Polytrauma – Definition Management Aspects and Trauma Score? (original) (raw)
Related papers
Polytrauma Management and Links to EMS
Albanian Journal of Trauma and Emergency Surgery, 2019
Background: Multiple injuries are the second leading cause of morbidity, invalidity and mortality in developed and developing countries in children, young people and the elderly. The most frequent causes are: road traffic accidents, falling from heights, firearms, vehicles, colds and explosive devices. The incidence and prevalence of polytrauma differs from region to region and the largest number of deaths from multiple injuries or polytraumatis occur within the first trauma time, often defined as the "golden hour of trauma". Aim: Provide medical care at all stages of managing the injured with politrauma with basic and advanced support in order to reduce: morbidity, disability and mortality. Materials and methods: The research material was obtained from UCCK Emergency Clinic archive. The research is retrospective, descriptive, qualitative, for the period January-December 2018 In the research only injured with: injuries, sex, type of pathologies, causes, road traffic, firea...
The journal of trauma and acute care surgery, 2014
The nomenclature for patients with multiple injuries with high mortality rates is highly variable, and there is a lack of a uniform definition of the term polytrauma. A consensus process was therefore initiated by a panel of international experts with the goal of assessing an improved, database-supported definition for the polytraumatized patient. The consensus process involved the following: RESULTS: A total of 28,211 patients in the trauma registry met the inclusion criteria. The mean (SD) age of the study cohort was 42.9 (20.2) years (72% males, 28% females). The mean (SD) ISS was 30.5 (12.2), with an overall mortality rate of 18.7% (n = 5,277) and an incidence of 3% of penetrating injuries (n = 886). Five independent physiologic variables were identified, and their individual cutoff values were calculated based on a set mortality rate of 30%: hypotension (systolic blood pressure ≤ 90 mm Hg), level of consciousness (Glasgow Coma Scale [GCS] score ≤ 8), acidosis (base excess ≤ -6....
Evaluation of the Berlin polytrauma definition: A Dutch nationwide observational study
Journal of Trauma and Acute Care Surgery, 2021
BACKGROUND: The Berlin polytrauma definition (BPD) was established to identify multiple injury patients with a high risk of mortality. The definition includes injuries with an Abbreviated Injury Scale score of ≥3 in ≥2 body regions (2AIS ≥3) combined with the presence of ≥1 physiological risk factors (PRFs). The PRFs are based on age, Glasgow Coma Scale, hypotension, acidosis, and coagulopathy at specific cutoff values. This study evaluates and compares the BPD with two other multiple injury definitions used to identify patients with high resource utilization and mortality risk, using data from the Dutch National Trauma Register (DNTR). METHODS: The evaluation was performed based on 2015 to 2018 DNTR data. First, patient characteristics for 2AIS ≥3, Injury Severity Score (ISS) of ≥16, and BPD patients were compared. Second, the PRFs prevalence and odds ratios of mortality for 2AIS ≥3 patients were compared with those from the Deutsche Gesellschaft für Unfallchirurgie Trauma Register. Subsequently, the association between PRF and mortality was assessed for 2AIS ≥3-DNTR patients and compared with those with an ISS of ≥16. RESULTS: The DNTR recorded 300,649 acute trauma admissions. A total of 15,711 patients sustained an ISS of ≥16, and 6,263 patients had suffered a 2AIS ≥3 injury. All individual PRFs were associated with a mortality of >30% in 2AIS ≥3-DNTR patients. The increase in PRFs was associated with a significant increase in mortality for both 2AIS ≥3 and ISS ≥16 patients. A total of 4,264 patients met the BPDs criteria. Overall mortality (27.2%), intensive care unit admission (71.2%), and length of stay were the highest for the BPD group. CONCLUSION: This study confirms that the BPD identifies high-risk patients in a population-based registry. The addition of PRFs to the anatomical injury scores improves the identification of severely injured patients with a high risk of mortality. Compared with the ISS ≥16 and 2AIS ≥3 multiple injury definitions, the BPD showed to improve the accuracy of capturing patients with a high medical resource need and mortality rate.
Update on the definition of polytrauma
European Journal of Trauma and Emergency Surgery, 2014
Purpose The definition and use of the term ''polytrauma'' is inconsistent and lacks validation. This article describes the historical evolution of the term and geographical differences in its meaning, examines the challenges faced in defining it adequately in the current context, and summarizes where the international consensus process is heading, in order to provide the trauma community with a validated and universally agreed upon definition of polytrauma. Conclusion A lack of consensus in the definition of ''polytrauma'' was apparent. According to the international consensus opinion, both anatomical and physiological parameters should be included in the definition of polytrauma. An Abbreviated Injury Scale (AIS) based anatomical definition is the most practical and feasible given the ubiquitous use of the system. Convincing preliminary data show that two body regions with AIS [2 is a good marker of polytrauma-better than other ISS cutoffs, which could also indicate monotrauma. The selection of the most accurate physiological parameters is still underway, but they will most likely be descriptors of tissue hypoxia and coagulopathy.
The journal of trauma and acute care surgery, 2013
The international trauma community has recognized the lack of a validated consensus definition of "polytrauma." We hypothesized that using a subjective definition, trauma surgeons will not have substantial agreement; thus, an objective definition is needed. A prospective observational study was conducted between December 2010 and June 2011 (John Hunter Hospital, Level I trauma center). Inclusion criteria were all trauma call patients with subsequent intensive care unit admission. The study was composed of four stages as follows: (1) four trauma surgeons assessed patients until 24 hours, then coded as either "yes" or "no" for polytrauma, and results compared for agreement; (2) eight trauma surgeons representing the United States, Germany, and the Netherlands graded the same prospectively assessed patients and coded as either "yes" or "no" for polytrauma; (3) 12 months later, the original four trauma surgeons repeated assessment via da...
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Background: Although 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. Methods: All 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. Results: Three 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. Discussion: A 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. Conclusions: Solely 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.
Resuscitation of Polytrauma Patients - An Overview
Trauma is considered as the sixth leading cause of death worldwide, resulting in 10% of all deaths or five million died annually. It is the fifth leading cause of significant disability. About half of trauma deaths are in people aged between 15 and 45 years and is the leading cause of death in this age group. Mechanism of trauma can be classified as mechanical, physical and chemical according to the source of energy. Trauma induced hemorrhage accounts for the largest proportion of mortality within the first hour of trauma, Moreover, hemorrhageinduced hypotension in trauma patients is predictive of greater than 50% mortality. Assessment and resuscitation of Polytrauma patient begins before the event by prophylactic measurements, at the site of event, during transport (pre hospital phase 50% immediate death of patients) and in emergency room. Trauma care in the 1970s is the start of Advanced Trauma Life Support (ATLS) course, and the golden hours of trauma care has been based on an organized approach that aims to manage life threatening injuries. This ABCDE and trauma team approach can be applied to all critically injured patients and the goal of resuscitation is to restore organ perfusion. Resuscitation of Polytrauma patients should depend mainly on ATLS guidelines and Prophylactic measures should be respected to avoid the event e.g. wearing seat belt, helmet and controlling the speed of vehicles etc. The Role of ER team include TMT (Triage for Polytrauma, Management means life saving interventions, ABCDE approach, Transfer for definitive care) Key words : • Poly Trauma • Resuscitation• ATLS Guidelines