[The preclinical care of polytraumatized patients]

Mortality associated with extremity injuries compared with other types of trauma

Background:

The aim of this study was to evaluate one-month hospital mortality in victims with injuries of the extremities.

Methods:

All accident victims admitted to the Hospital de Base in São José do Rio Preto, Brazil, during the period from July 2004 to June 2005, were evaluated in an observational study. Patients were classified using the Abbreviated Injury Scale (AIS). Patients with severe injuries of the extremities (AIS 3–4) were compared with those without injuries or with minor extremity injuries (AIS 0–2).

Results:

A total of 3489 accident victims were evaluated; 3244 (92.98%) did not suffer injuries or had minor injuries of the extremities (AIS 0–2) and 245 (7.02%) had severe injuries (AIS 3–4). Of the 245 patients with AIS 3–4 extremity injuries, 13 (5.31%) patients died, and of those without severe injuries to the extremities, 34 (1.05%) died (Fisher’s Exact test P = 0.0000, relative risk 5.063, 95% confidence interval [CI]: 2.707–9.467).

Conclusion:

Patients with injuries of the extremities are at greater risk of death than accident victims with other types of trauma.

[Emergency treatment of thoracic trauma]

Thoracic trauma, most often associated with other serious injuries, is the main cause of death in the first 45 years of life. The percentage of chest injuries in multiple trauma, mainly from blunt impact, has remained relatively constant at 80% during the last 30 years. Isolated thoracic injuries comprise only 25% of all trauma cases, 90% of chest injuries are due to blunt impact, while penetrating injuries make up 5-10%. Since 25% of deaths from trauma are attributable to chest injuries, they determine the survival rate in multiple trauma to a significant extent. The pattern of chest injuries is variable, frequently in different combinations comprising rib cage and diaphragm, lung parenchyma, airway and mediastinal organs. This article details the immediate simultaneous diagnostic and therapeutic procedures in the prehospital phase, management in the emergency room, the relative importance of computed tomography, ultrasound examination and endoscopy in the primary diagnostic evaluation and the principles of anaesthetic management of thoracic trauma.