Multicenter Study of Optimal Management Strategy in Severe Multiple Trauma

• Authors: Leszek Brongel , Jerzy Lasek , Jerzy Karski , Jacek Gwoździewicz , Waldemar Hładki , Jacek Lorkowski
• Languages of publication: 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.

Keywords

EN

multiple trauma; damage control; inflammatory response; emergency thoracotomy; abbreviated laparotomy

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2009
• Volume: 81
• Issue: 11
• Pages: 518-525

Dates

published

1 - 11 - 2009

online

24 - 12 - 2009

Contributors

author

Leszek Brongel

• Department of Emergency Medicine and Multiple Trauma, 2 Chair of General Surgery, Medical College Jagiellonian University in Cracow

author

Jerzy Lasek

• Chair of Trauma Surgery, Medical University in Gdańsk

author

Jerzy Karski

• Chair of Trauma Surgery and Emergency Medicine, Medical University in Lublin

author

Jacek Gwoździewicz

• Chair of Trauma Surgery, Medical University in Gdańsk

author

Waldemar Hładki

• Department of Emergency Medicine and Multiple Trauma, 2 Chair of General Surgery, Medical College Jagiellonian University in Cracow

author

Jacek Lorkowski

• Department of Emergency Medicine and Multiple Trauma, 2 Chair of General Surgery, Medical College Jagiellonian University in Cracow

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Identifiers

DOI

10.2478/v10035-009-0084-z