Thoracic trauma: severity of injury in 342 patients

"nBackground: Trauma is a common problem in the world, predominately affecting young adults. Considering the high mortality rate in patients suffering from thoracic trauma, the condition is considered to be extremely important. The purpose of this study was to evaluate the prevalence and the epidemiology of chest trauma as well as the severity of the resulted injury in Tehran, Iran. "nMethods: This prospective, descriptive study was conducted on patients admitted to three medical centers in Tehran during June 1997 and 1998 due to chest trauma. The data on the demographic information of the patients, the mechanism of the trauma and the severity of the injury were collected and analyzed. "nResults: Three hundred forty two patients were admitted to hospital due to thoracic trauma; the majority of which were male adults. Blunt trauma especially secondary to motor vehicle accidents were the most frequent cause of chest injury in the studied patients. In 280(82%) of the cases, another form of trauma was also reported. Chest wall injury was the most common type of thoracic trauma in these patients. The trauma was reported to be mild in 181(53%) of the patients (ISS<7). Only 42(12%) patients required surgical intervention. The overall mortality rate was 14% which was reported to be ISS- related. "nConclusion: Chest injury is quite prevalent among trauma patients and is associated with other injuries in a considerable number of the patients. This type of trauma is associated with a high mortality rate among elderly and therefore needs special attention and care

ASA and Goldman scoring systems in prediction of open cholecystectomy surgeries

A

Non-operative management in blunt splenic trauma

Background: Splenic preservation following trauma has been decisively established as the preferred, safe and feasible therapeutic modality. Objective: To evaluate the outcomes of non-operative management in adults with blunt splenic injuries and determine the predictive factors of failure. Methods: Patients admitted to a tertiary trauma centre with blunt splenic trauma during a 10 year period were studied retrospectively. They were divided into three groups according to the type of management they received: emergent laparotomy; non-operative management; and those in whom failure of non-operative management led to laparotomy. Patients' age, Glasgow coma score at admission, the spleen injury score, volume of blood transfused, hospitalisation period and number of deaths were the other variables gathered from the records and analysed. Results: 320 consecutive patients were enrolled in the study. A total of 188 ( 58.7%) went directly to the operating room, and 41.2% ( 132 patients) were admitted with the goal of non-operative management for close observation; however, this management failed in 23.4% ( 31 patients) of the cases in the latter group, and laparotomy ( total or partial splenectomy) was the next step. The need for laparotomy increased significantly in cases with higher injury scores. Conclusion: The decision to pursue non-operative management rather than splenic preservation or splenectomy depends on the individual merits of each case. There is an increasing trend towards splenic preservation, particularly in younger, stable patients. Keyword