How the changes in the system affect trauma care provision: The assessment of and implications for Lithuanian trauma service performance in 2007-2012.

OBJECTIVE: The aim of this study was to identify and assess the effects of changes in the Lithuanian trauma service from 2007 to 2012. We postulate that the implications derived from this study will be of importance to trauma policy planners and makers in Lithuania and throughout other countries of Eastern and Central Europe. MATERIALS AND METHODS: Out of 10,390 trauma admissions to four trauma centers in 2007, 294 patients (2.8%) were randomly selected for the first arm of a representative study sample. Similarly, of 9918 trauma admissions in 2012, 250 (2.5%) were randomly chosen for comparison in the study arm. Only cases with a diagnosis falling into the ICD-10 "S" and "T" codes were included. A survey of whom regarding changes in quality of trauma care from 2007 to 2012 was carried out by emergency medical service (EMS) providers. RESULTS: The Revised Trauma Score (RTS) mean value was 7.45±1.04 for the 2007 year arm; it was 7.53±0.93 for the 2012 year arm (P=0.33). Mean time from the moment of a call from the site of the traumatic event to the patient's arrival at the trauma center did not differ between the arms of the sample: 49.95min in 2007 vs. 51.6min in 2012 (P=0.81). An application of the operational procedures such as a cervical spine protection using a hard collar, oxygen therapy, infusion of intravenous fluids, and pain relief on the trauma scene was more frequent in 2012 than in 2007. Management of trauma patients in the emergency department improved regarding the availability of 24/7 computed tomography scanner facilities and an on-site radiographer. Time to CT-scanning was reduced by 38.8%, and time to decision-making was reduced by 16.5% in 2012. CONCLUSIONS: Changes in operational procedures in the Lithuanian pre-hospital care provision and management of trauma patients in emergency departments of trauma centers improved the efficiency of trauma care delivery over the 2007-2012 period.

[The assessment of clinical evaluation and treatment results of high-energy blunt polytrauma patients]. / Dideles energijos buka trauma patyrusiu pacientu klinikinio tyrimo duomenu ir gydymo rezultatu ivertinimas.

UNLABELLED: The aim of this study was to evaluate the mechanism of high-energy blunt trauma, age and gender of patients, severity of regional and multiple injury, ventilation time, length of stay in intensive care unit and in-hospital stay, in-hospital complications, and treatment outcome. MATERIALS AND METHODS: Data on 159 patients with severe multiple injuries, meeting inclusion criteria, were collected prospectively and evaluated retrospectively. RESULTS: The mean age of multiple trauma patients was 43.9+/-1.4 years; males were injured 2.5 times more often than females (P<0.001). More than half (66.7%) of patients were 17-64-year-old males. Majority (83%) of all patients were injured in motor vehicle crashes, and 52.2% of these patients were pedestrians. The mean Injury Severity Score was 29.5+/-0.8, and severe (Abbreviated Injury Scale score of 3 and more) injuries of extremities, head, and chest made up 69.1% of all injuries. The mean ventilation time, mean length of stay in intensive care unit, and mean in-hospital stay were 5.5+/-0.7, 7.0+/-0.8, and 23.6+/-1.6 days, respectively. Acute lung complications were the most common (25.2%). Systemic inflammatory response syndrome developed in 7.5% of patients, and sepsis in 3.8% of patients. More than one-fifth (20.8%) of polytrauma patients died. CONCLUSIONS: Working-age male pedestrians (17-64 years old) made up two-thirds of all polytrauma patients. Severe injuries of extremities, head, and chest were present in 69.1% of all cases. Lung complications were the most common.

[Trauma in pregnancy: complications, outcomes, and treatment]. / Nesciuju trauma: komplikacijos, baigtys, gydymas.

UNLABELLED: The aim of this study was to analyze the effects of the various traumas on mother and fetus and to present the solutions of trauma management. METHODS: A review of data archive of Kaunas University of Medicine Hospital and articles published during the last 13 years (1990-2003) and selected by computerized Medline search. Trauma affects 7-8% of all pregnant women; motor vehicle accidents account for 42%, falls--for 34%, and violence--for 18% of the most frequently cited cases of injuries. Of the 27,715 pregnant females attending antenatal clinics, 372 (1.3%) experienced trauma: 84% of women had blunt injuries and 16% had penetrating injuries. There were 14 maternal deaths (3.8%) and 35 fetal deaths (9.4%). The success of pregnancy is associated with severity of maternal trauma. The survival of the fetus after trauma depends on the mother's condition in regard to respiratory passage, oxygenation, and hypovolemia. During 1990-2003, six pregnant patients with severe trauma were treated at Kaunas University of Medicine Hospital. Traumatic separation of placenta was observed in two cases. Three women and three fetuses died.

Early and late reconstruction in brachial plexus palsy: a preliminary report.

OBJECTIVE: To evaluate the most effective surgical procedures in the early and late reconstruction of brachial plexus after its traumatic injury. MATERIAL AND METHODS: A total of 14 consecutive patients with brachial plexus injuries were examined and operated on at the Department of Plastic and Reconstructive Surgery and Burns at Kaunas University of Medicine Hospital. Less than half of them (43%) came for surgery in the early stage of disease--within 12 months after injury--and 57% in the late stage--1-15 years after trauma. Altogether, 23 operations--neurolysis, nerve transfer, tendon transfer, and arthrodesis--were performed. Patients were followed up for an average of 12.5 months (range 4 to 19 months) after surgery. Postoperative motor assessment of hand function was based on the motor classification M0-M6 of Mallet and British Medical Research Council Muscle grading system. Results were considered positive if the range of active movements increased no less than 5-10 degrees odependently from the level of injury and motor strength--no less than 1-2 grades (M0-->M2 or M2-->M3). RESULTS: Of the eight investigated, six patients from early group showed positive results. The most effective surgical procedures were neurolysis and nerve transfer. A significant improvement in the patients of late group was observed after tendon transfer procedure. Nevertheless, the recovery process of motor function was too slow or even minimal in 31% of patients to satisfy the patient and the surgeon. CONCLUSIONS: Neurolysis or nerve transfer in the early stage or tendon transfer in the late stage after brachial plexus injury may result in a significant improvement of motor function of the hand. Sharing the information concerning brachial plexus reconstruction with neonatologists, neuropathologists, traumatologists, and hand therapists would be helpful in operating such patients timely and treating them adequately after surgery.

The treatment of multiple injuries: prehospital emergency aid.

OBJECTIVE: To evaluate initial (prehospital) assessment and management of high-energy blunt polytrauma patients. MATERIAL AND METHODS: Prehospital assessment and management of high-energy blunt polytrauma patients was analyzed. The extent of initial assessment and management was compared with Advanced Trauma Life Support recommendations. RESULTS: Altogether, 101 (63.05%) of 159 polytrauma patients (mean Injury Severity Score was 28.04) were admitted to Kaunas University of Medicine Hospital by the Emergency Aid Service after motor vehicle traffic accidents. In comparison with Advanced Trauma Life Support recommendations initial assessment (ABCDE) reached 14% and management reached 10.6%. CONCLUSIONS: Initial assessment of high-energy blunt polytrauma patients reached 14% and management reached 10.6% of that recommended by Advanced Trauma Life Support.

[Successful treatment with continuous infusion of coagulation factor concentrates in severe hemophilia A complicated with mixed trauma, crush syndrome and acute renal failure]. / Sunkios hemofilijos A, komplikuotos misrios traumos, ilgalaikio suspaudimo sindromo ir uminio inkstu nepakankamumo, veiksmingas gydymas pastoviomis kresejimo faktoriaus infuzijomis.

Treatment method of hemophilia with continuous infusion of clotting factor concentrates is not widespread. We report our experience with the use of continuous infusion of factor VIII in patient with mixed trauma, crush syndrome and acute renal failure. Patient was successfully treated with fasciotomy of left upper arm and forearm, 6 procedures of hemodialysis, 34.500 units of clotting factor VIII concentrate, and 13 red blood cells units. Our experience confirms the safety, efficiency, and economy of the method of the constant infusion of clotting factor concentrates for hemophilia patient requiring replacement therapy, surgical intervention, and hemodialysis.

[First clinical experience with nonreamed intramedullary nailing in Lithuania]. / Ikalama intrameduline vinis su skersiniu sutvirtinimu (pirmoji didesne klinikine patirtis Lietuvoje).

Long bone diaphyseal fractures are very common. Limited choice of implants for treatment of these fractures in Lithuania often leads to unsatisfactory treatment results and complications. Unreamed intramedullary nailing is relatively simple and effective method for treatment of severely injured patients. Using this method early stabilization and rehabilitation, decreased number of complications, and shortened stay in hospital can be ensured. Indications, technique and early results of first fifty intramedullary fixations with unreamed nails performed in the Clinic of Orthopedics and Traumatology, Kaunas University of Medicine are presented.

[Primary non-Hodgkin's lymphoma of bone]. / Pirmine kaulu ne Hodgkino limfoma.

Primary lymphoma of bone is a rare condition that has been described as a malignant neoplasm formed of lymphoid and myelopoetic tissues. Morphologic substrate is formed of lymphoid cells of different evolutional stages. Primary lymphoma of bone occurs predominantly in males; a male to female ratio is 1.8:1. It may occur at any age. The sites commonly affected are the long bones. In Lithuania 400 new cases of lymphoma are diagnosed every year. About 75% of them are non-Hodgkin's lymphoma. Many histological types and subtypes of lymphoma exist. This variation leads to difficulties when reviewing the literature and comparing prognoses, treatment and oncologic outcomes. Treatment options for primary bone lymphoma historically have included local therapy with radiation or surgery with or without systemic therapy. The aim of surgery is prophylactic fixation of impending fractures or treatment of pathological fractures. We present a clinical case report of 40-year-old male who developed primary lymphoma of bone with pathological fracture of femur. The systemic chemotherapy was applied during the time of treatment. The choice of surgical treatment was intramedullary nailing without using of methylmethacrylate, because regeneration of bone was visible on roentgenograms. After twelve-month follow-up the patient is full weight bearing without external support.

Golden hour - early postinjury period.

Quality and adequacy of specialized first aid for patients affected by high energy trauma is extremely important factor in order to reduce postraumatic disability and mortality of polytrauma patients. Treatment strategies for high energy trauma management are in early stages of development. Adequate aid can be rendered only in a few centers of Lithuania. Pre-hospital and very early hospital stages of patients with high energy trauma, which significance is proven, are unsatisfactory and inadequate. A retrospective study was performed in order to analyze efficacy and adequacy of pre-hospital (Kaunas Emergency Station, KES) and very early hospital (Kaunas University of Medicine Hospital Emergency Room, ER) management stages for 53 patients affected by high energy trauma and admitted to Kaunas University of Medicine Hospital during the period of 2001-2002. Averaged injury severity score, according to ISS, was 21.3, mortality rate was 34%. It was established long duration of pre-hospital and early hospital stage of management (accordingly 34+/-6.5 and 50+/-17.2 minutes), extremely rare monitoring of vital signs in pre-hospital stage (breathing was evaluated for 1.9% of patients, heart rate for 26.4% of patients). Fluid therapy as a part of complex treatment was applied for 7.5% of patients in pre-hospital stage and 3.8% in very early hospital stage.

[Multiple trauma: evaluation of patient's condition and local injuries by trauma classification systems]. / Daugine trauma: ligonio bunkles ir lokaliu suzalojimu vertinimas pagal traumu klasifikavimo sistemas.

Evaluation of polytrauma patient's status by using scoring system is very important for selection of patient's placement and management, prophylaxis and diagnosis of early complications. In the article trauma classification systems are presented and discussed. Clinical evidences of Kaunas Medical University Hospital are presented as well. There are suggestive recommendations on evaluation of polytrauma patient's status and proper separation of severely injured.