Objective Assessment of the Severity of Patients Suffering from Fall from Height with Combined Injuries of the Abdominal Parenchymal Organs

CLINICAL RESEARCH
Abdukhakim Khadjibaev, PhD, ScD; Pulat Sultanov*

Republican Scientific Center of Emergency Medicine; Tashkent, Uzbekistan

*Corresponding author: Pulat Sultanov. Republican Scientific Center of Emergency Medicine Tashkent, Uzbekistan E-mail: sultanovp@bk.ru

Published: June 25, 2015. DOI: 10.21103/Article5(2)_CR6

Abstract: 

In recent years, fall from a height (FFH) has been a relatively frequent cause of injury and death in the urban environment. The purpose of this study was to optimize the risk stratification of FFH victims with combined injuries of the abdominal organs by using Injury Severity Score (ISS) scale. The study included 111 patients (aged between 15 and 80 years) injured by FFH. All the falls were accidental and occurred mainly among males (82%). The height of the fall ranged from 2 to 5 meters. Combined injuries were found in 98 patients and isolated injuries in 13 patients. The combination of the 6 injured body regions was identified in 5 patients, 5 regions in 17, 4 in 35, 3 in 23, and 2 in 18. The abdomen trauma was most commonly associated with the following injured body regions: head and neck-chest-extremities and pelvis (13.3%), head and neck-chest-extremities (12.2%), and head and neck-chest-pelvis (9.2%). Among the combined injuries of the abdomen, ruptures of parenchymal organs (liver, spleen and kidneys) were predominant. To assess the severity of the injury, the ISS scale was applied. The injuries of abdominal parenchymal organs were evaluated according to the AAST (American Association for the Surgery of Trauma) classification.  Comparative analysis of the assessment of the severity of a patient's condition according to the traditional scale and the ISS scale showed that the ISS scale promotes the active and timely detection of the extremely severe and terminal condition in patients with injuries due to FFH with combined trauma of the abdominal organs. Objective assessment of the severity of trauma and the dominant injury region allows determining the optimal treatment algorithm and predicting the outcome of the injury.

Keywords: 
fall from a height; combined injuries; abdominal trauma, Injury Severity Score; severity of a patient's condition.
References: 
  1.   Khadjibaev A Sultanov P. Katatravma: Problems and Perspectives. Bulletin of Emergency Medicine 2013; 4: 83-88. [Article in Russian].
  2. Dickinson A1, Roberts M, Kumar A, Weaver A, Lockey DJ. Falls from height: injury and mortality. J R Army Med Corps 2012; 158(2):123-7.
  3. Abakumov M, Lebedev N, Malyarchuk V. Abdominal injury with an associated trauma. Moscow: Meditsina; 2005. [in Russian].
  4. Ermolova A Khubutiya M, Abakumov M. Abdominal trauma. St. Petersburg: Vidar- M; 2010. [in Russian].
  5. Alekseev V, Ivanov V, Alekseev S,  Vanyukov V.  Objective assessment of the severity of injury in victims with splenic injury. Bulletin of Surgery 2013; 1: 50-54. [Article in Russian].
  6. Puzanov S,  Alishikhov A,  Rutenberg  G,  Bogdanov D. The usefulness of laparoscopy in traumatic injuries of the abdominal cavity. Endoscopic Surgery 2014; 2: 14-17. [Article in Russian].
  7. Longo WE, Baker CC, McMillen MA, Modlin IM, Degutis LC, Zucker KA. Nonoperative management of adult splenic trauma. Criteria for successful outcome. Ann Surg 1989; 210(5):626-9.
  8. Bagnenko S. Combined mechanical trauma. St. Petersburg, 2005. [in Russian].
  9. Nathens AB, Cryer HG, Fildes J. The American College of Surgeons Trauma Quality Improvement Program. Surg Clin North Am Apr 2012;92(2):441-54
  10. Baker SP, O’Neill B, Haddon WJr, Long WB. The Injury Severity Score; a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14(3):187-96.
  11. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method.Trauma Score and the Injury Severity Score. J Trauma 1987; 27(4):370-8.
  12.  Malinin D, Bosco O. Methods of objective assessment of the severity of injuries and their practical application (Guidelines). Volgograd, 2008. [Article in Russian].
  13. Brivet F. Scoring system and severe acute pancreatitis. Crit Care Med 2000; 28(8):3124-5.
  14. Svetukhin AM, Zviagin AA, Slepnev SIu. Systems of objective evaluation of patients' severity status. Part II.  Khirurgiia (Mosk) 2002; 10: 60-9. [Article in Russian].
  15. Moreno R, Morais P. Outcome prediction in intensive care: results of prospective, multicentre, Portuguese study. Intensive Care Med 1997; 23(2):177-86.
  16. Gumanenko E, Boyarintsev B,  Suprun T, et al. Objective evaluation of the severity of injuries. St. Petersburg: Military Medical Academy, 1999. [in Russian].
  17. John D. States: The Abbreviated and the Comprehensive Research Injury Scales. In: STAPP Car Crash Journal. 13, Society of Automotive Engineers, Inc., New York 1969, ISSN 1532-8546, S. 282–294, LCCN 67-22372.
  18.  Committee on Medical Aspects of Automotive Safety. Rating the severity of tissue damage, I. The abbreviated scale. JAMA 1971; 215(2):277-80.
  19. Kaida A, Petruk J, Sevcik W, Latoszek K, Ohinmaa A, Jacobs P , et al. Investigating the impact of lowering the Injury Severity Score cutoff for major trauma in pediatrics. Acad Emerg Med. 2004;11:513.
  20. Aharonson-Daniel L, Giveon A, Stein M; Israel Trauma Group (ITG), Peleg K. Different AIS triplets: different mortality predictions in identical ISS and NISS. J Trauma 2006;61(3):711–7.
  21. Moore EE1, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR, et al. Organ injury scaling: spleen, liver, and kidney. J Trauma 1989; 29(12):1664-6.

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Int J Biomed. 2015; 5(2):79-83. © 2015 International Medical Research and Development Corporation. All rights reserved.