Analysis of causes and risk factors of lethality of ingured persons with abdominal trauma

2021 ◽  
Vol 42 (2) ◽  
pp. 64-68
Author(s):  
M. О. Gogiya ◽  
Keyword(s):  
Abdominal Trauma ◽  
Injury Severity ◽  
Craniocerebral Trauma ◽  
Severe Trauma ◽  
City Council ◽  
Hospital Treatment ◽  
Care Hospital ◽  
Skeletal Trauma ◽  
Concomitant Injuries ◽  
Results Of Treatment

The study was carried out on the basis of the polytrauma department of the KNP “Municipal Clinical Emergency and Critical Care Hospital named after O. I. Meshchaninov” of Kharkiv City Council. O. I. Meshchaninov” of the Kharkiv City Council. The initial data, results of treatment of 240 victims and their dependence on peculiarities of trauma and peculiarities of victims with abdominal trauma were analysed. Patients with concomitant abdominal trauma predominated in the structure of the injured — 178 (74,2 %), including concomitant injuries of one anatomofunctional area (AFA) in 80 (33,3 %), two AFA– in 67 (27,9 %), and three AFA– in 31 (12,9 %) patients. Isolated abdominal trauma was diagnosed — in 62 (25.9 %) patients. In addition to abdominal injuries, the majority of patients had injuries of other localisations: thoracic trauma — in 129 (53.8 %) patients, skeletal trauma was found — in 96 (40 %) patients, craniocerebral trauma — in 84 (35 %) patients. During in-hospital treatment, 34 (14.2 %) victims died. In the acute period of trauma (1–7 days) 12 (35 %) victims died, including 5 cases within the first day. Lethality was found to increase with the number of injured ASOs, from 4.8 % for isolated abdominal trauma to 41.9 % for additional trauma, thoracic and skeletal trauma (χ2 = 27, 791, p < 0.001), and an increase in injury severity from 7.7 % to 6.7 % for mild to moderately severe trauma to 58.8 % for extremely severe trauma (χ2 = 34.342, p < 0.001) as well as the severity of individual injuries. An increase in lethality was also found with increasing age of the victims and in the presence of increased weight and obesity.

scholarly journals Structure of abdominal injury and its consequences

2021 ◽  
Keyword(s):  
Abdominal Trauma ◽  
Road Traffic ◽  
Abdominal Cavity ◽  
Craniocerebral Trauma ◽  
Premature Death ◽  
City Council ◽  
Hospital Treatment ◽  
Non Profit ◽  
Results Of Treatment ◽  
Working Age

Introduction. Mechanical injuries are a leading cause of disability and premature death among the working-age population in most countries worldwide. Injuries to the abdominal and retroperitoneal organs (abdominal trauma) significantly aggravate the course of trauma and are a frequent cause of death. The aim of the study was to analyse the structure and outcome of the treatment of abdominal trauma victims. Materials and methods. On the basis of the polytrauma department of the municipal non-profit enterprise «Municipal clinical hospital of emergency and urgent medical care named after A. I. Meshchaninov» of Kharkiv City Council councilаnalysis damage structure and the results of treatment of 240 patients with abdominal trauma were carried out, the main causes of lethal outcomes were determined. Results. Most of the patients with abdominal trauma were male (78,7%), and they were young (18 to 44 years old) (72,5 %). The cause of injury in 95 (39.6 %) victims was road traffic accident, in 58 (24.2 %) – catatrauma; in 65 (27.1 %) – domestic injury. In the abdominal cavity, parenchymatous organs (spleen and/or liver) were injured most frequently, identified in 66.7 % of victims. In 26.3 % of patients revealed damage to the small or large intestine, in some cases, trauma to the stomach and gallbladder was detected. In 37 (15.4 %), mesenteric injury was detected, and in 32 (13.3 %), omental injury was detected. Among retroperitoneal organs the renal trauma was frequent – 46 (19.2 %), pancreatic and urinary bladder injuries were revealed in 27 (11.2%) and in 13 (5.4%) cases, retroperitoneal haematoma was revealed in 63 (26.7 % ) victims. In 178 (74.2 %) victims a combined trauma was diagnosed: thoracic in 129 (53.8%) cases, skeletal in 96 (40 %), craniocerebral in 84 (35 %). Combined injuries of one anatomofunctional region were diagnosed in 80 (33.3 %), two in 67 (27.9 %), and three in 31 (12.9 %) victims. During in-hospital treatment, 34 (14.2 %) victims died, of which 12 (35 %) during the first week after injury. The duration of inpatient treatment for the victims who were discharged was 15.0 [12.0; 25.0] beds/day. The causes of mortality and prolonged hospitalization (more than 14 days) in most cases were cardiovascular, respiratory, purulent-septic and renal complications. Conclusion. Abdominal parenchymal injuries predominate in the structure of abdominal trauma, occurring in 66.7 % of victims. Combined (thoracic, skeletal and/or craniocerebral) trauma occurs in 74.2 % of victims. The fatality rate for isolated abdominal trauma was 4.8 %, with a significant increase in cases of combined trauma, up to 41.9 % for combined thoracic, skeletal and craniocerebral trauma.

scholarly journals Use of Innovative Technologies in the Treatment of Patients with Severe Concomitant Injury with Liver Damage: Clinical Observation

2021 ◽  
pp. 61-63
Author(s):  
A.E. Voynovsky ◽  
◽  
I.A. Semenenko ◽  
A.S. Kuptsov ◽  
◽  
...  
Keyword(s):  
Liver Damage ◽  
Abdominal Trauma ◽  
Clinical Observation ◽  
Damage Control ◽  
Severe Trauma ◽  
Nonoperative Treatment ◽  
Concomitant Injuries ◽  
Innovative Technologies ◽  
Bleeding Management ◽  
Severity Of Injury

Liver injury is one of the most common abdominal injuries in patients with severe trauma. A total of 2988 patients with concomitant injuries were treated at the city clinical hospital named after S.S. Yudin during the period from 2010 to 2020, of which 371 (12.4%) were found to have closed abdominal trauma. Damage to the liver was revealed in 124 (33.4%) patients with closed abdominal trauma. The number of discharged patients was 78 (62,9%), lethal outcome — 46 patients (37,1%). The severity of injury according to ISS was (38,1±11,3) points. The development of innovative multimodal approaches, such as endovascular trauma and bleeding management (EVTM), as well as damage control tactics have significantly increased the likelihood of nonoperative treatment for individual patients. A clinical observation is presented that allows to evaluate the effectiveness of innovative technologies in the treatment of patients with severe concomitant trauma with liver damage.

scholarly journals Acromioclavicular and sternoclavicular joint dislocations indicate severe concomitant thoracic and upper extremity injuries in severely injured patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
M. Sinan Bakir ◽  
Rolf Lefering ◽  
Lyubomir Haralambiev ◽  
Simon Kim ◽  
Axel Ekkernkamp ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Injury Severity ◽  
Severe Trauma ◽  
Severely Injured ◽  
Body Parts ◽  
Concomitant Injuries ◽  
Joint Dislocations ◽  
Standardized Treatment ◽  
Extremity Injuries ◽  
Injured Patients

AbstractPreliminary studies show that clavicle fractures (CF) are known as an indicator in the severely injured for overall injury severity that are associated with relevant concomitant injuries in the thorax and upper extremity. In this regard, little data is available for the rarer injuries of the sternoclavicular and acromioclavicular joints (SCJ and ACJ, respectively). Our study will answer whether clavicular joint injuries (CJI), by analogy, have a similar relevance for the severely injured. We performed an analysis from the TraumaRegister DGU (TR-DGU). The inclusion criterion was an Injury Severity Score (ISS) of at least 16. In the TR-DGU, the CJI were registered as one entity. The CJI group was compared with the CF and control groups (those without any clavicular injuries). Concomitant injuries were distinguished using the Abbreviated Injury Scale according to their severity. The inclusion criteria were met by n = 114,595 patients. In the case of CJI, n = 1228 patients (1.1%) were found to be less severely injured than the controls in terms of overall injury severity. Compared to the CF group (n = 12,030; 10.5%) with higher ISS than the controls, CJI cannot be assumed as an indicator for a more severe trauma; however, CF can. Concomitant injuries were more common for severe thoracic and moderate upper extremity injuries than other body parts for CJI. This finding confirms our hypothesis that CJI could be an indicator of further specific severe concomitant injuries. Despite the rather lower relevance of the CJI in the cohort of severely injured with regard to the overall injury severity, these injuries have their importance in relation to the indicator effect for thoracic concomitant injuries and concomitant injuries of the upper extremity. A limitation is the collective registration of SCJ and ACJ injuries as one entity in the TR-DGU. A distorted picture of the CJI in favor of ACJ injuries could arise from the significantly higher incidence of the ACJ dislocation compared to the SCJ. Therefore, these two injury entities should be recorded separately in the future, and prospective studies should be carried out in order to derive a standardized treatment strategy for the care of severely injured with the respective CJI.

scholarly journals Structured and Systematic Team and Procedure Training in Severe Trauma: Going from ‘Zero to Hero’ for a Time-Critical, Low-Volume Emergency Procedure Over Three Time Periods

2021 ◽  
Vol 45 (5) ◽  
pp. 1340-1348
Author(s):  
Maryam Meshkinfamfard ◽  
Jon Kristian Narvestad ◽  
Johannes Wiik Larsen ◽  
Arezo Kanani ◽  
Jørgen Vennesland ◽  
...  
Keyword(s):  
Injury Severity ◽  
Trauma System ◽  
Severe Trauma ◽  
Emergency Procedure ◽  
Emergency Thoracotomy ◽  
Severity Scores ◽  
Time Periods ◽  
Low Volume ◽  
Time Critical ◽  
Over Time

Abstract Background Resuscitative emergency thoracotomy is a potential life-saving procedure but is rarely performed outside of busy trauma centers. Yet the intervention cannot be deferred nor centralized for critically injured patients presenting in extremis. Low-volume experience may be mitigated by structured training. The aim of this study was to describe concurrent development of training and simulation in a trauma system and associated effect on one time-critical emergency procedure on patient outcome. Methods An observational cohort study split into 3 arbitrary time-phases of trauma system development referred to as ‘early’, ‘developing’ and ‘mature’ time-periods. Core characteristics of the system is described for each phase and concurrent outcomes for all consecutive emergency thoracotomies described with focus on patient characteristics and outcome analyzed for trends in time. Results Over the study period, a total of 36 emergency thoracotomies were performed, of which 5 survived (13.9%). The “early” phase had no survivors (0/10), with 2 of 13 (15%) and 3 of 13 (23%) surviving in the development and mature phase, respectively. A decline in ‘elderly’ (>55 years) patients who had emergency thoracotomy occurred with each time period (from 50%, 31% to 7.7%, respectively). The gender distribution and the injury severity scores on admission remained unchanged, while the rate of patients with signs on life (SOL) increased over time. Conclusion The improvement over time in survival for one time-critical emergency procedure may be attributed to structured implementation of team and procedure training. The findings may be transferred to other low-volume regions for improved trauma care.

Splanchnic Hypoperfusion-Directed Therapies in Trauma: A Prospective, Randomized Trial

2005 ◽  
Vol 71 (3) ◽  
pp. 252-260 ◽  
Author(s):  
Stephen M. Cohn ◽  
Stephen M. Cohn ◽  
Orlando Kirton ◽  
Margaret Brown ◽  
S. Morad Hameed ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Injury Severity ◽  
Ischemia Reperfusion ◽  
Unit Group ◽  
Severe Trauma ◽  
Prospective Randomized Trial ◽  
Gastric Tonometry ◽  
Trauma Patients ◽  
Splanchnic Perfusion ◽  
Splanchnic Hypoperfusion

Splanchnic hypoperfusion as reflected by gastric intramucosal acidosis has been recognized as an important determinant of outcome in shock. A comprehensive splanchnic hypoperfusion-ischemia reperfusion (IRP) protocol was evaluated against conventional shock management protocols in critical trauma patients. The study was a prospective randomized trial comparing three therapeutic approaches to hypoperfusion after severe trauma in 151 trauma patients admitted to the intensive care unit. Group 1 patients received hemodynamic support based on conventional indicators of hypoperfusion. In group 2, resuscitation was further guided by gastric tonometry-derived estimates of splanchnic hypoperfusion and included more invasive hemodynamic monitoring and additional administration of colloid or crystalloid solutions, or inotropic support. Group 3 patients additionally received therapies specifically aimed at optimizing splanchnic perfusion and minimizing oxidant-mediated damage from reperfusion. The three groups were similar based on age, Injury Severity Score, and Acute Physiology and Chronic Health Evaluation II Scores. There were no statistically significant differences in mortality rates, organ dysfunction, ventilator days, or length of stay between any of the interventions. Techniques of optimization of splanchnic perfusion and minimization of oxidant-mediated reperfusion injury evaluated in this study were not advantageous relative to standard resuscitation measures guided by conventional or tonometric measures of hypoperfusion in the therapy of occult and clinical shock in trauma patients.

Evaluation of Microvascular Perfusion and Resuscitation after Severe Injury

2015 ◽  
Vol 81 (12) ◽  
pp. 1272-1278 ◽  
Author(s):  
Yann-Leei L. Lee ◽  
Jon D. Simmons ◽  
Mark N. Gillespie ◽  
Diego F. Alvarez ◽  
Richard P. Gonzalez ◽  
...  
Keyword(s):  
Injury Severity ◽  
Capillary Flow ◽  
Severe Trauma ◽  
Dark Field ◽  
Serum Lactate ◽  
Microvascular Perfusion ◽  
Trauma Patients ◽  
Sidestream Dark Field ◽  
Trauma Population ◽  
Severity Scores

Achieving adequate perfusion is a key goal of treatment in severe trauma; however, tissue perfusion has classically been measured by indirect means. Direct visualization of capillary flow has been applied in sepsis, but application of this technology to the trauma population has been limited. The purpose of this investigation was to compare the efficacy of standard indirect measures of perfusion to direct imaging of the sublingual microcirculatory flow during trauma resuscitation. Patients with injury severity scores >15 were serially examined using a handheld sidestream dark-field video microscope. In addition, measurements were also made from healthy volunteers. The De Backer score, a morphometric capillary density score, and total vessel density (TVD) as cumulative vessel area within the image, were calculated using Automated Vascular Analysis (AVA3.0) software. These indices were compared against clinical and laboratory parameters of organ function and systemic metabolic status as well as mortality. Twenty severely injured patients had lower TVD (X = 14.6 ± 0.22 vs 17.66 ± 0.51) and De Backer scores (X = 9.62 ± 0.16 vs 11.55 ± 0.37) compared with healthy controls. These scores best correlated with serum lactate (TVD R2 = 0.525, De Backer R2 = 0.576, P < 0.05). Mean arterial pressure, heart rate, oxygen saturation, pH, bicarbonate, base deficit, hematocrit, and coagulation parameters correlated poorly with both TVD and De Backer score. Direct measurement of sublingual microvascular perfusion is technically feasible in trauma patients, and seems to provide real-time assessment of micro-circulatory perfusion. This study suggests that in severe trauma, many indirect measurements of perfusion do not correlate with microvascular perfusion. However, visualized perfusion deficiencies do reflect a shift toward anaerobic metabolism.

scholarly journals Traumatic Liver Injury in Hong Kong: The Management Strategy and Outcome

2009 ◽  
Vol 16 (4) ◽  
pp. 208-216 ◽  
Author(s):  
CN Chong ◽  
YS Cheung ◽  
KF Lee ◽  
TH Rainer ◽  
BSP Lai
Keyword(s):  
Hong Kong ◽  
Liver Injury ◽  
Hospital Stay ◽  
Injury Severity ◽  
Road Traffic ◽  
Demographic Data ◽  
Operative Management ◽  
Concomitant Injuries ◽  
Significant Difference ◽  
Non Operative Management

Introduction Management of liver injury is challenging and evolving. The aim of this article is to review the outcome of traumatic liver injury in Chinese people in Hong Kong. Materials & methods Records of 40 patients with hepatic injury who received treatment at the Prince of Wales Hospital between December 2000 and May 2005 were reviewed. Demographic data, severity of liver injury, Injury Severity Score (ISS), haemodynamic status and Glasgow Coma Scale (GCS) score on admission, investigations made, concomitant injuries, management scheme, and outcome of patients were analysed. Results There were 23 male and 17 female patients with a mean age of 31.3 (SD=15.4) years. Road traffic accident was the most common injury mechanism (65%). Half of the patients were treated by non-operative management (NOM). None of them required surgery during subsequent management. Patients in the operative management (OM) group had a significantly higher ISS (p=0.026), but there was no significant difference in the mortality rate between the OM and NOM groups. Patients with stable haemodynamic status and who were treated non-operatively had a significantly shorter hospital stay (p=0.006). High grade liver injury (OR=8.0, 95% CI=1.2 to 53.8, p=0.03) and ISS greater than 25 (OR=21.6, 95% CI=2.0 to 225.3, p=0.01) were independent risk factors for mortality on multivariate analysis. Conclusions Non-operative management of liver injury can be safely accomplished in haemodynamically stable patients, with the possible benefit of a shorter hospital stay.

scholarly journals 186 Acute Kidney Injury in Skeletal Trauma Admissions to Intensive Care: An Under-Estimated Complication

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
O Brown ◽  
T Crisp ◽  
M Flatman ◽  
C Hing
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Kidney Injury ◽  
Long Bone ◽  
Trauma Patients ◽  
Skeletal Trauma ◽  
Body Regions ◽  
Intensive Care Stay

Abstract Introduction Acute kidney injury (AKI) is associated with prolonged admission and 3.5 times increased mortality for trauma patients requiring intensive care (ICU) treatment. Blunt trauma confers greater risk of AKI than penetrating trauma, potentially related to long bone fracture. The relationship between skeletal trauma and AKI in ICU has not previously been investigated. Method Retrospective data was analysed from 202 consecutive adult patients admitted to ICU with skeletal trauma from 01/06/2018 to 01/06/2019. AKI was defined by creatinine rise &gt;1.5 times baseline. Results AKI was found in 70/202 (34.65%) patients aged 16-99 years, 138 males and 64 females. Mean limb Abbreviated Injury Scale (AIS) was significantly higher in AKI (AIS= 2.57 (SD 0.53) versus non-AKI AIS=2.38 (SD 0.61), p = 0.027). Other body regions and total Injury Severity Score (ISS) were non-significant. AKI was associated with a significantly worse Glasgow Outcome Score (AKI 3.28 (SD 1.52) versus 4.02 (SD 1.08) p &lt; 0.001), increased intensive care stay (AKI 7.03 (SD 8.30) days versus non-AKI 3.8 (SD 4.1) days p &lt; 0.001) and increased 30-day mortality (AKI 18/70 (25.71%) versus non-AKI 10/132 (7.58%) p &lt; 0.001) Conclusions Skeletal trauma patients have a high incidence of AKI, which was significantly correlated with severity of skeletal limb trauma but not overall ISS.

scholarly journals A retrospective cohort study of 27,049 polytraumatized patients age 60 and above: identifying changes over 16 years

2021 ◽  
Author(s):  
Y. Kalbas ◽  
M. Lempert ◽  
F. Ziegenhain ◽  
J. Scherer ◽  
V. Neuhaus ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Descriptive Analysis ◽  
Patient Characteristics ◽  
Severe Trauma ◽  
Diagnostic Tools ◽  
Trauma Patients ◽  
Treatment Algorithms ◽  
Injured Patients ◽  
Over Time

Abstract Purpose The number of severely injured patients exceeding the age of 60 has shown a steep increase within the last decades. These patients present with numerous co-morbidities, polypharmacy, and increased frailty requiring an adjusted treatment approach. In this study, we establish an overview of changes we observed in demographics of older severe trauma patients from 2002 to 2017. Methods A descriptive analysis of the data from the TraumaRegister DGU® (TR-DGU) was performed. Patients admitted to a level one trauma center in Germany, Austria and Switzerland between 2002 and 2017, aged 60 years or older and with an injury severity score (ISS) over 15 were included. Patients were stratified into subgroups based on the admission: 2002–2005 (1), 2006–2009 (2), 2010–2013 (3) and 2014–2017 (4). Trauma and patient characteristics, diagnostics, treatment and outcome were compared. Results In total 27,049 patients with an average age of 73.9 years met the inclusion criteria. The majority were males (64%), and the mean ISS was 27.4. The proportion of patients 60 years or older [(23% (1) to 40% (4)] rose considerably over time. Trauma mechanisms changed over time and more specifically low falls (< 3 m) rose from 17.6% (1) to 40.1% (4). Altered injury patterns were also identified. Length-of-stay decreased from 28.9 (1) to 19.5 days (4) and the length-of-stay on ICU decreased from 17.1 (1) to 12.7 days (4). Mortality decreased from 40.5% (1) to 31.8% (4). Conclusion Length of stay and mortality decreased despite an increase in patient age. We ascribe this observation mainly to increased use of diagnostic tools, improved treatment algorithms, and the implementation of specialized trauma centers for older patients allowing interdisciplinary care.

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