[Epidemiological profile of late mortality in severe polytraumatisms]

Navigating the 'Triangle of Death': A Multidisciplinary Approach in Severe Multi-Trauma Management

This case report details the challenging management of a 45-year-old male construction worker who suffered severe multiple injuries after a fall and subsequent collision with cement mixers. The patient presented with extensive injuries, including amputation, fractures and internal bleeding, leading to a state known as the 'triangle of death'. Despite the initial grim prognosis, evidenced by an ISS score of 28 and a mortality risk coefficient of 89.56%, the patient was successfully resuscitated and managed through a multidisciplinary approach. This included damage control resuscitation, emergency vascular interventions and targeted temperature management for brain protection. The patient's recovery highlights the effectiveness of comprehensive trauma management and the critical role of coordinated care in severe multi-trauma cases.

Rendimiento de escalas de trauma ISS, NISS y RTS en accidentes de tránsito para predecir mortalidad en un hospital de alta complejidad

Introducción. La población mundial crece y con ello los accidentes de tránsito, incrementando la morbimortalidad. La combinación de factores clínicos y paraclínicos mediante las escalas de trauma impacta en los desenlaces al permitir tomar acciones oportunas. Métodos. Estudio de corte transversal en el que se incluyeron pacientes con lesiones por colisión en accidentes de tránsito, atendidos entre 2017 y 2018, en urgencias del Hospital Universitario San José de Popayán, Colombia, un hospital de alta complejidad. Se recolectaron variables sociodemográficas y biológicas y se aplicaron tres escalas de trauma, Revised Trauma Score, Injury Severity Score y New Injury Severity Score. Posteriormente, se evaluó su rendimiento para predecir mortalidad. Resultados. Se atendieron en el servicio de urgencias 650 pacientes con lesiones en accidentes de tránsito y se presentaron 16 muertes. Al evaluar el rendimiento de las escalas de trauma se encontró que la sensibilidad para mortalidad varía entre el 75 % para Revised Trauma Score y el 93,8 % para Injury Severity Score y New Injury Severity Score, con una especificidad que varía entre 89,1 % y 96,8 %. Se identificó que la mejor razón de verosimilitud positiva fue para Revised Trauma Score, mientras que la mejor razón de verosimilitud negativa fue para Injury Severity Score y New Injury Severity Score. Conclusiones. Los resultados evidencian un adecuado rendimiento de las escalas de trauma evaluadas para predecir mortalidad. La escala que presentó mejor rendimiento fue Injury Severity Score por su sensibilidad, especificidad y razón de verosimilitud positiva.

Loss of Consciousness in Injuries of the Extremities is an Alert to a Higher Probability of Death

Background:

There are many published studies about loss of consciousness related to general trauma however works on loss of consciousness in respect to orthopedic injuries are scarce.

Aim:

The aim of this study was to investigate whether loss of consciousness worsens the prognosis of patients with orthopedic injuries.

Method:

A retrospective cohort study of orthopedic traumas was performed in the university Hospital of Base in São José do Rio Preto. All accident victims with injuries of the extremities classified as Score 3 or 4 by the Abbreviated Injury Scale (AIS) were included in this observational quantitative study. Patients with minor injuries and injuries that did not involve the extremities were not included. The association of loss of consciousness at the scene of the accident with evolution to death was investigated. The t-test, chi-squared and Fisher exact tests, and relative risk were used for statistical analysis. An alpha error of 5% (p-value ≤ 0.05) was considered statistically significant.

Results:

A total of 245 patients with ages between 13 and 98 years old and a mean of 45.4 years had extremity AIS scores of 3 or 4. Of these, significantly more men (170 - p< 0.001) suffered this type of injury than women (71). Thirty-six (14.94%) of these patients lost consciousness compared to 205 (85.06%) who did not lose consciousness. The total death rate in this group of patients was 5.39%; 9 (25%) of the 36 patients who lost consciousness and 4 (1.95%) of the 205 who did not lose consciousness died (Fisher exact test: p-value = 0.0001 and relative risk = 12,813 – 95% confidence index: 4,166 to 39,408).

Conclusion:

Loss of consciousness in patients with orthopedic injuries of the extremities is associated to a higher death rate.