Predictors of death in seriously injured patients

Abstract

The purpose of the study. To analyze the structure of the incoming flow in conditions of conducting large-scale military operations at the stage of emergency specialized surgical care and to determine the predictors of an unfavorable outcome in patients with severe combined wounds. Materials and methods. A retrospective cohort study of medical data was performed in seriously wounded during a special military operation who were admitted to the department of anesthesiology, intensive care and intensive care of a level 3 military medical organization with severe combined wounds and trauma in 45 seriously wounded. Depending on the outcome of treatment, the seriously injured and injured were divided into 2 groups: survivors (n=30, 66.6%) and deceased (n=15, 33.4%) within a 30-day period from the moment of injury. Results. In the structure of seriously injured people in need of resuscitation, gunshot wounds predominate 84.5% (fragmentation — 95.4%, bullet — 4.6%), surgical diseases account for 7.2% of cases, closed trauma occurs in 5.1% of cases, thermal lesions — 3.2%. Combined and multiple wounds were diagnosed in 96.2% of cases. Upon admission, the predictors of death are hypothermia (p-value=0.011), the time elapsed from injury to qualified surgical care (p-value=0.035), the severity of the condition on the APACHE II scale (p-value=0.047). During treatment at the stage of emergency specialized surgical care, the predictors of death are the laboratory assessment of total bilirubin (p-value=0.006), the SOFA scale (p-value=0.015), an increase in creatinine levels (p-value=0.018), the appearance of metabolic acidosis (p=0.022), an increase in the dose of norepinephrine (p-value=0.015).value=0.033), as well as an increase in potassium levels (p-value=0.041). Conclusion. The result of the study showed a high frequency of combined injuries admitted to the OARIT. The predictors of an unfavorable outcome at admission were hypothermia; the time elapsed from the moment of injury to the provision of qualified surgical care; the severity of the condition on the APACHE II scale. And during intensive therapy, the predictors were: an assessment on the SOFA scale, an increase in creatinine levels, total bilirubin, potassium levels and metabolic acidosis.