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the aim of the study. The development of a triage system to implement proper treatment based on severity of injury. Material and methods. The study is based on material from three Polish Universities' trauma departments: Cracow, Lublin, and Gdańsk. Using trauma scales, 300 of the most severely injured multiple trauma (MT) patients from 2000-2004 have been chosen for this study. Medical documentation was carefully analysed, particularly the time and extent of the surgical procedures performed as well as their potential to influence later results. Results. There are three groups of patients: 1 -critically injured, with an ISS>50, LSo>15, RTS 3 pts, two body cavity involvement, multiple long bone and/or pelvis fractures. only damage control was allowed and the definitive treatment necessary was within 48 hours. 2 -severely injured, with an unstable ISS 35-50, LSo 10-15, RTS 4-10 pts, one body cavity involvement, multiple long bone and/or pelvis fractures. Life-saving operations were possible with orthopaedic management (within 48 hours) provided using the "2+2 rule" (less than 2 hours of operation and no more than 2 units of blood transfused). 3 -moderately injured, with a stable ISS<35, LSo<10, RTS>10 pts, one body cavity involvement, a long bone or pelvis fracture. Classic surgical and orthopaedic management occurred within 48 hours. Conclusions. The history and course of post-traumatic syndrome from metabolic, immune and endocrine viewpoints requires a special strategy for repairing life -threatening trauma injures at the right time, in proper sequence, and with limited surgical activity in more severe cases. Key words: multiple trauma, damage control, inflammatory response, emergency thoracotomy, abbreviated laparotomy Despite considerable progress in medical sciences and profound changes in the organization of emergency services within the past quarter of a century, severe multiple trauma continues to be a major problem in traumatology with the associated mortality rates exceeding 10% in the best centers worldwide. According to recent reports, the most common causes of posttraumatic deaths in hospitals (>30-50% of all fatal outcomes) are late complications of a severe traumas and post-traumatic shock, including septic complications and multi-organ failure (MoF). Severe primary injuries of the central nervous system and exsanguinations continue to be the main causes of death (50-70%), at the site of the accident, in an ambulance (i.e. in the pre-hospital period), and during the first hours of hospitalization (1).Thus, we are witnessing continued progress in reaching the injured victims as quickly as Unauthenticated Download Date | 5/11/18 3:46 AM

After accidents, elderly patients (aged 75 years and older) have been demonstrated to have increased mortality rates after trauma, however, the prognosis of those patients surviving their hospitalization is unknown. We hypothesized that surviving elderly patients would also have decreased functional outcomes. The aim of the study. This study examined the outcome of elderly patients exposed to varying trauma relative to all trauma patients. Material and methods. This was a retrospective study of 5046 patients with trauma in 2001-2005 treated. 972 of these patients were aged 75 or more. Data included demographics, risks factors, cause of trauma, operative or conservative management and result of treatment. Results. Mechanisms of injury were falls (almost 90%), motor vehicle collisions (8%) and other. Statistical differences in the mechanisms of trauma between the studied and younger groups were observed. The mortality rate was doubled in the older group. Almost 2/3 of the patients underwent surgery. The strategy of management and treatment of elderly trauma patients has not been studied in the literature. This group may require special management and monitoring, and if possible, noninvasive modes of treatment. There are big advantages by aggressive, operative treatment of oldest patients, but is the "thin red line" in profits and loss in this group. Conclusions. In our opinion, it is necessity to operate on all elderly patients in good overall condition who were mobile and of good mental status prior to the accident, status, but we do not recommend operations in low-risk patients or those with bad prognosis for successful rehabilitation. Key words: elderly, functional outcome, risk of operation, trauma in the aged POLSKI PRZEGLĄD CHIRURGICZNY 10.2478/v10035-007-0017-7 2007 Similar to other countries, in Poland, as in other countries, the elderly population continues to rise. The percentage of people over 60 doubled within last 50 years (rose from 8.3 in 1950 to 17.6 in 2000), and nowadays, the group of people over 75 constitute 4% of the entire population.According to statistical data from GUS, a typical Pole suffers from 3.8 chronic diseases, with cardiovascular disorders playing prominent role (1, 2). They are diagnosed in 75% of elderly people. Elderly patients are commonly affected by disease that significantly affect their quality of life, such as degenerative arthropathies, eye and ear dysfunction and mobility problems. Musculoskeletal, respiratory, and digestive disorders affect 68%, 46%, and 34% of the elderly population, respectively. Diabetes mellitus, a disease of modern civilization, affects about 40% of population over 65. It results in an increased risk of infectious complications and delayed bone healing. Obesity affects the same group of patients and worsens prognosis, which results in an increased number of complications, prolongs hospitalization, lengthens mechanical ventilation time and increases mortality (3). Only about 20% of elderly people do not report Unauthenticated Download Date | 5/...