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Ultrasound in Diagnosing Torso Injuries

100%
Budzyński P., Kuliś M., Brongel L., Trybus M., Hładki W.
Polish Journal of Surgery
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2009
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vol. 81
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issue 11
497-502
EN
In patients with torso injuries, especially the ones with suspicion of injuries of intraabdominal organs, prompt making of diagnosis and decision about further management plays crucial role. Nowadays ultrasound is the first imaging technique used in Emergency Room in such cases.The aim of the study. Assessment of the value of ultrasound in diagnostics of patients with torso injuries, especially in qualification for operative or conservative treatment.Material and methods. 808 patients with an average age of 44.92 with torso injuries treated in the Department of Emergency Medicine and Multiple Injuries of 2nd Chair of General Surgery, Medical College of Jagiellonian University from 2004 to 2008, in whom ultrasound according to FAST protocol was used were included in the study. Results of sonographic examinations were verified during surgical operation (in patients treated surgically), or with the use of computed tomography (in patients treated conservatively), or on the basis of post-mortem examination (in patients who died due to sustained injuries), or on the basis of clinical course of hospitalization.Results. Sensitivity of ultrasound in the study material amounted to 90.43%, while specificity as much as 99.44%. Positive predictive value (so percentage of patients with truly positive result amongst the patients with positive result of diagnostic test) for whole study material was 95.5 while negative predictive value was 98.75.Conclusion. Results of the study confirm that ultrasound constitutes imaging technique of unique value in diagnostics of patients suffering from torso injuries, especially the circulatory unstable ones, allowing for precise qualification for prompt surgery.
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Quality of Life and Disability as a Result of Multiple Injuries

86%
Hładki W., Lorkowski J., Brongel L., Trybus M., Nazimek R., Kuliś M., Budzyński P.
Polish Journal of Surgery
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2007
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vol. 79
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issue 3
218-223
EN
The aim of the study was the comparison of quality of life as a result of multiple injury in the aspect of disability.Material and methods. The study group comprised 1259 patients treated effectively in the years 1989-2003 whose degree of injuries amounted to at least 18 scores in the Injury Severity Scores (ISS). The prospective study included 827 (65.9%) patients. Their quality of life as a disability was determined.Results. The results of the treatment in the successive 5-years periods were compared and statistically analyzed. In the first 5 years 71.8% persons were assessed as disable. In the second 5-years period 51.5% were found to be disabled. In the third 5-years period 47.3% of people present disability. The decrease in the number of individuals disable and increase in quality of life were observed.Conclusions. The highest quality of live improvement and the decrease in the amount of the disabled people was noted in the second 5-years period and was statistically significant related to first 5 years. The improvement of quality of life was decreased also in the third 5-years period related to second 5-years period, but the difference was not statistically significant. The increase of injuries severity and age was one of reasons of reduction positive changes in the last 5-years period.
3
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Models of Certain Types of Surgical Shock Based on the Assessment of Selected Critical Parameters

86%
Budzyński P., Brongel L., Nazimek R., Kuliś M., Hładki W., Lorkowski J., Trybus M.
Polish Journal of Surgery
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2007
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vol. 79
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issue 5
346-352
EN
The aim of the study was to devise models that describe three types of surgical shock based on a set of simple biochemical and clinical parameters and establish a method of assigning new patients to each surgical shock scenario.Material and methods. Prospective analysis included patients hospitalized in IInd Chair of Surgery from 2001 to 2005 who belonging to the following groups: multiple injuries (at least 7 points according to LSO), upper GI bleeding (in patients requiring blood transfusions during first day) and severe acute pancreatitis (at least 3rd degree according to Trapnell's scale). A set of nineteen parameters was evaluated on the first, fourth and seventh day in every patient. Discrimination analysis was used for statistical analysis with calculation of Mahalanobis squared distances between groups that reflect their reciprocal differences. Discrimination functions were calculated allowing the assignment of a new observation to one of the models. Eventually, reliability of categorizing patients to the studied groups was evaluated.Results. Differences among the groups - reflected by Mahalanobis squared distances - proved statistically significant in every studied day. Overall, the ratio of proper classifications according to discrimination functions equaled about 87%. The most common mistake in categorizing was observed in groups of multiple injuries and acute pancreatitis - due to similar pathophysiological processes leading through SIRS to MOF.Conclusions. The abovementioned results indicate that the presented models can be successfully used in diagnostic processes, especially in emergency cases. The set of clinical and biochemical parameters used is simple and easy to obtain even in non-specialized centers.
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