Thursday, 16 February 2012

score "A" for your journal - 'The title of the journal that I chose is ‘Epidemiology and Risk Factors of Sepsis after Multiple Trauma’

The objectives of this study were
1) To assess potential changes in the incidence and outcome of sepsis after multiple trauma in Germany between 1993 and 2008 and
2) To evaluate independent risk factors for posttraumatic sepsis.

Retrospective analysis of a nationwide, population-based prospective database, the Trauma Registry of the German Society for Trauma Surgery.

- A total of 166 voluntarily participating trauma centers (levels I–III).

Patients registered in the Trauma Registry of the German Society for Trauma Surgery between 1993 and 2008 with complete data sets who presented with a relevant trauma load (Injury Severity Score of ≥9) and were admitted to an intensive care unit (n = 29,829).

Measurements and Main Results:
 -Over the 16-yr study period, 10.2% (3,042 of 29,829) of multiply injured patients developed sepsis during their hospital course. Annual data were summarized into four subperiods: 1993–1996, 1997–2000, 2001–2004, and 2005–2008. The incidences of sepsis for the four subperiods were 14.8%, 12.5%, 9.4%, and 9.7% (p < .0001), respectively. In-hospital mortality for all trauma patients decreased for the respective subperiods (16.9%, 16.0%, 13.7%, and 11.9%; p < .0001). For the subgroup of patients with sepsis, the mortality rates were 16.2%, 21.5%, 22.0%, and 18.2% (p = .054), respectively. The following independent risk factors for posttraumatic sepsis were calculated from a multivariate logistic regression analysis: male gender, age, preexisting medical condition, Glasgow Coma Scale score of ≤8 at scene, Injury Severity Score, Abbreviated Injury ScaleTHORAX score of ≥3, number of injuries, number of red blood cell units transfused, number of operative procedures, and laparotomy.

-The incidence of sepsis decreased significantly over the study period; however, in this decade the incidence remained unchanged. Although overall mortality from multiple traumas has declined significantly since 1993, there has been no significant decrease of mortality in the subgroup of septic trauma patients. Thus, sepsis has remained a challenging complication after trauma during the past 2 decades. Recognition of the identified risk factors may guide early diagnostic workup and help to reduce septic complications after multiple traumas.


- Several factors have been recognized to substantially contribute to impaired outcomes after severe injury, but sepsis is one of the most significant in patients who survive initial trauma resuscitation since it represents the leading cause of death in noncardiac intensive care units (ICUs).  However, while overall mortality from multiple traumas has gradually decreased in western countries over the past few decades, there is only limited information on the development of sepsis in injured patients over recent years. Epidemiologic data from the United States have shown a general decrease in the incidence of sepsis; however, comparable European investigations do not exist. In addition, independent predictors for sepsis during trauma-associated hospitalization are debated controversially. Several authors have reported that the transfusion of allogenic blood during trauma resuscitation is associated with the systemic inflammatory response syndrome and infection In a large trauma study, Osborn et al identified the Injury Severity Score (ISS), the Revised Trauma Score, the Glasgow Coma Scale (GCS) score, comorbidities, and male gender as predictors for posttraumatic sepsis but were not able to adjust for transfusion or other therapy-related variables. Therefore, using a large multicenter population-based trauma registry, the aims of the present study were
1.    To investigate the incidence and outcome of sepsis after multiple trauma and potential temporal changes since the establishment of the database in 1993 and
2.   To identify independent risk factors for sepsis after multiple traumas.


'The title of the journal that I chose is ‘Epidemiology and Risk Factors of Sepsis after Multiple Trauma’

I think the title is specific enough. It clearly shows the main objective or purpose of the study. This shows that the writer able to give clear understanding about the main point in this article. According to my view, the arrangement of the sentence should be changed to attract the readers to view it. The title of plays an important role in each component of research papers.

- This part contain brief summary of the contents papers. This is used to define the problem, to describe methodology, to summarize result and state conclusion of research paper. Although the abstract is a bit long but it fulfills the needs in abstract. The abstract should be explained in simple ways and make readers attracted with it. Arrangement of words should be more systematic to capture the attention of the readers.

- In this section, the author describes the recent research about mortality after multiple traumas.  In this paper, the researcher explains about posttraumatic sepsis that happens after trauma. He clearly explain the title of this paper which involving the main factor of multiple trauma that is sepsis. It also describes the different between several author case study and he clearly acknowledge the existence of other author name from previous research conducted that he use to compare with this paper. The researcher best describe the aim of this study because the aim will act as a target and give a reader brief idea regarding the author expectation.

- There is no specific column for literature review part. The researcher combines it with methodology.

- The method section is a major strength of the study. The author describes the process and the way the work was done not in a detail form. It describes how the work setting but does not describe what procedure was performed to collect the data. This study used a chi-square test to compare two researches. This design is appropriate to the researcher aim and because it involves observation and analysis of more than one statistical variable at a time. The strength of the analysis is it performs trade studies across multiple dimensions while taking into account the effects of all variables on the responses of interest. The data are collected prospectively and are structured into four consecutive time phases:
  •        Pre hospital phase
  •        Emergency room and initial treatment until ICU admission
  •       ICU
  •         Discharge and list of injuries and interventions. 
The author combines the literature review with the methodology which makes the part not systemic. The result shows in form of table and not easily understood. The researcher also provides description of data analysis in quit details. The author use bar chart to produce brief statistic for the study.

- Findings were accurately presented. In this paper, there is four tables represent the findings of this study. Each of the table represents different analysis for genders as factors of incidence sepsis, analysis of different years of the incidence and mortality for post trauma. But the author does not provide bar chart for table four which the author just explaining in simple way. So, the author does not meet the requirement of this part. For each tables it comes with simple explanation which make it easier to understand. The author does not represent the result with a complete calculation technique.  The result is hard to understand as the author use decimal in presented it

- The author describes well in the discussion part. He showed discussion regarding the both aim that he claimed early in this paper. He explained well as the author divide into three about the incidence, outcomes and risk factors. This part show the author clearly describes the result. The researcher has strengthened his report by identifying the study limitation and shows the outcome of the study. In my opinion, the researcher should simplify but pack for his discussion to make readers attracted in reading his paper and for easy understanding.

- For this part the author meet the requirement needs which he simplify the aim of the study in the best way. The author shows the overall result and makes the study as a challenge as no prevention plan was made. In this part the author suggest the prevention method rather than giving any suggestion.

- All references in this journal are been cited in APA style but it should be listed according to an alphabetical order.

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