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Master Thesis

Le CHAR : trauma center malgré lui ? Étude prospective

Abstract : Introduction : The management of severe trauma patients (ST) is mainly based on the quality of management during the first hour (golden hour), admission to a referral center and hemostatic control. Speed of management and orientation are prognostic criteria for survival. In French Guiana, there is no reference center. Due to the distance with the nearest Trauma Center (French West Indies), it is difficult to apply the concept of Golden Hour. The objective of this study is to describe the activity of management of ST in the regional hospital center. Material and methods : This is a prospective study between November 2014 and April 2015, conducted at the Andrée Rosemon hospital in Cayenne, France (CHAR). Inclusion criteria were ST patients defined according to VITTEL criteria. Exclusion criteria were patients who died before reaching hospital. The main primary endpoints were defined according to the VITTEL criteria. The secondary endpoint was the evaluation of over-sorting. Results and discussions : We included 108 patients, the median age was 24 years [1-85]. The mortality rate was 1.8%. 54% of ST were caused by road accidents, 25% of assaults (firearm / knife), 10% of burns, 7% of falls and 4% of other reasons. The VITTEL criteria involved were 38% physiological abnormalities, 77% violent kinetics, 75% anatomical lesions and 21% prehospital resuscitation. The over-sorting rate was 51% (n = 55), of which the major criterion for over-sorting was violent kinetics (69%). One out of 10 patients admitted for ST came from peripheral health centers and 1 out of 2 non over sorted patients was after an assault. The general practitioner was the head doctor in charge in 11% of ST. Conclusion: The trauma activity of the CHAR is similar to the activity of a trauma center, with a proportion of penetrating trauma approaching North American rates.
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Master Thesis
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Saïd Agouram. Le CHAR : trauma center malgré lui ? Étude prospective. Médecine humaine et pathologie. 2018. ⟨dumas-02265870⟩

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