Multicenter Study of Optimal Management Strategy in Severe Multiple Trauma

Abstract

the aim of the study. The development of a triage system to implement proper treatment based on severity of injury. Material and methods. The study is based on material from three Polish Universities' trauma departments: Cracow, Lublin, and Gdańsk. Using trauma scales, 300 of the most severely injured multiple trauma (MT) patients from 2000-2004 have been chosen for this study. Medical documentation was carefully analysed, particularly the time and extent of the surgical procedures performed as well as their potential to influence later results. Results. There are three groups of patients: 1 -critically injured, with an ISS>50, LSo>15, RTS 3 pts, two body cavity involvement, multiple long bone and/or pelvis fractures. only damage control was allowed and the definitive treatment necessary was within 48 hours. 2 -severely injured, with an unstable ISS 35-50, LSo 10-15, RTS 4-10 pts, one body cavity involvement, multiple long bone and/or pelvis fractures. Life-saving operations were possible with orthopaedic management (within 48 hours) provided using the "2+2 rule" (less than 2 hours of operation and no more than 2 units of blood transfused). 3 -moderately injured, with a stable ISS<35, LSo<10, RTS>10 pts, one body cavity involvement, a long bone or pelvis fracture. Classic surgical and orthopaedic management occurred within 48 hours. Conclusions. The history and course of post-traumatic syndrome from metabolic, immune and endocrine viewpoints requires a special strategy for repairing life -threatening trauma injures at the right time, in proper sequence, and with limited surgical activity in more severe cases. Key words: multiple trauma, damage control, inflammatory response, emergency thoracotomy, abbreviated laparotomy Despite considerable progress in medical sciences and profound changes in the organization of emergency services within the past quarter of a century, severe multiple trauma continues to be a major problem in traumatology with the associated mortality rates exceeding 10% in the best centers worldwide. According to recent reports, the most common causes of posttraumatic deaths in hospitals (>30-50% of all fatal outcomes) are late complications of a severe traumas and post-traumatic shock, including septic complications and multi-organ failure (MoF). Severe primary injuries of the central nervous system and exsanguinations continue to be the main causes of death (50-70%), at the site of the accident, in an ambulance (i.e. in the pre-hospital period), and during the first hours of hospitalization (1).Thus, we are witnessing continued progress in reaching the injured victims as quickly as Unauthenticated Download Date | 5/11/18 3:46 AM

The effect of ethyl alcohol on the severity of injuries in fatal pedestrian victims of traffic crashes

“…In other words, the older the casualty is, the less severe injury may lead to their death. Therefore, age, like gender, as a risk factor for a crash, is also a »moderator« of its consequences when other demographic factors diminish in importance" [32]. The influence of age upon the outcome of injury treatment is mainly connected with the presence of various age-related diseases as well as with the difference in the response of the organism to trauma, which numerous authors describe and highlight in their works.…”