  the  changing  demographics  of  trauma  populations.