DOI: https://doi.org/10.22141/2224-0586.1.96.2019.158753

The structure of modern civilian multiple trauma at the stage of providing tertiary care in the intensive care unit of regional hospital

A. A. Krishtafor

Abstract


Background. Traumatic injuries remain one of the leading causes of death and disability, which grounds a high social and medical significance of this pathology. Objective: to determine the structure of multiple trauma, demographic and clinical features and mortality of victims with multiple trauma at the stage of providing tertiary medical care in the intensive care unit of the regional hospital. Materials and methods. A retrospective analysis of 785 case histories of victims who were admitted to the regional hospital from 2008 to 2012 was carried out. We have analyzed diagnoses, severity of the injury according to the Injury Severity Score (ISS), severity of the patients’ state upon admission to the hospital on the Emergency Trauma Score (EmTraS), and the survival rate for 28 days. Statistical processing and analysis of the obtained data were performed using LibreOffice and the Social Science Statistics online statistical calculator (https://www.socscistatistics.com). Results. More than 55 % of victims were people under the age of 40 years, over 25 % were 41–60 years old. The average age of men was 38.9 ± 13.0 years, women — 41.3 ± 15.6 years. In all age groups, men prevailed. The average mortality during the studied time interval was 17.45 % without a significant difference between patients by gender. Given the risk of death with p < 0.05, abdominal trauma (risk ratio (RR) = 1.932), chest trauma (RR = 1.578) and intracranial hemorrhage (RR = 1.526) were statistically significant. The significance of open brain injury was less and statistically unreliable (RR = 1.351, p > 0.05). The lowest risk of death was in patients with musculoskeletal injury (RR = 1.149), closed head injury (RR = 0.914) and spinal injury (RR = 0.510). The ave­rage initial ISS in patients who survived was 23.47 ± 0.43 points, in the dead — 48.80 ± 0.72 points (p < 0.00001). On the EmTraS, the initial severity of the condition among the survivors was 3.14 ± 0.10 points, and in the dead — 7.50 ± 0.08 points. The 50% survival rate calculated for the severity of injury on the ISS was 32.94 points, and on the EmTraS — 5.57 points. Conclusions. The victims with intraabdominal and intrathoracic injuries, as well as intracranial hemorrhages have the greatest risk of death after admission to the tertiary hospital. The severity of injury on the ISS of 32.94 points and the severity of the initial state on the EmTraS of 5.75 points are the limit of survival, and can be used as a prognostic marker when patients are admitted to tertiary hospital on the first day after injury.


Keywords


multiple trauma; mortality; tertiary care

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