Predictores de mortalidad en abdomen abierto por trauma grave. Experiencia del Hospital Central Militar

García-Núñez, Luis Manuel; Macías-Millán, Jorge Antonio; Delgado-Arámburo, José Lauro Gilberto; Cabello-Pasini, Ruy; Núñez-Cantú, Olliver; Soto-Ortega, Enrique; Rivera-Cruz, José María
July 2011
Revista de Sanidad Militar;jul/aug2011, Vol. 65 Issue 4, p148
Academic Journal
Background. There are not available national series focusing on factors related to mortality in trauma patients undergoing open-abdomen technique; referring international series focus on different objectives, turning them not well-known. Material and methods. Comparative and retrospective study of patients whom sustained severe trauma, admitted to our trauma center over a 58-months span (2004-2008). Demographics, admission variables, operative variables, specific injuries and outcome were analyzed. Object of study-mortality, related factors and independent predictive factors of death. Statistics. Occurrence relative frequency, t-test, Fisher´s exact test and stepwise logistic regression analysis. Results. 17 patients were included. Male-100%; age- 28.2±10.1. There was significant difference between survivors vs. non-survivors in systolic nadir at admission-112 ± 28.3 vs. 77.2 ± 28.8 mmHg (p = 0.0367); hemoglobin at admission-12.3 ± 2.2 vs. 8.2 ± 3.7 g/dL (p = 0.0403); hematocrit at admission- 36.4 ± 6.9 vs. 23.5 ± 10.7% (p = 0.0308) and colorectal injury- 27 vs. 100% (p = 0.0004). Factors related to mortality at the bivariate analysis-SBP at admission ≤ 90 mmHg (p = 0.05;RR 0.90;95%IC 0.37-2.19), hematocrit at admission ≤ 30% (p = 0.03;RR 2.7;95%IC 0.98-4.53), hemoglobin at admission ≤ 10 g/dL (p < 0.0001;RR 3.3;95%IC 2.58-5.70), hepatic (p = 0.05;RR 0.7;95%IC 0.28-1.14) and colorectal injury (p = 0.03;RR 1.7;95%IC 0.79-3.01) and blunt mechanism of injury (p = 0.049;RR 1.8;95%IC 0.98-3.73). Independent predictive factors of mortality at stepwise logistic regression analysis-hemoglobin at admission ≤ 10 g/dL (p = 0.0017;ORA 1.34;95%IC 1.08-1.41) and blunt mechanism of injury (p = 0.0258;ORA 1.16;95%IC 1.01-1.74). Conclusions. By knowing factors related to mortality and independent predictive factors of death, surgeons are capable to anticipate the need to perform an advanced thorough investigation and to institute early management of clinical situations in trauma patients, increasing their survival.


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