“Zooming” in strategies and outcomes for trauma cases with Injury Severity Score (ISS) ≥16: promise or passé?

Abstract

OBJECTIVE:Rescuing severe trauma cases is extremely demanding. The present study purposed to analyze the efficiency of trauma management at Emergency Centre, University Clinical Centre of Serbia, Belgrade, included outcome within 28 days. METHODS: This retrospective study involved 131 intensive care unit trauma cases with total Injury Severity Score ≥16, in terms of administrating the two strategies: (i) definitive surgical repair and (ii) damage control laparotomy. RESULTS: The damage control laparotomy cases revealed statistically higher Injury Severity Score and APACHE II scores, significant brain dysfunction, and hemorrhagic shock on arrival (p<0.001). In addition, the damage control laparotomy had a higher rate of respiratory complications, multiple organ deficiency syndrome, and surgical wound complications (p=0.017, <0.001, and 0.004, respectively), with more days on mechanical ventilation (p=0.003). Overall mortality was 29.8%. Although higher early mortality within ≤24 h in the damage control laparotomy (p=0.021) had been observed, no difference between groups (p=0.172) after the 4th day of hospitalization was detected. CONCLUSIONS: Trauma patients have a high mortality rate in the 1st hours after the incident. Compelling evidence linking host and pathogen factors, such as mitochondrial apoptosis pathways, appears to correlate with loss of organ dysfunction, both cytopathologically and histopathologically. Adequate selection of patients necessitating damage control laparotomy, allowed by the World Society of Emergency Surgery, abdominopelvic trauma classifications, and improvements in resuscitation, may improve the results of severe trauma treatment.

Phytobezoar: An Unusual Condition Leading to Small Bowel Obstruction

“…histopathologically [16]. Therefore, emergency surgery remains significant and critical, globally, in severe cases [17][18][19][20].…”

Ambulatory Laparoscopic Appendectomy: Does the Conventional Approach Need a Reappraisal?

“…de Wijkerslooth et al [25] concluded that same-day discharge after LApp for uncomplicated appendicitis is safe without an augmented risk of readmission, complications, or unplanned hospital visits. As a matter of fact, emergency surgery remains significant and severe globally in the mentioned era [26][27][28][29][30].…”

A needful, unique, and in-place evaluation of the injuries in earthquake victims with computed tomography, in catastrophic disasters! The 2023 Turkey-Syria earthquakes: part II

“…The data from each patient were input into a Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) chart, and data analysis was conducted on a personal computer using statistics software (SPSS for Windows, version 23.0; SPSS, Chicago). The relevant injuries in six categories were examined with regard to three age groups (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), and 65 years and older) and four different imaging intervals (<24, 24-48, 49-72, and >72 h) (Figure 1). The Pearson χ 2 test was used in order to determine the differences associated with the age groups and imaging intervals in the involved body parts.…”