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Mat og flokkun áverka og afdrif slasaðra 1975-1979 á gjörgæsludeild Borgarspítalans

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Authors
Bergþóra Ragnarsdóttir
Þorbjörg Magnúsdóttir
Bjarni Torfason
Issue Date
1992-11-01

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Citation
Læknablaðið 1992, 78(9):363-72
Abstract
The records of 458 trauma patients admitted to the Intensive Care Unit at the City Hospital, Reykjavik, Iceland, during the years 1975-79 were examined retrospectively. The main aim of the study was to evaluate and group the injuries according to AIS-ISS scoring system and from mortality judge whether patients had received satisfactory treatment. There were 339 male and 119 female patients (3:1). The patients' age ranged from 7 months to 86 years. Mean age was 30.2 years and 279 patients (60.9 %) were less than thirty years of age. Ninetyfive percent of patients were victims of blunt trauma. Motor vehicle accident was the most common cause of injury (249/458 or 54.4%) with fall coming second (120/458 or 26.2%). Major trauma patients (ISS >16) were 263 (57.4%). Injured in more than one body region were 247 patients (54%). Head injury was the most common regional injury (68.1 %) and 80% of those who died had head injury as the main injury as judged from the highest AIS. Mortality was 10.5% in the ICU (48/458) but overall hospital mortality was 12.0% (55/458). Mortality increased steadily by age and reached 64.7% at age 75 and was highest for patients with isolated head injuries (22.9%), lowest for those injured in one region other than head (5.6%). Eight patients (14.5%) died from complications. No patient died in the ICU with ISS less than 25 but mortality for patients with ISS >25 was 35.9 %. According to mortality and injuries as measured retrospectively by the AIS-ISS scoring system (version 1980) and considering the high proportion of head injured it seems that treatment for this group of patients was quite satisfactory.
Gerð var afturskyggn könnun á nýslösuðum sjúklingum sem vistaðir voru á gjörgæsludeild Borgarspítalans 1975-1979. Áverkar hinna slösuðu voru flokkaðir og metnir eftir AIS-ISS kerfi 1980 (revision). Um var að ræða 458 sjúklinga í kynjahlutföllunum þrír karlar á móti einni konu. Meðalaldur var 30,2 ár. Innan við þrítugt voru 279 manns eða 60,9%. Sljóa (blunt) áverka hlutu 95% sjúklinganna, en 5% urðu fyrir áverkum af völdum eggjárna eða byssukúlna (penetrating). Rúmur helmingur sjúklinganna hafði lent í umferðarslysum, en fallslys voru næst algengust. Svæðaflokkun leiddi í ljós að 68,1% höfðu hlotið höfuð- og/eða hálsáverka. Rúmlega helmingur sjúklinga hafði fjölsvæðaáverka. Dauðvona við komu, með ISS 75, voru 17 sjúklingar. Með ISS >20 voru 178 sjúklingar (39%) og 145 (31,7%) með ISS >25. Alvarlega slasaðir eða með ISS >16 voru 263 sjúklingar (57,4%). Meðal-ISS allra innlagðra var 19,7. Alls létust 55, 15 konur og 40 karlar, af þeim dóu 48 á gjörgæslu, en sjö sjúklingar eftir útskrift á legudeild. Af þeim sem létust höfðu 45,8% látist innan 24 stunda. Heildardánartíðni þeirra sem rannsóknin náði til var 12,0%, en á gjörgæsludeild 10,5%. Hjá þeim sem létust var meðaltal 1SS 43,3. Enginn sjúklingur dó á gjörgæslu með ISS minna en 25 og dánartíðni sjúklinga með ISS >25 var 35,9%. Dánartíðni fór hækkandi með hækkandi aldri og var 64,7% hjá þeim sem voru >75 ára. Hæst var dánartíðnin hjá sjúklingum með hreina höfuð- eða hálsáverka, 22,9%, en höfuð- eða hálsáverki var aðaláverki hjá 80% þeirra sem létust. Fylgikvillar áttu verulegan þátt í dauða 14,5% sjúklinganna. Þessar niðurstöður benda til að meðferð sú sem sjúklingarnir hlutu á gjörgæsludeild Borgarspítalans hafi verið vel viðunandi, miðað við dánartíðni og áverka mælda í ISS og tillit tekið til þess hve stór hluti sjúklinganna var með höfuðáverka.
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