Background: Inclusion of a measure of comorbidity in trauma scoring has been suggested due to the potential for preexisting conditions to impact on patient outcomes, but studies have reported varied results. The Charlson Comorbidity Index (CCI) includes 19 diseases weighted on the basis of their association with mortality, and can be extrapolated from International Classification of Diseases, Ninth Revision (ICD-9) codes for administrative databases. Objectives: To evaluate the CCI as a predictor of trauma outcome. Methods: Major trauma patient data from the Victorian State Trauma Registry (VSTR) were used to evaluate the CCI (n= 2,819). The CCI was scored from ICD-10 codes through modification of a previous method of mapping ICD-9 codes to the CCI. Logistic regression was used to determine the association between the CCI and mortality, the effect of adding the CCI to the Trauma and Injury Severity Score (TRISS) methodology, and the impact of adding the CCI to a modification of the TRISS methodology. Model performance was assessed through discrimination and calibration. Results: The CCI was associated with death (p < 0.001), but adding the CCI to TRISS [area under the receiver-operating characteristic curve (AUC) 0.86; 95% CI = 0.84 to 0.88] did not result in improved discrimination over TRISS alone (AUC 0.83; 95% CI = 0.81 to 0.86). Modifying TRISS methodology, with age left as a continuous variable, performed better than the original TRISS (AUC 0.91; 95% CI = 0.89 to 0.92), but the addition of the CCI did not further improve this model (AUC 0.91; 95% CI = 0.89 to 0.92). Conclusions: While the CCI can be extrapolated from ICD codes and provides a measure of comorbid condition severity and was associated with mortality, addition of the CCI to prediction models did not result in a substantial improvement in performance.
Abstract Background There is limited evidence describing the long‐term outcomes of severe pelvic ring fractures. The aim of this study was to describe the longer term independent living and return to work outcomes following severe pelvic ring fracture. Methods Adult survivors to discharge from two major trauma centres with AO / T ile type B and C fractures were followed up at 6, 12 and 24‐months post‐injury to capture functional ( G lasgow O utcome S cale‐ E xtended [ GOS ‐ E ]) and return to work data. Multivariable, mixed effects models were used to identify predictors of outcome. Results A total of 111 of 114 (97%) cases were followed up. The mean ( SD ) age of participants was 41.9 (18.9) years, 77% were male, 81% were transport‐related and 90% were multi‐trauma patients. Further, 11% were managed conservatively, 10% with external fixation and 79% with open reduction and internal fixation. At 24 months, 77% were living independently ( GOS ‐ E > 4) and 59% had returned to work. Higher I njury S everity S cores ( ISS ) were associated with lower risk‐adjusted odds of return to work ( P = 0.04) and independent living ( P = 0.06). Post‐operative infection was associated with living independently ( P = 0.02). Conclusion Despite the severity of the injuries sustained, 77% of severe pelvic ring fracture patients were living independently and 59% had returned to work, 2‐years post‐injury. Fracture type and management were not key predictors of outcome. Large‐scale multi‐centre studies are needed to fully understand the burden of severe pelvic ring fractures and to guide clinical management.
Objective To establish the relationship between the history of hip and groin injuries in elite junior football players prior to elite club recruitment and the incidence of hip and groin injuries during their elite career. Design Retrospective cohort study. Setting Analysis of existing data. Participants 500 Australian Football League (AFL) players drafted from 1999 to 2006 with complete draft medical assessment data. Assessment of risk factors Previous history of hip/groin injury, anthropometric and demographic information. Main outcome measurement The number of hip/groin injuries resulting in ≥1 missed AFL game. Results Data for 500 players were available for analysis. 86 (17%) players reported a hip/groin injury in their junior football years. 159 (32%) players sustained a hip/groin injury in the AFL. Players who reported a previous hip or groin injury at the draft medical assessment demonstrated a rate of hip/groin injury in the AFL >6 times higher (IRR 6.24, 95% CI 4.43 to 8.77) than players without a pre-AFL hip or groin injury history. Conclusions This study demonstrated that a hip or groin injury sustained during junior football years is a significant predictor of missed game time at the elite level due to hip/groin injury. The elite junior football period should be targeted for research to investigate and identify modifiable risk factors for the development of hip/groin injuries.
Subsequent injury (SI) is a major contributor to disability and costs for individuals and society.To identify modifiable risk factors predictive of SI and SI health and disability outcomes and costs.To (1) describe the nature of SIs reported to New Zealand's no-fault injury insurer (the Accident Compensation Corporation (ACC)); (2) identify characteristics of people underaccessing ACC for SI; (3) determine factors predicting or protecting against SI; and (4) investigate outcomes for individuals, and costs to society, in relation to SI.Prospective cohort study.Previously collected data will be linked including data from interviews undertaken as part of the earlier Prospective Outcomes of Injury Study (POIS), ACC electronic data and national hospitalisation data about SI. POIS participants (N=2856, including 566 Māori) were recruited via ACC's injury register following an injury serious enough to warrant compensation entitlements. We will examine SI over the following 24 months for these participants using descriptive and inferential statistics including multivariable generalised linear models and Cox's proportional hazards regression.Subsequent Injury Study (SInS) will deliver information about the risks, protective factors and outcomes related to SI for New Zealanders. As a result of sourcing injury data from New Zealand's 'all injury' insurer ACC, SInS includes people who have been hospitalised and not hospitalised for injury. Consequently, SInS will provide insights that are novel internationally as other studies are usually confined to examining trauma registries, specific injuries or injured workers who are covered by a workplace insurer rather than a 'real-world' injury population.
To achieve expert consensus on the content of an exercise training program (known as FootyFirst) to prevent lower-limb injuries.Three-round online Delphi consultation process.Community Australian Football (AF).Members of the Australian Football Leagues' Medical Officers (n = 94), physiotherapists (n = 50), and Sports Science (n = 19) Associations were invited to participate through e-mail. Five people with more general expertise in sports-related lower-limb injury prevention were also invited to participate.The primary outcome measure was the level of agreement on the appropriateness of the proposed exercises and progressions for inclusion in FootyFirst. Consensus was reached when ≥75% of experts who responded to each item agreed and strongly agreed, or disagreed and strongly disagreed, that an exercise or its progressions were appropriate to include in FootyFirst.Fifty-five experts participated in at least 1 Delphi round. In round 1, consensus was achieved that the proposed warm-up (run through and dynamic stretches) and the exercises and progressions for hamstring strength and for balance, landing, and changing direction were appropriate to include in FootyFirst. There was also consensus in round 1 that progressions for hip/core strength should be included in FootyFirst. Consensus was reached in round 2 that the revised groin strength and hip strength exercises should be included in FootyFirst. Consensus was reached for the progression of the groin strength exercises in round 3.The formal consensus development process has resulted in an evidence-informed, researcher-developed, exercise-based sports injury prevention program that is expert endorsed and specific to the context of AF.Lower-limb injuries are common in running, kicking, and contact sports like AF. These injuries are often costly to treat, and many have high rates of recurrence, making them challenging to treat clinically. Reducing these injuries is a high priority for players, teams, and medical staff. Exercise programs provide a method for primary prevention of lower-limb injuries, but they have to be evidence based, have currency with sports practitioners/clinicians, and utility for the context in which they are to be used. However, the comprehensive methods and clinical engagement processes used to develop injury prevention exercise programs have not previously been described in detail. This study describes the results of engaging clinicians and sport scientists in the development of a lower-limb sports injury prevention program for community AF, enabling the development of a program that is both evidence informed and considerate of expert clinical opinion.
Uncertainty estimation is essential to make neural networks trustworthy in real-world applications. Extensive research efforts have been made to quantify and reduce predictive uncertainty. However, most existing works are designed for unimodal data, whereas multi-view uncertainty estimation has not been sufficiently investigated. Therefore, we propose a new multi-view classification framework for better uncertainty estimation and out-of-domain sample detection, where we associate each view with an uncertainty-aware classifier and combine the predictions of all the views in a principled way. The experimental results with real-world datasets demonstrate that our proposed approach is an accurate, reliable, and well-calibrated classifier, which predominantly outperforms the multi-view baselines tested in terms of expected calibration error, robustness to noise, and accuracy for the in-domain sample classification and the out-of-domain sample detection tasks.
The use of text messaging or short message service (SMS) for injury reporting is a recent innovation in sport and has not yet been trialled at the community level. Considering the lack of personnel and resources in community sport, SMS may represent a viable option for ongoing injury surveillance. The aim of this study was to evaluate the feasibility of injury self-reporting via SMS in community Australian football.A total of 4 clubs were randomly selected from a possible 22 men's community Australian football clubs. Consenting players received an SMS after each football round game asking whether they had been injured in the preceding week. Outcome variables included the number of SMS-reported injuries, players' response rates and response time. Poisson regression was used to evaluate any change in response rate over the season and the association between response rate and the number of reported injuries.The sample of 139 football players reported 167 injuries via SMS over the course of the season. The total response rate ranged from 90% to 98%. Of those participants who replied on the same day, 47% replied within 5 min. The number of reported injuries decreased as the season progressed but this was not significantly associated with a change in the response rate.The number of injuries reported via SMS was consistent with previous studies in community Australian football. Injury reporting via SMS yielded a high response rate and fast response time and should be considered a viable injury reporting method for community sports settings.
The majority of patients hospitalised for trauma survive their injuries, with the quality of the survival potentially influenced by early acute hospital rehabilitation. The aim of this study was to review the outcomes of patients managed under an intensive Allied Health Model of Care (AHMOC) compared to a baseline cohort.
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