One-day surgery in multiple trauma patients.
The aim of the authors was evaluation of influence of progress in MT procedures, particularly on final results of treatment, with special attention to aggressive one-day surgery, including definitive orthopaedic operations. The study is based on own material from the 2-nd Department of Surgery of the Jagellonian University. From almost 3000 victims of accidents with multitrauma (MT), who were treated between 1968 and 1997, 932 patients were selected. They were treated in consecutive 2-year periods in a 5-year cycle, starting from 70/71 up to 95/96. From 1987, the patient material has been prospectively coded. A steadily growing number of MT patients were stated with the only exception in 85/86 period. Traffic accidents were the major cause of injuries in over 2/3 of victims and men were predominated. Time lapse from accident to arrival became shorter. Severity of injuries was growing steadily as well: from 21.55 to 26.17 points of ISS (Injury Severity Score). At the same time percentage of operated increased from 34.88 to 47.62, and length of stay decreased from 23.45 to 19.79 days. The most significant finding, however, was the fact that deep-set objective increase of trauma severity, mortality rate decreased twofold--from 29.07% at the beginning to only 14.85% at the end. The improvement resulted from progress in diagnosis and treatment of MT patients. Implementation of diagnostic peritoneal lavage, refurbishing of our intensive care unit, installment of computed tomography in the cases of head injuries, gradual introduction of early stabilisation of major fractures and routine early anticoagulant prophylactic and hyperalimentation as well as full standardisation of the therapeutic process--all these were the "mile-stones" which assured reaching such satisfactory results.
Brongel
L
L
Collegium Medicum UJ, Kraków.
D000007:Abdominal Injuries / Q000453:epidemiology; D006259:Craniocerebral Trauma / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007869:Leg Injuries / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology / Q000601:surgery*; D010388:Pelvis / Q000293:injuries; D011044:Poland / Q000453:epidemiology; D017678:Sex Distribution; D015996:Survival Rate; D015599:Trauma Severity Indices