Surgery in the early post-trauma period in patients with triage positive injuries

Czech version

Authors: František Vyhnánek ¹; Jakub Štefka ²; David Jirava ²; Martin Očadlík ²; Pavel Douša ³; Marek Laboš ⁴; Michal Fric ⁵
Authors‘ workplace: Traumatologické centrum FNKV, Praha Traumatology Centre, FNKV, Prague, Czech Republic ¹; Chirurgická klinika 3. LF UK, Praha Department of Surgery, Third Faculty of Medicine, Charles University, Prague, Czech Republic ²; Ortopedicko-traumatologická klinika 3. LF UK, Praha Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University, Prague, Czech Republic ³; Radiodiagnostická klinika 3. LF UK , Praha Department of Radiodiagnostics, Third Faculty of Medicine, Charles University, Prague, Czech Republic ⁴; Klinika anesteziologie a resuscitace Department Anaesthesiology and Resuscitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic ⁵
Published in: Úraz chir. 24., 2016, č.3

Overview

Introduction:
Timely indication of surgery in the early post-injury period is one of the factors influencing treatment outcomes of the seriously polytraumatized with triage positivity. Stopping the bleeding, decompression of the body cavities and prevention of continuous contamination are the primary aims of emergency surgical procedures in patients with blunt and penetrating injuries. Significant decrease of the lethality in patients with triage-positive injuries is associated with the use of damage-control surgeries, especially in patients with chest, abdominal and pelvic trauma, and patients with extremity injuries.

Material, methods, results:
We analysed a total of 1735 patients with triage-positive injuries admitted to our Traumatology Centre who underwent an emergency or delayed surgical procedure between 2008 and 2014. In this group there were 1334 males and 401 females. A total of 1447 (83 %) patients had the ISS<16 upon admission. In most cases, they were patients with primary injuries – 82.9 %. The injuries were most frequently caused by traffic collisions (51 %), followed by falls from height (36 %). From the total number of patients, triage positivity was observed in 45 % of patients with polytrauma, in 33 % of patients with an isolated craniocerebral injury, in 15 % of patients with associated injuries, and in 7 % of patients with a monotrauma. Head was the most frequently injured body region (79 %), followed with the chest (49 %) and extremities (41 %). A total of 1320 patients underwent surgery, 72 % of them as an emergency procedure. Delayed surgery was indicated in 24 % of patients, reoperation was performed in 4 % of patients. Mortality in our study group was 17.9 %, where more than 65 % of these patients had an ISS score 40 or higher.

Conclusion:
Timely indication and performance of emergent or acute surgical procedure in patients with triage-positive injuries, with the aim to control bleeding, reduce contamination and to achieve decompression of the body cavities is the principal aim of treatment. Timing of the surgical procedures is based on clinical examination of the patient and the results of imaging. Depending on the site of injury, the most frequent procedures performed in the early post-injury period in triage-positive patients include osteosynthesis of fractures of the extremities, the pelvis, craniotomy and laparotomy. Staged surgical management (damage-control surgery and orthopaedics) is a treatment method of choice in patients with prolonged hypotension, metabolic acidosis, hypothermia and coagulopathy.

Keywords:
Triage-positive injuries, emergency – delayed surgery.

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Labels

Surgery Traumatology Trauma surgery

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Article was published in

Trauma Surgery

2016 Issue 3