Abstract

BORDERLINE POLYTRAUMA PATIENTS MANAGEMENT PROTOCOL

Spassoff V.* and Kazalakova K.

ABSTRACT

Introduction: The adoption of the use of the damage control orthopаedics (DCO) protocol in clinical practice is of particular importance for trauma centers in this country. The concept of damage control (DC) in polytrauma patient management has been developed in an attempt to answer the question, when and how to operate on a patient with a severe trauma based upon inflammatory trauma response. The purpose of DCO is to minimize the time of surgical intervention and bleeding and thus reduce to a minimum the “second wave” of postoperative complications. While patients with stable vital signs can be treated with primary definitive osteosynthesis, DCO is a safe method that can be applied when it is advisable to cut the time for surgical intervention, or when a systemic immune response is inevitable. Borderline patients are those who, while stabilized through initial resuscitation measures, are exposed to factors that place them at risk of an adverse treatment outcome or rapid deterioration of their condition. Material and Methods: A prospective study was conducted on, and data processed from, 93 borderline polytrauma patients over a 5-year period. The study population were of 42.2316.07 years’ average age, ranging between 17 and 81 years; of them, 60 (64.5%) were male and 33 (35.5%) female. The most numerous age group (18) among the males were the 40-49 year-olds, followed by the 20-29 year-olds (13), and the least numerous (2) were the 70-79 age group. Among the female patients, the most numerous (8) was the 30-39 age group, followed by the 60-69 year-olds (6), while the 80-89 age group numbered a single patient. Patients with polytrauma injuries treated in Bulgaria all had Injury Severity Score (ISS) over 16. Methods: diagnostic (laboratory) tests; imaging diagnostics: X-ray images; CT; ultrasound diagnostics; angio CT. Therapeutic – debridement; external fixation; conversion. Results and Discussion: Lethal exitus: in 4 males and 1 female. The mortality rate among the 93 patients in the study was calculated at 4.65%. One patient died during surgery, two survived the first 36 hours from admission, and the remaining two survived 72 hours from admission. Average duration of stay in ICU: 5.91 days for the males and 7.61 days for the females. Disability for up to 1 ½ years occurred in 10 males and 7 females; pulmonary thromboembolism in 1 male, no females; sepsis, in 2 males and 3 females; infections, in 16 males and 8 females; bone nonunion, in 11 males and 7 females. Conversion was performed on 52 male and 29 female patients. Conclusions: Our clinical experience in polytrauma patient management is based on DCO. We have made no significant distinction between open and closed fracture in administering DCO. As we adhered to the DCO principles in dealing with such patients, clinical experience shows that the average stay in ICU was 6.763 days, and the average total length of stay in hospital, 28 days, with a mortality rate of 4.65%.

Keywords: Polytrauma, DCO, SIRS, CARS, external fixation, conversion.