Present concept for management of severely injured patients in Trauma Centre Faculty Hospital Královské Vinohrady
Abstract
The implementation of standardized protocols for management of polytrauma, multiple injuries and complicated monotrauma has led to improvement in trauma care with decrease in posttraumatic morbidity and mortality. The introduction of algorithm "Definitive Surgical Trauma Care" (DSTC) with concept of "damage control" surgery assumed the principal role in care of polytrauma patients.
It can be accomplished only in the trauma- centre with implementation of care system for severely injured patients. Analysis of severely injured patients treated in Trauma Centre Faculty Hospital Královské Vinohrady was performed in a retrospective study.
Methods and results. 515 injured patients admitted to emergency unit of the Department of anaesthesiology and resuscitation in years 2009-2010 were evaluated. There were 385 men and 130 women.
Average age of patients was 45 years. Primary trauma admissions were 482 (83%) victims.
There were 248 (48%) polytrauma patients, 158 (31%) with craniocerebral injuries, 76 (15%) with associated injuries and 33 (6 %) injured with monotrauma. ISS > 16 were in 309 injured patients, average rate ISS was 26.5.
Trauma care in emergency unit was provided with the team of specialists (general surgeon for visceral traumatology, orthopaedic surgeon for extremities trauma, specialist for intensive care, anaesthesiology and diagnostic radiology). 412 surgical or radiointervention procedures were performed. There were 313 (76%) urgent surgeries and 99 delayed (24%).
The most frequent urgent surgery was for fractures of extremities, (36%) and neurotraumas (29%). Acute operations for thoracic and abdominal trauma were performed in 24% of patients.
Delayed surgeries were mostly operations of extremities fractures (66%) and maxillofacial injuries (15%). Mortality was 18% (95 patients); being highest in group of patients with Injury Severity Score (ISS) > 40 (65%).
Conclusions. The implementation of trauma care system in severely injured patients brings increased numbers of primary trauma admissions to trauma centres.
Polytraumas and craniocerebral injuries were the most frequently admitted patients to emergency unit. Implementation of standardized protocols with interdisciplinary cooperation in trauma management represents improvements of trauma care.
Early indication and performance of urgent operations with control of bleeding and prevention of subsequent contamination belongs to principal steps in the management of severely injured patients. Definitive management with reoperation in polytrauma patients can be indicated after the stabilisation.
ISS > 40 was connected with high mortality rate (65%)