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      Incidence of hospital mortality in polytrauma patients in a tertiary center in Bosnia and Herzegovina

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          Abstract

          Introduction:

          In the late 70s of the last century, the mortality rate due to polytrauma amounted to 40%. This led to a new approach to this patient category with the goal of improving the treatment outcome. According to the German trauma register, the rate of mortality in polytrauma at the end of the last century was 18.6%. The goal of this study is to determine the incidence of hospital mortality in polytrauma patients in a tertiary institution in Bosnia and Herzegovina.

          Methods:

          We analyzed patient medical records from the Intensive Care Unit of the Clinic of Orthopedics and Traumatology at University Clinical Center Sarajevo, from January 1, 2012 to December 31, 2012.

          Results:

          There were 70 polytrauma patients in 2012, with average age 47.55 (range 8-77) years. Half of the patients were younger than 50 years. Age groups most frequently affected were 61 and older (25.7%), 51-60 years (24.3%), and 31-40 years (21.4%). Lethal outcome occurred in 10 patients (14.3%), while 60 patients (85.7%) survived and were treated until discharge or transfer to a different department. The average Injury Severity Score (ISS) in patients with lethal outcome was 71.50, while in survivors was 37. The largest percentage of lethal outcomes was recorded in cases of traffic accidents.

          Conclusion:

          The mortality rate among hospitalized polytrauma patients in the tertiary institution in Bosnia and Herzegovina is similar to reported mortality rates in other countries with developed healthcare system.

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          Most cited references15

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          The definition of polytrauma revisited: An international consensus process and proposal of the new 'Berlin definition'

          The nomenclature for patients with multiple injuries with high mortality rates is highly variable, and there is a lack of a uniform definition of the term polytrauma. A consensus process was therefore initiated by a panel of international experts with the goal of assessing an improved, database-supported definition for the polytraumatized patient.
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            A regional trauma system to optimize the pre-hospital triage of trauma patients

            Introduction Pre-hospital triage is a key element in a trauma system that aims to admit patients to the most suitable trauma center, and may decrease intra-hospital mortality. We evaluated the performance of a pre-hospital procedure in a regional trauma system through measurements of the quality of pre-hospital medical assessment and the efficacy of a triage protocol. Methods Our regional trauma system included 13 hospitals categorized as Level I, II or III trauma centers according to their technical facilities. Each patient was graded A, B or C by an emergency physician, according to the seriousness of their injuries at presentation on scene. The triage was performed according to this grading and the categorization of centers. This study is a registry analysis of a three-year period (2009 to 2011). Results Of the 3,428 studied patients, 2,572 were graded using the pre-hospital grading system (Graded group). The pre-hospital gradation was closely related with injury severity score (ISS) and intra-hospital mortality rate. The triage protocol had a sensitivity of 92% (95% confidence interval (CI) 90% to 93%) and a specificity of 41% (95% CI 39% to 44%) to predict adequate admission of patients with ISS more than 15. A total of 856 patients were not graded at the scene (Non-graded group). Undertriage rate was significantly reduced in the Graded group compared with the Non-graded group, with a relative risk of 0.47 (95% CI 0.40 to 0.56) according to the definition of the American College of Surgeons Committee on Trauma (P <0.001). Where adjusted for trauma severity, the expected mortality rate at discharge from hospital was higher than observed mortality, with a difference of +2.0% (95% CI 1.4 to 2.6%; P <0.01). Conclusions Implementation of a regional trauma system with a pre-hospital triage procedure was effective in detecting severe trauma patients and in lowering the rate of pre-hospital undertriage. A beneficial effect on outcome of such an organization is suggested. Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-0835-7) contains supplementary material, which is available to authorized users.
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              Update on the definition of polytrauma

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                Author and article information

                Journal
                J. Health. Sci
                Journal of Health Sciences
                University of Sarajevo Faculty of Health Studies (Bosnia )
                2232-7576
                1986-8049
                2016
                : 6
                : 1
                : 67-71
                Affiliations
                [1 ]Department of Orthopedics and Traumatology, University Clinical Center Sarajevo, Bosnia and Herzegovina
                [2 ]Faculty of Health Studies Sarajevo, University of Sarajevo, Bosnia and Herzegovina
                Author notes
                [* ]Corresponding Author: Hadžan Konjo, Clinic of Orthopedics & Traumatology, University Clinical Center Sarajevo, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina, E-mail: hadjank@ 123456hotmail.com
                Article
                JHS-6-67
                10.17532/jhsci.2016.331
                509b12ae-e67c-4ac2-8af3-0c6448f6442a
                Copyright: © Hadžan Konjo¹ et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 February 2016
                : 30 March 2016
                Categories
                RESEARCH ARTICLE

                Nursing,General medicine,Medicine,Molecular medicine,Life sciences
                hospital mortality,incidence,polytrauma
                Nursing, General medicine, Medicine, Molecular medicine, Life sciences
                hospital mortality, incidence, polytrauma

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