Role of Neutrophil-to-Lymphocyte Ratio as a Predictor of Systemic Inflammatory Response Syndrome in Blunt Abdominal Trauma Following Emergency Laparotomy in Sanglah General Hospital, Denpasar

BACKGROUND: Abdominal trauma, both blunt and penetrating abdominal trauma, is the third most common trauma, which is about 10% after head trauma (30%) and chest trauma (20%). Trauma has an influence on the balance of the immune system. The excessive inflammatory response can trigger systemic inflammatory response syndrome (SIRS). The ratio of neutrophils to lymphocytes acts as a marker of the inflammatory response in both surgical and non-surgical patients. AIM: The purpose of the study was to predict the incidence of SIRS using neutrophils-to-lymphocytes ratio (NLR) in patients with blunt abdominal trauma undergoing emergency laparotomy. METHODS: This study is an observational analytic study with a prospective design which was carried out at the emergency room, intensive care unit, Sanglah Hospital, Denpasar, Surgery for 1 year from January 2019 to December 2019, involving 59 research subjects with the consecutive sampling method who is met the inclusion and exclusion criteria. RESULTS: The area under the curve value obtained an NLR sensitivity of 87.1% with a cutoff point of 5.25. In the path analysis, it was found that NLR was the dominant factor and had a positive effect of 43.9% (p < 0.001) on SIRS. CONCLUSION: NLR is expected to be used as a reference to predict the incidence of SIRS in blunt abdominal trauma following laparotomy emergency.

Management of Maxillofacial Fracture: Experience of Emergency and Trauma Acute Care Surgery Department of Sanglah General Hospital Denpasar Bali

BACKGROUND:

Maxillofacial fracture is one of the major trauma; the cases were increasing because of the high number of motorcycles in Bali. The goal of the treatment is proper positioning of the occlusion, and it depends on rapid diagnosis and proper treatment.

AIM:

This study aims to know the characteristics of the maxillofacial fracture patients in Sanglah General Hospital Denpasar Bali.

METHODS:

A retrospective study, based on medical record were concluded, samples taken in Sanglah General Hospital from January to June 2015. Total recorded patient were 35 patients. The data obtained include age, gender, type of the fractures, and operation management.

RESULTS:

The injury was more common in male compared to female (80% vs 20%). Age 20 to 40 years old were more common (48.57%), followed by the child to adolescent (aged 0 to 20 years old) were 31.43%, and adult to elderly (aged 40 to 60 years old) was 20%. The mandibular fracture was most common (51.43%), other fractures such as a zygomatic fracture (31.43%) and maxillary fracture (17.14%). Internal fixation was the gold standard of the treatment (65.71%), and the other was an arch bar (34.29%).

CONCLUSION:

Diagnosing the right injury to the facial bone is a key step in determining a treatment plan. Rapid diagnosis and proper treatment lead to good occlusion, both internal fixation and arch bar were an effective treatment. The importance of dealing with almost all maxillofacial fracture problems in the first surgery.