Models of Certain Types of Surgical Shock Based on the Assessment of Selected Critical Parameters

Abstract

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.