Fatores associados ao óbito em pacientes submetidos à “Onda Vermelha”: ênfase na toracotomia de emergência

Abstract

Objective: To identify and analyze the factors associated with death, with a focus on performing laparotomy alone or associated with emergency thoracotomy. Method: Prospective longitudinal study of patients submitted to the “Onda Vermelha” protocol, after admission to the Risoleta Tolentino Neves Hospital, from 2011 to 2015. Descriptive analyses, Student’s t-test, χ2 test, and regression multiple binary logistics were used to identify predictors of death. Results: One hundred and thirty-two patients were studied, of which 47 (35.6%) died. The average age was 28 years old. The majority was male (90.9%), with penetrating trauma predominating in the study sample (91.7%). The trauma scores were compatible with moderate severity trauma. The average time of hospitalization and stay in the intensive care unit exceeded 10 days. Laparotomy and thoracotomy occurred in 72.7 and 28% of cases, respectively. Complications were severe for 38.6% of patients, and the most common lesions were gastrointestinal (48.5%) and abdominal vessels (28.8%). Thoracotomy, severe complications and abdominal vessel injury were more frequent among patients who died (p<0.001). Factors associated to death were: emergency thoracotomy (OR=6.9, p=0.002), severe complications (OR=6.1, p=0.010), and lesions to the abdominal and pelvic vessels (OR=16.8, p<0.001). Conclusion: Emergency thoracotomy was associated with higher odds of death, regardless of other factors, as well as the mechanism of penetrating trauma, complications and injuries to the abdominal and pelvic vessels. Survival in the presence of thoracotomy was 25.7% for victims of penetrating trauma.