Osteosynthesis and Trauma Care 2006; 14(2): 93-97
DOI: 10.1055/s-2006-933398
Original Article

© Georg Thieme Verlag Stuttgart · New York

Management of Polytrauma Patients During 10 Years

S. Aldrian1 , T. Nau1 , F. Koenig2 , P. Weninger1 , V. Vécsei1
  • 1Department of Trauma Surgery, University of Vienna Medical School, Vienna, Austria
  • 2Department of Medical Statistics, University of Vienna Medical School, Vienna, Austria
Further Information

Publication History

Publication Date:
01 June 2006 (online)

Abstract

Background: This epidemiological study presents the treatment results of multiple traumatised patients over the last 10 years. Method: Our study includes all polytrauma patients treated between 1992 and 2002 at a level 1 trauma centre. Data of 501 cases were collected prospectively and analysed retrospectively. Major issues of this analysis were the ISS, preclinical haemodynamics and intubation rate, incidence of MOF, ARDS and mortality. Results: In the last few years an increase in frequency of preclinical intubation was apparent (1992-1997: 69.3 % 1998-2002: 76.1 %). The number of primary shock patients decreased from the first period (34.0 %) to the second period (27.0 %). Comparing both periods, the mean ISS (34.3) and injury pattern showed no significant difference. The incidence of MOF decreased from 10.3 % in the first period to 5.5 % in the second period, while the frequency of ARDS decreased from 19.7 % to 9.4 %. The mortality rate increased from 28.2 % in the first to 32.2 % in the last 5 years. Conclusion: Protracted time of initial rescue, early intubation and good quality of preclinical treatment leads to a reduction of complications during ICU therapy. The transport of more patients who would have died in the field if there had not been a reduced scene time and rapid transport available in our trauma system could be a reason for the increasing mortality of multiple traumatised patients in our hospital.

References

  • 1 Aldrian S, Nau T, Koenig F, Vécsei V. Geriatric polytrauma.  Wien Klin Wochenschr. 2005;  117 145-149
  • 2 Aufmkolk M, Voggenreiter G, Majetschak M, Neudeck F, Schmit-Neuerburg K P, Obertacke U. Injuries due to falls from a considerable height. A comparative analysis from injuries and clinical course after international or accidental fall.  Unfallchirurg. 1999;  102 525-530
  • 3 Baker S P, O'Neill B, Haddon W, Long W B. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care.  J Trauma. 1974;  14 187-196
  • 4 Bone L B, Johnson K D, Weigelt J, Scheinberg R. Early versus delayed stabilization of femoral fractures. A prospective randomised study.  J Bone Joint Surg [Am]. 1989;  71 336-340
  • 5 Bosse M J, MacKenzie E J, Riemer B L, Brumback R J, McCarthy M L, Burgess A R, Gens D R, Yasui Y. 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 [Am]. 1997;  79 799-809
  • 6 Demetriades D, Sava J, Alo K, Newton E, Velmahos G, Murray J A, Belzberg H, Asensio J A, Berne T V. et al . Old age is a criterion for trauma team activation.  J Trauma. 2001;  51 754-757
  • 7 Faist E, Baue A E, Dittmer H, Heberer G. Multiple organ failure in polytrauma patients.  J Trauma. 1983;  23 775-787
  • 8 Ferring M, Vincent J L. Is outcome from ARDS related to the severity of respiratory failure?.  Eur Respir J. 1997;  10 297-1300
  • 9 Fry D E, Pearlstein L, Fulton R L, Polk H C. Multiple organ failure: the role of uncontrolled infection.  Arch Surg. 1980;  115 136-140
  • 10 Goris R JA, Te Brockhorst T PA, Nuytink J KS, Gimbrere J S. Multiorgan failure: generalized autodestructive inflammation?.  Arch Surg. 1985;  120 1109-1115
  • 11 Guenther S, Waydhas C, Ose C, Nast-Kolb D. Quality of multiple trauma care in 33 German and Swiss trauma centres during a 5-year period: regular versus on-call service.  J Trauma. 2003;  54 973-978
  • 12 Jardin F, Fellahi J L, Beauchet A, Vicillard-Baron A, Loubieres Y, Page B. Improved prognosis of acute respiratory distress syndrome 15 years on.  Intensive Care Med. 1999;  25 936-941
  • 13 Lane P L, McClafferty K J, Nowak E S. Pedestrians in real world collisions.  J Trauma. 1994;  36 231-236
  • 14 Matthes G, Seifert J, Ostermann P AW, Würfel S, Ekkernkamp A, Wich M. Early death of the severely injured patient - a retrospective analysis.  Zentralbl Chir. 2001;  126 995-999
  • 15 Milberg J A, Davis D R, Steinberg K P, Hudson L D. Improved survival of patients with acute respiratory distress syndrome (ARDS).  JAMA. 1995;  273 306-309
  • 16 Nast-Kolb D, Aufmkolk M, Rucholtz S, Obertacke U, Waydhas C. Multiple organ failure still a major cause of morbidity but not mortality in blunt multiple trauma.  J Trauma. 2001;  51 835-841
  • 17 Nau T, Aldrian S, Koenig F, Vécsei V. Fixation of femoral fractures in multiple-injury patients with combined chest and head injuries.  ANZ J Surg. 2003;  73 1018-1021
  • 18 Pape H C, Stalp M, Griensven M, Weinberg A, Dahlweit M, Tscherne H. Optimal timing for secondary surgery in polytrauma patients: an evaluation of 4 314 serious-injury cases.  Chirurg. 1999;  70 1287-1293
  • 19 Regel G, Lobenhoffer P, Grotz M, Pape H C, Lehmann U, Tscherne H. Treatment results of patients with multiple trauma: an analysis of 3 406 cases treated between 1972 and 1991 at a German Level 1 trauma centre.  J Trauma. 1995;  38 70-78
  • 20 Regel G, Grotz M, Weltner T, Sturm J A, Tscherne H. Pattern of organ failure following severe trauma.  World J Surg. 1996;  20 422-429
  • 21 Roupie E, Lepage E, Wysocki M. Prevalence, aetiologies and outcome of the acute respiratory distress syndrome among hypoxemic ventilated patients: SRLF Collaborative Group on Mechanical Ventilation - Société dé Réanimation de Langue Française.  Intensive Care Med. 1999;  25 920-929
  • 22 Schweiberer L, Nast-Kolb D, Duswald K H, Waydhas C, Müller K. Das Polytrauma - Behandlung nach dem diagnostischen und therapeutischen Stufenplan.  Unfallchirurg. 1987;  90 529-538
  • 23 Waydhas C, Nast-Kolb D, Trupka A. et al . Posttraumatic inflammatory response, secondary operations and late multiorgan failure.  J Trauma. 1996;  40 624-631

S. AldrianMD 

Department of Trauma Surgery · University of Vienna Medical School

Währinger Gürtel 18-20

1090 Vienna

Austria

Phone: +43/1/4 04 00/59 02

Fax: +43/1/4 04 00/59 49

Email: silke.aldrian@aon.at