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2009 | 81 | 11 | 518-525
Article title

Multicenter Study of Optimal Management Strategy in Severe Multiple Trauma

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EN
Abstracts
EN
The aim of the study. The development of a triage system to implement proper treatment based on severity of injury.Material and methods. The study is based on material from three Polish Universities' trauma departments: Cracow, Lublin, and Gdańsk. Using trauma scales, 300 of the most severely injured multiple trauma (MT) patients from 2000-2004 have been chosen for this study. Medical documentation was carefully analysed, particularly the time and extent of the surgical procedures performed as well as their potential to influence later results.Results. There are three groups of patients:1 - critically injured, with an ISS>50, LSO>15, RTS 3 pts, two body cavity involvement, multiple long bone and/or pelvis fractures. Only damage control was allowed and the definitive treatment necessary was within 48 hours.2 - severely injured, with an unstable ISS 35-50, LSO 10-15, RTS 4-10 pts, one body cavity involvement, multiple long bone and/or pelvis fractures. Life-saving operations were possible with orthopaedic management (within 48 hours) provided using the "2+2 rule" (less than 2 hours of operation and no more than 2 units of blood transfused).3 - moderately injured, with a stable ISS<35, LSO<10, RTS>10 pts, one body cavity involvement, a long bone or pelvis fracture. Classic surgical and orthopaedic management occurred within 48 hours.Conclusions. The history and course of post-traumatic syndrome from metabolic, immune and endocrine viewpoints requires a special strategy for repairing life -threatening trauma injures at the right time, in proper sequence, and with limited surgical activity in more severe cases.
Publisher
Year
Volume
81
Issue
11
Pages
518-525
Physical description
Dates
published
1 - 11 - 2009
online
24 - 12 - 2009
References
  • Vaslef SN, Knudsen NW, Neligan PJ et al: Massive transfusion exceeding 50 units of blood products in trauma patients. J Trauma 2002; 53: 291-96.[Crossref]
  • Bose D, Tejwani NC: Evolving trends in the care of polytrauma patients. Injury 2006; 37: 20-28.[PubMed][Crossref]
  • Helling TS, Nelson PW, Moore BT et al.: Is trauma centre care helpful for less severely injured patients? Injur 2005; 36: 1293-97.[Crossref]
  • trauma. Ann Chir 2006; 131: 342-46.
  • Margulies DR, Cryer HG, McArthur DL et al.: Patient volume per surgeon does not predict survival in adult level I trauma centers. J Trauma 2001; 50: 597-603.[Crossref][PubMed]
  • Osler TM, Vane DW, Tepas JJ: Do pediatric trauma centers have better survival rates then adult trauma centers? An examination of the national pediatric trauma registry. J Trauma 2001; 50: 96-101.[PubMed][Crossref]
  • Potoka DA, Schall LC, Ford HR: Improved functional outcome for severely injured children treated at pediatric trauma centers. J Trauma 2001; 51: 824-34.[Crossref][PubMed]
  • Selzer D, Gomez G, Jacobson L et al.: Public hospital-based level I trauma centers: Financial survival in the new millenium. J Trauma 2001; 51: 301-07.[Crossref]
  • Blaivas M: Triage in the trauma bay with the focused abdominal sonography for trauma (FAST) examination. J Emerg Med 2001; 21: 41-44.[Crossref][PubMed]
  • Blaivas M: Emergency diagnostic paracentesis to determine intraperitoneal fluid identity discove red on bedside ultrasound of unstable patients. J Emerg Med 2005; 29: 461-65.[Crossref]
  • Fong SY, Yip SK, Tay KH: Clinics in diagnostic imaging. Singapore Med J 2000; 41: 511-14.[PubMed]
  • Grove CA Lemmon G, Anderson G et al.: Emergency thoracotomy: appropriate use in the resuscitation of trauma patients. Amer Surg 2002; 68: 313-17.
  • Lazzara S, Palmeri R, Melita G et al.: Laparoscopy in traumatic abdominal emergencies. Chir Ital 2006; 58: 485-91.
  • Miglietta MA, Robb TV, Eachempati SR et al.: Current opinion regarding indications for emergency department thoracotomy. J Trauma 2001; 51: 670-76.[Crossref][PubMed]
  • Biffl WL, Smith WR, Moore EE et al.: Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures. Ann Surg 2001: 233: 843-50.
  • Bowley DM, Barker P, Boffard KD et al.: Damage control surgery: concepts and practice. JR Army Med Corps 2000; 146: 176-82.[Crossref]
  • Brongel L: One-day surgery in multiple trauma patients. Eurosurgery, Przegl Lek 2000; 57: (suppl. 5) 133-35.
  • Broos PLO, Janzing HMJ, Vandermeeren LAS et al.: Life saving surgery in polytrauma patients. Eurosurgery. Przegl Lek 2000; 57: (suppl. 5) 118-19.
  • Jacome T, Hunt J: Salvage surgery. South Med J 2001; 94: 933-35.[PubMed]
  • Johnson JW, Gracias VH, Schwab CW et al.: Evolution in damage control for exsanguinating penetrating abdominal injury. J Trauma 2001; 51: 261-71.[PubMed][Crossref]
  • Lipiński J, Lasek J: Modern approach to management of patients following major trauma. Przegl Lek 2000; 57: (suppl. 5) 120-23.[PubMed]
  • Rittmeister M, Lindsey RW, Kohl HW III: Pelvic fracture among polytrauma decedents. Traumabased mortality with pelvic fracture - a case series of 74 patients. Arch Orthop Trauma Surg 2001; 121: 43-49.
  • Shapiro MB, Jenkins DH, Schwab CW et al.: Damage control: Collective review. J Trauma 2000; 49: 969-78.[PubMed][Crossref]
  • Vargo DJ, Battistella FD: Abbreviated thoracotomy and temporary chest closure: an application of damage control after thoracic trauma. Arch Surg 2001; 136: 21-24.[Crossref][PubMed]
  • Zacharias SR, Offner P, Moore EE et al.: Damage control surgery. AACN Clin Issues 1999; 10: 95-103.[PubMed][Crossref]
  • Hagiwara A, Murata A, Matsuda T et al.: The efficacy and limitations of transarterial embolization for severe hepatic injury. J Trauma 2002; 52: 1091-96.[Crossref][PubMed]
  • Velmahos GC, Chahwan S, Falabella A et al.: Angiographic embolisation for intraperitoneal and retroperitoneal injuries. World J Surg 2000; 24: 539-45.[PubMed][Crossref]
  • Velmahos GC, Toutouzas KG, Vassiliu P et al.: A prospective study on the safety and efficacy of angiographic embolization for pelvic and visceral injuries. J Trauma 2002; 52: 303-08.[Crossref]
  • Wahl WL, Ahrns KS, Brandt MM et al.: The need for early angiographic embolization in blunt liver injuries. J Trauma 2002; 52: 1097-1101.[PubMed][Crossref]
  • Lynn M, Jerokhimow I, Jewelewicz D et al.: Early use of recombinant factor VIIa improves mean arterial pressure and may potentially decrease mortality in experimental hemorrhagic shock: a pilot study. J Trauma 2002; 52: 703-07.[Crossref][PubMed]
  • Martinowitz U, Holcomb JB, Pusateri AE et al.: Intravenous rFVIIa administered for hemorrhage control in hypothermic coagulopathic swine with grade V liver injuries. J Trauma 2001; 50: 721-29.[PubMed][Crossref]
  • Schreiber MA, Holcomb JB, Hedner U et al.: The effect of recombinant factor VIIa on coagulopathic pigs with grade V liver injuries. J Trauma 2003; 53: 252-59.
  • Wong YCh, Wang LJ, Ng ChJ et al.: Mortality after successful transcatheter arterial embolization in patients with unstable pelvic. J Trauma 2000; 49: 71-80.[Crossref][PubMed]
  • Hunt PA, Greaves I, Owens WA: Emergency thoracotomy in thoracic trauma-a review. Injury 2006; 37: 1-19.[Crossref][PubMed]
  • Routt ML Jr, Falicov A, Woodhouse E et al.: Circumferential pelvic antishock sheeting: a temporary resuscitation aid. J Orthop Trauma 2006; 20: (Suppl. 1): 3-6.[Crossref]
  • Martinowitz U, Kenet G, Segal E et al.: Recombinant activated factor VII for adjunctive hemorrhage control in trauma. J Trauma 2001; 51: 431-39.[PubMed][Crossref]
  • Heyer CM, Rduch GJ, Wick M et al.: Anwendung der 16-Zeilen-Mehrdetektor-CT in der Initialdiagnostik beim Polytrauma: Eine Zeitanalyse. Rofo 2005; 177: 1677-82.
  • Kirkpatrick AW, Sirois M, Laupland KB et al.: Prospective evaluation of hand-held focused abdominal sonography for trauma (FAST) in blunt abdominal trauma. Can J Surg 2005; 48: 453-60.[PubMed]
  • McGahan JP, Horton S, Gerscovich EO et al.: Appearance of solid organ injury with contrastenhanced sonography in blunt abdominal trauma: preliminary experience. Am J Roentgenol 2006; 187: 658-66.[Crossref]
  • Prokop A, Hotte H, Kruger K et al.: Multiplice CT in diagnostic work-up of polytrauma. Unfallchirurg 2006; 109: 545-50.[Crossref][PubMed]
  • Salim A, Sangthong B, Martin M et al.: Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study. Arch Surg 2006; 141: 468-73.
  • Wurmb T, Fruhwald P, Brederlau J et al.: Management of seriously injured patients without conventional radiography? Does a whole body MSCT scanner replace the conventional X-ray unit in the emergency room? Anaesthesist 2006; 55: 17-25.[Crossref]
  • Brandt MM, Kazanjian S, Wahl W: The utility of endovascular stents in the treatment of blunt arterial injuries. J Trauma 2001; 51: 901-905.[PubMed][Crossref]
  • Johnson JW, Gracias VH, Gupta R et al.: Hepatic angiography in patients
  • Krotz M, Pfeifer KJ, Reiser M: Radiological intervention in multiply injured patients. Radiologe 2005; 45: 1129-45.[PubMed]
  • Peterson BG, Matsumura JS, Morasch MD et al.: Percutaneous endovascular repair of blunt thoracic aortic transsection. J Trauma 2005; 59: 1062-65. undergoing damage control laparotomy. J Trauma 2002; 52: 1102-06.
  • Velmahos GC, Demetriades D, Chahwan S et al.: Angiographic embolisation for arrest of bleeding after penetrating trauma to the abdomen. Am J Surg 1999; 178: 367-73.[Crossref]
  • Baue AE, Faist E: Multiple Organ Failure - summary. World J Surg 1996; 20: 499-503.
  • Blow O, Magliore L, Claridge JA et al.: The golden hour and the silver day: detection and correction of occult hypoperfusion within 24 hours improves outcome after major trauma. J Trauma 1999; 47: 964-69.
  • Burch JM: New Concepts in Trauma. Am J Surg 1997; 173: 44-46.[PubMed][Crossref]
  • Ciesla DJ, Moore EE, Johnson JL et al.: Decreased progression of postinjury lung dysfunction to the acute respiratory distress syndrome and multiple organ failure. Surgery 2006; 140: 640-47.[Crossref][PubMed]
  • Cosgriff N, Moore EE, Sauaia A et al.: Predicting Life-Threatening Coagulopathy in the Massively Transfused Trauma patient: Hyporthermia and Acidosis Revisited. J Trauma 1997; 42: 857-61.[Crossref]
  • Hill AG, Hill GL: Metabolic response to severe injury. Br J Surg 1998; 85: 884-90.[Crossref][PubMed]
  • Moore EE. Thomas G: Orr Memorial Lecture. Staged Laparotomy for the Hypothermia, Acidosis, and Coagulopathy Syndrome. Am J Surg 1996; 172: 405-10.[PubMed][Crossref]
  • Nathens AB, Marshall JC: Sepsis, SIRS, and MODS: what's in a bame? World J Surg 1996; 20: 386-91.[Crossref]
  • Peng RY, Bongard FS: Hypothermia in Trauma Patients. J Am Coll Surg 1999; 188: 685-96.
  • Sauaia A, Moore FA, Moore EE et al.: Early risk factors for postinjury multiple organ failure. World J Surg 1996; 20: 392-400.[PubMed][Crossref]
  • Schulman AM, Claridge JA, Carr G et al.: Predictors of patients who will develop prolonged occult hypoperfusion following blunt trauma. J Trauma 2004; 57: 795-800.[Crossref]
  • Aihara R, Millham FH, Blansfield J et al.: Emergency room thoracotomy for penetrating chest injury: effect of an institutional protocol. J Trauma 2001; 50: 1027-30.[Crossref]
  • Arthurs Z, Kjorstad R, Mullenix P et al.: The use of damage-control principles for penetrating pelvic battlefield trauma. Am J Surg 2006; 191: 604-09.
  • Arvieux C, Cardin N, Letoublon C: Abbreviated laparotomy in severe abdominal trauma. Ann Chir 2006; 131: 342-46.
  • Coats TJ, Keogh S, Clark H et al.: Prehospital resuscitative thoracotomy for cardiac arrest after penetrating trauma: rationale case series. J Trauma 2001; 50: 670-73.[Crossref][PubMed]
  • Coplin WM, Cullen NK, Policherla PN et al.: Safety and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traumatic brain injury. J Trauma 2001; 50: 1050-59.[PubMed][Crossref]
  • Henderson KI, Coats TJ, Hassan TB et al.: Audit of time to emergency trauma laparotomy. Br J Surg 2000; 87: 472-76.[Crossref][PubMed]
  • Lee JC, Peitzman AB: Damage-control laparotomy. Curr Opin Crit Care 2006; 12: 346-50.[Crossref][PubMed]
  • Meier U, Lemcke J, Reyer T et al.: Decompressive craniectomy for severe head injury in patients with major extracranial injuries. Acta Neurochir Suppl 2006; 96: 373-76.[PubMed][Crossref]
  • Navsaria P, Thoma M, Nicol A: Foley catheter balloon tamponade for life-threatening hemorrhage in penetrating neck trauma. World J Surg 2006; 30: 1265-68.[PubMed][Crossref]
  • Nicholls TP, Shoemaker WC, Wo CC: Survival, hemodynamics, and tissue oxygenation after head trauma. J Am Coll Surg 2006; 202: 120-30.
  • Nast-Kolb D, Ruchholtz S, Waydhas C et al.: Damage control orthopedics. Unfallchirurg 2005; 108: 806-11.
  • Renaldo N, Egol K: Damage-control orthopedics: evolution and practical applications. Am J Orthop 2006; 35: 285-91.[PubMed]
  • Rixen D, Sauerland S, Oestern HJ et al.: Management strategies in the first operative phase after long-bone injury of the lower extremity in multiple-injured patients. A systematic literature review. Unfallchirurg 2005; 108: 829-42.[PubMed][Crossref]
  • Demetriades D, Sava J, Alo K Newton E et al.: Old age as a criterion for trauma team activation. J Trauma 2001; 51: 754-57.[PubMed][Crossref]
  • Gruen RL, Jurkovich GJ, McIntyre LK et al.: Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths. Ann Surg 2006; 244: 371-80.
  • Shen LY, Marcotte KN, Helmer SD et al.: Correlation of clinical findings and autopsy results after fatal injury from motor vehicular-related crashes. Am Surg 2006; 72: 282-87.[PubMed]
  • Stanescu L, Talner LB, Mann FA: Diagnostic errors in polytrauma: a structured review of the recent literature. Emerg Radiol 2006; 12: 119-23.[Crossref]
  • Twardosz W, Słowiński W, Salamon-Słowińska D: Miejsce urazów klatki piersiowej i brzucha w leczeniu mnogich obrażeń ciała po ATLS. Now Lek 2004; 73(1): 3-6.
  • Gwoździewicz J, Lasek J, Raniszewska E i wsp.: Krytyczna ocena wstępnego postępowania diagnostyczno-leczniczego w przypadku mnogich obrażeńciała. Pol J Emerg Med 2008; 1(2) 4-12.
  • Gwoździewicz J, Lasek J, Urbański A i wsp.: Packing wątroby u chorych z ciężkimi, mnogimi ograżeniami ciała. I Krakowskie Sympozjum "Ostry dyżur"; IV Sympozjum Sekcji Chirurgii Urazowej TChP, Kraków 31.05.-2.06.2007: streszczenia.
  • Nogalski A, Lübek T, Jankiewicz L et al.: Patients withltiple injures - diagnosis and treatment in Emergency Department. Annales Universitatis Mariae Skłodowska-Curie, Sectio D: Medicina 2005; 60(2): 762-66.
Document Type
Publication order reference
YADDA identifier
bwmeta1.element.-psjd-doi-10_2478_v10035-009-0084-z
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