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PubMed2001

[Specialized surgical care of severe mechanical multiple trauma].

The authors share their experiences with diagnosing and surgical treatment of 1792 patients with mechanical combined traumas. The average age of the patients was (31.6 +/- 1.4) years. All the patients were divided into two groups according to the medico-diagnostic methods. The traditional methods of diagnosis and treatment were used in 811 patients of the first group. Complications took place in 39.2%, lethality was 28.4%. The diagnosis in 981 patients of the second group included an ultrasound investigation, computed tomography, videothoraco- and laparoscopy. The surgical treatment was based on the objective multifactorial assessment of the trauma severity and determination of the prognosis criteria. Complications developed in 24.8% of the patients. Lethality was 19.5%.

Abdominal Injuries↗
PubMed1991

[Evolution of the assessment of diagnosis of multiple trauma patients and orientation in emergency care].

Emergency care is estimated on the basis of experience at Tours University Hospital (20,000 emergencies per year). The study deals with adult patients with multiple injuries in relation to the overall activity of the department, from 1981 to 1989. The accuracy of the diagnosis and the severity criteria are essential parameters for an exploitable study. The analysis of the surgical parameters shows an overall increase in the severity of bone and visceral injuries. The overall increase from 157,686 surgical unit codes (proportional to the complexity of the operation) in 1981 to 601,109 in 1988 markedly exceeds the increase in the number of patients, from 16,404 to 22,608. Out of about 4,000 emergent operations per year, 12% involve patients with multiple injuries. The consequence of the fourfold increase in these individual treatments, especially in light surgery and surgery with a stay in hospital not exceeding 24 hours, is a sixfold increase in biological examinations and a threefold increase in radiological examinations. The cost of care in the Emergency Department makes up to 1% of the general budget of the hospital. In order to achieve a valuable control of these structures, a permanent participation of the upstream (SAMU-Emergency Medical Assistance Department) and downstream (specialist departments) medical teams is essential, in order to properly assess the diagnostic and therapeutic performances and to obtain the best possible fit between the complete evaluation of the lesions and the minimum costs.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergencies↗
PubMed2000

One-day surgery in multiple trauma patients.

The aim of the authors was evaluation of influence of progress in MT procedures, particularly on final results of treatment, with special attention to aggressive one-day surgery, including definitive orthopaedic operations. The study is based on own material from the 2-nd Department of Surgery of the Jagellonian University. From almost 3000 victims of accidents with multitrauma (MT), who were treated between 1968 and 1997, 932 patients were selected. They were treated in consecutive 2-year periods in a 5-year cycle, starting from 70/71 up to 95/96. From 1987, the patient material has been prospectively coded. A steadily growing number of MT patients were stated with the only exception in 85/86 period. Traffic accidents were the major cause of injuries in over 2/3 of victims and men were predominated. Time lapse from accident to arrival became shorter. Severity of injuries was growing steadily as well: from 21.55 to 26.17 points of ISS (Injury Severity Score). At the same time percentage of operated increased from 34.88 to 47.62, and length of stay decreased from 23.45 to 19.79 days. The most significant finding, however, was the fact that deep-set objective increase of trauma severity, mortality rate decreased twofold--from 29.07% at the beginning to only 14.85% at the end. The improvement resulted from progress in diagnosis and treatment of MT patients. Implementation of diagnostic peritoneal lavage, refurbishing of our intensive care unit, installment of computed tomography in the cases of head injuries, gradual introduction of early stabilisation of major fractures and routine early anticoagulant prophylactic and hyperalimentation as well as full standardisation of the therapeutic process--all these were the "mile-stones" which assured reaching such satisfactory results.

Abdominal Injuries↗