Does the applied polytrauma definition notably influence outcome and patient population? – a retrospective analysis

Abstract

BackgroundAlthough the term “polytrauma” has been in use for decades, no generally accepted definition exists. The aim of this study was to demonstrate that different polytrauma definitions applied to a specific patient population result in diverse subgroups of individuals, who in turn present a varying outcome.MethodsAll patients (≥18 years) treated at our level I trauma center within a time period of three years were classified according to 11 selected polytrauma definitions and included in our study, if they were rated “polytraumatized” by at least one of these definitions. All patients, who met the criteria of a certain definition, were combined to the relevant definition-positive group, thus resulting in 11 patient subgroups. Their demographic data (number of patients, mean patient age, mean Injury Severity Score value, median number of ventilator days, median length of stay at the intensive care unit and at the hospital, mortality rate and odds ratio) were statistically compared.ResultsThree hundred seventy-five patients (73% male) with a mean age of 47 years met the inclusion criteria and were allocated to the relevant subgroups; their patient number varied from 55 to 346 and their mean Injury Severity Score value ranged from 4 to 75. Not surprisingly, all examined parameters were subject to variations. Whereas most definition-positive groups showed a mortality rate of about 21% to 30%, 18% of the individuals, who met the criteria according to Blacker, and 40% of the polytrauma victims according to Schalamon died. The Pape 1-, Schalamon-, and Berlin-positive groups presented a significant odds ratio with regard to mortality that considerably exceeded 1.DiscussionA polytrauma definition can only be a reliable tool in classifying trauma victims if it provides a significant odds ratio with regard to mortality that considerably exceeds 1 and if it succeeds in capturing patients with multiple severe injuries and a higher mortality rate without reducing the number of polytraumatized patients to a not representatively small number.ConclusionsSolely the Berlin definition resulted in a patient number reflecting clinical reality, thus enabling a transparent evaluation of treatment results provided by different institutions and allowing objective comparison of published studies.

Erythropoietin in the Evaluation of Treatment Outcomes in Patients with Polytrauma

“…Appropriate triage and optimization of treatment approach in such patients is one of the key factors that aff ect fi nal outcome in these patients 1,6,7 . Treatment of patients with polytrauma requires plenty of resources and eff orts, multiple surgeries, prolonged stay at the intensive care unit, and complex rehabilitation programs considering the course of the disease is complicated by sepsis, anemia and multiorgan dysfunction 1,2,7 .…”

“…Another defi nition that is also appropriate describes it as injury to at least two body regions with Abbreviated Injury Scale (AIS) ≥3 and with the presence of systemic infl ammatory response syndrome (SIRS) on at least one day during the fi rst 72 hours 1,5 . Appropriate triage and optimization of treatment approach in such patients is one of the key factors that infl uence fi nal outcome in these patients 1,6,7 . Treatment of patients with polytrauma requires plenty of resources and eff ort, multiple surgeries, prolonged stay at intensive care unit, and complex rehabilitation programs 1,2,7 .…”

“…Appropriate triage and optimization of treatment approach in such patients is one of the key factors that infl uence fi nal outcome in these patients 1,6,7 . Treatment of patients with polytrauma requires plenty of resources and eff ort, multiple surgeries, prolonged stay at intensive care unit, and complex rehabilitation programs 1,2,7 . Mortality in patients with polytrauma varies from 9% to 48%, depending on age group, extent of injuries, other comorbidities, and appropriate triage 5,6,[8][9][10] .…”

Rationality of using whole-body computed tomography in trauma patients

“…The literature provides various definitions of the term polytrauma, based on different abbreviated injury scale (AIS)/ISS values for injuries occurring in at least two body regions. In clinical trials, the most common cut-off values are ISS > 15 and ISS > 17, while some authors suggest adopting the criterion of AIS > 2 for injuries in at least two body regions [15]. This study adopted the lowest cutoff value, i.e.…”

Age and traumatic brain injury as prognostic factors for late-phase mortality in patients defined as polytrauma according to the New Berlin Definition: experiences from a level I trauma center

“…A well-known definition of polytrauma is the New Berlin Definition that adds at least one of five standardized physiological conditions to the definition of ISS ≥ 16 and at least two different affected body regions with an AIS ≥ 3 [12]. The New Berlin Definition has been shown to be feasible and applicable for polytrauma patients [12][13][14][15]. Rau et al [13] showed that polytrauma patients identified according to the New Berlin Definition had significantly higher ISS scores and significantly higher mortality rates.…”