Frank Hildebrand1, Rolf Lefering2, Hagen Andruszkow3, Boris A Zelle4, Bilal M Barkatali5, Hans-Christoph Pape6. 1. Department of Orthopaedic Trauma at Aachen University, NRW, Germany. 2. Institute for Research in Operative Medicine (IFOM), Cologne, NRW, Germany. 3. Department of Orthopaedic Trauma at Aachen University, NRW, Germany; Harald Tscherne Research Laboratory for Orthopaedic Trauma at Aachen, NRW, Germany. 4. The University of Texas Health Science Center at San Antonio, TX USA. 5. Department of Trauma and Orthopaedics, Royal Bolton Foundation NHS Trust, UK. 6. Department of Orthopaedic Trauma at Aachen University, NRW, Germany. Electronic address: papehc@aol.com.
Abstract
BACKGROUND: The impact of conventional laboratory data to identify polytrauma patients at risk of complications is established. However, it has not been assessed in terms of prognostic accuracy for systemic complications (ARDS, organ failure). We therefore assessed the most predictive parameters for systemic complications and developed a scoring system for early grading of polytrauma patients. METHODS: A population based trauma registry was used. INCLUSION CRITERIA: age >16 years, Abbreviated Injury Score (AIS) of the abdomen or chest ≥ 3 points and treatment in an intensive care unit, or Injury Severity Score (ISS) ≥ 16 points. The primary endpoint was hospital mortality. Patients were graded according their risk of death: low risk of death (5-14% mortality), intermediate risk patients (15-39% mortality) and high risk (>40%). Routine clinical and laboratory parameters on admission were assessed to determine their specific relevance to describe the risk profile of the patient. Based on these data, a scoring system for the description of the clinical status was developed. Statistical analysis included uniand multivariate analysis. RESULTS: 11.436 patients were included, the mean ISS was 22.7 ± 11.2 points, 73% were male, and 95.6% had blunt injuries. The most sensitive parameters were found to be the following ones: systolic blood pressure, INR, thrombocytes, base deficit, NISS, packed red blood cells administered. The multivariate analysis revealed the following threshold levels: BP 76-90 mmHg: r = 0.249, OR 1.283: Base deficit 8-10 r = 0.474, OR 1.606; INR 1.4-2 r = 0.160, OR 1.174; NISS 35-39 r = 0.9, OR 2.46; pBRC 3-14: r = 0.671, OR 1.957. The following ranges of score values were found to be associated with different patient status: <6 points: stable patients; 6-11 points: borderline condition; >11 points: unstable patients. When using this score, 80.6% were stable, 14.6% in a borderline condition and 4.8% unstable. CONCLUSION: We developed a scoring system to discriminate polytrauma patients on admission that are at risk of systemic complications. Systolic blood pressure, INR, thrombocytes, base deficit, NISS, packed red blood cells administered are able to provide a prognosis of patients at risk of posttraumatic complications. Further prospective studies should be performed to verify this new scoring system.
BACKGROUND: The impact of conventional laboratory data to identify polytraumapatients at risk of complications is established. However, it has not been assessed in terms of prognostic accuracy for systemic complications (ARDS, organ failure). We therefore assessed the most predictive parameters for systemic complications and developed a scoring system for early grading of polytraumapatients. METHODS: A population based trauma registry was used. INCLUSION CRITERIA: age >16 years, Abbreviated Injury Score (AIS) of the abdomen or chest ≥ 3 points and treatment in an intensive care unit, or Injury Severity Score (ISS) ≥ 16 points. The primary endpoint was hospital mortality. Patients were graded according their risk of death: low risk of death (5-14% mortality), intermediate risk patients (15-39% mortality) and high risk (>40%). Routine clinical and laboratory parameters on admission were assessed to determine their specific relevance to describe the risk profile of the patient. Based on these data, a scoring system for the description of the clinical status was developed. Statistical analysis included uniand multivariate analysis. RESULTS: 11.436 patients were included, the mean ISS was 22.7 ± 11.2 points, 73% were male, and 95.6% had blunt injuries. The most sensitive parameters were found to be the following ones: systolic blood pressure, INR, thrombocytes, base deficit, NISS, packed red blood cells administered. The multivariate analysis revealed the following threshold levels: BP 76-90 mmHg: r = 0.249, OR 1.283: Base deficit 8-10 r = 0.474, OR 1.606; INR 1.4-2 r = 0.160, OR 1.174; NISS 35-39 r = 0.9, OR 2.46; pBRC 3-14: r = 0.671, OR 1.957. The following ranges of score values were found to be associated with different patient status: <6 points: stable patients; 6-11 points: borderline condition; >11 points: unstable patients. When using this score, 80.6% were stable, 14.6% in a borderline condition and 4.8% unstable. CONCLUSION: We developed a scoring system to discriminate polytraumapatients on admission that are at risk of systemic complications. Systolic blood pressure, INR, thrombocytes, base deficit, NISS, packed red blood cells administered are able to provide a prognosis of patients at risk of posttraumatic complications. Further prospective studies should be performed to verify this new scoring system.
Authors: Carlos Oliver Valderrama-Molina; Nelson Giraldo; Alfredo Constain; Andres Puerta; Camilo Restrepo; Alba León; Fabián Jaimes Journal: Eur J Orthop Surg Traumatol Date: 2016-12-20
Authors: Ladislav Mica; Cedric Niggli; Peter Bak; Avi Yaeli; Margaret McClain; Charles M Lawrie; Hans-Christoph Pape Journal: World J Surg Date: 2020-03 Impact factor: 3.352
Authors: Sascha Halvachizadeh; P J Störmann; Orkun Özkurtul; Till Berk; Michel Teuben; Kai Sprengel; Hans-Christoph Pape; Rolf Lefering; Kai Oliver Jensen Journal: BMJ Open Date: 2022-04-13 Impact factor: 3.006
Authors: Sascha Halvachizadeh; Larissa Baradaran; Paolo Cinelli; Roman Pfeifer; Kai Sprengel; Hans-Christoph Pape Journal: PLoS One Date: 2020-01-24 Impact factor: 3.240