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Master Thesis

Efficacité d'un Trauma System régional français dans la prise en charge intra-hospitalière des plaies thoraciques : expérience marseillaise de 2009 à 2019

Abstract : Objective: To describe the impact of trauma system (TS) on in-hospital mortality in management of penetrating thoracic injuries after regional trauma’s organization, with the hypothesis that is associated with increased mortality. Methods: This cohort study was conducted from January 2009 to January 2019. All patients from 15 to 80 years old admitted alive or with cardiac arrest less than 15 min after penetrating thoracic injuries were eligible. Mortality outcomes were compared among patients treated in 4 hospitals in Marseilles area before and after TS implementation in 2014. The association between death and TS was assessed with a multivariable model. Results: A total of 396 patients were included in two comparable groups (range [min-max] age, 28 [15-80] ; 363 men [92%]) affected by predominantly stab wound injuries (318 [80%]), with a mean (SD) Injury Severity Score of 17 (14) points. On unadjusted analysis, no difference of mortality was observed (9 [7%] vs 14 [5%], p=0,638). Considering ISS, Glasgow coma scale, transfusion, shock, mechanism and cardiac box injury, the TS implementation was associated with a trend of decreasing penetrating trauma-related mortality (OR: 0,80 [95% CI, 0,1-5,8]), particularly if ISS up to 25 (OR: 0,66 [95% CI, 0,2-2,7]. An improved management of penetrating thoracic injuries was noted since the TS setting : systematic evaluation by Fast (55% vs 80%, p < 0,001), CT-scan evaluation and surgical incision less than 60 min for unstable patients: 76min [±41] vs 57 min [±59], p=0,049 and 100min [±89] vs 63min [36], p=0,459) respectively. Conclusion: More than a reduction in the mortality of penetrating thoracic wounds, it is the analysis of practices that support effectiveness of a Trauma System.
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https://dumas.ccsd.cnrs.fr/dumas-02512031
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Submitted on : Thursday, March 19, 2020 - 11:51:13 AM
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Matthieu Vasse. Efficacité d'un Trauma System régional français dans la prise en charge intra-hospitalière des plaies thoraciques : expérience marseillaise de 2009 à 2019. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02512031⟩

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