Influences on Mortality of Polytrauma Patients

Abstract

The organization of treatment for a severe, multiply injured patient remains controversial and different. The importance of the prehospital period is unquestionable and well established. Best results are obtained by having well-organized prehospital trauma care and early aggressive treatment. The aim of this study was to examine the peculiarities of the treatment of severe polytrauma patients. A retrospective analysis of 159 blunt polytrauma patients treated in the University Hospital (UH) during the period 1998-2003 was made. Multiple severe injuries (ISS ≥ 16) with lower extremity long bone diaphyseal fractures were inclusion criteria. The mean age of the patients was 43.9 ± 1.4 years (male: 40.9 ± 1.5 vs. female: 51.3 ± 3.1, p < 0.01). Mean injury severity evaluated by the Injury Severity Score (ISS) was 29.50 ± 0.8 and the mean amount of lower extremity long bone fractures was 1.2 ± 0.05/patient. Prehospital time of patients transported directly to UH (64.2 % of all) was 47.7 ± 2.8 min. The rate of primary survey reached 11.6 % and the amount of resuscitation reached 4.3 % in comparison with ATLS recommendations. 83.6 % of the severe polytrauma patient's lower extremity long bone diaphyseal fractures were operated and the remaining 16.4 % of fractures were treated by conservative means. Early (during 24 hours of hospitalization) operative stabilization of the fracture was done in 58.5 % of the cases. The mean length of stay at hospital was 23.6 ± 1.6 days. The average mortality was 20.8 %. The mortality rate was 11.3 % in the operative fracture treatment group vs. 69.2 % in the conservative fracture treatment group (χ² = 44.5; df = 2; p < 0.001). These two groups were similar by age and ISS. In a situation of poor primary survey and resuscitation, the prediction of satisfactory treatment outcome is problematic. The anatomic assessment of injury severity and age of the patient seem to be the valuable tools in a presumption of outcome. Aggressive stabilization of long bone lower extremity fractures has a positive influence on treatment results. The mortality of severe polytrauma patients was related to patient age (OR 1.069; 95 % C.I. 1.035-1.104; p < 0.001) and Injury Severity Score (OR 1.245; 95 % C.I. 1.151-1.346; p < 0.001). We estimate that age, injury severity and early operative lower extremity fracture stabilization were significant for the severe polytrauma patient's mortality (p < 0.001).

Key words

blunt polytrauma - lower extremity fracture - fracture stabilization

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