Η αποτελεσματικότητα της κλινικής διαχείρισης του σοβαρά τραυματία στο Γενικό Νοσοκομείο Λευκωσίας

Abstract

Introduction: Trauma represents a major public health problem and one of the leading causes of death and disability worldwide. Despite the serious consequences it causes on a personal, social, economic and psychological level, it was for many years a neglected problem with unknown aspects and limited interest. In reality, however, the numbers recorded in all countries leave no room for complacency, given that each injury at the same time represents the failure to take preventing measures. The most advanced health countries, led by the USA, have recognized, recorded and are trying to deal with the trauma for decades. In this context, they created modern trauma systems investing in scientific research and best medical practice to improve the services provided at all levels. In Cyprus, the absence of a trauma system creates deficiencies in both the recording and the evaluation of the trauma services provided, which are characterized by fragmentation, deficits and weaknesses. The operation of the Trauma Registry at the Nicosia General Hospital in the last decade is only the beginning of the effort to solve the problems, without currently utilizing the data recorded to the extent necessary to formulate appropriate policies and promote strategic goals. In this context, the present study attempts to record and analyse in detail all the parameters of the treatment of the seriously injured patient, to highlight the weaknesses and peculiarities of the problem in the Cypriot society and through them to identify the areas that need restructuring and adaptation to the modern era. Aim and objectives: The aim of the study is to investigate the effectiveness of the clinical management of the seriously injured at the Nicosia General Hospital through the recording, evaluation and utilization of parameters and characteristics (demographic data, clinical signs, type of injuries, therapeutic interventions, processing times, outcome) related to in-hospital health care for the seriously injured. Objectives are the categorization of serious injuries based on scientific scales of severity assessment, the recording of care procedures in relation to the time factor, the time recording of all traumatic deaths in relation to the factors that cause them and the identification of problems during inpatient care using valid scientific criteria. Methodology: This is a retrospective sampling observation study which concerned the seriously injured who were treated at the Nicosia General Hospital and the traumatic deaths of the Nicosia district during the five years 2013-2017. The study consists of two sections. The first concerns all traumatic deaths, pre-hospital and in-hospital, with the main object of their temporal distribution and the correlation with the classical model of trim odal distribution but also the standards of modern trauma systems of other countries. The second section focuses on the procedures for caring the seriously injured who were hospitalized, the quality indicators of the services provided and the factors related to the outcomes. Both the methods of descriptive statistics and various tests of inferential statistics were used in the present study. Results: The findings of the study of traumatic deaths demonstrate the abolition of the trim odal time distribution model in the study population, but the maintenance of the third peak of the curve corresponding to late deaths (19.4% of the total) which indicates deficiencies in resuscitation and clinical care in the absence of an organized trauma system. In the study of the treatment of the seriously injured during their hospitalization, the quality indicators in most cases fail to follow the international standards and guidelines. Specifically, there is an increased length of stay of the seriously injured in the Emergency Department (mean 199.62 minutes), longer stay in the ICU (mean 13.37 days), longer duration of mechanical respiratory support (mean 10.4 days), more days of hospitalization (mean 31.62 days) and higher overall mortality (28%). The time to first surgery and the time to CT scan in patients with moderate or severe craniocerebral injury correspond to the above suggested limits and are considered satisfactory. Conclusions: The provision of health services to the seriously injured patient is characterized by weaknesses and problems that arise through the lack of organization and implementation of management procedures based on international standards. The creation of a trauma system is scientifically the appropriate way to improve the services provided, which is reflected in the best results of achieving quality indicators and outcomes.