The impact of certain factors on complications development in patients with multiple long bone fractures of lower extremities and severe associated trauma
DOI:
https://doi.org/10.12775/JEHS.2020.10.04.035Keywords
polytrauma, long bone fractures, definitive osteosynthesis, complication, outcomesAbstract
The aim: to determine the influence of individual factors on the development of complications in patients with polytrauma and multiple long bone fractures of lower extremities.
Materials and methods: a prospective study conducted inKyivCityClinicalHospital №17 from December 2016 to January 2020. The study included 57 patients with polytrauma and multiple long bone fractures of lower extremities, treated according to the proposed algorithm.
Results: the most common complications were: pneumonia (21.1%), acute respiratory distress syndrome (ARDS) (15.8%), multiple organ failure (MOF) (15.8%), sepsis (8.8%), mortality (12.3%). A number of factors influenced the development of complications in patients with multiple long bone fractures of lower extremities and polytrauma were identified and the correlation analysis was conducted. These factors included: age; sex; the Injury Severity Score (ISS); the Glasgow Coma Scale (GCS); the severity of a general condition of a patient according to the Clinical Grading Scale (CGS); trauma to the head, and neck, chest, abdomen, pelvis; head and neck, chest, abdomen, pelvis trauma in accordance with the Abbreviated Injury Scale (AIS); the number of segments of damaged limbs; Gustilo-Anderson fracture type; blood loss volume; massive blood transfusions; respiratory index; duration of mechanical ventilation (MV); treatment tactics; osteosynthesis method; conversion phasing.
Conclusion: the analysis allowed to identify the most significant factors that lead to complications in patients with multiple long bone fractures of lower extremities and polytrauma. Informative parameters were:
− for pneumonia: GCS and CGS; chest injury; AIS head and neck, chest ≥ 4; duration of MV; treatment tactics; conversion phasing (IC = 1.0-2.1).
− for ARDS: GCS and CGS; AIS chest ≥ 4; fractures > 2 long bones; blood loss volume; massive blood transfusions; respiratory index; duration of MV; treatment tactics (IC = 1.2-4.6).
− for sepsis: GCS; trauma to the chest, abdomen; AIS head and neck, abdominal cavity ≥ 4; fractures > 2 long bones; conversion phasing (IC = 1.1-3.2).
− for MOF: GCS and CGS; abdominal trauma; AIS abdominal cavity ≥ 4; fractures > 2 long bones; massive blood transfusions; conversion phasing (IC = 1.2-2.2).
− for mortality: age, ISS, GCS and CGS; abdominal trauma; AIS head and neck; chest, abdomen, pelvis ≥ 4; blood loss volume; massive blood transfusions; duration of MV (IC = 1,1-5,9).
Among the factors there were those for which the diagnostic and treatment process:
− affected: the choice of treatment tactics (IC = 1,1-1,3); use of massive blood transfusions (IC = 1.8-4.8); duration of MV (IC = 1,2-2,1); conversion of the fixation method (IC = 1.2-1.8).
− did not affect: GCS (IC = 1,2-3,1), CGS (IC = 1,1-1,3), AIS (IC = 1,0-6,2).
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