OUTCOMES FACTORS IN TRAUMATIC INJURY OF ABDOMINAL PARENCHYMAL ORGANS IN THE DEPARTMENT OF PEDIATRIC SURGERY BEETWEN 2000 – 2013 : HISTORY INTERSECTION STUDY

Abstract

Cilj istraživanja. Istražiti utjecaj etiologije, vrste ozljede, stanja svijesti, “zlatnog sata“ i AIS i ISS vrijednosti na odabir metode liječenja i preživljenje. Ispitanici i metode. Bolesnici koji su imali traumatsku ozljedu parenhimnih organa trbuha u razdoblju od 1. siječnja, 2000. do 31. prosinca, 2012. godine. Istražili smo udio bolesnika koji su liječeni operacijski i konzervativno. Zatim smo u obje skupine raščlanili bolesnike na hemodinamski stabilne i nestabilne pri prijemu. 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. Izračunali smo ISS vrijednost, također bodovali težinu ozljede AIS vrijednošću, te uspoređivali dobivene vrijednosti u odnosu na etiologiju i stanje svijesti, preživljenje i vrijeme dolaska u bolnicu. Proučili smo operacijski tijek svakog bolesnika koji je liječen operacijski, te izdvojili najčešće operacijske metode. Rezultati. Istraživanje je obuhvatilo 89 bolesnika, od čega je većina bila muškog spola. Prosječna dob bila je 11.11 godina. Bilo je 50,5 % politrauma. Bolesnika koji su liječeni transfuzijom krvnih pripravaka bilo je 16 (17.9 %). Preživjelo je 88 bolesnika. Etiološki je najviše bolesnika stradalo pri padu. Slezena je najčešće ozlijeđen organ, uglavnom se radilo o rupturi. AIS i ISS niže su u bolesnika koji su preživjeli, te u onih koji su dovedeni u “zlatnom satu“ i bili pri svijesti pri prijemu. Bolesnik koji nije preživio bio je hemodinamski nestabilan, sa pridruženim ozljedama. Zaključci. Na preživljenje utječu hemodinamska stabilnost pri prijamu, AIS i ISS vrijednosti, ozljede ostalih organa u trbušnoj šupljini i ostatku tijela, stanje svijesti pri prijamu, dolazak u “zlatnom satu“. Svi ti parametri utječu i na odabir metode liječenja, pa će se bolesnici koji su hemodinamski nestabilni sukladno tome uglavnom liječiti operacijski. Hemodinamska stabilnost, stanje svijesti i AIS i ISS vrijednosti pokazali su se kao kvalitetni prediktori preživljenja nakon traumatskih ozljeda trbuha.Objectives and background. To research the influence of ethiology, the types of injury, states of consciousness, “golden hour“, AIS and ISS values in selecting the method of treatment and survival. Patients and Methods. Patients who had a traumatic injury of parenchymal organs in the abdomen in the period between January 1, 2000. and December 31, 2012. We examined the proportion of patients who were treated surgically or conservatively. Then, in both groups we divided the patients in hemodynamically stable ones and those unstable on admission. The next step was the analysis in relation to gender, age, ethiology, state of consciousness and those brought in the “golden hour“and those brought after. We calculated the ISS value and we assessed the severity of injury by AIS value, and compared the obtained values in relation to ethiology and state of consciousness, survival and the time of arrival at the hospital.We studied the operational course of each patient treated surgically, and we separated the most common surgical methods. Results. The study included 89 patients, most of whom were male sex. The average age was 11,11 years. There were 50,5% of polytrauma. There were 16 (17,9%) patients treated with transfusion of blood products. 88 patients survived. Ethiologically most patients got injured falling. The spleen is the most commonly injured organ; it was mainly about the rupture. AIS and ISS are lower in the patients who were brought within “golden hour“ and were conscious on admission. The patient who did not survive was hemodynamically unstable, with associated injuries. Conclusions. Survival is influenced by hemodynamic stability on admission, AIS and ISS values, the injuries of other organs in abdominal cavity and in the rest of the body, the state of consciousness on admission, arrival within “golden hour“. All these parameters influence the selection of treatment methods, so the patients who are hemodynamically unstable will mainly be treated surgically. Hemodynamic stability, the state of consciousness, AIS and ISS values have proved to be good predictors of survival after traumatic injuries of abdomen