Matic I, Titlic M, Jurjevic M, Majeric-Kogler V, Sakic-Zdravcevic K
Department of Anaesthesiology and Intensive Care, General Hospital, Slavonski Brod, Croatia.
Bratisl Lek Listy. 2008;109(12):555-9.
Polytrauma and its consequences present a rising diagnostic and therapeutic problem we face at ICU every day. The goal of this research was to analyze and improve the diagnostic and treatment procedures.
A prospective research carried out at the multidisciplinary Intensive Care Unit during a period of over 2 years included 126 patients aged less than 15 years. Immediately on admission, all patients received the necessary care strictly complying with polytrauma treatment algorithms. We recorded the patients basic data (age, sex), cause of injury (fall, traffic accidents etc.) and injury type (blunt or penetrating) as well as the immediately performed procedures. The analysis of patients and calculation of mortality rates was based on time that had elapsed from injury to arrival at ICU, and severity of their injuries assessed as ISS score. Injury severity was assessed on admission also by using GCS, PTS, NISS and TRISS. Performed surgical interventions, mechanical ventilation duration, and total ICU time were recorded, as well as the need for transfer to a pediatric trauma centre.
96 patients arrived within 2 hrs from injury, with ISS>15, and/or PTS<8. 52 patients arrived within "golden hour"; 37 of them had ISS 16-26 and 15 had ISS>26 with mortality rate 3 (8%) vs 3 (20%) (p<0.001). Of the remaining 44 patients, 30 had ISS 16-26 and 14 had ISS>26, with mortality rate 7 (23.3%) vs. 5 (35.7%) (p<0.001).
The arrival at ICU during "golden hour", precise algorithms, high quality of diagnosis, monitoring and therapeutic procedures had an essential influence on the positive end-outcome and improved the survival and recovery rates in polytraumatized children (Tab. 4, Fig. 1, Ref. 18). Full Text (Free, PDF) www.bmj.sk.
多发伤及其后果是我们重症监护病房（ICU）每天面临的一个日益严峻的诊断和治疗问题。本研究的目的是分析并改进诊断和治疗程序。
在多学科重症监护病房进行的一项为期两年多的前瞻性研究纳入了126名15岁以下的患者。所有患者入院后立即接受严格遵循多发伤治疗算法的必要护理。我们记录了患者的基本数据（年龄、性别）、受伤原因（跌倒、交通事故等）和损伤类型（钝性或穿透性）以及立即实施的程序。对患者的分析和死亡率计算基于从受伤到抵达ICU所经过的时间，以及根据损伤严重程度评分（ISS）评估的损伤严重程度。入院时还使用格拉斯哥昏迷量表（GCS）、创伤严重度评分（PTS）、简明损伤定级标准（AIS）和创伤严重度特征评分（TRISS）评估损伤严重程度。记录实施的外科干预、机械通气持续时间和总ICU时间，以及转至儿科创伤中心的需求。
96名患者在受伤后2小时内抵达，ISS>15，和/或PTS<8。52名患者在“黄金一小时”内抵达；其中37名患者的ISS为16 - 26，15名患者的ISS>26，死亡率分别为3例（8%）和3例（20%）（p<0.001）。其余44名患者中，30名患者的ISS为16 - 26，14名患者的ISS>26，死亡率分别为7例（23.3%）和5例（35.7%）（p<0.001）。
在“黄金一小时”内抵达ICU、精确的算法、高质量的诊断、监测和治疗程序对积极的最终结局具有至关重要的影响，并提高了多发伤儿童的生存率和康复率（表4，图1，参考文献18）。全文（免费，PDF）www.bmj.sk 。
