الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: Trauma is still the leading cause of death in young adults and a major cause of morbidity and mortality at all ages. The human body is programmed to maintain constant homeostasis of all body systems. Through a complex neuroendocrine and autonomic network, it is able to orchestrate a synchronous equilibrium between all body systems that is integrated with the host defense system. However, after significant traumatic injury, the human body’s ability to maintain homeostasis is significantly altered. The body responds through various exaggerated autonomic and cytokine responses in an attempt to regain equilibrium. This is often unaccomplished resulting in serious adverse sequelae, such as infection. One of the systems that may become altered post injury is the neuroendocrine system, as the body becomes unable to maintain normal serum glucose levels. Stress hyperglycemia has been associated with increased morbidity, mortality and prolonged hospital stay. The aim of the work: to determine the relationship of early blood glucose elevation to outcome in trauma patient to improve the management of polytrauma patients at Emergency Hospital Mansoura University. Patients: 104 polytrauma patients selected from the Emergency Hospital-Mansoura University were enrolled in this study, patients with pre-injury diagnosis of diabetes and patients with high risk factors for dysglycemia were excluded from the study. Methods: All patients were resuscitated first on arrival to the hospital using ATLS protocols. Highest serum glucose values were recorded on admission, daily for each patient and on discharge, using both point of care testing and routine laboratory analysis. Results: Admission hyperglycemia were 28.8%. HLOS were statistically significant (p value <0.001) higher in the admission hyperglycemia group with mean 19.33±6.9 days. Also, infection rate and mortality rate were statistically significant (p value <0.001) higher in that group with values 53.3% and 30% respectively. Conclusion: Hyperglycemia on admission also persistent and difficult to control hyperglycemia were strongly associated with increased morbidity, especially infections, prolonged intensive care unit, and hospital length of stay independent of injury severity, gender and age. Recommendations: Admission glucose level should be used as a screening tool in polytrauma patients. Trauma patients with hyperglycemia should be evaluated with a greater index of suspicion. A randomized controlled trial in a large group of trauma patients is needed to bring the value of glucose control in trauma patients to light to assess the optimal mode of insulin delivery, and to better define therapeutic goals in the critically ill, injured population.