Factors of parenchymal organ injury treatment outcome in children at Department of Pediatric Surgery, Split University Hospital Center during the 2000-2015 period

Abstract

Cilj ovog rada bio je istražiti čimbenike ishoda liječenja i preživljenje u bolesnika s ozljedom parenhimskih organa trbuha. U vremenskom razdoblju od siječnja 2000. do siječnja 2015. retrospektivno su pregledane povijesti bolesti bolesnika koji su imali traumatsku ozljedu parenhimskih organa. Istražili smo udio bolesnika koji su liječeni operacijski i konzervativno. Zatim smo u obje skupine raščlanili bolesnike na hemodinamski stabilne i nestabilne pri prijmu. Idući korak bila je raščlamba u odnosu na spol, dob, etiologiju, stanje svijesti te na one dovedene u “zlatnom satu” i na one dovedene nakon njega. Izračunali smo ISS (engl. injury severity score) vrijednost, također bodovali težinu ozljede AIS (engl. abbreviated injury scale) vrijednošću te uspoređivali dobivene vrijednosti u odnosu na etiologiju i stanje svijesti, preživljenje i vrijeme dolaska u bolnicu. Istraživanje je obuhvatilo 89-ero bolesnika, od kojih je većina bila muškog spola. Prosječna dob je bila 11 godina. Od ukupnog broja ozlijeđenih udio politraumatiziranih bolesnika iznosio je 50,5%. Bolesnika koji su liječeni transfuzijom krvnih pripravaka bilo je 16 -ero (17,9%). Preživjelo je 88-ero (98,8%) bolesnika. Etio loški je najviše bolesnika stradalo prilikom pada. Slezena je najčešće ozlijeđen organ, uglavnom je posrijedi bila ruptura. AIS i ISS niže su u bolesnika koji su preživjeli te u onih koji su dovedeni u “zlatnom satu” i pri prijmu bili pri svijesti. Na preživljenje utječu hemodinamska stabilnost pri prijmu, AIS i ISS vrijednosti, ozljede ostalih organa u trbušnoj šupljini i ostatku tijela, stanje svijesti pri prijmu, dolazak u “zlatnom satu”. Hemodinamska stabilnost, stanje svijesti i AIS i ISS vrijednosti pokazali su se kao kvalitetni prediktori preživljenja nakon traumatskih ozljeda trbuha.The aim of this study was to determine treatment outcome and survival in patients with blunt abdominal trauma. From January 2000 to January 2015, medical histories of patients treated for traumatic injury of parenchymal organs were retrospectively reviewed and the proportion of patients treated surgically or conservatively was estimated. In both categories, patients were divided into two groups of hemodynamically stable and hemodynamically unstable on admission. The following parameters were analyzed: gender, age, etiology, state of consciousness, and time from injury to admission. Regarding time to admission, patients were divided in those brought within the ‘golden hour’ and those brought beyond it. The Injury Severity Score (ISS) was calculated and the severity of injury assessed by Abbreviated Injury Scale (AIS). The values obtained were compared according to the etiology and state of consciousness, survival, and time to hospital admission. The study included 89 patients, most of them male, average age 11 years. There were 50.5% of polytrauma cases. Sixteen (17.9%) patients were treated with transfusion of blood products. Eighty-eight (98.8%) patients survived. Etiologically, most patients were injured by falling. Spleen was the most commonly injured organ and rupture was the most common type of injury. AIS and ISS were lower in patients brought within the ‘golden hour’ and those that were conscious at admission. The patient who did not survive was hemodynamically unstable, with associated injuries. Survival is infl uenced by hemodynamic stability at admission, AIS and ISS values, injuries of other organs in abdominal cavity and the rest of the body, state of consciousness at admission, and arrival within the ‘golden hour’. Hemodynamic stability, state of consciousness, AIS and ISS values were proved to be good predictors of survival after traumatic injuries of the abdomen