ISSN 2415-3060 (print), ISSN 2522-4972 (online)
JMBS
  • 19 of 59
Up
JMBS 2016, 1(1): 91–95
https://doi.org/10.26693/jmbs01.01.091
Medicine

The Polytrauma Objective Scales Prognostic Values Comparison for the Severe Combined Thoracic Trauma

Stupnytskyi M.A.
Abstract

Introduction. According to WHO data near 2 million people die as the result of polytrauma every year. Up to 93% cases of thoracic injuries are recorded in patients with polytrauma in case of traffic accidents. For the correct decision of polytrauma management with the evaluation of indications/contraindications for polytrauma second step surgery, including combined chest trauma, evaluation of the patient state is necessary in early posttraumatic period after primary resuscitation in conditions of damage control strategy. The specific objective of this study was to evaluate prognostic abilities of the common scales used for the polytrauma severity objective rating in case of the severe combined thoracic trauma. Materials and methods. Study was performed on 73 male patients aged from 20 to 68. Patients with the severe blunt combined thoracic trauma with pneumothoraxes and hemothoraxes, lung contusions, heart contusions and multiply (≥3) rib fractures were included in this study. ISS, PTS, ВПХ-МТ scales were used for injury rating. RTS and TRISS – for evaluation of the patient status severity in admission. The cohort was divided into two groups according to outcome - survival (n=42, mean ISS=24,5 (22,73-28,22)) and non-survival (n=31, mean ISS=34 (30,38-38,53), p=0,0006 in comp. with survival group). Mann-Whitney test was used to assess differences between groups. ROC-analysis was used for the parameters’ diagnostic value evaluation. A Fisher exact test was performed to consider differences in nominal data. Results. The highest values of AUROC among all injury severity objective methods were got for ВПХ-МТ (0,7569, (0,6448-0,869), р=0,0001913) and for TRISS model (0,8076 (0,701-0,9142), р<0,0001). Cut-off values were established according to Youden coefficient in points of ISS>25,5 (acc=65,75%, odds=5,044 (1,715-14,83), p=0,0034), ВПХ-МТ>13,15 (acc=72,6%, LR=2,71, odds=6,899 (2,433-19,43), p=0,0003), RTS<7,004 (acc=78,08%, odds=12,57 (4,105-38,5), p<0,0001) and TRISS<0,8339 (acc=79,45%, LR=5,69, odds=15,54 (4,681-51,59), p<0,0001). It is possible to calculate probability of mortality according to Bayes theorem with the help of this data considering that apriory probability is 18,47 – 19,37%. So if the severity of polytrauma is greater than 13,15 according to ВПХ-МТ scale in patient with the severe blunt combined thoracic trauma, the probability of mortality becomes 38,03-39,43%. Decrease of TRISS model probability below 0,8339 increases probable mortality up to 56,31-57,75%. Conclusions. This study has shown that it can be possible with statistically significant level to predict outcome in patients with the severe blunt combined thoracic trauma based on objective methods, evaluated in this study. But low prognostic accuracy does not allow recommending for the use of the estimated cut-off values alone for outcome prediction in case of such type wound dystrophy. The objective methods of the patient’s status severity in admission give better outcome prediction than scales for rating injury severity. The most accurate is TRISS model as it consists of objective criteria for injury severity, the severity of patient’s status on admission and age of the victim. The PTS scale is least suitable for outcome prediction because components of chest injury are not enough represented in it.

Keywords: thoracic trauma, polytrauma, forecasting of a survival, scales prognostic values comparison

Full text: PDF (Ukr) 137K

References
  1. Gumanenko EK, Boyarintsev VV, Suprun TYu, i dr. Ob'ektivnaya otsenka tyazhesti travm. Uchebnoe posobie. Sankt-Peterburg, 1999. 110 p.
  2. Gur'ev SO, Satsik SP. Problemi nadannya medichnoyi dopomogi postrazhdalim vnaslidok dorozhno-transportnih prigod. Travma. 2012; 13 (2): 27–9.
  3. Linchevskiy OV, Myasnikov DV, Makarov AV, ta in. Poednana travma: dozhiti do svitanku (problemna stattya). Travma. 2012; 13 (2): 98–102.
  4. Mischenko VV, Grubnik VV, Goryachiy VV. Torako-abdominalna travma v praktitsi urgentnogo hirurga - optimizatsiya algoritmu nadannya dopomogi. Visnik Vinnitskogo natsionalnogo medichnogo universitetu. 2014; 18 (1): 87–90.
  5. Poltoratskiy V.G. Kliniko-epidemiologichni osoblivosti poednanoyi kranio-torakalnoyi travmi. Odeskiy medichniy zhurnal. 2004; 4 (48): 63–4.
  6. Puras YuV, Talyipov AE. Faktoryi riska razvitiya neblagopriyatnogo ishoda v hirurgicheskom lechenii ostroy cherepno-mozgovoy travmyi. Neyrohirurgiya. 2013; 2: 8–16.
  7. Sohaneva IL, Kostikov YuP, Gilborg GR, i dr. Lechebno-diagnosticheskaya taktika u bolnyih s torakalnoy travmoy pri sochetannyih povrezhdeniyah. Neotlozhnaya meditsinskaya pomosch. Sbornik statey Harkovskoy gorodskoy klinicheskoy bolnitsyi skoroy neotlozhnoy meditsinskoy pomoschi. 2004; 7: 140-3.
  8. Trutyak IR. Damage control u hirurgiyi ushkodzhen organiv cherevnoyi porozhnini. Hirurgiya Ukraine. 2008; 4: 77–81.
  9. Usenko LV, Belotserkovets OV. Sovremennyie aspektyi intensivnoy terapii politravmyi s prevalirovaniem torakalnoy travmyi na dogospitalnom i gospitalnom etapah. Meditsina neotlozhnyih sostoyaniy. 2008; 6: 35–7.
  10. Sheyko VD. Deyaki pokazniki gemodinamiki pri riznih variantah tyazhkoyi poednanoyi travmi v gostromu periodi travmatichnoyi hvorobi. Shpitalna hirurgiya. 2001; 4: 34–7
  11. AlEassa EM, Al-Marashda MJ, Elsherif A, Hani O Eid, Fikri M Abu-Zidan. Factors affecting mortality of hospitalized chest trauma patients in United Arab Emirates. J Cardiothorac Surg. 2013; 8 (1): 57. https://doi.org/10.1186/1749-8090-8-57
  12. Beuran M, Iordache F. Damage control surgery- new concept or reenacting of a classical idea? J Med Life. 2008; 1 (3): 247–53.
  13. Bewick V, Cheek L, Ball J. Statistics review 13: receiver operating characteristic curves. Crit Care. 2004; 8 (6): 508–12. https://doi.org/10.1186/cc3000
  14. Brøchner AC, Toft P. Pathophysiology of the systemic inflammatory response after major accidental trauma. Scand J Trauma Resusc Emerg Med. 2009; 17: 43. https://doi.org/10.1186/1757-7241-17-43
  15. Costa G, Tomassini F, Tierno SM, et al. The prognostic significance of thoracic and abdominal trauma in severe trauma patients. Ann Ital Chir. 2010; 81: 171–6.
  16. Demirhan R, Onan B, Oz K, Semih Halezeroglu. Comprehensive analysis of 4205 patients with chest trauma: a 10-year experience. Interact Cardiovasc Thorac Surg. 2009; 9 (3): 450–3. https://doi.org/10.1510/icvts.2009.206599
  17. Emircan S, Ozguc H, Aydin SA, Ozdemir F, Köksal O, Bulut M. Factors affecting mortality in patients with thorax trauma. Turkish J Trauma Emerg Surg. 2011; 17 (4): 329–33. https://www.ncbi.nlm.nih.gov/pubmed/21935831
  18. Hasenboehler E, Williams A, Leinhase I, Steven J Morgan, Wade R Smith, Ernest E Moore, Philip F Stahel. Metabolic changes after polytrauma: an imperative for early nutritional support. World J Emerg Surg. 2006; 1: 29. https://doi.org/10.1186/1749-7922-1-29
  19. Mommsen P, Zeckey C, Andruszkow H, Weidemann J, Frömke C, Puljic P, van Griensven M, Frink M, Krettek C, Hildebrand F. Comparison of different thoracic trauma scoring systems in regards to prediction of post-traumatic complications and outcome in blunt chest trauma. J Surg Res. 2012; 176 (1): 239–47. https://doi.org/10.1016/j.jss.2011.09.018
  20. Pape H-C, Peitzman AB, Schwab CW, Peter Giannoudis. Damage Control Management in the Polytrauma Patient. New York: Springer; 2010. 331 p.
  21. Pathak MN. Damage control philosophy in polytrauma. MJAFI. 2010; 66: 347–9.
  22. Ried M. Bein T, Philipp A, Thomas Müller, Bernhard Graf, Christof Schmid, David Zonies,Claudius Diez, Hans-Stefan Hofmann. Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience. Crit Care. 2013; 17 (3): R110. https://doi.org/10.1186/cc12782
  23. Veysi VT, Nikolaou VS, Paliobeis C, Efstathopoulos N, Giannoudis PV. Prevalence of chest trauma, associated injuries and mortality: A level I trauma centre experience. Int Orthop. 2009; 33 (5): 1425–33. https://doi.org/10.1007/s00264-009-0746-9
  24. Virgós Se-or B, Nebra Puertas C, Sánchez Polo C, et al. Predictors of outcome in blunt chest trauma. Arch Bronconeumol. 2004; 40 (11): 489-94.https://doi.org/10.1016/S1579-2129(06)60363-7