  |
| |
| |
| |
 |
| |
|
| |
|
 |
| |
In 2000, the World Health Organization reported that more than 5 million people die worldwide each year as a result of trauma and injury. This represents approximately 10% of all recorded deaths, and trauma is the leading cause of death in persons below 40 years of age. The incidence of traumatic death is increasing, and by 2010 it is estimated that there will be 8.5 million deaths per year due to trauma [1, 2].
Injuries to the central nervous system are the most common cause of death due to injury, accounting for 40–50%. The second leading cause is bleeding, accounting for 30–35%. Some 20% of all intraabdominal injuries require surgery. Delay in diagnosis and treatment of blunt and penetrating abdominal injuries is one of the most common causes of preventable deaths. In Europe, 90% of abdominal injuries are due to blunt trauma.
A first step in trauma management is to understand the distribution of injuries by their nature and severity. With this understanding, priorities can be established for prevention, treatment and system development.
The management of bleeding in trauma patients is directed towards correcting the underlying cause of the bleeding while maintaining adequate circulatory volume, respiratory support and cardiac output. Conventional means of controlling bleeding are often successful, and include local pressure, ligation or embolization of specific vessels, resection or partial resection of organs, use of adhesives and coagulation. In addition, correction of acidosis, hypothermia and coagulopathy are essential. The relationship between bleeding control and morbidity/mortality may be attributable to the level and duration of initial shock, thereby reflecting injury severity, and may be a result of the harmful immunomodulating effects of allogeneic blood transfusions. Moore et al. [3] found a positive correlation between the incidence of multi-organ failure and the number of RBC units received with an odds ratio of 8.6 in patients receiving > 6 U of RBC [3].
This issue of the European Journal of Trauma and Emergency Surgery is devoted to certain chosen organ injuries that are particularly important for the outcome. Cardiopulmonary injuries present a special challenge, both in diagnosis and treatment [4]. Any delay can mean death and ideal treatment requires optimal interdisciplinary cooperation. Other subjects of interest in this issue are the liver [5], pancreas [6] and spleen [7] as frequent sites of intraabdominal injury. Liver and spleen trauma are increasingly treated non-surgically; indications and criteria for such treatment have changed with increasing experience and undergone further development. Success can also greatly depend on interventional radiology and cooperation with intensivists. Pancreas injuries are in a class of their own; diagnosing them requires vast experience in trauma surgery. More severe pancreas injuries that require immediate surgery are a challenge for any trauma surgeon. The last article in this series is devoted to primary abdominal compartment syndrome [8], an important aspect of trauma surgery that was long neglected and did not receive the attention it was due.
The aim of this issue is to draw attention to these special aspects of trauma surgery. Our common aim is optimal care of the injured patient and the authors hope that they have taken a small step in this direction.
|
| |
|
| |
|
|
|
