Based on several consensus meetings and a database analysis, the expert panel proposes the following parameters for a definition of "polytrauma": significant injuries of three or more points in two or more different anatomic AIS regions in conjunction with one or more additional variables from the five physiologic parameters. Further validation of this proposal should occur, favorably by mutivariate analyses of these parameters in a separate data set.

This review identified the lack of a validated or consensus definition of the term polytrauma. The international trauma community should consider establishing a consensus definition for polytrauma, which could be validated prospectively and serve as a basis for future research.

No abstract

Compartment syndrome is defined as the dysfunction of organs/tissues within the compartment due to limited blood supply caused by increased pressure within the compartment. The aim of this article is to introduce and discuss acute compartment syndromes that are essential for critical care physicians to recognize and manage. Various pathophysiological mechanisms (ischemia-reperfusion syndrome, direct trauma, localized bleeding) could lead to increased compartmental pressure and decreased blood flow through the intracompartmental capillaries. Although compartment syndromes are described in virtually all body regions, the etiology, diagnosis, treatment, and prevention are best characterized for three key body regions (extremity, abdominal, and thoracic compartment syndromes). Compartment syndromes can be classified as either primary (pathology/injury is within the compartment) or secondary (no primary pathology or injury within the compartment), and based on the etiology (e.g., trauma, burn, sepsis). A recently described phenomenon is the "multiple" compartment syndrome or "poly"-compartment syndrome, which is usually a complication of a severe shock and massive resuscitation. The prevention of compartment syndromes is based on preemptive open management of compartments (primary syndromes) in high-risk patients and/or careful fluid resuscitation (both primary and secondary syndromes) to limit interstitial swelling.

Diagnostic test/ criteria, level III.

A lack of consensus in the definition of "polytrauma" was apparent. According to the international consensus opinion, both anatomical and physiological parameters should be included in the definition of polytrauma. An Abbreviated Injury Scale (AIS) based anatomical definition is the most practical and feasible given the ubiquitous use of the system. Convincing preliminary data show that two body regions with AIS >2 is a good marker of polytrauma-better than other ISS cutoffs, which could also indicate monotrauma. The selection of the most accurate physiological parameters is still underway, but they will most likely be descriptors of tissue hypoxia and coagulopathy.

The understanding of post injury multiple organ failure (MOF) has evolved considerably since it was first described more than 30 years ago. Improved trauma care has decreased the mortality of single organ injury, although these patients may go on to MOF. There has been significant investigation in both the basic science and clinical understanding of MOF. This research has altered management strategies thereby decreasing the incidence and mortality related to MOF. Despite this MOF remains the greatest contributor to late trauma death and morbidity. This review defines essential terminology, examines the historical perspective of MOF, describes common scoring systems, describes the changes in epidemiology, discusses the aetiology and pathophysiology, reviews current prevention, resuscitation and treatment strategies and provides future direction for research.

Based on subjective assessments, trauma surgeons do not agree on the definition of polytrauma, with the subjective definition differing both within and across institutions.