Upgrade Of The Software On Revised Injury Severity Score And Its Application In The Prevention Of Bone Trauma Complications

Objective Intergration of Chinese traditional and western medicine in emergency medicine has a long history and rich experience in the field of trauma.The traditional Chinese medicine focuses on the whole and macro aspects of traumatic emergency,while western medicine pays more attention to local and micro aspects of traumatic emergency,the combination of the Chinese traditional and western medicine can explore the rule of trauma from the whole,organ,tissue and molecular levels.For clinicians,making a reasonable assessment of the injury is the most important task in the process of evaluation of trauma.Reasonable evaluation of the injury can help clinicians quickly formulate reasonable treatment scheme.Tan Zongkui put forward a method named the revised injury severity score(RISS),which has been widely used in the field of trauma and greatly improved the success rate of trauma treatment.Based on RISS,Zeng Jinshan has designed the software of the revised injury severity score,which can replace the RISS,match the requirement of the development of hospital digitization and informatization.However,there are some deficiencies such as the fracture classification is too simple,i.e.,femoral fracture ignore the distal and proximal of the femur acording to international standards in fracture classification,imperfect database and lacking the methods of retrieval.This research aims to upgrade the RISS software,improve theprecision and efficiency of the RISS software,and provide a new method for traumatic emergency and the prevention of bone trauma complications through applying the upgraded software to the patients with bone trauma in Wuhan general hospital of the people's liberation army.Method 1.Based on the RISS software,the classification of fracture,database and the methods of information retrieval were upgraded.100 cases of trauma patients in Wuhan general hospital of the people's liberation army from Jun.2015 to Jul.2015 were retrospectivly analyzed by the RISS software and the upgraded RISS software,in order to verify the accuracy,validity,scope of application of the RISS software and the database establishment.2.36 cases with femoral fractures and 60 cases of trauma patients with lower leg fracture in Wuhan general hospital of the people's liberation army from Jan.2010 to Aug.2016 were respectively quantitative assessed by the upgraded RISS software.By respectively observation the upgraded RISS value of 36 patients with femoral fractures and the type of AO femoral fracture,the upgraded RISS value of 60 patients with lower leg fracture patients,in order to find an innovative strategy for preventing the bone trauma complicated with FES and OCS.3?Prospective study was employed to evaluate the patients who had been suffered from long tubular bone trauma admitted in our hospital from Mar.2016 to Oct.2017.According to the concomitant injuries such as chest,abdomen and craniocerebral injury and FES early warning criterion which was proposed by Cai xianhua,by using the upgraded RISS software for quantitative evaluation,patients were divided into four groups:Group A included a simple long tubular bonefractures of the limbs bone trauma patients with RISS<11 points;Group B,a simple long tubular bone fractures of the limbs bone trauma patients with RISS?11 points;Group C,a long tubular bone fractures of limbs and concomitant with chest,abdomen,craniocerebral injury patients with multiple fractures with RISS score<18 points;Group D,a long tubular bone fractures of limbs and a concomitant with chest,abdomen,craniocerebral injury RISS?18 points.Among them,the cases of Groups A and B were not given drug prevention measures,while the cases of Group B and D were given dextran 40 plus dexamethasone drug to prevent.The prevention effect of FES were recorded.Result 1.The RISS software was upgraded successfully.The upgraded RISS software was divided into four interfaces:the login interface,the trauma score entry interface,the trauma score query interface and the database query statistics interface.According to the test,the upgraded RISS software was faster in the evaluation of the patient's condition(t=4.56,P <0.01)and had more advantages in the query of patients in the database data(t=9.83,P < 0.01).Besides,the accuracy was the same as the original RISS software.The data of the trauma patients could automatically be saved to the database.The upgraded RISS software was improved to be more simple,convenient,intuitive and a huge database functions,which could further improve the efficiency of clinical work.2.When the value of RISS was higher than 11 in patients with simple femoral shaft fracture combined with multiple bone fractures,or RISS value more than 18 in patients with femoral shaft fracture associated with splanchnocoele or craniocerebral injury,or the type C femoral shaft fracture,FES was likely to happen.When the value of RISS was higher than 8 in patients with simple lower leg fractures,orRISS value more than 14 in patients with lower leg fractures associated with other parts of the fracture or splanchnocoele or craniocerebral injury,OCS was likely to happen.Preventive measures should be taken as soon as possible to these kinds of the patients.3.1305 patients with bone trauma were included into this study,among which 3 patients happened FES,male and female ratio was 2:1,the average age was 38.3 years.There were no FES happened in Group A(104)and Group C(358).There was 1 case of FES happened in Group B(256)with RISS 13,and 2 cases in Group D(587)with RISS21 and 25 respectively.There was no significant difference(P>0.05)in gender,age and hospitalized time among the groups,while the RISS had significant differences(P<0.05)among these group.The incidence rate of FES in group B and group D were 0.4%,0.34% respectively.Conclusion Through the validation and analysis of the application in bone trauma complications,this-group-designed the upgraded RISS software not only can preserve the original RISS'advantage,but also make up the shortage and has a huge database.It is more efficient,concise and less influenced by subjective factors.The upgraded RISS software can assess the injury of patients fast and comprehensively,which facilitates the treatment.The upgraded RISS software focuses on the relationship of the whole and local,the micro and macro,conform to the traditional Chinese medicine ideas of emergency treatment-"treating secondary symptoms for emergency,delay is put to its".The upgraded RISS software can promote emergency treatment of traditional Chinese medicine informationization,and transition of experience medicine to standardized medicine.The upgraded RISS software can be applied to assess the condition for trauma patients and can be used as an earlywarning tool for bone trauma complications of FES or OCS.Besides,the combination of the upgraded RISS software and drug has been improved to be obvious effective to preventive of FES.The upgraded RISS software is worth to be promoted for its strong clinical practical prospective.