The relationship between scores and outcomes for polytrauma patients in the emergency department. A case study.

AIM: Traumas are one of the most relevant pathological events in health care, because of clinical and prognostic relevance. Morbidity and mortality rates are strongly affected by the timely and correct approach to the patient (golden hour). The objective of this study was to investigate the possible influence of the diagnostic time and of the Injury Severity Score (ISS) on outcomes in trauma patients. MATERIAL OF STUDY: Out of a total of 240,833 emergency patients, we observed, 447 polytrauma. All patients were assessed according to the Advanced Trauma Life Support (ATLS) guidelines, diagnosed by computed tomography (CT), and summarized using an adapted complex trauma card (italian version). RESULTS: Overall, 2.5% (11/447) of patients died during the assessment, whereas the remaining 436 patients were diagnosed at the Emergency room and afterwards hospitalised. In 76 out of 436 patients (17.43%) the outcome was poor. Particularly, the most significant complications involved the central nervous system, chest and abdomen lesions respectively, with an ISS of 41.7 ± 15.9. The mean time for the diagnostic assessment in patients with poor outcome was 115.2 ± 0.4 minutes. DISCUSSION: The immediate mortality percentage, as well as the delayed ones, was highest in patients involved in road accidents. The early management certainly plays a crucial role, reducing death rate and permanent disability. CONCLUSIONS: The high percentage of patients affected by haemodynamic instability (24.3%) demonstrates the existence of a criticality identifiable in the approach to the patient during the pre-hospital phase: a phase that is dramatically characterised by the exclusion of intensivists from rescue teams. KEY WORDS: Complex Trauma Card, Mortality, Multiple injuries, Polytrauma, Scores.

Late recurrent cutaneous breast angiosarcoma in an elderly woman: A case report.

Breast angiosarcomas are malignant tumours of the vascular endothelium that arise frequently following radiation therapy. Their clinical and radiological aspects are highly heterogeneous. The current study reports an unusual case, never previously reported, of a late recurrent breast angiosarcoma occurring in an 83-year old female patient 11 years after a breast-conserving surgery followed by radiation therapy for an invasive ductal carcinoma, and 5 years after her initial angiosarcoma excision. The first physician to examine the patient noted a palpable mass near the scar and, following ultrasonography, described the breast lesion as suggestive of an abscess, despite the previous history of neoplasia. Typically, recurrences of breast angiosarcoma occur within the first postsurgical year. The present patient remains alive at 25 months after her last surgical treatment, and no evidence of any local or distant disease is observable.

Atraumatic splenic rupture: an atypical presentation in a previously healthy patient.

UNLABELLED: Atraumatic splenic rupture represents a life-threatening abdominal event that requires immediate diagnosis and prompt surgical treatment to ensure the survival of the patient. Atraumatic rupture is relatively uncommon and can occur either in pathological spleens or, more rarely, in normal ones. It has a high morbidity, frequently with few and non specific signs suggesting its presence, can be associated to other pathologies incidentally discovered by imaging. We present a case, successfully treated, of a 51-year-old man, previously healthy, that referred to our hospital for arterial hypertension and abdominal pain; the patient, for an idiopathic splenic rupture with haemoperitoneum, underwent an open splenectomy whose histology examination showed a normal spleen. KEY WORDS: Atraumatic splenic rupture, Normal spleen, Spontaneos haemoperitoneum - Full text is available at: www.annaliitalianidichirurgia.it.