Traumatology
doi: 10.25005/2074-0581-2023-25-3-334-345
RISK FACTORS ASSOCIATED WITH IN-HOSPITAL MORTALITY AND PREDICTING OUTCOMES IN SEVERE ACUTE COMPOSITE TISSUE INJURIES
Department of Traumatology, Orthopedics and Military Surgery, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
Objective: To develop a reliable risk score prediction model to accurately predict the likelihood of lethal outcomes (LO) in severe acute composite tissue injuries (CTI) cases.
Methods: We conducted an analysis of data from 3,186 patients with CTIs who were aged between 18 and 74. Of these patients, 2,432 were men (76.3%), and 754 were women (23.7%). The age distribution of patients was as follows: 2290 (71.9%) were between 18-44 years old, 638 (20.0%) were between 45-59 years old, and 258 (8.1%) were between 60-74 years old. The patients with CTIs were split into two groups based on their diagnosis and treatment. The study group consisted of 1669 patients (52.4%) who received optimized approaches considering the likelihood of developing LO. The control group included 1517 patients (47.6%) diagnosed and treated using traditional methods. LO were noted in 514 (16.1%) cases. To determine the risk factors (RFs) associated with LO, we analyzed the distribution of frequency variables between lethal and non-lethal outcomes.
Results: The probability of developing LO in CTI was analyzed for statistical significance based on several RFs such as the patient's age, the presence of concomitant sub- and decompensated comorbid diseases, type and location of injury, severity of injuries, patient's state, and clinical forms of fat embolism syndrome (FES). Considering the identified RFs, a highly effective risk assessment scoring model for predicting the likelihood of developing LO in acute CTIs has been developed. Implementing optimized approaches and predicting the probability of developing LO significantly reduced fatality rates compared to traditional methods of diagnosis and treatment (13.5% and 18.5%, respectively, p<0.05).
Conclusion: Based on the testing results of the proposed scale with the significant decrease in LO observed in the study group, we highly recommend implementing these approaches in clinical practice.
Keywords: Composite injury, hospital mortality, optimized approach for diagnosis and treatment of composite trauma, scale for predicting lethal outcomes in concomitant injury.
References
- Inozemtsev EO, Grigoryev EG, Apartsin KA. Aktual’nye voprosy khirurgii sochetannykh povrezhdeniy [Topical issues of surgery of combined injuries]. Politrauma. 2017;1:14-8.
- Esipov AV, Abushinov VV, Onishchenko AA. Primenenie protsesnogo podkhoda k organizatsii okazaniya spetsializirovannoy medittsinskoy pomoshchi postradavshim pri dorozhnoy politravme [Application of the process approach to the organization of the provision of specialized medical care to victims of road polytrauma]. Gospital’naya meditsina: nauka i praktika. 2019;1(3):10-5.
- Stoica B, Paun S, Tanase I, Negoi I, Chiotoroiu A, Beuran M. Probability of survival scores in different trauma registries: A systematic review. Chirurgia (Bucharest). 2016;111(2):115-9.
- Razzokov AA, Salimzoda NF, Salikhov DN, Kurbanov SKh, Bandaev IS, Dzhuraev KhM, i dr. Sovershenstvovanie meditsinskoy pomoshchi, diagnostiki i lechenya ostrogo perioda mnozhestvennoy i sochetannoy travmy [Improvement of medical aid, diagnostics and treatment of the acute period of multiple and combined trauma]. Dushanbe, RT: Maorif; 2016. 649 p.
- Agadzhanyan VV, Kravtsov SA, Shatalin AV. Gospital’naya letal’nost’ pri politravme i osnovnye napravleniya eyo snizheniya [Hospital mortality in polytrauma and the main directions of its reduction]. Polytrauma. 2015;1:6-15.
- Shchyokolova NB, Nenakhova JB, Zubareva NS. Analiz letal’nosti, oshibki i oslozhnenya pri lechenii postradavshikh s mnozhestvennymi i sochetannymi travmami [Analysis of mortality, errors and complications in the treatment of victims with multiple and concomitant injuries]. Ural’skiy meditsinskiy zhurnal. 2015;7:127-31.
- Reith FC, Lingsma HF, Gabbe BJ, Lecky FE, Roberts I, Maas AI. Differential effects of the Glasgow Coma Scale Score and its Components: An analysis of 54.069 patients with traumatic brain injury. Injury. 2017;48(9):1932-43.
- Skoroglyadov AV, Lyadova MV, Ratiev AP. Kontseptsiya uluchsheniya kachestva okazaniya kvalifitsirivannoy pomoshchi postradavshim v dorozhno transportnykh proisshestviyakh v usloviyakh mnogoprofil’noy bol’nitsy [The concept of improving the quality of qualified assistance to victims of road traffic accidents in a multidisciplinary hospital]. Rossiyskiy meditsinskiy zhurnal. 2014;2:10-2.
- Sefrioui I, Amadini R, Mauro J, El Fallahi A, Gabbrielli M. Survival prediction of trauma patients: A study on US National Trauma Data Bank. Eur J Trauma Emerg Surg. 2017;43(6):805-22.
- Sirodzhov KKh, Kholov DI, Rakhimov AT, Akhmedov ShM, Safarov AKh. Optimizirovannyy podkhod k lecheniyu perelomov s uchyotom narusheniy nekotorykh aspektov lipidnogo spektra u bol’nykh s sochetannoy travmoy [Optimized approach to the treatment of fractures taking into account violations of some aspects of lipid spectrum in patients with concomitant traumatic brain injury]. Ural’skiy meditsinskiy zhurnal. 2016;5:90-4.
- Domingues CA, Coimbra R, Poggetti RS, Nogueira LS, de Sousa RMC. New Trauma and Injury Severity Score (TRISS) adjustments for survival prediction. World J Emerg Surg. 2018;13(1):1-6.
- Skaga NO, Eken T, Sovik S. Validating performance of TRISS, TARN and NORMIT survival prediction models in a Norwegian trauma population. Acta Anaesthesiol Scand. 2018;62(2):253-66.
- Valderrama Molina CO, Giraldo N, Constain A, Puerta A, Restrepo C, Leon A, et al. Validation of trauma scales: ISS, NISS, RTS and TRISS for predicting mortality in a Colombian population. European Journal of Orthopaedic Surgery and Traumatology. 2017;27(2):213-20. https://doi.org/10.1007/ s00590-016-1892-6
- Banerjee P, Rudra S, Ghosh M, Panose P. CT scans in primary survey for polytrauma patients. Advances in Computed Tomography. 2013;2:46-51.
- Dmitriev AV, Drosevich AE. Zhirovaya emboliya: etiologiya i klinicheskaya diagnostika: obzor literatury [Fat embolism: Etiology and clinical diagnosis: Literature review]. Vestnik obrazovaniya i razvitiya nauki Rossiyskoy akademii estestvennykh nauk. 2016;1:83-8.
Authors' information:
Naimov Abdukarim Mamadrakhimovich,
Candidate of Medical Sciences, Assistant of the Department of Traumatology, Orthopedics and Military Surgery, Avicenna Tajik State Medical University
Researcher ID: HRB-5983-2023
ORCID ID: 0000-0001-7515-1696
E-mail: naimov.abdukarim@bk.ru
Razzokov Abduvali Abdukhamitovich,
Doctor of Medical Sciences, Full Professor, Professor of the Department of Traumatology, Orthopedics and Military Surgery, Avicenna Tajik State Medical University
Researcher ID: G-2628-2019
ORCID ID: 0000-0001-6429-1116
SPIN: 1768-1891
Author ID: 418277
E-mail: rfiruz@mail.ru
Parpiev Farkhad Merganboevich,
Assistant of the Department of Traumatology, Orthopedics and Military Surgery, Avicenna Tajik State Medical University
Researcher ID: HOH-8565-2023
ORCID ID: 0000-0001-9808-4078
SPIN: 5077-7839
E-mail: farhatparpiev1988@mail.ru
Information about support in the form of grants, equipment, medications
The authors did not receive financial support from manufacturers of medicines and medical equipment
Conflicts of interest: No conflict
Address for correspondence:
Naimov Abdukarim Mamadrakhimovich
Candidate of Medical Sciences, Assistant of the Department of Traumatology, Orthopedics and Military Surgery, Avicenna Tajik State Medical University
734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139
Tel.: +992 (918) 888822
E-mail: naimov.abdukarim@bk.ru
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