Influence of trauma origin site on admission rates of patients submitted to emergency laparotomy.

Luis Fernando Spagnuolo Brunello,Iwan Augusto Collaço,Flávio Daniel Saavedra Tomasich,Adonis Nasr,Phillipe Geraldo Teixeira De Abreu Reis,Thamyle Moda De Santana Rezende,Camila Roginski Guetter,Ana Luísa Bettega

doi:10.1590/0100-6991e-20181970

Luis Fernando Spagnuolo Brunello, Iwan Augusto Collaço + Show 6 more

Open Access

https://doi.org/10.1590/0100-6991e-20181970

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Abstract

to evaluate the influence of the site of trauma occurrence on the trauma scores of patients submitted to emergency laparotomy. this is a retrospective, observational, analytical study. We included 212 patients who underwent exploratory laparotomies in the period of January 2015 and December 2017. We obtained information about the accident site and vital data of the patients based on data collection through electronic and physical records. We analyzed the trauma indices of patients from Curitiba and its Metropolitan Region and the place where the patient was rescued (physical establishment or public road). among the 212 patients studied, 184 (86.7%) were brought by the Prehospital Care Service from the city of Curitiba, and 28 (13.3%), from the Metropolitan Region of Curitiba. Twenty-five patients (17.6%) were rescued in physical establishments, while 117 (82.4%) were rescued on public roads. We observed higher values of Injurity Severity Scores (ISS) in patients coming from the Metropolitan Region than in those coming from Curitiba (29.78 vs 22.46, P=0.009), but higher values of Trauma and Injury Severity Scores (TRISS) in patients from Curitiba than the ones from the Metropolitan Region (90.62 vs 81.30, P=0.015). Patients rescued in public roads presented lower Revised Trauma Scores (RTS) (6.96 vs 7.65, P=0.024) and TRISS (86.42 vs 97.21; P=0.012). trauma victims from sites more distant from the referral center and rescued on public roads presented worse prognosis.

Highlights

The evolution of rescue systems and the possibility of initiating interventions at the trauma scene have led to a significant fall in early post-traumatic mortality rates, especially in those injuries directly associated with the development of early death[1]
We classified and analyzed the data collected in two different ways: the first corresponded to the trauma site (Curitiba or Metropolitan Region) and the second corresponded to the trauma scene in which the patient was found and assisted for the first time after trauma
We found higher Injury Severity Score (ISS) values in patients coming from the Metropolitan Region than in those coming from Curitiba (P=0.009)

Summary

Introduction

The evolution of rescue systems and the possibility of initiating interventions at the trauma scene have led to a significant fall in early post-traumatic mortality rates, especially in those injuries directly associated with the development of early death[1]. Studies show that population density is a strong and independent predictor of a county’s mortality rates[2,3]. The time elapsed between injury and definitive treatment is important and it is reasonable to assume that the time of transport to the hospital seems to be an independent predictor of mortality. Some authors affirm that there is greater mortality in patients living in rural areas[4]. These studies were mostly based on national databases, not containing anatomical and physiological data of the lesions, necessary to calculate the indices of trauma to assess the probability of survival. All scores are used to estimate survival and risk of complications, being used in the preparation of care protocols[5,6,7]

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