The impact of age, severity and localisation of injuries on the intrahospital mortality of polytraumatised patients

Autori analiziraju lokalizaciju i težinu ozljeda, te intrahospitalni mortalitet politraumatiziranih bolesnika, liječenih na Kirurškom odjelu i u Jedinici intenzivne terapije Opće bolnice u Karlovcu. Većina ozljeđenika stradala je u prometnim nezgodama (85,4%). Od ukupno 41 bolesnika, umrlo je 11 (26,8%). Preživjeli bolesnici praćeni su prosječno 3 godine i 8 mjeseci. Od primarno preživjelih naknadno je umrlo 3 (7,3%). Težina dominantne ozljede procijenjena je pomoću Abbreviated Injury Scale (AIS), a težina ukupnih ozljeda pomoću Injury Severity Score (ISS). Umrli bolesnici bili su stariji (p = 0,07), a razlika u težini dominantne i ukupnih ozljeda između umrlih i preživjelih je signifikantna (p < 0,001). Lokalizacija dominantne ozljede ne utječe na ishod. Statistički je značajna razlika u lokalizaciji svih relevantnih ozljeda izraženih kroz tjelesne sustave među promatranim grupama. Predikcija smrtnog ishoda, izražena kroz ISS, pokazuje da bolesnici, s visinom ISS-a od 33 i više, imaju veliku vjerojatnost letalnog ishoda (specificitet 72,7, senzitivitet 96,7, efikasnost 90,2). ISS se može korisno primijeniti pri prognozi ishoda liječenja traumatiziranih bolesnika na razini intrahospitalnog mortaliteta.The authors analyse localisation and severity of injuries as well as intrahospital mortality of polytraumatised patients treated at the Department of Surgery and Intensive Therapy Unit, General Hospital, Karlovac. Most of the injured suffered in traffic accidents (85.4%). Eleven (26.8%) patients died, out of forty-one. The mean followup for survived patients was 3 years and 8 moths, in which period three of them (7.3%) died. The severity of the dominant injury was assessed by Abbreviated Injury Scale (AIS), and the severity of all injuries by Injury Severity Score (ISS). The patients who died were older (p=0.07) and the difference between severity of the dominant as well as severity of all injurie in the groups of survived vs. deceased patients was significant (p=0.001). Localisation of the dominant injury had no impact on the outcome. The difference between localisations of all relevant injuries expressed by body areas between groups is statistically significant. The prediction of lethal outcome expressed by ISS showed that patients with ISS of 33 or higher have a great possibility of lethal outcome (specificity 72.7%, sensitivity 96.7%, efficiency 90.2%). ISS can be usefully used in prediction of outcome in injured patients on the level of intrahospital mortality

Liječenje akutne poslijeoperacijske boli: današnje stanje - iskustva bolesnika

In effective control of acute postoperative pain, it is essential to respect the principles of multimodal balanced analgesia, and to apply them within organized units for the management of acute postoperative pain (acute pain service). The aim of the study was to find out patient expectations and experience in the intensity of acute postoperative pain, and the efficiency of therapy they received. Between October 11, 2002 and December 14, 2002, 103 patients having undergone elective operative procedures under general endotracheal anesthesia were surveyed at Karlovac General Hospital. All patients were asked the preoperative group of questions on the intensity of pain they expected after surgery and on the intensity of pain at which he/she wanted to be given an analgesic. The postoperative group of questions referred to the intensity of pain 24 hours after the operative procedure and to the reason for not taking an analgesic. Results showed that prior to surgery, 33.98% of patients expected mild and 37.86% moderate postoperative pain. After the surgery, most patients felt moderate pain (33.98%). The study showed the therapy for acute postoperative pain and pain control to be still inadequate. The preconditions for successful pain control are the existence of acute pain service and implementation of the multimodal balanced analgesia concept. In this context, it is important to stress the education of patients as well as of the entire team participating in the management of pain.Za učinkovitu kontrolu akutne poslijeoperacijske boli neophodno je poštivati načela multimodalne balansirane analgezije, te ista provoditi unutar organiziranih jedinica za liječenje akutne perioperacijske boli. Cilj ovoga ispitivanja bio je ispitati očekivanja i iskustva bolesnika o jačini akutne poslijeoperacijske boli te učinkovitost primijenjene terapije. U razdoblju od 11. listopada 2002. do 14. prosinca 2002. godine u Općoj bolnici Karlovac anketirano je 103 bolesnika koji su bili podvrgnuti elektivnom operacijskom zahvatu u općoj endotrahealnoj anesteziji. Svim bolesnicima je nakon pristanka za operacijski zahvat u anesteziološkoj ambulanti postavljena prijeoperacijska skupina pitanja o jačini boli koju bolesnik očekuje poslije operacije te jačini boli kod koje želi dobiti analgetik. Poslijeoperacijska skupina pitanja odnosila se je na jačinu boli 24 sata nakon operacijskog zahvata te razlog neprimanja analgetika. Rezultati su pokazali da je prije operacijskog zahvata 33,98% bolesnika očekivalo blagu, a 37,86% bolesnika srednje jaku poslijeoperacijsku bol. Nakon operacijskog zahvata najveći broj bolesnika imao je srednje jaku poslijeoperacijsku bol (33,98%). Ovo je ispitivanje pokazalo kako je terapija akutne poslijeoperacijske boli, kao i njena kontrola još uvijek nedostatna. Preduvjet za njezinu uspješnu kontrolu je postojanje jedinice za liječenje akutne perioperacijske boli te provođenje koncepta multimodalne balansirane analgezije. U okviru njega važno je staviti naglasak na izobrazbu bolesnika, ali i cjelokupnog tima koji sudjeluje u liječenju boli

Nonelective surgery at night and in-hospital mortality - Prospective observational data from the European Surgical Outcomes Study

BACKGROUND Evidence suggests that sleep deprivation associated with night-time working may adversely affect performance resulting in a reduction in the safety of surgery and anaesthesia. OBJECTIVE Our primary objective was to evaluate an association between nonelective night-time surgery and in-hospital mortality. We hypothesised that urgent surgery performed during the night was associated with higher in-hospital mortality and also an increase in the duration of hospital stay and the number of admissions to critical care. DESIGN A prospective cohort study. This is a secondary analysis of a large database related to perioperative care and outcome (European Surgical Outcome Study). SETTING Four hundred and ninety-eight hospitals in 28 European countries. PATIENTS Men and women older than 16 years who underwent nonelective, noncardiac surgery were included according to time of the procedure. INTERVENTION None. MAIN OUTCOME MEASURES Primary outcome was in-hospital mortality; the secondary outcome was the duration of hospital stay and critical care admission. RESULTS Eleven thousand two hundred and ninety patients undergoing urgent surgery were included in the analysis with 636 in-hospital deaths (5.6%). Crude mortality odds ratios (ORs) increased sequentially from daytime [426 deaths (5.3%)] to evening [150 deaths (6.0%), OR 1.14; 95% confidence interval 0.94 to 1.38] to night-time [60 deaths (8.3%), OR 1.62; 95% confidence interval 1.22 to 2.14]. Following adjustment for confounding factors, surgery during the evening (OR 1.09; 95% confidence interval 0.91 to 1.31) and night (OR 1.20; 95% confidence interval 0.9 to 1.6) was not associated with an increased risk of postoperative death. Admittance rate to an ICU increased sequentially from daytime [891 (11.1%)], to evening [347 (13.8%)] to night time [149 (20.6%)]. CONCLUSION In patients undergoing nonelective urgent noncardiac surgery, in-hospital mortality was associated with well known risk factors related to patients and surgery, but we did not identify any relationship with the time of day at which the procedure was performed