Elsevier

Injury

Volume 38, Issue 9, September 2007, Pages 1059-1064
Injury

Characteristics of polytrauma patients between 1992 and 2002: What is changing?

https://doi.org/10.1016/j.injury.2007.04.022Get rights and content

Summary

Objective

To analyse the characteristics of polytrauma patients and the quality and progress of treatment regimens by an evaluation of a trauma population.

Methods

The study included all polytrauma patients treated between 1992 and 2002 at a level 1 trauma centre. Data of 501 cases were collected prospectively and analysed retrospectively. The analysis included the demographic data, injury severity, preclinical haemodynamics, intubation rates, incidences of multiorgan failure and adult respiratory distress syndrome, and mortality.

Results

Per year of the study, the average age of patients increased by 0.748 years. Preclinical intubation rates also increased and the number of cases of primary shock decreased. The Injury Severity Score fell on average by 0.59 points per year. There was a significant decrease in multiorgan failure and adult respiratory distress syndrome. The mortality rate remained constant.

Conclusions

Protracted time of initial rescue, early intubation and good preclinical treatment lead to a reduction of complications during intensive care. The increasing number of elderly patients results in persistently high mortality even with decreasing injury severity.

Introduction

Treatment of polytrauma requires qualified trauma management that may involve several care professionals. Over the last decades polytrauma care has developed into an established trauma centre specialty with its own unique identity and characteristics. Care of patients with multiple-trauma demands maximal diagnostic and therapeutic effort, and advances have occurred mostly in a succession of small steps rather than any dramatic leap. Numerous authors have described changes of clinical and preclinical algorithms over the last 20 years. Advances in pre-hospital care, intensive care medicine and surgical techniques have also contributed to the changing face of major trauma care. Infrastructure, algorithms and personal experience are key to optimal results.

This epidemiological study represents acute clinical management, treatment processes and outcomes over the last 10 years. In order to learn from the past and offer guidance for future progress, the impact of our therapeutic algorithm was analysed also, hoping to enhance the quality of treatment of our multiple-trauma population.

Section snippets

Study population

Data for this study were obtained from our prospectively gathered computerised trauma database, and retrospectively analysed. We collected data on all polytrauma patients admitted to the hospital for at least 1 day, including all patients declared dead in the emergency department; patients with isolated, severe, potentially life-threatening injuries were not included.

In addition to demographic data, injury severity, injury pattern, type of accident, frequency of preclinical intubation,

Epidemiological data

Between 1992 and 2002, 501 patients were entered into our polytrauma database. The mean age was 37.5 ± 0.9 years. The regression model yields a significant influence of time on the patient's age (logistic regression: age = 33 years, 12 + 0.75 time, p = 0.009), which means that per calendar year the age increased by 0.75 years on average (Fig. 1). The majority of patients were men (n = 338, 67.5%). Most of our patients (65.5%) were injured in road traffic accidents (RTAs), 24.0% by falls from height, and

Discussion

The management pathway for multiply injured patients evolved considerably during the last century. As our understanding of the altered physiological processes after severe trauma has increased, there have been major changes in the care of such cases. In Western Europe, Scandinavian countries and the USA, regional systems for trauma care management started operating during the 1970s or 1980s.2 The regionalisation of trauma care has lowered the preventable death rate and morbidity due to major

References (29)

  • S. Aldrian et al.

    Geriatric polytrauma

    Wien Klin Wochenschr

    (2005)
  • P. Alginmantas et al.

    Golden hour—early postinjury period

    Medicina

    (2003)
  • S.P. Baker et al.

    The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care

    J Trauma

    (1974)
  • L. Bone et al.

    Early versus delayed stabilization of femoral fractures. A prospective randomised study

    J Bone Joint Surg Am

    (1989)
  • D. Bose et al.

    Evolving trends in the care of polytrauma

    Injury

    (2006)
  • M.J. Bosse et al.

    Adult respiratory distress syndrome, pneumonia and mortality following thoracic injury and a femoral fracture treated either with intramedullary nailing with reaming or with a plate

    J Bone Joint Surg

    (1997)
  • D. Demetriades et al.

    Old age is a criterion for trauma team activation

    J Trauma

    (2001)
  • E. Faist et al.

    Multiple organ failure in polytrauma patients

    J Trauma

    (1983)
  • M. Ferring et al.

    Is outcome from ARDS related to the severity of respiratory failure?

    Eur Respir J

    (1997)
  • D.E. Fry et al.

    Mutiple organ failure: the role of uncontrolled infection

    Arch Surg

    (1980)
  • R.J.A. Goris et al.

    Multiple organ failure: generalized autodestructive inflammation?

    Arch Surg

    (1985)
  • S. Guenther et al.

    Quality of multiple trauma care in 33 German and Swiss trauma centers during a 5-year period: regular versus on-call service

    J Trauma

    (2003)
  • N.P. Haas et al.

    The management of polytraumatized patients in Germany

    Clin Orthop

    (1985)
  • J.D. Harviel et al.

    The effect of autopsy on injury severity and survival probability calculations

    J Trauma

    (1989)
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