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PubMed1991

Monitoring the response to injury.

Tissue trauma leads to a severity-dependent activation of plasma and cellular systems. This response can be recorded by determining parameters which represent the activation state of these systems. In severely injured patients with multiple trauma three out of 14 parameters measured at the time of admission proved to be indicators of subsequent septic complications with a high degree of accuracy: Fibrinopeptide A (FPA--the first split product of fibrinogen), the C3 split product C3a, and the elastase-alpha 1 proteinase inhibitor-complex (E alpha 1 PI). In a second series of multiple-injured patients with femoral fractures who did not develop clinical sepsis (N = 25) these parameters were measured continuously to evaluate the influence of injury severity and of therapeutic strategy on the further course. We found a strong correlation between injury severity (ISS) and the degree of activation. The signs of activation decreased rapidly following immediate operative fixation, and remained elevated or even increased after primary femoral traction and secondary stabilization. The operative procedure did not cause any additional activation. Complications such as infection or the formation of haematomas were reflected by raised parameter levels.

Adolescent↗
PubMed1994

Enhancement of protein synthesis efficiency in parenterally fed trauma victims by adjuvant recombinant human growth hormone.

In the early catabolic phase of severe injury, conventional nutritional support is inadequate to reverse negative nitrogen balance and an anabolic stimulus may be beneficial. The utilization efficiency of body energy sources after injury could be improved by adjuvant recombinant human growth hormone (rhGH) therapy. We measured the protein kinetic response to exogenous rhGH in trauma patients fed parenterally (TPN). Severely injured (mean ISS, 31 +/- 2), highly catabolic (mean nitrogen loss, 19 +/- 2 g/day), and hypermetabolic (mean BEE/REE, 1.41 +/- 0.05), adult (mean age, 46 +/- 5 years), multiple trauma victims (n = 20, 17 men/3 women) were investigated. Rates of whole-body protein kinetics (turnover [WBPT], synthesis [WBPS], breakdown [WBPB], and protein synthesis efficiency [PSE]--the fraction of nitrogen turnover utilized for protein synthesis) were measured using a primed-constant infusion of 18N glycine 48 to 60 hours after injury when the patients were receiving only maintenance fluids without calories or nitrogen. The patients were then fed glucose-based TPN (1.1 x REE; 250 mg N/kg/day) and randomized to receive or not to receive rhGH. Group H (n = 10) received daily rhGH (0.15 mg/kg/day, Somatropin, Genentech, Inc.) intramuscularly at 8 am and group C (n = 10) received only the vehicle of infusion. Protein kinetic measurements were repeated at the end of 7 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Does oxygen delivery-directed resuscitation worsen outcome of head injured patients with multisystem injuries?

There is concern that oxygen delivery-directed resuscitation in patients with multiple trauma, including severe head injury, may worsen neurologic recovery. To study this, we retrospectively examined 31 patients admitted over an 18-month period who met the inclusion criteria of having suffered blunt trauma, were between 15 and 65 years of age, had an admission Glasgow coma scale of < or = 8, intact corneal and gag reflexes, and extracranial injury with an Abbreviated Injury score of > or = 3. All patients were placed on intracranial pressure monitors. In comparing the 14 patients whose resuscitation was guided by oxygen delivery (DO2) with the 17 who were resuscitated by standard fluid restriction (FR), we found that despite the DO2 group's having received a significantly greater volume of resuscitation fluids in the first 48 hours after injury, there was no difference in the neurologic recovery between the two groups.

Abbreviated Injury Scale↗
PubMed1997

[Kidney injuries in children. Apropos of 65 cases].

The authors report a retrospective series of 65 cases of renal contusion in children affecting 45 boys and 20 girls between the ages of 10 months and 15 years (mean age: 10 years). The causes of renal trauma were dominated by household accidents (53.8%) and road accidents (33.8%). Associated extrarenal lesions were observed in 21.5% of cases. 55.4% of the 65 contusions were considered to be benign, 27.7% of moderate severity and 16.9% were serious. The blunt trauma affected a pathological kidney in 19 cases. Exclusively medical treatment was recommended in 31 patients, while surgery was indicated in the other 34 patients. Apart from one death in a context of multiple trauma, few complications were observed in the group of operated patients and consisted of 4 cases of urinary fistula and 4 cases of infection, all of which resolved.

Accidents, Home↗
PubMed1991

[Heart contusion as an unusual cause of shock in severe polytrauma].

The reported incidence of myocardial contusion after blunt chest trauma is 7-17%. Only one third of these patients present with significant morbidity. The polytrauma is generally dominated by hypovolemic and traumatic shock. Other causes of hypotension are less common, and may thus be ignored. The standard algorithm of care in multiple trauma care, however, leads to the diagnosis even in these cases, as illustrated by a case of prolonged shock induced by blunt myocardial trauma.

Adult↗
PubMed1997

[New diagnostic strategies in multiple injury].

The diagnostic strategies in multiple trauma aim at rapid identification of life-threatening injuries, recognition of serious organ lesions, and evaluation of the systemic trauma impact, as well as the resulting host reaction. Besides improvements in the structure and organization, major innovations in imaging techniques have significantly improved and accelerated evaluation of the patient with multiple injuries in the emergency room. Systematic diagnostic work-up, integrated multidisciplinary approach, and defined algorithms for traumatic key symptoms represent the hallmarks of successful emergency room management. In particular, diagnostic work-up of injured body cavities using sonography and helical computed tomography are evaluated.

Acute Disease↗
PubMed2007

The radiological management of bomb blast injury.

A need to understand the nature and patterns of bomb blast injury, particularly in confined spaces, has come to the fore with the current worldwide threat from terrorism. The purpose of this review article is to familiarize the radiologist with the imaging they might expect to see in a mass casualty terrorist event, illustrated by examples from two of the main institutions receiving patients from the London Underground tube blasts of 7 July 2005. We present examples of injuries that are typical in blast victims, as well as highlighting some blast sequelae that might also be found in other causes of multiple trauma. This should enable the radiologist to seek out typical injuries, including those that may not be initially clinically apparent. Terror-related injuries are often more severe than those seen in other trauma cases, and multi-system trauma at distant anatomical sites should be anticipated. We highlight the value of using a standardized imaging protocol to find clinically undetected traumatic effects and include a discussion on management of multiple human and non-human flying fragments. This review also discusses the role of radiology in the management and planning for a mass casualty terrorist incident and the optimal deployment of radiographic services during such an event.

Adult↗
PubMed1992

[Burns].

Extensive burns are severe, life-threatening injuries. Cutaneous burns are often accompanied by injury to inhalation, leading to severe pulmonary problems with a high rate of mortality. Published reports on series of burn patients state that in 2-5% of all (burn) cases, cutaneous thermal injury was accompanied by mechanical injuries such as fractures, closed head injuries, or blunt injuries to chest and abdomen. The care of the burn is often made difficult by concomitant orthopaedic injury, and in a multiple trauma victim, the burn itself often complicates diagnosis and treatment. It is important to recognize all injuries as soon as possible. The article briefly discusses practical considerations when treating patients with multiple injuries including cutaneous burns and/or inhalation injury. After initial resuscitation and stabilization these patients should be transferred to a specialized treatment facility for burns. As a rule, open surgical reduction and fixation of fractures should be carried out no later than 48 hours after the injury.

Burns↗
PubMed1999

Epidemiological study on high grade trauma. Friuli VG Major Trauma Study Group.

A better understanding of trauma epidemiology may allow to enhance the organisation of trauma systems with a potentially relevant impact on the level of trauma care. A one year epidemiology study (1st March 1998-28th February 1999) was planned in Friuli Venezia Giulia with the aim to collect all prehospital, hospital and outcome data of patients who sustained a major trauma (ISS > 15) within the regional border. In 12 months 15,429 traumatized patients (14,108 residents) were admitted to any one of the Regional hospitals. Over 1% of the whole population sustained injuries severe enough to cause hospital admission. 630 people (77.3% male, 27.7% female average age 42 ys) had a major trauma. The incidence of major trauma is 525 per million people per year. RTA was by far the most important cause of major injuries (78.6%) followed by work accidents (6.8%), domestic (5.9%) and sport accidents (1.9%). Only 1.2% of all the major injuries was the consequence of interpersonal violence. One hundred-sixty-six trauma victims died on the spot (149) or before hospital arrival (17). 464 patients with major injuries reached the hospital alive. More than two third of the patients with ISS > 15, suffered from a multiple trauma. 70% had a severe injury to the head (AIS > or = 3). Head trauma occurred as an isolated injury in only 35.3%. Hospital mortality within 30 days from admission (trauma death) was 25.1%. The results of the follow-up at 6 months are still incomplete. However the preliminary data clearly show that a high percentage of the patients who were discharged alive from the ICU had a good neurologic recovery.

Accidents↗
PubMed2002

Prognostic factors and outcome of children with severe head injury: an 8-year experience.

OBJECTIVES: Our aim was to analyze prognostic factors and their association with outcome among children with severe head injury. METHODS: We conducted a retrospective study among children with severe head injury admitted to our Pediatric Intensive Care Unit (PICU) from November 1992 to December 2000. The patients were immediately evaluated for the severity of head injury (Glasgow Coma Score, GCS), clinical presentation, cerebral axial tomography, early complications (hypoxia and hypotension), metabolic and hematological alterations and early post-traumatic seizures. Six months after injury we applied the Glasgow Outcome Score (GOS). Correlations with GOS were evaluated using univariate and multivariate logistic models. RESULTS: In all, 122 children with severe head injury were identified. The patients presented the following scores: 18 (14.7.0%) children had a GOS of 1; 2 had a GOS of 2 (1.6%); 27 (22.2%) a GOS of 3 and 75 (61.5%) a GOS of 4 or 5. A low GOS was significantly and independently associated with low GCS, multiple trauma, the presence of hypoxia and hypotension, disseminated intravascular coagulation (DIC), hyperglycemia and early post-traumatic seizures. Hematological alterations (white blood cells) were also associated with a low GOS, though not significantly. CONCLUSION: In addition to GCS, types of trauma and brain lesion, hypoxia and hypotension, hemocoagulative disorders (DIC), hyperglycemia and early post-traumatic seizures are predictors of GOS. A knowledge of these prognostic factors and the correct management of children with severe head injury helps clinicians to improve outcome and to reduce morbidity and mortality.

Adolescent↗
PubMed2004

Clinical analysis of craniocerebral trauma complicated with thoracoabdominal injuries in 2165 cases.

OBJECTIVE: To explore the optimal treatment for craniocerebral trauma complicated with thoraco-abdominal injuries. METHODS: A total of 2165 cases of craniocerebral trauma complicated with thoraco-abdominal injuries admitted to our hospital between July 1993 and June 2003 were retrospectively studied. Among them, 382 cases sustained severe craniocerebral trauma (in which 167 were complicated with shock), 733 thoracic injuries, 645 abdominal injuries and 787 thoraco-abdominal injuries. On admittance, 294 cases had developed shock. With the prime goal of saving life, respiratory and circulatory systems and encephalothilipsis were especially treated and monitored. Priority in management was directed to severe or open injures rather than to moderate or closed injures. For cases with cerebral hernia due to intracranial hematoma and severe shock due to blood loss, cerebral hernia and shock were treated concurrently. RESULTS: After treatment, 2024 (93.49%) cases survived and the other 141 (6.51%) died. Among patients who had severe craniocerebral injury with shock and those without, 78 (46.71%) and 53 (24.56%) died, respectively. For patients who had underwent craniocerebral and thoraco-abdominal operations concurrently and those who had not, the death rates were 58.49%-65.96% and 28.57% respectively, indicating a significant difference (P<0.05). CONCLUSIONS: Treatment for hematoma hernia, shock and disturbed respiration is the key in the management of multiple trauma of craniocerebral, thoracic or abdominal injuries, especially when two or three conditions occurred simultaneously. Unless it is necessary, operations at two different parts at the same time is not recommended. It is preferred to start two concurrent operations at different time.

Adult↗
PubMed1995

[Treatment of severe concomitant injuries in severely burned patients].

Over a period of almost 6 years, 18 out of 320 burn patients treated in the burn centre had sustained additional severe trauma; for the most part the trauma was due to a motor vehicle accident or a fall. The risk of overlooking such additional injuries can be minimized by systematic examination and a team approach, the same as in normal multiple-trauma patients. Apart from the burn, life-threatening complications such as intra-abdominal bleeding or haemopneumothoracic injuries are to be treated immediately. In order to facilitate appropriate burn wound care and optimize mobilization, early internal or external fixation of unstable orthopaedic injuries should be performed as soon as possible. In our experience, operations carried out within 48 h after the injury have neither led to complications in wound healing nor to osteomyelitis.

Adolescent↗
PubMed1991

Time of rehabilitation admission and severity of trauma: effect on brain injury outcome.

Outcome after traumatic brain injury, defined by the Glasgow Outcome Scale (GOS) and length of stay in acute rehabilitation, was measured in 59 patients admitted to an intensive rehabilitation program to examine the effects of severity of the initial brain injury, severity of multiple trauma, and length of stay in the acute care hospital. Severity of initial brain injury, best measured by length of coma, was the most significant predictor of GOS outcome. Length of acute hospitalization was a small, but significant, predictor of GOS. Severity of initial brain injury, length of acute hospitalization, and gender emerged as predictors of length of rehabilitation hospital stay. Although length of acute hospitalization is apparently affected by severity of brain injury, it adds significantly--more than severity of brain injury--to the prediction of length of rehabilitation.

Adolescent↗
PubMed1992

[Trauma scores: reproducibility and reliability].

The inter-rater reliability of the Injury Severity Score (ISS) and the Polytraumaschlüssel (PTS) [multiple trauma code] was studied using diagnosis sheets filled in for 107 multiple injured patients. The scoring was performed by eight physicians with different levels of qualification. The scores for individual patients varied widely depending on the scorer, with extremes differing from the mean by about 80% and 70% for the ISS and PTS, respectively. The mean ISS and PTS for the whole study population also varied significantly between the scorers (P less than 0.0001, one-way analysis of variance). Raters with experience in trauma scoring calculated significantly higher scores (P less than 0.01, t-test) Neither the ISS nor the PTS seem reliable enough to describe injury severity in an individual patient. Treatment decisions must not be based on such grounds. Even for larger groups, caution must be exercised in comparison of different populations of multiple traumatized patients.

Humans↗
PubMed1993

Pharmacology, monitoring, and nutritional support.

Three areas of particular importance in dealing with critical complications of trauma are pharmacology, monitoring, and nutritional support. This article deals with each of these from the perspective of the doctor or nurse at the bedside. This survey stands as a sampler and guidebook to these subjects as they pertain to the critically ill multiple trauma patient.

Chronic Disease↗
PubMedDate not supplied

[Management of polytrauma: our experience].

In the advanced nations trauma represents the third cause of death after cardiovascular diseases and tumours. Recently, great importance has been given to the need to treat traumas as quickly as possible in order to reduce mortality and morbidity. Prompt management of is the gold standard in the emergency setting and the phrase "golden hour" is now commonly used. The authors report on their experience with the management of multiple trauma, through the study of 617 clinical cases. Patients were evaluated with the Revised Trauma Score (RTS), Injury Severity Score (ISS) and Abbreviated Injury Scale (AIS). Of 420 (68%) cases of major trauma only one patient had ISS > 60. Patients were admitted on average after 47 +/- 18 min. Only two deaths occurred in the emergency unit. The task of the emergency unit is to stabilise the patients, anticipate the complications, including mainly shock and multiple organ failure, optimizing time, interventions and resources to reduce morbidity and mortality.

Abbreviated Injury Scale↗
PubMed2004

Etiology and patterns of pediatric mandibular fractures in Portugal: a retrospective study of 10 years.

OBJECTIVE: To determine the pattern of occurrence of mandibular fractures in the pediatric population in Portugal. MATERIALS AND METHODS: This retrospective study reviews the records of patients 18 years of age or younger from the 10-year period 1993 to 2002. Age, gender, anatomic site, cause of the accident, weekly and monthly variation, location and type of fractures, presence and location of associated injuries, treatment methods, and complications were reviewed. RESULTS: During this 10-year period, 521 patients with 681 mandibular fractures were treated. Motor-vehicle accident (MVA) was the most common (53.9% patients) cause of fracture. Almost half of the patients (48.8%) were in the oldest age group (16 to 18 years old). The condyle of the mandible was involved in 31.0% of the fractures. Maxillomandibular (MMF) fixation was used in 534 (78.4%) fractures. Overall mortality in this series was 0.6% (3 patients); mortality was caused by multiple traumas, mainly head trauma. CONCLUSION: There is a need to reinforce legislation aimed to prevent MVA and the total enforcement of existing laws to reduce maxillofacial injuries among children and adolescents.

Accidental Falls↗
PubMed2004

[Relevant factors influencing the evolution of 206 patients with severe head injury].

The search for head injury prognostic factors has been intense in the last decades. The importance of identification of these factors has been also recognised to treatment orientation and results estimatives. Based on 206 severe head injuried patients series, we analyzed the influence of factors over the outcome. The initial severity by Glasgow coma scale, the presence of intracranial hypertension (over 20 mmHg), the type of intracranial lesion and the presence of hypoxia, systemic hypotension or both, significantly influenced the results. The presence of multiple traumas (at least two sites of lesion over head injury), as age, did not influence the final results in this series.

Adult↗