Comparative characteristics of civilian and military multiple trauma in a level III hospital
Background. Combat multiple injuries are more severe than civilian ones due to the difference in the adverse factors, trauma circumstances, medical aid timing, number of injuries. The purpose was to conduct a comparative analysis of civilian and combat trauma patients’ status upon admission to a level III hospital. Materials and methods. Seventy-nine victims with civilian multiple trauma and 65 wounded persons from the ATO zone were included in the study. We studied consciousness (Glasgow coma scale), hemodynamics, need for vasopressor support and mechanical ventilation, intestinal peristalsis, general blood count, hepatic and renal parameters, coagulogram, acid-base balance and blood gases, serum cytokine levels (interleukins 6, 10). Results. In civilian multiple trauma, traumatic brain injuries and thoraco-abdominal trauma were more common, while combat trauma patients more often had soft tissue injuries. Road accidents and catatrauma were the main causes of civilian multiple trauma, while in combat trauma, blast injuries prevailed. Urgent surgical interventions rate was 12.2 % higher in combat trauma. In combat trauma, impaired consciousness was associated with sedation, in civilian — directly with traumatic brain injury. Hypotension and tachycardia were less severe in combat trauma due to prior resuscitation and vasopressor support. Hypoalbuminemia, hypocoagulation and renal dysfunction were more severe in combat trauma. With cytolytic syndrome manifestations in combat trauma, AST increase prevailed, which was most likely explained by massive tissue destruction. Inflammatory reaction did not depend on the nature of injury and was associated only with its severity and localization. Complications rate was 41.8 % in civilian trauma and 47.7 % in combat trauma, mortality rate — 8.9 and 13.8 %, respectively. Conclusions. Despite similar severity of injury and blood loss, combat wounds have different injury patterns and result in more severe systemic disorders, such as hepatic, renal and hemocoagulation dysfunction. This leads to the higher complications and mortality rates.
Full Text:PDF (Русский)
Von Rüden C., Woltmann A., Röse M. [et al.] Outcome after severe multiple trauma: a retrospective analysis. J Trauma Manag Outcomes. 2013:7:4. doi: 10.1186/1752-2897-7-4
R. Pfeifer, M. Teuben, H. Andruszkow [et al.] Mortality Patterns in Patients with Multiple Trauma: A Systematic Review of Autopsy Studies. PLoS One. 2016:11(2). doi: 10.1371/journal.pone.0148844
J. Sim, J. Lee, J. C. Lee [et al.] Risk factors for mortality of severe trauma based on 3 years' data at a single Korean institution. Ann Surg Treat Res. 2015:89(4):215-9. doi: 10.4174/astr.2015.89.4.215
Reihani H., Pirazghandi H., Bolvardi E. [et al]. Assessment of mechanism, type and severity of injury in multiple trauma patients: A cross sectional study of a trauma center in Iran. Chin J Traumatol. 2017 Apr;20(2):75-80. doi: 10.1016/j.cjtee.2016.02.004
[Field Surgery: textbook]. 2nd rev. ed. Gumanenko E.L. Moscow: GEOTAR-Media; 2008. 768 p. Russian
[Diagnostics and treatment of wounds]. Ed. Shaposhnikov Yu. G. Moscow; 1984. 343 p. Russian
Emergency War Surgery. Fourth United States Revision. Ed. Cubano M.A. San-Antonio; 2013. 589 p
Penn-Barwell J.G., Roberts S.A., Bishop J.R., Midwinter M.J. Improved survival in UK combat casualties from Iraq and Afghanistan: 2003–2012. J Trauma. 2015:78(5):1014-20. doi: 10.1097/TA.0000000000000580
Mathews Z.R., Koyfman A. Blast Injuries. J Emerg Med. 2015:49(4):573-87. doi: 10.1016/j.jemermed.2015.03.013
D. R. Spahn, B. Bouillon, V. Cerny [et al.] Management of bleeding and coagulopathy following major trauma: an updated European guideline. Critical Care. 2013:17:R76. doi: 10.1186/cc12685
Bhandari P. S., Maurya S., Mukherjee M. K. Reconstructive challenges in war wounds. Indian J Plast Surg. 2012:45(2):332–9. doi: 10.4103/0970-0358.101316.
Ministry of Health of Ukraine (2010). [About approving standards and clinical protocols for medical care in the specialty "Surgery"] (Order No. 297 from 02.04.2010). Retrieved from http://www.moz.gov.ua/ua/portal/dn_20100402_297.html. Ukrainian.
Usenko L.V., Tsarev A.V., Petrov V.V., Kobelyatskiy Yu.Yu. [Modern principles of fluid resuscitation in multiple trauma and the protocol of massive blood transfusion]. Gematologija. Transfuziologija. Vostochnaja Evropa. 2016:1:64-75. Russian.
Sokolov V.A. [Multiple and combined injuries]. Moscow: GEOTAR-Media; 2006. 512 p. Russian
Ministry of Health of Ukraine (2002). [About approving methods of measuring the medical and biological indicators] (Order No. 417 from 15.11.2002). Retrieved from http://mozdocs.kiev.ua/view.php?id=1960. Ukrainian.
Ostrovskij V. K., Svitich Yu. M., Veber V. R. [Leukocyte index of intoxication in acute purulent and inflammatory diseases of the lungs]. Vestn. hirurgii im. I. I. Grekova. 1983:11:12-24. Russian.
Copyright (c) 2019 EMERGENCY MEDICINE
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2019