Character and Frequency of Complications in Patients With Polytrauma and Chronic Alcohol Intoxication

Abstract

Purpose. Identify patterns of traumatic disease and characterize complications in patients with polytrauma (PT) and chronic alcohol intoxication (CAI).
 Materials and methods. Case histories of 39 victims with PT and alcohol history at age 19-60 years who were undergoing treatment at the Prof. Meshchaninov Kharkov City Clinical Emergency Hospital in 2016. Patient inclusion criteria: age 19-60, damage of two or more anatomical functional areas, severity of traumatic injury on the ISS scale 9-25 points, Glasgow coma scores ≥14 at the time of admission, absence of craniocerebral trauma, the absence of general anesthesia.
 Results. The average age of patients was 37.4 ± 9.4 years. Among these groups of patients were 29 men (74%), which is 2.9 times the number of women 10 (26%). Attention is drawn to the fact that the most important part of the victims (28.2%) was precisely the patients of the young able-bodied age. Infectious complications that developed in the early and late period of traumatic disease in victims with CAI are the main causes of death in PT - patients and induce a negative prognosis for survival. During analyzing the timing of the development of purulent-septic complications in this group of patients, we came to the conclusion that they occur on average at 7.2 ± 2.4 days. Among the infectious complications of PT in patients with CAI were pneumonia (28.2%), sepsis (7.6%), peritonitis (7.6%), pleural empyema (5.1%), osteomyelitis (5.1%). Non-infectious complications, in contrast to infectious, manifested from the first hours of injury and reached maximum development during the period by 2.3 ± 0.8 days, they were the main trigger for the development of severe infectious complications in the early period of traumatic disease. Noninfectious complications were consisted by delirium - in 29 patients, which increased the patients duration at intensive care unit on 39,6 ± 5 3 hours. These complications significantly increased the severity of the PT patients with CAI. With a higher incidence, it occurred in hyperactive, (62%) patients with delirium, and mixed (38%) form. Attention is drawn to the fact that patients with fatal outcome (29 cases), delirium was observed significantly more frequently (χ2 to include Yeats = 3.641, p <0.05) was found in 25 patients. Less frequently in patients occurred thrombosis 5(12.8%) and fat embolism syndrom 2 (5.1%).
 Conclusions. Most often, multiple injuries with history of alcohol use are obtained by young working aged men. The cause of injury in more than 60% of cases is accidents. 82% of the victims were in the state of alcohol intoxication during their hospitalization. On average, the terms of stay of patients with ICU are 64.9 ± 23.7 hours, although with the development of complications, these terms increase to 103.2 ± 14.2 hours. In patients with CAI there is a complicated course of traumatic disease. Among the infectious complications that develop at 7.2 ± 2.4 days, pneumonia, sepsis and peritonitis predominate. The most common non-infectious complications were delirium, thrombophlebitis thrombosis, fat embolism. Risk of fatal outcome in patients with delirium in 6.25 times higher than in patients without acute encephalopathy. Thus, the treatment of patients with a history of with polytrauma and chronic alcohol intoxication is an extremely important medical problem that needs further study and improvement.