Principles of trauma care and treatment results of trauma patients

Trauma is the leading cause of death worldwide for patients under the age of 45. The main cause of potentially preventable deaths among these patients is uncontrolled hemorrhage leading to a “lethal triad” of coagulopathy, metabolic acidosis and hypothermia. Aggressive intervention is required to stabilize such patients, encompassing not only surgical treatment but restoring normal physiology as well. In such cases an alternative for traditional laparotomy is damage control surgery (DCS). Aim of this research was to evaluate treatment results of patients who underwent surgery for trauma in the Department of Surgery of Hospital of Lithuanian University of Health Sciences and assess potential indications for use of damage control surgery. Objectives were to analyze characteristics of trauma and trauma patients, and treatment results; to assess possible indications for use of DCS; to compare trauma characteristics and treatment results between patients with indications and without indications for DCS in blunt force and penetrating trauma groups. Retrospective review of abdominal, thoracic and multiple trauma patients between the years of 2010-2014 was performed. We analyzed 98 patients: 77 males (78.6%) and 21 females (21.4%). Mean age 36.0±12.4 years. 54.1% of cases were blunt and 45.9% – penetrating trauma. In blunt and penetrating groups, patients that were found with indications for DCS had more severe traumas, operative times were longer and more packed RBC and intravenous fluids were used for correction of physiology. These patients had longer hospital stay and postoperative complications were more common. Survival rate was 99% and postoperative complication rate was 6.1%. Approximately quarter of all patients had indications for DCS. Patients who had indications for DCS had more severe traumas, postoperative complications were more common and correction of physiology was achieved after more aggressive therapy in both blunt force and penetrating trauma groups