Evaluation of the Berlin polytrauma definition: A Dutch nationwide observational study

Abstract

BACKGROUND:The Berlin polytrauma definition (BPD) was established to identify multiple injury patients with a high risk of mortality. The definition includes injuries with an Abbreviated Injury Scale score of ≥3 in ≥2 body regions (2AIS ≥3) combined with the presence of ≥1 physiological risk factors (PRFs). The PRFs are based on age, Glasgow Coma Scale, hypotension, acidosis, and coagulopathy at specific cutoff values. This study evaluates and compares the BPD with two other multiple injury definitions used to identify patients with high resource utilization and mortality risk, using data from the Dutch National Trauma Register (DNTR). METHODS:The evaluation was performed based on 2015 to 2018 DNTR data. First, patient characteristics for 2AIS ≥3, Injury Severity Score (ISS) of ≥16, and BPD patients were compared. Second, the PRFs prevalence and odds ratios of mortality for 2AIS ≥3 patients were compared with those from the Deutsche Gesellschaft für Unfallchirurgie Trauma Register. Subsequently, the association between PRF and mortality was assessed for 2AIS ≥3-DNTR patients and compared with those with an ISS of ≥16. RESULTS:The DNTR recorded 300,649 acute trauma admissions. A total of 15,711 patients sustained an ISS of ≥16, and 6,263 patients had suffered a 2AIS ≥3 injury. All individual PRFs were associated with a mortality of >30% in 2AIS ≥3-DNTR patients. The increase in PRFs was associated with a significant increase in mortality for both 2AIS ≥3 and ISS ≥16 patients. A total of 4,264 patients met the BPDs criteria. Overall mortality (27.2%), intensive care unit admission (71.2%), and length of stay were the highest for the BPD group. CONCLUSION:This study confirms that the BPD identifies high-risk patients in a population-based registry. The addition of PRFs to the anatomical injury scores improves the identification of severely injured patients with a high risk of mortality. Compared with the ISS ≥16 and 2AIS ≥3 multiple injury definitions, the BPD showed to improve the accuracy of capturing patients with a high medical resource need and mortality rate.

Standards of fracture care in polytrauma: results of a Europe-wide survey by the ESTES polytrauma section

“…However, across Europe, it seems that three polytrauma definitions (ISS > 15, "Berlin definition" and "life-threatening"-definitions) are used predominantly. Several studies indicated that taking physiological parameters into account when defining polytrauma (such as the "Berlin definition") can improve the identification of patients with higher risk of mortality and extended need of resources [22][23][24]. However, an abbreviated injury scale (AIS)-based anatomical definition is the most practical and feasible tool in daily practice.…”

The definition of major trauma using different revisions of the abbreviated injury scale

“…However, this is not the case. Various studies have included other anatomical summary scores [ 11 ], or added physiological parameters and biomarkers [ 32 , 33 ] to national trauma registries, and distinguish between severe single-system trauma and polytrauma [ 34 , 35 ] to better define MT populations or risk-adjust when evaluating outcomes [ 36 ]. Modifying or selectively using ISS thresholds for defining MT should therefore be seen as an important, but temporary measure when comparing data collected across more than one AIS revision.…”

Polytrauma: Definition of the Problem and Management Strategy (Review)

“…Авторы пришли к выводу, что добавление физиологических параметров к анатомической шкале улучшает чувствительность при определении вероятности неблагоприятно-го исхода. Так у больных, отнесенных к «политравме» по БОП (n=4 264), летальность составила 27, 2%, а необходимость госпитализации в ОИТ -71, 2% [23].…”

“…Принцип шкалы основан на подсчете суммы квадратов трех максимально поврежденных областей тела. В конце прошлого века клиницистами было принято определять травму как «тяжелая», в случае если летальность превышала 20%, что соответствовало ISS 16 баллов [23]. Однако, с развитием травматологической службы летальность стала снижаться, что привело к расхождению мнений относительно минимального порога, который в настоящее время варьируется от 15 до 26 баллов [19].…”