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Identifier 000454720
Title Η καταγραφή του σοβαρού τραύματος σε τμήμα επειγόντων Πανεπιστημιακού Νοσοκομείου και η εκτίμηση της προβλεπτικής ικανότητας των GAP, MGAP, RTS και ISS σκορ βαρύτητας στην έκβαση ασθενών με μείζον τραύμα
Alternative Title Recording of severe trauma in an emergency department of the University Hospital and the evaluation of the predictive ability of GAP, MGAP, RTS and ISS severity scoring systems in the outcome of patients with major trauma
Author Παπαγιαννάκη, Δέσποινα
Thesis advisor Νότας, Γεώργιος
Reviewer Μπριασούλης, Γεώργιος
Ηλία, Σταυρούλα
Abstract Introduction: A trauma is now being considered as a ‘disease’ and this is how it should be managed by every health system that aims to have a holistic approach to the patient. The electronic trauma registries that have been developed as well as the stratification of the severity of the trauma are now an integral part of care for trauma patients and are now considered as two of the most important needs that the health system has to cover. The purpose of this study is to record the frequency, type, and mechanism of trauma in patients who come to the ED of University General Hospital of Heraklion (PAGNI) and require further treatment and care, as well to assess the predictability of the trauma outcome by using the GAP, MGAP, RTS and ISS trauma severity scores. Methodology: This study was conducted in the ICU of the University General Hospital of Heraklion. The data were collected from medical records of trauma patients that had been admitted between June and October 2022. A data recording form was used which included demographics, injury related data and prognostic injury severity rating tools. The exclusion criteria from the study were data that had to do with ages under 18 year old and death before arrival to the ED without ongoing resuscitation. Results: 448 patients with a mean age of 59,9 years old were included in the study. 94,6% of the patients had blunt trauma, with the predominant injury being fractures of the femur (122, 27,2%) and the majority of the accidents being caused by falls from the same height (172, 38,5%). In 133 patients the Glasgow scale was used for calculation, with only 12 (9,0%) receiving a score below or equal to 8. On an emergency basis, 25 patients were intubated, with 55% of them intubated within the first half hour of their arrival at the reference health facility. A computed tomography was performed in 49.3% of the patients with the most common type being a brain CT (146, 68,2%). 91,7% were transferred to a surgical clinic, while 5.0% and 3.3% were taken to the ICU and operating room respectively. The majority of patients (200, 57,1%) remained in the ICU for more than two hours until the diagnostic procedure was completed and their admittance to the clinic. In 18 patients (4,0%) it was necessary either immediately or within a few hours to perform an urgent interventional procedure. The average length of hospitalized stay was 8,7 days, while the average ICU stay was 11,9 days. 385 people (85,9%) were discharged and 11 patients (2,5%) died. The ISS scale was used to stratify patients based on the severity of their injury which was calculated in 100% of the hospitalized patients. 52 patients (11,6%) were estimated to have severe – very severe trauma. Based on the Gap and MGAP scales, 3 (2,4%) and 9 (7,4%) of the patients had severe – very severe trauma respectively. Only 9 patients were assessed on the RTS scale as it included respiratory rate, a data that is rarely recorded in patient files. Regarding the correlation of gender to injury data, there were more men (40, 81,6%) who were presented with trauma from other prefectures of Crete (p<0,001). Injuries at home were more common in women (94, 77,1%) while street injuries were more common in men (87, 77,7%) (p<0,001). Occupational accidents were recorded only in men (15, 100,0%) (p<0,001). The frequency of traffic accidents of any type is more frequent in men (80, 77,7%) while falls are more frequent in women (149, 59,4%) (p<0,001). Regarding the association of age to injury data, injuries at home occur at older ages with an average of 78.7 years (p<0,001), while accidents at work and road accidents occur at younger ages, with an average of 44,4 and 42,0 years respectively (p=0,001). The patients admitted to the ICU had a higher mean score on the ISS (27,3 ± 16,6) and a lower mean score on the MGAP (23,0 ± 4,8) & GAP (18,7 ± 4,6) scales. Patients who died had a higher mean on the ISS scale (40,5 ± 27,7) and lower means on the MGAP (19,6 ± 3,6) & GAP (16,6 ± 4,3) scales. The ISS scale had a better discriminative ability to identify patients who would pass away from their trauma than the GAP & MGAP scales, although this difference was not statistically significant. With a cutoff of 11 (based on the Youden Index), the ISS had 100% sensitivity and 86% specificity. Conclusions: Falls and traffic accidents are the most frequent types of accidents that cause in majority, femur fractures and head injuries. A limited number were multi-traumatized as was also demonstrated by the use of the prognostic scales of trauma severity. Significant correlations emerged based on both gender and age. Our study supports the need for a comprehensive trauma registry, which could determine the frequency and types of injury, gather clinical results of the injured and their outcome, giving the possibility to assess the cause – effect relationship.
Language Greek
Issue date 2023-04-05
Collection   School/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
Permanent Link https://elocus.lib.uoc.gr//dlib/5/2/b/metadata-dlib-1682505634-214075-26024.tkl Bookmark and Share
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