in 1981 it is known worldwide as a predictor of mortality in trauma patients 9). The concept of the lethal triad was described by Feliciano et al. Hypothermia, metabolic acidosis, and coagulopathy with hemostatic disorder have been reported as indications for DCS these elements comprise the lethal triad 1, 8).
#TRAUMA TRIAD OF DEATH SKIN#
Although the abbreviated injury scale (AIS) assesses injury severity on a scale from 1 (minor) to 6 (fatal) in each of six body systems (i.e., head, face, chest, abdomen, limbs and pelvis, and skin surface), along with the ISS, only a few studies have focused on the association of other injury sites with abdominal trauma even if multiple organs are often injured 11). The TRISS is calculated using the injury severity score (ISS) as an anatomic index, revised trauma score (RTS) as a physiologic index, patient age, and mechanism of injury. Decreasing the incidence of PTDs is considered important for the quality control of the treatment of trauma patients 22, 26). Deaths in trauma patients with a PS score of 0.5 or higher are defined as preventable trauma deaths (PTDs), which accounted for approximately 40% of all trauma deaths in Japan according to the Ministry of Health 23). The trauma and injury severity score (TRISS) has commonly been used to evaluate injury severity, and the probability of survival (PS) calculated using the TRISS has been used as a predictor of mortality 2, 4). In the management of abdominal trauma, both criteria should be defined to evaluate injury severity associated with mortality and to determine whether to perform DCS. Many surgeons have reported that patients who underwent DCS had a survival advantage compared with those not managed with DCS 7, 13, 21). These indications provide a practical basis for determining whether to use damage control surgery and postoperative management.Īmong the recent advances in severe abdominal trauma treatment, damage control surgery (DCS) has led to reduction in mortality and has become a standard approach.
This study found that head injury and metabolic acidosis are predictors of mortality. Of the lethal triad, the incidence of metabolic acidosis was significantly higher in the non-survivors (p < 0.050). The injury severity score (p = 0.035) and abbreviated injury scale score of the head (p = 0.005) were significantly higher among the non-survivors than among the survivors.
The patient characteristics, including age, sex, and mechanism of injury were not related to survival. Of the 15 included patients, eight (53.3%) survived and seven (46.7%) died. We compared the short-term outcomes and perioperative factors associated with the trauma and injury severity score and the lethal triad between survivors and non-survivors. Fifteen patients with severe abdominal trauma underwent damage control surgery from January 2011 to September 2017. In this study, we aimed to investigate the survival outcomes and clinical factors in patients undergoing damage control surgery for severe abdominal trauma, in relation to trauma severity based on the trauma and injury severity score and lethal triad (hypothermia, metabolic acidosis, and coagulopathy), to assess the indicators of mortality and criteria for performing damage control surgery. In trauma management, damage control surgery is an effective approach to decrease the incidence of preventable trauma death.
Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-kanda, Minami-ku, Hiroshima 734-8530, Japanĭepartment of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-kanda, Minami-ku, Hiroshima 734-8530, Japan Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
0 kommentar(er)
