The aim of the study was to devise models that describe three types of surgical shock based on a set of simple biochemical and clinical parameters and establish a method of assigning new patients to each surgical shock scenario. Material and methods. Prospective analysis included patients hospitalized in IInd Chair of Surgery from 2001 to 2005 who belonging to the following groups: multiple injuries (at least 7 points according to LSO), upper GI bleeding (in patients requiring blood transfusions during first day) and severe acute pancreatitis (at least 3 rd degree according to Trapnell's scale). A set of nineteen parameters was evaluated on the first, fourth and seventh day in every patient. Discrimination analysis was used for statistical analysis with calculation of Mahalanobis squared distances between groups that reflect their reciprocal differences. Discrimination functions were calculated allowing the assignment of a new observation to one of the models. Eventually, reliability of categorizing patients to the studied groups was evaluated. Results. Differences among the groups -reflected by Mahalanobis squared distances -proved statistically significant in every studied day. Overall, the ratio of proper classifications according to discrimination functions equaled about 87%. The most common mistake in categorizing was observed in groups of multiple injuries and acute pancreatitis -due to similar pathophysiological processes leading through SIRS to MOF. Conclusions. The abovementioned results indicate that the presented models can be successfully used in diagnostic processes, especially in emergency cases. The set of clinical and biochemical parameters used is simple and easy to obtain even in non-specialized centers. Key words: multiple injuries, acute pancreatitis, upper GI bleeding, discrimination analysis POLSKI PRZEGLĄD CHIRURGICZNY 10.2478/v10035-007-0054-2 2007 Significant effort was made to create a uniform system for the assessment of patient clinical status -regardless of the underlying disease, which would serve as a help for making therapeutic decisions and evaluating prognosis. For this purpose, many scales assessing the severity of homeostatic disturbances were created. In spite of their abundance, there is still a lack of single scale that can quickly, precisely and unequivocally set proper diagnosis in different life-threatening conditions. Moreover, many from the recently devised scales are based on parameters that require significant time or sophisticated techniques to obtain results (1-11). A system established to assess patient clinical status and aid in making proper diagnosis -especially in situations requiring immediate interventions -could improve the process of initial triage in Emergency Departments with limited access to highly specialized diagnostic techniques.The aim of this study was to create models of response in three commonly found settings of surgical and traumatological shock based on a set of selected critical parameters.

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The aim of the study was analysis of diagnostic techniques relative to the type of trauma sustained (blunt versus penetrating), the patients' haemodynamic status (stable versus in shock), the character of injuries (isolated versus multiple) and the type of treatment employed (conservative versus operative) in patients with suspected abdominal injuries. Material and methods. The study included 1406 trauma victims hospitalized in the 2nd Department of Surgery in Cracow from 1995 to 2004 who were diagnosed with or underwent surgery for suspected abdominal organ injury. In addition to the clinical examination performed in each case, the ultrasonographic examination according to FAST procedure was used in 1373 patients, diagnostic peritoneal lavage (DPL) in 46, computed tomography (CT) in 27, laparoscopy in 45 and contrast studies of the urinary tract in 45 patients. Data concerning treatment process were obtained retrospectively from the computer databases entitled "Kopernik" and "Pacjenci". The efficiency of diagnostics provided in our clinic was estimated on the basis of the percentage of exploratory laparotomies and the number of missed injuries. Results. Of 218 patients with abdominal organ injuries, 72% underwent surgery and the remaining 28% were treated conservatively. Regardless of the type of trauma, the patients in shock received surgical treatment more often. In the group of patients suffering from blunt injuries, exploratory laparotomies were performed in 5.9% of haemodynamically stable patients and in 12.3% of patients admitted in shock. In the group of penetrating injuries the percentage of exploratory laparotomies reached 23.5 and 6.25% respectively. In six patients with blunt abdominal trauma who were treated conservatively the abdominal injuries were missed. One out of every ten patients was qualified for laparotomy solely on the basis of clinical examination. Most of these patients suffered from abdominal wounds. In the vast majority of remaining patients, FAST was used as the only diagnostic technique or (more often) in combination with additional diagnostic techniques. Except for FAST, additional diagnostic techniques were used in every tenth patient with isolated abdominal injury and in every fourth with multiple injuries. In the most abundant group of patients operated on due to bleeding, FAST was supplemented by additional techniques in half of the patients. Conclusions. FAST played a crucial role in diagnosing patients with injuries of the torso. CT or laparoscopy was additionally recommended for patients with suspected intra-abdominal organ injury, especially in cases of multiple injuries. Peritoneal penetration of the wound without symptoms of intra-abdominal organ injury should not constitute an indication for laparotomy. Qualification for laparotomy on the basis of clinical examination only is permissible only in haemodynamically unstable patients with abdominal wounds.