• Users Online: 179
  • Print this page
  • Email this page

 
Table of Contents
ORIGINAL ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 5  |  Page : 191-196

Comparison of risk factors associated with sepsis between road traffic injuries and non-road traffic injuries in ICU patients with severe trauma


1 State Key Laboratory of Trauma, Burns and Combined Injury, First Department, Research Institute of Surgery, Third Affiliated Hospital of Army Military Medical University; Department of Critical Care Medicine, ChongGang General Hospital, Chongqing, PR China
2 State Key Laboratory of Trauma, Burns and Combined Injury, First Department, Research Institute of Surgery, Third Affiliated Hospital of Army Military Medical University, Chongqing, PR China
3 State Key Laboratory of Trauma, Burns and Combined Injury, First Department, Research Institute of Surgery, Third Affiliated Hospital of Army Military Medical University, Chongqing; Trauma Center, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, PR China
4 Department of Critical Care Medicine, ChongGang General Hospital, Chongqing, PR China

Date of Submission17-Sep-2018
Date of Decision25-Sep-2018
Date of Acceptance06-Oct-2018
Date of Web Publication30-Oct-2018

Correspondence Address:
Bin Wang
ChongGang General Hospital, Chongqing
PR China
Dr. Hua-Ping Liang
State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Third Affiliated Hospital of Army Military Medical University, Chongqing
PR China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2221-6189.244166

Rights and Permissions
  Abstract 


Objective: To estimate the incidence and related risk factors of sepsis between road traffic injuries (RTIs) and non-RTIs. Methods: Clinical data of 339 patients with severe trauma who were admitted into ICU in both Third Affiliated Hospital of Army Military Medical University and ChongGang General Hospital from January 2012 to December 2015 were retrospectively analyzed. Twenty items of potential risk factors affecting sepsis were evaluated by univariate and multivariate Logistic Analysis with the purpose of drawing a comparison between RTI patients and non-RTI patients. Results: There were 154 cases of RTI and 185 cases of non-RTI entering the study period. The significant independent risk factor of sepsis in RTIs was SOFA 11 (OR=4.821; 95% CI=1.901-12.226; P=0.001). The significant independent risk factors of sepsis in non-RTIs were SOFA 11 (OR=12.410; 95% CI=2.559-60.185; P=0.002), tracheal intubation (OR=8.913; 95% CI=2.322-34.206; P=0.001), APACHE II 15 (OR=3.684; 95% CI=1.750-7.753; P=0.001). Conclusions: The clinical medical personnel should not give equal treatment to RTI patients and non-RTI patients admitted in ICU in that factors predicting sepsis within above two groups are different. The sample volume should be increased and validated in further prospective research.

Keywords: Road traffic injuries, Non-road traffic injuries, Severe trauma, Sepsis, Risk factors


How to cite this article:
Ma XY, Jin HJ, Cheng SW, Tang WQ, Ma W, Luo L, Yang X, Wang Q, Wang B, Liang HP. Comparison of risk factors associated with sepsis between road traffic injuries and non-road traffic injuries in ICU patients with severe trauma. J Acute Dis 2018;7:191-6

How to cite this URL:
Ma XY, Jin HJ, Cheng SW, Tang WQ, Ma W, Luo L, Yang X, Wang Q, Wang B, Liang HP. Comparison of risk factors associated with sepsis between road traffic injuries and non-road traffic injuries in ICU patients with severe trauma. J Acute Dis [serial online] 2018 [cited 2022 Dec 3];7:191-6. Available from: https://www.jadweb.org/text.asp?2018/7/5/191/244166

Funding: This study was supported by the National Nature Science Foundation of China (NSFC, No. 81671906), National Natural Science Foundation of China (81860347), Hainan Provincial Natural Science Foundation of China (818MS140),Young Talents' Science and Technology Innovation Project of Hainan Association for Science and Technology (QCXM201816) and Hainan Provincial health and family planning commission project (18A200178).





  1. Introduction Top


According to the World Health Organization report, adverse outcomes following severe trauma will be the primary causes threatening human health especially in developing countries by 2020[1]. The pattern of severe trauma patients admitted in Intensive Care Unit (ICU) mainly consist of road traffic injury (RTI), which are predominant over other injury causes, followed by high falling injury, blunt force injury, sharp injury and other types[2]. A disproportionate higher health burden of RTIs occurs in low and middle income countries, while a lower rests on high income countries[3]. Nearly 1.2 million people die owing to road traffic accidents and additional 20-50 million people struggle for existence on non-fatal injuries from road trauma every year[4]. Most studies of risk factors after RTIs have been limited to some aspects associated with the severity and prevalence of road traffic injuries, such as the age of driver (>65 years old), drivers' road safety knowledge (primary), geographic location of residence, weather conditions, etc[5],[6],[7],[8],[9]. There are also some researches concentrated on risk factors of mortality in RTI patients with various poor outcomes, commonly seen in acute respiratory distress syndrome (ARDS), post-traumatic acute lung injury, etc[10],[11]. Given that the incidence of wound infection/nosocomial infection and sepsis is higher in the post-traumatic pathologic process, however, determinants of infection or sepsis after RTIs among severe trauma patients are limited[12],[13]. We, therefore, evaluated the independent risk factors related to sepsis in RTI patients admitted ICU and drew a comparison between RTIs and non-RTIs further. To such an extent, identification of distinctive risk factors among two groups that targeted prevention can be implemented in the subsequent process of clinical diagnosis and treatment.


  2. Materials and methods Top


2.1. Sites and patients

Clinical data of 339 patients with severe trauma who were admitted into ICU in both Third Affiliated Hospital of Army Military Medical University and ChongGang General Hospital between January 2012 and December 2015 were retrospectively collected. There were 154 cases of RTI and 185 cases of non-RTI. The criteria of cases selection for these severe trauma patients had were as follows: age ⩾16 years; the time of initial treatment achieved in hospital within 24 h; the length of ICU stay ⩾48 h; Injury Severity Score ⩾16; without coexisting illness. Patients who abandoned treatment or requested to transfer to another hospital were excluded. Patients were divided into two groups of RTIs including 57 infections cases of sepsis and 49 infections cases of non-sepsis. Patients were divided into two groups of non-RTIs including 71 infections cases of sepsis and 50 infections cases of non-sepsis. Non-RTI patients were comprised of 97 cases of high falling injuries, 37 cases of blunt instrument injuries, 29 cases of sharp instrument injuries and 22 cases of other types. Data of 339 patients' demographic characteristics, injury severity, common scoring systems in ICU, blood biochemical indices and identification of infectious bacteria were collected at the time of ICU admission. In addition, bacterial culture in sputum, blood, drainage liquid, cerebrospinal fluid, wound secretion, ascites, hydrothorax, urine and catheter were positive, which was identified as infection[14]. A suspicion of sepsis according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) was composed of infection and Sequential Organ Failure Assessment (SOFA) ⩾2 simultaneously[15]. The study was approved by the Third Affiliated Hospital of Third Military Medical University (Daping Hospital, Chongqing, China) Ethics and Research Committee (Clinical trial registration number of ChiCTR-TRC-14005119).

2.2. Risk factors

The following 20 potential risk factors associated with sepsis both in RTIs and non-RTIs were selected: (1) red blood count (RBC); (2) packed cell volume (PCV); (3) platelets (PLTs); (4) albumin; (5) carbamide; (6) international normalized ratio (INR); (7) blood FIO2; (8) blood pH; (9) prothrombin time (PT); (10) thrombin time; (11) Glasgow Coma Scale (GCS); (12) Acute Physiology and Chronic Health Evaluation II (APACHE II), grouped as <15 or ⩾15; (13) SOFA, grouped as <6, 6-10 or ⩾11; (14) New Injury Severity Score (NISS), grouped as <16, 16-25 or ⩾26; (15) gender; (16) tracheal intubation; (17) central vena catheterization (CVC); (18) shock on admission; (19) the number of injured area; (20) the degree of wound contamination (small wounds only involved in the epidermis or dermis, such as scratches, which were defined as 1; full-thickness wounds with raw surface or larger open wounds, such as fractures, which were defined as 1.5; severe penetrating wounds or compound wounds accompanied by obvious contaminants, such as dust or sediment, which were defined as 3). The first 14 items were measured and calculated during the first 24 hours after ICU admission.

2.3. Statistical analysis

Data within two groups was statistically compared by Student's t test for continuous variables and chi-square test for categorical variables. Variables presenting significant differences between above two groups in univariate comparison were entered in stepwise Logistic regression analysis. Entry and removal probabilities for the stepwise procedure are 0.15 and 0.05 respectively. Goodness of fit in the regression model was evaluated by the Hosmer-Lemeshow test (P<0.05). Adjusted ORs with 95% CI were calculated. All analyses in this paper were performed by SAS 9.3. A two-side P value < 0.05 was considered to be statistically significant.


  3. Results Top


There were 339 cases of severe trauma patients admitted in ICU in this retrospective study. Sepsis occurred in 57 infections cases in RTI group and 71 infections cases in non-RTI group, while non-sepsis occurred in 49 infections cases and 50 infections cases respectively in above two groups. There was also no significant difference in the incidence of sepsis between RTIs and non-RTIs (37.01% vs. 38.37%; P=0.882). It did not show significant difference in demographic characteristics and baseline clinical data of patients between RTI group and non-RTI group [Table 1]. A total of 37.01% (n=57) had developed sepsis in RTI group. Statistically significant unadjusted ORs among RTI patients in sepsis were associated with SOFA (OR=3.005; P=0.001), the degree of wound contamination (OR=2.151; P=0.038), INR (OR=3.437; P=0.031), PT (OR=3.369; P=0.039), PCV (OR=3.343; P=0.011), PLT (OR=1.121; P=0.025), RBC (OR=2.312; P=0.030), blood FIO2 (OR=1.841; P=0.023) and blood pH (OR=3.431; P=0.007) [Table 2]. The significant independent risk factor of sepsis in RTIs was SOFA 11 (OR=4.821; 95% CI=1.901-12.226; P=0.001). A total of 38.37% (n=71) had developed sepsis in non-RTIs. Statistically significant unadjusted ORs among non-RTI patients in sepsis were associated with albumin (OR=1.741; P=0.034), carbamide (OR=2.835; P=0.025), APACHE Ц (OR=2.313; P=0.018), SOFA (OR=3.228; P=0.001), tracheal intubation (OR=4.410; P<0.001), CVC (OR=3.230; P=0.027) and shock on admission (OR=3.382; P=0.014) [Table 3]. The significant independent risk factors of sepsis in non-RTIs were SOFA 11 (β=2.519, OR=12.410; 95% CI=2.559-60.185; P=0.002), tracheal intubation (β=2.188, OR=8.913; 95% CI=2.322-34.206; P=0.001), APACHE II 15 (β=1.304, OR=3.684; 95% CI=1.750-7.753; P=0.001).
Table 1: Demographic characteristics of 339 patients during ICU stay.

Click here to view
Table 2: Unadjusted odds ratios for potential risk factors associated with sepsis in RTIs (n=106).

Click here to view
Table 3: Unadjusted odds ratios for potential risk factors associated with sepsis in non-RTIs (n=121).

Click here to view



  4. Discussion Top


This retrospective case-control study revealed that several risk factors associated with sepsis were different between RTI patients and non-RTI patients in ICU.

The SOFA score was not so much called sepsis-related organ failure assessment score as under the title of Sequential Organ Failure Assessment when it was also applied to evaluate the prognosis of non-sepsis patients[16]. In Southern Europe, Mbongo et al. reported that the predictive effect of Simplified Acute Physiology Score 3 on hospital mortality was superior to SOFA (AUC: 0.916 vs. 0.846, P>0.05) in adult patients admitted to ICU[17]. Nonetheless, value of SOFA in predicting ICU mortality is more satisfactory than Multiple Organ Dysfunction Score[18],[19]. In the field of trauma surgery, SOFA score can dependably describe organ dysfunction/failure and mortality as well. It showed that the non-survivors had a higher SOFA score on admission than survivors which conformed to a longer length of ICU stay[20]. With respect to the critically ill patients with severe sepsis or sepsis shock, Macdonald et al. demonstrated that SOFA score had a positive correlation with mortality of patients with severe sepsis and septic shock from emergency department[21]. It should be noted that the new definition of sepsis (Sepsis 3.0) was put forward by Professor Craig Coopersmith, chairman of the Society of Critical Care Medicine, in 2016, which mainly concentrates on organ dysfunction[12],[15]. We, therefore, evaluated the risk factors of sepsis on the basis of New Sepsis 3.0 within RTIs and non-RTIs. In the present study, as with non-RTIs (SOFA ⩾11, OR=12.41), SOFA ⩾11 (OR=4.821) was also confirmed to be a significant factor for sepsis progression in RTIs.

The difference involving the incidence of infection, sepsis, MODS, ARDS, mortality caused by sepsis and all-cause mortality between RTIs and non-RTIs, though, were not statistically significant. However, there were 97 cases of high falling injuries, 37 cases of blunt instrument injuries, 29 cases of sharp instrument injuries and 22 cases of other types of injury embracing electrical injury and animal bites in non-RTIs group, indicating that more complicated kinds of trauma than that of singular RTIs group. This important factual characteristics are perhaps an explanation for three independent predictors of sepsis (SOFA⩾11; tracheal intubation; APACHE II⩾15) in non-RTIs compared with only one factor (SOFA⩾11) correlated with the risk of sepsis in RTIs in this setting. It is recognized that there are particular disciplines associated with airway management in critical care patients with severe trauma owing to exact cardinal rule of sufficient ventilation and oxygenation[22]. For that reason, the guidelines for emergency tracheal intubation among traumatic population were updated by the Eastern Association for Surgery of Trauma Practice Management Guidelines Committee, briefly covering a ketch of the determinants of oxygenation and ventilation, the severity and mechanism of trauma, the need of surgical operation and the complication following trauma etc[23]. The tracheal intubation is believed as a high risk factor of hospital infection which can wildly induce sepsis. In our research, patients who already had tracheal intubation in ICU admission had higher risk of sepsis occurred in non-RTIs (OR=8.913). Though tracheal intubation was not included in the stepwise Logistic regression analysis of RTIs, attention should be paid to the severe traumatic patients with submental tracheal intubation as before. Sirvent et al. reported patients with head trauma who had tracheal intubation within 24 hours had an closely correlation with colonization of Staphylococcus aureus, Haemophilus influenzae or Streptococcus pneumoniae, which was identified as a risk factor for developing early-onset ventilator-associated pneumonia[24]. In addition, tracheal injuries characterized by tracheal stenosis, trachemalacia, tracheoesophageal fistula, laryngotracheal ulceration, and vocal cord paralysis from endotracheal intubation are concerned with an increasing healthcare burden[25]. If these severe patients did not receive the treatment of endotracheal intubation, they would have their lives detrimentally imperiled.

APACHE II, one of the physiologic scoring systems widely used in critically ill patients in ICU, is composed of age score, acute physiology score and chronic health evaluation score[26]. Reports have revealed that APACHE II are positively correlated with sepsis and one-month mortality of ICU critical patients and injured patients[27],[28],[29],[30],[31],[32],[33]. In this setting, APACHE II⩾15 calculated during the first 24 hours after ICU admission among patients in non-RTIs was identified as an independent predictor for sepsis (OR=3.684), which was complied with previous studies. It was a surprise that the risk factor of APACHE II⩾15 was found in non-RTI patients rather than in RTI patients in our report. Nevertheless, APACHE II⩾20 for RTI patients with ARDS acquired within 24 h in EICU stay had a definite relationship with mortality of surviving beyond 96 h (OR=2.534), but was not a risk factor of mortality in duration of mechanical ventilation beyond 7 d[11]. Similarly, APACHE II⩾20 for RTI patients with acute lung injury acquired within 24 h in EICU stay was the essential risk factor for the outcome of acute lung injury among patients who survived > 24 h (OR=3.992)[12]. The risk factor of APACHE II⩾15 emerging in non-RTI could be explained by the deficiency of clinical cases in this research. Therefore, it is needed to increase and validate the samples in further prospective study.

This study indicates that, in RTI population admitted in ICU, the SOFA score ranged from 6 to 10 might predict the outcome of sepsis in the early phase of treatment following trauma. SOFA score⩾11, tracheal intubation and APACHE II score⩾15 are significantly correlated with sepsis following non-RTI population admitted in ICU.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Acknowledgments

The author thanks ICU in both Third Affiliated Hospital of Army Military Medical University and ChongGang General Hospital.

Funding

This study was supported by the National Nature Science Foundation of China (NSFC, No. 81671906), National Natural Science Foundation of China (81860347), Hainan Provincial Natural Science Foundation of China (818MS140), Young Talents' Science and Technology Innovation Project of Hainan Association for Science and Technology (QCXM201816) and Hainan Provincial health and family planning commission project (18A200178).



 
  References Top

1.
Peden M, Scufield R, Sleet D, Mohan D, Hyder AA, Jarawan E, et al. World report on road traffic injury prevention. Geneva: WHO; 2004.  Back to cited text no. 1
    
2.
Lalwani S, Rajkumari N, Bindra A, Mathur P. Profile of fatal patients admitted to a neuro trauma critical care unit. Eur J Trauma & Emerg Surg 2015; 41(1): 65-67.  Back to cited text no. 2
    
3.
Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2197-2223.  Back to cited text no. 3
    
4.
WHO. WHO global status report on road safety 2013: Supporting a decade of action 2013. Geneva: World Health Organization; 2013.  Back to cited text no. 4
    
5.
Celik AK, Oktay E. A multinomial logit analysis of risk factors influencing road traffic injury severities in the Erzurum and Kars Provinces of Turkey. Accid Anal Prev 2014; 72: 66-77.  Back to cited text no. 5
    
6.
Waseela M, Laosee O. Determinants of road traffic injury among adult motorcyclists in Male, Maldives. Asia Pac J Public Health 2015; 27(3): 277-285.  Back to cited text no. 6
    
7.
Abu-Zidan FM, Eid HO. Factors affecting injury severity of vehicle occupants following road traffic collisions. Injury 2015; 46(1): 136-141.  Back to cited text no. 7
    
8.
Parkinson F, Kent S, Aldous C, Oosthuizen G, Clarke D. Road traffic crashes in South Africa: the burden of injury to a regional trauma centre. S Afr Med J 2013; 103(11): 850-852.  Back to cited text no. 8
    
9.
Rockett IRH, Jiang S, Yang Q, Yang T, Yang XY, Peng S, et al. Prevalence and regional correlates of road traffic injury among Chinese urban residents: A 21-city population-based study. Traffic Inj Prev 2017: 1-8.  Back to cited text no. 9
    
10.
Sheng L, Wu JS, Zhang M, Xu SW, Gan JX, Jiang GY. Analysis of risk factors associated with outcomes in road traffic injury patients with acute lung injury. J Int Med Res 2009; 37(3): 835-840.  Back to cited text no. 10
    
11.
Zhao XG, Wu JS, He XD, Ma YF, Zhang M, Gan JX, et al. Risk factors of mortality in road traffic injury patients with acute respiratory distress syndrome. Chin Med J (Engl) 2008; 121(11): 968-972.  Back to cited text no. 11
    
12.
Ma XY, Tian LX, Liang HP. Early prevention of trauma-related infection/sepsis. Mil Med Res 2016; 3: 33.  Back to cited text no. 12
    
13.
Salentijn EG, Collin JD, Boffano P, Forouzanfar T. A ten year analysis of the traumatic maxillofacial and brain injury patient in Amsterdam: Complications and treatment. J Craniomaxillofac Surg 2014; 42(8): 1717-1722.  Back to cited text no. 13
    
14.
Jordana-Lluch E, Gimenez M, Quesada MD, Rivaya B, Marco C, Dominguez MJ, et al. Evaluation of the broad-range PCR/ESIMS technology in blood specimens for the molecular diagnosis of bloodstream infections. PLoS One 2015; 10(10): e0140865.  Back to cited text no. 14
    
15.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016; 315(8): 801-810.  Back to cited text no. 15
    
16.
Vincent JL, Ferreira F, Moreno R. Scoring systems for assessing organ dysfunction and survival. Crit Care Clin 2000; 16(2): 353-366.  Back to cited text no. 16
    
17.
Mbongo CL, Monedero P, Guillen-Grima F, Yepes MJ, Vives M, Echarri G. Performance of SAPS3, compared with APACHE and SOFA, to predict hospital mortality in a general ICU in Southern Europe. Eur J Anaesthesiol 2009; 26(11): 940-945.  Back to cited text no. 17
    
18.
Khwannimit B. A comparison of three organ dysfunction scores: MODS, SOFA and LOD for predicting ICU mortality in critically ill patients. J Med Assoc Thai 2007; 90(6): 1074-1081.  Back to cited text no. 18
    
19.
Khwannimit B. Serial evaluation of the MODS, SOFA and LOD scores to predict ICU mortality in mixed critically ill patients. J Med Assoc Thai 2008; 91(9): 1336-1342.  Back to cited text no. 19
    
20.
Antonelli M, Moreno R, Vincent JL, Sprung CL, Mendoca A, Passariello M, et al. Application of sofa score to trauma patients. Sequential organ failure assessment. Intensive Care Med 1999; 25(4): 389-394.  Back to cited text no. 20
    
21.
Macdonald SP, Arendts G, Fatovich DM, Brown SG. Comparison of PIRO, SOFA, and MEDS scores for predicting mortality in emergency department patients with severe sepsis and septic shock. Acad Emerg Med 2014; 21(11): 1257-1263.  Back to cited text no. 21
    
22.
Kita R, Kikuta T, Takahashi M, Ootani T, Takaoka M, Matsuda M, et al. Efficacy and complications of submental tracheal intubation compared with tracheostomy in maxillofacial trauma patients. J Oral Sci 2016; 58(1): 23-28.  Back to cited text no. 22
    
23.
Mayglothling J, Duane TM, Gibbs M, McCunn M, Legome E, Eastman AL, et al. Emergency tracheal intubation immediately following traumatic injury: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73(5): S333-S340.  Back to cited text no. 23
    
24.
Sirvent JM, Torres A, Vidaur L, Armengol J, de Batlle J, Bonet A. Tracheal colonisation within 24 h of intubation in patients with head trauma: Risk factor for developing early-onset ventilator-associated pneumonia. Intensive Care Med 2000; 26(9): 1369-1372.  Back to cited text no. 24
    
25.
Bhatti NI, Mohyuddin A, Reaven N, Funk SE, Laeeq K, Pandian V, et al. Cost analysis of intubation-related tracheal injury using a national database. Otolaryngol Head Neck Surg 2010; 143(1): 31-36.  Back to cited text no. 25
    
26.
Giamarellos-Bourboulis EJ, Norrby-Teglund A, Mylona V, Savva A, Tsangaris I, Dimopoulou I, et al. Risk assessment in sepsis: A new prognostication rule by APACHE II score and serum soluble urokinase plasminogen activator receptor. Crit Care (London, England) 2012; 16(4): R149.  Back to cited text no. 26
    
27.
Liu X, Shen Y, Li Z, Fei A, Wang H, Ge Q, et al. Prognostic significance of APACHE II score and plasma suPAR in Chinese patients with sepsis: a prospective observational study. BMC Anesthesiol 2016; 16(1): 46.  Back to cited text no. 27
    
28.
Jiang L, Feng B, Gao D, Zhang Y. Plasma concentrations of copeptin, C-reactive protein and procalcitonin are positively correlated with APACHE II scores in patients with sepsis. J Int Med Res 2015; 43(2): 188-195.  Back to cited text no. 28
    
29.
Dabhi AS, Khedekar SS, Mehalingam V. A prospective study of comparison of APACHE-IV & SAPS-II scoring systems and calculation of standardised mortality rate in severe sepsis and septic shock patients. J Clin Diagn Res 2014; 8(10): MC09-MC13.  Back to cited text no. 29
    
30.
Desai S, Lakhani JD. Utility of SOFA and APACHE II score in sepsis in rural set up MICU. J Assoc Physicians India 2013; 61(9): 608-611.  Back to cited text no. 30
    
31.
Qiao Q, Lu G, Li M, Shen Y, Xu D. Prediction of outcome in critically ill elderly patients using APACHE II and SOFA scores. J Int Med Res 2012; 40(3): 1114-1121.  Back to cited text no. 31
    
32.
Thanapaisal C, Saksaen P. A comparison of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Trauma-Injury Severity Score (TRISS) for outcome assessment in Srinagarind Intensive Care Unit trauma patients. J Med Assoc Thai 2012; 95(Suppl 11): S25-S33.  Back to cited text no. 32
    
33.
Polita JR, Gomez J, Friedman G, Ribeiro SP. Comparison of APACHE II and three abbreviated APACHE II scores for predicting outcome among emergency trauma patients. Rev Assoc Med Bras (1992) 2014; 60(4): 381-386.  Back to cited text no. 33
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  2. Materials and...
  In this article
Abstract
1. Introduction
3. Results
4. Discussion
References
Article Tables

 Article Access Statistics
    Viewed2608    
    Printed215    
    Emailed0    
    PDF Downloaded305    
    Comments [Add]    

Recommend this journal