Læknablaðið : fylgirit - 15.06.2002, Blaðsíða 16

ABSTRACTS / ICELAND 2002: EMERGENCY MEDICINE BETWEEN CONTINENTS
previous studies to provide stronger evidence of benefit for early
use of single-dose intravenous bolus salbutamol in children wilh
acute severe exacerbations of asthma.
Methuds: Randomised double-blind placebo controlied trial in 84
children with acute severe asthma presenting to the emergency
department of the Children's Hospital at Westmead. After clinical
evaluation patients who had severe asthma were given high dose
inhaled salbutamol and an intravenous cannula inserted. Additio-
nal treatment consisted of intravenous methylprednisolone
(lmg/kg), oxygen (6L/min via mask if Sa02 (93%), and frequent
high-dose inhaled salbutamol. Patients were then randomised to
receive an intravenous infusion of either salbutamol 15mcg/kg or
saline with clinical progress assessed hourly for 2 hours. All patients
were admitted to hospital and clinically monitored for the next 2-24
hours, with inhaled salbutamol treatment administered in accord
with hospital protocol.
Results: The intravenous salbutamol group (50) demonstrated
earlier clinical improvement, with earlier reduction in oxygen
therapy and reduced need for ongoing inhaled salbutamol therapy
by the end of phase one compared to the control group (34). The
intravenous salbutamol group was ready for discharge from the
emergency department 3.7 hours earlier than controls and ready for
discharge from hospital 9.7 hours earlier than controls. No signifi-
cant side effects were found in either group.
Conclusion: A single-dose intravenous salbutamol bolus of 15
mcg/kg administered over 10 minutes in the initial treatment of
children with acute severe asthma in the emergency deparlment has
the potential to shorten the duration of severe attacks and reduce
overall requirements for maintenance inhaled salbutamol.
O 20 - Trauma
Trauma score systems in the ED: are they easily applicable and
related to outcome?
Della Corte F, Vignazia GL, Cavaglia M, La Mura F, Pelosi G
A. Avogadro - University School of Medicine, Dept. of Intensive Care, Maggiore
della Carith Hospital Novara, Italy
Background: During the last twenty years many trauma-scoring
indexes have been developed and their applicability seems to be
important mainly because they could allow:
• Comparisons of the efficacy of different therapeutic interven-
tions and outcome
• Quick triage during the pre-hospital phases as well as priority
treatments.
The traumatic event can be simplified as input (anatomic component
and its related physiologic consequence) and output (mortality and
morbidity). The aim of a scoring system is to give a reliable output.
Material and methods: 126 consecutive severe trauma patients (ISS
> 15) admitted to our general ICU from 01/01/2001 to 31/01/2001
were collected. Physiologic parameters were recorded on admis-
sion in the Emergency Room; anatomical lesions were reviewed on
discharge. Then we evaluated the application of each score on the
basis of their different values in the group of dead patients (Group
A) and in the group of the living (Group B).
Kesults: We applied five trauma scores (GCS, RTS, ISS, NISS and
TRISS) to 107 patients (84,9% - 79,2% male, 11,5% of mortality
rate). The remaining 19 patients (15,1%) were not included in the
study because of missing physiologic parameters at the moment of
the review, mainly due to secondary transfer of the patients from
other hospitals, or to uncompleted or uncorrected recording. ISS,
NISS, and TRISS had different mean values between the group of
dead patients and the group of survivors (p< 0,05). GCS and RTS
failed to demonstrate a difference between the two groups.
Condusions: The methodology proposed by ISS, NISS and TRISS
should be applied with success even early in the ED and the
number of patients scored should increase with the training of all
the members of the trauma team. As reported in literature, for their
specific characteristics, NISS and TRISS should be largely applied
as tools for correctly stratifying the trauma patient on the basis of
the severity of injury and as predictors of death during the later
ICU stay.
Reference
Brenneman FD, et al. Measuring injury severity: time for a change? J Trauma 1998;
44: 580-2.
Offner PJ, et al. NISS predicts postinjury MOF better than the ISS. J Trauma 2000;
48:624-8.
Zoltie N, et al. The hit and miss of ISS and TRISS. BMJ 1993; 307:906-9.
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