Characteristics of polytrauma patients between 1992 and 2002: What is changing?
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)
- et al.
Geriatric polytrauma
Wien Klin Wochenschr
(2005) - et al.
Golden hour—early postinjury period
Medicina
(2003) - et al.
The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care
J Trauma
(1974) - et al.
Early versus delayed stabilization of femoral fractures. A prospective randomised study
J Bone Joint Surg Am
(1989) - et al.
Evolving trends in the care of polytrauma
Injury
(2006) - 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) - et al.
Old age is a criterion for trauma team activation
J Trauma
(2001) - et al.
Multiple organ failure in polytrauma patients
J Trauma
(1983) - et al.
Is outcome from ARDS related to the severity of respiratory failure?
Eur Respir J
(1997) - et al.
Mutiple organ failure: the role of uncontrolled infection
Arch Surg
(1980)
Multiple organ failure: generalized autodestructive inflammation?
Arch Surg
Quality of multiple trauma care in 33 German and Swiss trauma centers during a 5-year period: regular versus on-call service
J Trauma
The management of polytraumatized patients in Germany
Clin Orthop
The effect of autopsy on injury severity and survival probability calculations
J Trauma
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