["Simplified Acute Physiology Score" (SAPS II) ina the assessment of severity of illness in surgical intensive care patients]

INTRODUCTION

In 1993, Le Gall proposed a new Simplified Acute Physiology Score (SAPS II) to assess the severity of illness in intensive care patients and to predict the risk of hospital mortality using a large data base of more than 13,000 patients of different intensive care units. Up to the present time, no satisfactory form of validation for surgical intensive care patients has been available. We investigated the prognostic quality of this score system for the assessment of the severity of the illness in surgical intensive care patients.

METHODS

Between October 1997 and December 1998, 310 consecutive patients were included in our study. We calculated the SAPS II score according to the published guidelines. Additionally, we calculated the risk of mortality by referring to the score. We used a receiver operating characteristics (ROC) analysis for statistical evaluation.

RESULTS

The median duration of stay on our intensive care unit was 8.4 days. In all patients, the mean SAPS II was 29.9 +/- 12.7. In the survivors, calculation of mean SAPS II was 27.7 +/- 11.4. In the non-survivors, mean SAPS II was 45.7 +/- 11.2. The predicted risk of mortality was 15.7%, the actual risk of mortality was 15.8%.

CONCLUSION

The SAPS II score has proved to be a good prognostic instrument in surgical intensive care patients. SAPS II is particularly effective in providing an exact estimation of the risk of death, classifying patient groups in clinical studies, epidemiological investigations, and quality assessment.

L-selectin in trauma patients: a marker for organ dysfunction and outcome?

BACKGROUND

Systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) are important factors affecting morbidity and mortality after trauma. Adhesion molecules, e.g. L-selectin (CD62 L), play crucial roles in both conditions.

PATIENTS AND METHODS

In 51 multiple trauma patients, CD62 L surface expression on granulocytes, monocytes, lymphocytes, as well as sCD62 L plasma concentrations were determined during the first 6 days after trauma, starting at the site of accident. Clinical parameters were severity of injury scores (ISS, APACHE II), requirement of red blood cell transfusion, acute lung or liver failure, development of MODS or SIRS, early (< or = 6 d) or late (> 6 d), and outcome.

RESULTS

CD62 L expression was reversibly elevated on granulocytes, T cells and monocytes in comparison with initial values. sCD62 L plasma concentrations did not show temporal variations but were depressed throughout observation period, in comparison with healthy controls. Lung failure within the first 6 days was associated with increased CD62 L expression on monocytes and B cells on admission and increased sCD62 L concentrations after 12 and 24 h. Patients with more severe injuries (APACHE II > 20 points) had higher sCD62 L concentrations after 24 h. Non-survivors had decreased sCD62 L (on admission) and T-cell CD62 L expression (after 4 h). Patients with early MODS or SIRS showed increased monocyte CD62 L expression after 6 days.

CONCLUSIONS

In multiple trauma patients, severe organ dysfunction is associated with altered CD62 L expression on leukocytes and circulating sCD62 L plasma concentrations. However, the obvious complexity of the pattern currently restricts use of CD62 L quantitation for clinical purposes.

[Late results of surgical treatment of chronic anterolateral instability of the proximal ankle joint]

In the literature more than 30 methods of syndesmoplastic surgery are described for the treatment of chronic ligament instability in the ankle. The aim of our investigation was, on the basis of long-term results, to determine which surgical method has the least complications, which offers the best chances from the viewpoint of exercise and sports, and whether degenerative changes in the joint can be avoided by restitution of stability. By means of isokinetic testing with 36 patients we were able to determine differences in the long-term results of various surgical methods, viz. syndesmoplasty using the peroneus brevis muscle as modified by Evans and Watson/Jones, respectively, and periosteal syndesmoplasty. In the period from 1980 through 1990, at the Graz Hospital for Trauma Surgery we performed 77 syndesmoplastic operations on 75 patients suffering from chronic ligament instability in the ankle joint. Of these cases, 45 were followed up for 6-136 months after the operation. On the basis of the results of these postoperative examinations we recommend periosteal syndesmoplasty for management of chronic ligament instability in the ankle, as this method is relatively easy to perform, prevents post-traumatic arthrosis, ensures maximum stability, which consequently means a low complication rate, and shows favorable final results in isokinetic testing.