[Severe multiple injuries. Strategy and results. Experience at the Hôpital de la Pitié in 1988 and 1989].
In our series of 97 patients with multiple in juries observed in 2 consecutive years (1988-1989), we have selected only the most severe injuries, of which the patients died within 48 hours, and those that required a long stay in the intensive care department. On admission, we recorded 49 cases of stage II or more severe coma, and 67% of patients under respiratory assistance with an instable hemodynamic state. Out of the 44 deaths recorded, 30 subjects were comatose from the beginning. The justifies the confrontation of 3 specialist teams in 2/3 of cases. The specific recruitment of the hospital and the selection of the most severe cases of these "people under a death sentence" for the study shows a heavy toll of mortality (45,4%), including 60% on the first day. The main cause of death is head injuries (81%). The multivisceral and infectious consequences of long-lasting, heavy intensive care and pulmonary or myocardial contusions account fort secondary deaths in 25% of the patients who had survived. Emergent neurosurgical operations are exceptional, but a neurosurgeon's opinion is always essential. Orthopedic surgical issues are not specific, but the frequency of spinal lesions must be emphasized (27,2%). In this series, 85% of the patients with multiple trauma presented with a lesion of the locomotive apparatus and underwent emergent surgery in every second case in satisfactory conditions. Severe thoracic and maxillofacial lesions requiring surgery are rare. Abdominal lesions are more frequent (17%) and must be dealt with in priority, but they rarely cause death. On the contrary, lesions to the major blood vessels and retroperitoneal compound lesions have a very poor prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)
Vayre
P
P
Département anesthésie réanimation, Hôpital de La Pitié, Paris.
Clergue
F
F
Roy-Camille
R
R
Fohanno
D
D
Jawish
D
D
De Somer
B
B
Sichez
J P
JP
Venkiah
M G
MG
D004630:Emergencies; D006779:Hospitals, Public; D006801:Humans; D009104:Multiple Trauma / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D010297:Paris; D012189:Retrospective Studies
Polytraumatisés graves. Stratégie et résultats. Expérience de l'Hôpital de la Pitié 1988 et 1989.