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PubMed2005

Interhospital transportation of patients with severe lung failure on pumpless extracorporeal lung assist.

BACKGROUND: To describe the use of pumpless extracorporeal interventional lung assist (iLA) for transportation of patients with severe life-threatening acute lung failure from tertiary hospitals to a specialized centre. METHODS: Retrospective analysis in eight patients with severe lung failure requiring interhospital transport, in whom implementation of an iLA system at a tertiary hospital for air/ground transportation was performed. RESULTS: After implementation of iLA, a rapid increase in CO2-elimination (Pa(CO2) before iLA: 8.92+/-2.9 kPa, immediately after implementation: 5.06+/-0.93 kPa, 24 h after implementation: 4.53+/-1.20 kPa [mean+/-SD], P<0.05) was observed and a significant improvement in oxygenation (Pa(O2) before iLA: 6.66+/-2.26 kPa, immediately after implementation: 10.39+/-3.33 kPa, 24 h after implementation: 10.25+/-5.46 kPa, P<0.05) was noted. During transport, no severe complications occurred. Four patients died during further treatment due to multiple trauma or multiple organ failure. CONCLUSIONS: Due to ease of handling, high effectiveness and relatively low costs, iLA seems to be a useful system for treatment and transportation of patients with severe acute lung injury or ARDS suffering from life-threatening hypoxia and/or hypercapnia.

Adult↗
PubMed1998

Mortality prediction in head trauma patients: performance of Glasgow Coma Score and general severity systems.

OBJECTIVE: To assess the performance of general severity systems (Acute Physiology and Chronic Health Evaluation [APACHE] II, Simplified Acute Physiology Score [SAPS] II, and Mortality Probability Models [MPM] II) for head trauma patients and to compare these systems with the Glasgow Coma Score, in order to obtain a good estimate of severity of illness and probability of hospital mortality. DESIGN: Inception cohort. SETTING: Adult medical and surgical intensive care units in 12 European and North American countries. PATIENTS: Patients (n = 401) who were diagnosed with head trauma (with/without multiple trauma), leading to intensive care unit admission, and who were not brain dead at the time of arrival. INTERVENTIONS: Statistical analysis to assess the performance of general severity systems. MEASUREMENTS AND MAIN RESULTS: Vital status at the time of hospital discharge was the outcome measure. Performance of the severity systems (SAPS II, MPM II0 [MPM at admission], MPM II24 [MPM at 24 hrs], and APACHE II) was assessed by evaluating calibration and discrimination. Logistic regression was used to convert the Glasgow Coma Score into a probability of death. The MPM II system (either MPM II0 or MPM 1124) provided an adequate estimation of the mortality experience in patients with head trauma. SAPS II and APACHE II systems did not calibrate well, although they showed high discrimination (area under the receiver operating characteristic curve 0.95 for SAPS II, 0.94 for APACHE II, and 0.90 for MPM II0 and MPM II24). The logistic regression model containing the Glasgow Coma Score as an independent variable and developed in this group of patients was not as well calibrated as MPM II. The discrimination of this model was very high, in the range observed for the APACHE II, SAPS II, and MPM II systems. CONCLUSIONS: The MPM II system performs better than APACHE II, SAPS II, and Glasgow Coma Score for head trauma patients. If our results are supported by other studies, MPM II would be an appropriate tool to assess severity of illness in head trauma patients, with applications to clinical practice and clinical research.

APACHE↗
PubMed1983

Life events and myocardial infarction.

Life events reported to have occurred twelve months before the onset of the illness were compared in 55 in-patients who had a first episode of myocardial infarction and 55 control in-patients matched for age, sex, marital status and social class and afflicted with acute abdomen, trauma and multiple trauma. The Paykel interview for Recent Life Events was used. Myocardial infarction patients reported significantly more previous events than the control group (p less than 0.001) with more undesirable (p less than 0.01) and uncontrolled (p less than 0.01) events. Moreover, myocardial infarction patients had significantly more events (p less than 0.01) which had an "objective negative impact" (rated as being traumatic). These findings are consistent with the view that certain recent life events have a positive association with the onset of a first episode of myocardial infarction.

Adult↗
PubMed2006

Outcome from serious injury in older adults.

PURPOSE: To analyze the research published in peer-reviewed journals between 1996 and 2005 about factors affecting the physical outcomes of older adults after serious traumatic injury. ORGANIZING CONSTRUCT: Twenty-seven primary research studies published in the last 10 years pertained to in-hospital and long-term outcomes of serious injury among older adults. Research specific to isolated hip injury, traumatic brain injury, and burn trauma was excluded. METHODS: An integrative review of research published between January 1996 and January 2005 was carried out to examine the relationship between older age and outcome from severe injury. MEDLINE, BIOSIS previews, CINAHL, and PsycINFO databases were searched using the MeSH terms: injury, serious injury, trauma and multiple trauma, and crossed with type, severity, medical/surgical management, complication, outcome, mortality, morbidity, survival, disability, quality of life, functional status, functional recovery, function, and placement. FINDINGS: Older adults in these studies had higher short- and long-term mortality than did younger adults. The relationship between older age and poorer outcome persisted when adjusting for injury severity, number of injuries, comorbidities, and complications. At the same time, injury severity, number of injuries, complications, and gender each independently correlated with increased mortality among older adults. The body of research is limited by overreliance on retrospective data and heterogeneity in definitional criteria for the older adult population. CONCLUSIONS: Additional research is needed to clarify the contributory effect of variables such as psychosocial sequelae and physiologic resilience on injury outcome. The field of geriatric trauma would benefit from further population-based prospective investigation of the determinants of injury outcome in older adults in order to guide interventions and acute care treatment.

Activities of Daily Living↗
PubMed2006

Long-term outcome and quality of life of patients treated in surgical intensive care: a comparison between sepsis and trauma.

INTRODUCTION: Our aim was to determine long-term survival and quality of life of patients admitted to a surgical intensive care unit (ICU) because of sepsis or trauma. METHODS: This was an observational study conducted in an 11-bed, closed surgical ICU at a 860-bed teaching general hospital over a 1-year period (January 2003 to December 2003). Patients were divided into two groups according to admission diagnoses: group 1 included patients with sepsis; and group 2 included patients with trauma (polytrauma, multiple trauma, head injury, or spinal injury). Quality of life was assessed after 2 years following ICU admission using the EuroQol 5D questionnaire. RESULTS: A total of 164 patients (98 trauma patients and 66 patients with sepsis) were included in the study. Trauma patients were younger than patients with sepsis (53 +/- 21 years versus 64 +/- 13 years; P < or = 0.001). There was no significant difference between groups in Acute Physiology and Chronic Health Evaluation II score or length of stay in the surgical SICU. Trauma patients stayed longer on the general ward (35 +/- 44 days versus 17 +/- 24 days; P < 001). Surgical ICU survival, in-hospital survival, and post-hospital and cumulative 2-year survival were lower in the sepsis group than in the trauma group (surgical ICU survival: 60% versus 74%; in-hospital survival: 42% versus 62%; post-hospital survival: 78% versus 92%; cumulative 2-year survival: 33% versus 57%; P < 0.05). There was no significant difference in quality of life in all five dimensions of the EuroQol 5D between groups: 60% of patients had signs of depression, almost 60% had problems in usual activities and 56% had pain. CONCLUSION: Patients with sepsis treated in a surgical ICU have higher short-term and long-term mortality than do trauma patients. However, quality of life is reduced to the same level in both groups.

Adult↗
PubMed2006

[The evaluation of bicycle accidents that were admitted to a pediatric emergency department].

BACKGROUND: We planned this study to evaluate trauma cases secondary to bicycle driving in childhood and to draw attention to the importance of the regulation of traffic rules, the education of bicycle drivers, and the importance of helmet usage. METHODS: Data in this study were obtained by retrospective review of the files of trauma cases admitted to the Pediatric Emergency Unit of Trakya University Medical Faculty between January 2003 and August 2005. Patients' age, gender, clinical signs, type of injury, season of the event and percentage of hospitalization were obtained from hospital records. RESULTS: Fifteen (24.6%) of 61 cases who were admitted to our emergency unit were females and 46 (75.4%) were males. The types of trauma of all patients who suffered from bicycle accidents were as following: 42 (68.9%) head trauma, 29 (47.5%) extremity trauma, 49 (80.3%) soft tissue trauma, 2 (3.3%) abdominal trauma, and one case of urogenital trauma. Also multiple traumas were present in most of these cases. Thirteen patients had extremity fractures and three had cranial fractures. None of the bicycle drivers were using helmets at the time of the trauma. CONCLUSION: Bicycle drivers should have specific education, helmet use must become widespread and special traffic regulations have to be settled.

Accidents, Traffic↗
PubMed2005

The multiply injured child.

The treatment of multiple traumas in children requires knowledge of common injury patterns, incidence, mortality, and the consequences and differences between these injuries in children and adult patients. However, epidemiological studies concerning pediatric multiple trauma are rare. To address this, data were collected and analyzed from 682 multiple trauma patients treated at a Level I trauma center. The patients were divided into four age-related groups (< 6 years, 6-12 years, 13-18 years, and 18-40 years) and were evaluated for trauma mechanism, injury distribution, and cause of death. Children aged 6 to 17 years mostly were injured as pedestrians and cyclists whereas infants, preschoolers, and adults more commonly were injured as car passengers. Pediatric patients suffered a significantly higher mortality than adults, with a threefold increased risk of death when injured as passengers in car accidents. Injuries to the head and the legs were most common. A lower incidence of thoracic (28% versus. 62%), abdominal (20% versus 36%), pelvic (22% versus 35%), and upper limb (32% versus 43%) trauma was observed in children (< 18 years) than in adults (18-40 years). Nevertheless, trauma to the thorax, abdomen, and head were associated with a high risk of death in all groups. Spinal cord injuries, especially in the cervical region, also carried a high risk of mortality (36.8 in the group of patients younger than 18 years and 18.9 in the group of patients 18-40 years). Children younger than 6 years had the most severe head injuries. The data show that there are important differences in incidence, mortality, and injury patterns between pediatric and adult patients with multiple traumas.

Adolescent↗
PubMed1994

Gut mucosal nutritional support--enteral nutrition as primary therapy after multiple system trauma.

Over the past 10 years, several clinical and experimental studies report the potential benefit of enteral nutrition as primary therapy after multiple system trauma. In this study, 98 patients sustaining blunt and penetrating trauma were randomised to receive either enteral or parenteral feeding for 15 days. There were significantly fewer infectious complications in patients randomised to receive enteral feeding with particular benefit shown in the most severely injured patients. Serum protein concentrations correlated with the clinical outcome with an increase in constitutive protein and decrease in acute phase protein concentrations occurring in the enteral group through a decrease in septic complications and possible direct hepatic 'reprioritisation'. Enteral feeding serves as a primary therapy affecting the outcome of critically ill patients.

Adult↗
PubMed2002

Management of the burned trauma patient: balancing conflicting priorities.

PURPOSE: Approximately 5% of multiple trauma patients sustain concomitant burns. Complicated management issues arise in these patients as burn and trauma care often conflict. This study reviews 53 consecutive burned multiple trauma patients in order to examine common management conflicts and recommend appropriate compromises in caring for these difficult patients. PROCEDURE: A retrospective review of 53 consecutive burn patients with coincident trauma admitted to The Massachusetts General Hospital (MGH) from 1993-2001 was performed. FINDINGS: In the study period, 53 patients were admitted to the Massachusetts General Hospital with concomitant burns and trauma. Of this group, 42 (79%) were male. Average age was 31.5 +/- 15.0. Mechanisms included 11 motor vehicle collisions (MVC), 10 explosions, 10 electrocutions with subsequent falls, nine house fires, four motorcycle collisions (MCC), three pedestrian versus car accidents, two falls into fires, two plane crashes, and one each of a lawnmower accident and a patient drawn into a machine. Average burn size was 25.4% +/- 22.4. The most common traumatic injury was fracture (52). Management of fractures in burn patients and resuscitation in head injured burn patient represented the most common conflicts in patient care. There were five deaths (9.4%) in this series. CONCLUSIONS: Burns are a rare but significant complication in the trauma patient. Outcomes are dependent on rapid trauma evaluation as well as effective resuscitation and wound management. Given the complexities of their problems, these patients necessitate a balanced multidisciplinary approach to maximize their potential for full recovery. Thoughtful compromise between trauma and burn priorities is frequently necessary.

Adolescent↗
PubMed1977

Radioisotope diagnosis of splenic trauma.

Multiple injury or delay in seeking medical attention may prevent confident clinical diagnosis of splenic trauma. The spleen scan is a rapid, simple, noninvasive test useful in such circumstances. When peritoneal lavage is contraindicated, unrevealing, or inapproapriate, radioisotope imaging of the spleen can help confirm a suspicion of splenic injury.

Adolescent↗
PubMed1998

[Effect of primary femoral plate osteosynthesis on the course of polytrauma patients with or without thoracic trauma].

Primary intramedullary nailing of femoral fractures is well known to increase the risk of pulmonary complications, especially in multiple-trauma patients with severe thoracic injuries. Aim of this study was to investigate the influence of primary plate osteosynthesis of femur fractures on major complications after trauma. This retrospective study based on the records of 325 multiple trauma patients (Injury severity score ISS > 18, no lethal brain injury, age 16-65). According to the abbreviated injury scale of the Thorax (AIS T) patients were divided in groups without (AIS T < 3, "N") or with relevant thoracic injury (AIS T > = 3, "T"). Both groups were additionally divided in subgroups without severe trauma to the extremities (AIS E < 3, "O") or primary plate-osteosynthesis of femur fractures (< 24 h, "I"). 4 groups were performed: NO (n = 39, ISS 25 +/- 1, pneumonia 10%, ARDS 5%, lethality 10%); NI (n = 55, ISS 27 +/- 1, pneumonia 4%, ARDS 5%, lethality 4%); TO(n = 137, ISS 28 +/- 1, pneumonia 21%, ARDS 15%, lethality 16%); TI (n = 94, ISS 31 +/- 1, pneumonia 21%, ARDS 17%, lethality 15%). Primary plate-osteosynthesis of femur fractures did not increase lethality or incidence of pulmonary complications in patients with or without severe thoracic injuries. Also complication rate after primary plate-osteosynthesis was less compared to published results after intramedullary nailing. For this, primary plate-osteosynthesis is recommendable in case of multiple trauma with thoracic injuries.

Adolescent↗
PubMed1989

[Lung injuries].

Even though lungs can be injured solitarily, most of pulmonary lesions occur within the scope of multiple trauma. Because of various patho-physiological processes resulting from the multiple trauma, the valuation of extent, course and prognosis of pulmonary injuries is difficult. Depending on examined cases, mortality of thoracic injuries as stated in various references amounts to between 6 and 55%. Concerning thoracic injuries we dealt with severe traumas of the thorax. This explains the relatively high rate of thoracotomy of 17% as well as the high mortality of 34% we confirmed. Because of described variety of injuries, it is necessary for better comparison of clinical investigations to specify the lesions in accordance with general and specific thoracic severity of injury--as described in the multiple trauma score of the Medical University of Hannover--. Especially pulmonary contusions with associated conspicuous injuries are often primarily underestimated concerning their dimensions and consequences. Therefore the importance of subtle inquiry of pulmonary findings must be strictly underlined.

Humans↗
PubMed2005

Retrievable inferior vena cava filters: early clinical experience.

AIM: Multiple-trauma patients often have injuries that prevent the use of anticoagulant or sequential compression device prophylaxis. Temporary inferior vena cava filters (IVCFs) offer protection against pulmonary embolism (PE) during the early, highest-risk perioperative and immediate injury period, while avoiding potential long-term sequelae of a permanent IVCF. The objective of this study was to evaluate the efficacy of prophylactic, temporary IVCF placement at the intensive care unit (ICU) bedside under real-time intravascular ultrasound (IVUS) guidance in multiple-trauma patients. METHODS: One hundred and three multiple-trauma patients between July 1, 2002, and July 1, 2004, under-went placement of Günther-Tulip (n=38), Recovery (n=30) or OptEase (n=35) retrievable IVCFs under real-time IVUS guidance. The mean+/-SD injury severity score of the patients was 27.7 (+/-2.2). All patients had abdominal X-rays to verify filter location. Before IVCF retrieval, all patients underwent femoral vein color-flow ultrasonography to rule out deep vein thrombosis (DVT) and pre and postprocedure vena-cavography for possible IVCF thrombus entrapment and postretrieval IVC injury. RESULTS: Twenty-four patients died of their injuries; no deaths were related to IVCF placement. One PE occurred during follow-up after filter retrieval, and 2 insertion site femoral vein DVT occurred. As verified by abdominal X-rays, 97.1% (100/103) of IVCFs were placed without complications at the L2-3 level. Filter-related complications included 3 groin hematomas (2.9%) and 3 IVCFs misplaced in the right iliac vein early in our experience; these filters were uneventfully retrieved and replaced in the IVC within 24 h. Forty-four patients underwent uneventful retrieval of IVCFs after DVT or PE anticoagulation prophylaxis was initiated. Thirty-five filters were not removed, including 32 because severity of injury prevented DVT or PE prophylaxis and 3 because of thrombus trapped with the filter. CONCLUSIONS: Prophylactic, temporary IVCFs placed at the ICU bedside under IVUS guidance in multiple-trauma patients serves as an effective bridge to anticoagulation until venous thromboembolism prophylaxis can be initiated. Further investigation of this bedside technique and the role of temporary IVCFs in these patients is warranted.

Accidents, Traffic↗
PubMed1988

Incidence of dental trauma in the Western Australian School Dental Service.

A prospective study was undertaken to determine the annual incidence of trauma to the anterior permanent teeth of children enrolled in the Western Australian School Dental Service. The population comprised 66,500 6-12-yr-old children. 1.66 children and 2.05 teeth per 100 children received trauma. Of the children incurring trauma the incidence per 100 erupted teeth was 11.7. 80.5% of children traumatised one tooth only per incident, but 35% of all teeth that were traumatised involved trauma to two or more teeth. 88% of all traumatised teeth were central incisors. Girls received proportionately more trauma to the maxillary dental arch than did boys. Fracture involving both the enamel and the dentine was the most commonly recorded class of trauma (42.7% of cases). There was no obvious pattern to the overall distribution of trauma through the week or the year. Approximately one-third of all traumata occurred at school, one-third at home, and the remainder elsewhere. Trauma to the maxillary dental arch occurred most frequently at home, while trauma to more than one tooth (multiple trauma) occurred most commonly at school. Trauma incidence resulting from falling or being pushed was almost twice as high among girls as among boys. Bicycle accidents caused a higher than average rate of multiple trauma and of pulpal exposure.

Accidents, Home↗
PubMed2000

Risk evaluation and type of treatment of multiple dental trauma episodes to permanent teeth.

Studies have shown that some children and adolescents are effected only once with a dental trauma, while others seem to be accident-prone and suffer from multiple dental trauma episodes (MDTE). Studies have also shown that dental traumas mostly affect upper permanent and medial incisors. Less is known about treatment consequences related to teeth with repeated dental trauma episodes. The aim was therefore to evaluate the risk of MDTE to permanent teeth among children and adolescents by age and gender and to compare types of dental treatment modalities used for patients with one episode and those with MDTE and with single and repeated traumatized teeth. The study was based on a random sample of 83 Danish 6-18-year-old children and adolescents born in 1970 who suffered from dental trauma episodes. All patients were followed during a 12-year period (1976-1988). Forty-one of the patients were registered with MDTE with a range of 2-7 episodes and a mean of 2.9 episodes/patient (SD = 1.1). The mean age at single and MDTE was 11.4 years (SD = 3.6) and 8.6 years (SD = 2.1), respectively. No significant differences were found between age at first episode and the number of MDTE per patient. The number of patients with MDTE was significantly higher among those who suffered their first trauma episode in the age interval 6-10 years than in the age interval 11-18 years (P < 0.001). A survival analysis showed that the risk of sustaining another trauma episode increased by 14.9-30.3% when the first trauma occurred before the age of 11, compared to 0-7.4% after the age of 10. The risk of sustaining multiple injuries was 8.4 times higher when the first trauma episode occurred at 9 years of age, compared with those occurring at age 12. The survival analysis also showed that for every new trauma episode, the interval between them became closer. Forty-five per cent of the MDTE affected teeth had already sustained an injury. With an increased number of trauma episodes per patient followed an increase in the number of follow-ups, filling therapy, information and prosthetics, whereas the rates of endodontics, surgery, and consultations were unchanged or even decreased.

Accident Proneness↗
PubMed2003

Functional outcome in trauma patients with spinal injury.

STUDY DESIGN: A retrospective data analysis of all trauma patients admitted the Helicopter Emergency Medical Service was performed. OBJECTIVE: To assess the long-term outcome of trauma patients with spinal injuries using Functional Independence Measure scores. SUMMARY OF BACKGROUND DATA: Mortality after severe multiple trauma is well documented. However, evaluating morbidity in survivors of multiple trauma is complex, and less information is available regarding functional outcome. There are very few systems that can effectively predict the outcome for patients sustaining multiple trauma with spinal injuries. The Functional Independence Measure scoring system, which is easy to use, can be used to assess disability after hospital discharge, and may also be used to predict the long-term outcome for patients after spinal injuries. METHODS: The records of 1500 trauma patients admitted over a 6-year period by the Helicopter Emergency Medical Service were examined. All patients with documented injuries to the spinal column were selected for study. The distribution and pattern of spinal injury, the injury severity score, and the radiologic findings were determined for each patient, along with clinical outcome measures at 1 year using Functional Independence Measure scores. RESULTS: Among the 1500 trauma patients, 263 patients (17.5%) (195 men and 68 women; mean age, 37 years; range, 3-92 years) had sustained an injury to the spinal column. Mortality (70/263; 27%) was significantly higher (P < 0.02) in these patients than in those without spinal injury (247/1237; 20%). Injury severity scores higher than 16 were found in 96 patients (55%). The median Functional Independence Measure score was 40 on admission, 86 at discharge from the hospital, 113 at 3 months, 119 at 6 months, and 124 at 12 months. There was significant correlation between discharge Functional Independence Measure (FIM) scores (FIM = 86) and 12-month FIM scores (FIM = 124) (P < 0.01). CONCLUSIONS: Most of the patients had poor initial Functional Independence Measure scores, but there was significant improvement by 12 months. Discharge FIM scores were a good indicator for functional outcome at one year.

Adolescent↗
PubMed2001

[Predicting the outcome in severe injuries: an analysis of 2069 patients from the trauma register of the German Society of Traumatology (DGU)].

UNLABELLED: On hospital admission numerous variables are documented from multiple trauma patients. The value of these variables to predict outcome are discussed controversially. The aim was the ability to initially determine the probability of death of multiple trauma patients. Thus, a multivariate probability model was developed based on data obtained from the trauma registry of the Deutsche Gesellschaft für Unfallchirurgie (DGU). PATIENTS AND METHODS: On hospital admission the DGU trauma registry collects more than 30 variables prospectively. In the first step of analysis those variables were selected, that were assumed to be clinical predictors for outcome from literature. In a second step a univariate analysis of these variables was performed. For all primary variables with univariate significance in outcome prediction a multivariate logistic regression was performed in the third step and a multivariate prognostic model was developed. RESULTS: 2069 patients from 20 hospitals were prospectively included in the trauma registry from 01.01.1993-31.12.1997 (age 39 +/- 19 years; 70.0% males; ISS 22 +/- 13; 18.6% lethality). From more than 30 initially documented variables, the age, the GCS, the ISS, the base excess (BE) and the prothrombin time were the most important prognostic factors to predict the probability of death (P(death)). The following prognostic model was developed: P(death) = 1/1 + e(-[k + beta 1(age) + beta 2(GCS) + beta 3(ISS) + beta 4(BE) + beta 5(prothrombin time)]) where: k = -0.1551, beta 1 = 0.0438 with p < 0.0001, beta 2 = -0.2067 with p < 0.0001, beta 3 = 0.0252 with p = 0.0071, beta 4 = -0.0840 with p < 0.0001 and beta 5 = -0.0359 with p < 0.0001. Each of the five variables contributed significantly to the multifactorial model. CONCLUSIONS: These data show that the age, GCS, ISS, base excess and prothrombin time are potentially important predictors to initially identify multiple trauma patients with a high risk of lethality. With the base excess and prothrombin time value, as only variables of this multifactorial model that can be therapeutically influenced, it might be possible to better guide early and aggressive therapy.

Adolescent↗
PubMed1989

[Permanent sequelae of injuries in the otorhinolaryngology field].

The present retrospective study was aimed to scrutinize constant traumatic sequelae in otorhinolaryngology on 586 traumatic reports, which have been documented by the Bohemian State Insurance starting from 1965 to 1985. Constant sequelae appeared to be subsequent both to individual damages of otorhinolaryngologic organs and multiple traumas, from them 59.4% affected the ear region. Most frequently were presented the partial hearing loss, deafness, and labyrinth lesions especially in multiple traumas. As to the nasal area, the amount of 22.7 per cent consisted of external nasal shape deformities with the disordered passage, and olfactory disorders in multiple traumas. The remaining 17.9% sequelae was concerned with the anatomical and functional lesions of other otorhinolaryngologic organs. To determine features and the extent of constant sequelae, most current diagnostical approaches and consiliary examinations were used. However, the objective assessment of olfactory disorders and tinnitus aurium is stated to be still diagnostically intricated. Both the simulation and aggravation were found out in 2.5% of insurers. Other relations were also studied, e.g.: insurer vice versa physician. In addition to other causes, the most frequent ones represented an underestimation of traumatic consequences all along with their erroneous treatment, low levelled outpatient care of ORL specialists as to the multiple trauma management outside ORL service. In many instances, the injured subjects were not appropriately recommended to provide them with simple and effective surgical treatment of yet manifested constant sequelae. The proper expertize activity was complicated with the defective trauma documentation, terminology variants and erroneous regulations dealing with the recompensation of injuries.

Adolescent↗