Level 3 guideline on the treatment of patients with severe/multiple injuries

Bouillon, Bertil; Pieper, Dawid; Flohé, Sascha; Eikermann, Michaela; Prengel, Peggy; Ruchholtz, Steffen; Stürmer, K. M.; Waydhas, Christian; Trentzsch, Heiko; Lendemans, Sven; Huber‐Wagner, Stefan; Rixen, Dieter; Hildebrand, Frank; Mösch, Christoph; Nienaber, Ulrike; Sauerland, Stefan; Schenkel, Martin; Walgenbach, Maren; Becker, Monika; Bühn, Stefanie; He, Simone; Jaschinski, Thomas; Mathes, Tim; Bernhard, Michaël; Böttiger, Bernd W.; Bürger, T.; Fischer, Matthias; Gutwald, Ralf; Hohenfellner, Markus; Klar, E.; Rickels, E.; Schüttler, J.; Seekamp, Andreas; Swoboda, L; Vogl, Thomas J.; Waldfahrer, Frank; Wüstner-Hofmann, M.; Bader, W.; Duran, Andreas; Gathof, Birgit; Geyer, Lucas L.; Häske, David; Helm, Matthias; Hilbert-Carius, Peter; Kanz, Karl‐Georg; Kneser, Ulrich; Lehnhardt, Marcus; Lier, Heiko; Lott, Carsten; Ludwig, Corinna; Marzi, Ingo; Mauer, Uwe Max; Schäfer, Jürgen R.; Schwab, Robert; Siemers, Frank; Strasser, Erwin; Wessel, Lucas; Wirth, Stéfan; Wurmb, Thomas

doi:10.1007/s00068-018-0922-y

Cited by 92 publications

(34 citation statements)

References 1,374 publications

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“…This S3 guideline fulfills the highest level of standard of this organization [3]. The guideline is evidence based, was consented by the representatives of all participating medical societies and is now translated into English in 2018 in this issue [4] to provide guidance to the international trauma care community.…”

mentioning

confidence: 99%

See 1 more Smart Citation

The updated German “Polytrauma – Guideline”: an extensive literature evaluation and treatment recommendation for the care of the critically injured patient

Bouillon

Marzi

2018

Eur J Trauma Emerg Surg

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mentioning

confidence: 99%

“…The English version of the guideline is now available as "free access" to all those interested in the management of the severely injured [4]. We encourage all those involved in the management and research of trauma patients to use the guideline extensively, first to get knowledge of the extensive review, and second to challenge the key recommendations.…”

mentioning

confidence: 99%

The updated German “Polytrauma – Guideline”: an extensive literature evaluation and treatment recommendation for the care of the critically injured patient

Bouillon

Marzi

2018

Eur J Trauma Emerg Surg

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“…Prehospital treatment has become more sophisticated and methodical, addressing the haemorrhagic phase and preventing early mortality due to exsanguination prior to hospital admission. Time is critical and rapid identification and treatment of haemorrhagic shock with the activation of medical retrieval teams and aeromedical transport to a level 1 trauma centre that is equipped to treat these extensive and resource intensive injuries is essential ( 16 , 24 ). The availability of pre-hospital blood products and tranexamic acid (TXA), and the adoption of principles such as permissive hypotension (to avoid clot disruption prior to bleeding control), and avoidance of haemodilution by minimising crystalloid infusion [to prevent trauma induced coagulopathy (TIC) through haemodilution of clotting factors], has been adopted as the standard treatment of these patients enabling them to tolerate being transported to a level 1 trauma centre ( 25 ).…”

Section: Managementmentioning

confidence: 99%

“…Controversy surrounds the use of pelvic binding on lateral compression type injuries as they can become more haemodynamically unstable with the application of a binder due to the pelvis effectively collapsing inwards ( 27 ) and open pelvic fractures may also pose an impediment to binder application depending on the degree of soft tissue disruption. There are also a variety of haemostatic agents that can be used pre-hospital and during surgery to arrest bleeding including; systemic and topical haemostatic agents ( 24 , 28 ). Systemic haemostatic agents including; intravenous infusion of blood products, coagulation factors, and TXA, have become widely accepted, along with the guidance of a Haematologist to manage blood product administration in the haemorrhaging patient.…”

Section: Managementmentioning

confidence: 99%

“…Topical haemostatics are used more in combat situations, these are more useful prehospital and are not as commonly employed as part of the surgical management of these patients. They include; dressings impregnated with haemostatic agents (Chitosan, Zeolite, Combat gauze, Quickclot, Kaolin impregnated gauze) and injectable and self-expanding sponges (Xstat-multiple radiopaque expanding mini-sponges) ( 24 , 28 ).…”

Section: Managementmentioning

confidence: 99%

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The Road to Survival for Haemodynamically Unstable Patients With Open Pelvic Fractures

Watkins

Hsu

2020

Front. Surg.

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Management of haemodynamically unstable pelvic ring injuries has been simplified into treatment algorithms to streamline care and emergent decision making in order to improve patient outcomes whilst decreasing mortality and morbidity. Pelvic ring injuries are most commonly a result of high-velocity and energy forces that exert trauma to the pelvic bones causing not only damage to the bone but the surrounding soft-tissue, organs, and other structures and are usually accompanied by injuries to other parts of the body resulting in a polytraumatised patient. Open pelvic fractures are a rare subset of pelvic ring fractures that are on the more severe end of the pelvic fracture continuum and usually produce uncontrolled haemorrhage from fractured bone, retroperitoneal haematomas, intraabdominal bleeding from bowel injury, soft tissue injuries to the anus, perineum, and genitals, fractures of the pelvic bones, causing bleeding from cancellous bone, venous, and arterial injuries combined with bleeding from concomitant injuries. This is a very complex and challenging clinical situation and timely and appropriate decisions and action are paramount for a positive outcome. Consequently, open pelvic fractures have an extremely high rate of mortality and morbidity and outcomes remain poor, despite evidence-based improvements in treatment, knowledge, and identification of haemorrhage; in the pre-hospital, critical care, and operative settings. In the future utilisation of haemostatic drugs, dressings, devices, and procedures may aid in the time to haemorrhage control.

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Association of Low-Dose Whole-Body Computed Tomography With Missed Injury Diagnoses and Radiation Exposure in Patients With Blunt Multiple Trauma

et al. 2020

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Initial whole-body computed tomography (WBCT) for screening patients with suspected blunt multiple trauma remains controversial and a source of excess radiation exposure. OBJECTIVE To determine whether low-dose WBCT scanning using an iterative reconstruction algorithm does not increase the rate of missed injury diagnoses at the point of care compared with standard-dose WBCT with the benefit of less radiation exposure. DESIGN, SETTING, AND PARTICIPANTS This quasi-experimental, prospective time-series cohort study recruited 1074 consecutive patients admitted for suspected blunt multiple trauma to an academic metropolitan trauma center in Germany from September 3, 2014, through July 26, 2015, for the standard-dose protocol, and from August 7, 2015, through August 20, 2016, for the low-dose protocol. Five hundred sixty-five patients with suspected blunt multiple trauma prospectively received standard-dose WBCT, followed by 509 patients who underwent low-dose WBCT. Confounding was controlled by segmented regression analysis and a secondary multivariate logistic regression model. Data were analyzed from January 16, 2017, through October 14, 2019. INTERVENTIONS Standard-or low-dose WBCT. MAIN OUTCOMES AND MEASURES The primary outcome was the incidence of missed injury diagnoses at the point of care, using a synopsis of clinical, surgical, and radiological findings as an independent reference test. The secondary outcome was radiation exposure with either imaging strategy. RESULTS Of 1074 eligible patients, 971 (mean [SD] age, 52.7 [19.5] years; 649 men [66.8%]) completed the study. A total of 114 patients (11.7%) had multiple trauma, as defined by an Injury Severity Score of 16 or greater. The proportion of patients with any missed injury diagnosis at the point of care was 109 of 468 (23.3%) in the standard-dose and 107 of 503 (21.3%) in the low-dose WBCT groups (risk difference, −2.0% [95% CI, −7.3% to 3.2%]; unadjusted odds ratio, 0.89 [95% CI, 0.66-1.20]; P = .45). Adjustments for autocorrelation and multiple confounding variables did not alter the results. Radiation exposure, measured by the volume computed tomography dose index, was lowered from a median of 11.7 (interquartile range, 11.7-17.6) mGy in the standard-dose WBCT group to 5.9 (interquartile range, 5.9-8.8) mGy in the low-dose WBCT group (P < .001). CONCLUSIONS AND RELEVANCE Low-dose WBCT using iterative image reconstruction does not appear to increase the risk of missed injury diagnoses at the point of care compared with standard-dose protocols while almost halving the exposure to diagnostic radiation.

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Level 3 guideline on the treatment of patients with severe/multiple injuries

Cited by 92 publications

References 1,374 publications

The updated German “Polytrauma – Guideline”: an extensive literature evaluation and treatment recommendation for the care of the critically injured patient

The updated German “Polytrauma – Guideline”: an extensive literature evaluation and treatment recommendation for the care of the critically injured patient

The Road to Survival for Haemodynamically Unstable Patients With Open Pelvic Fractures

Association of Low-Dose Whole-Body Computed Tomography With Missed Injury Diagnoses and Radiation Exposure in Patients With Blunt Multiple Trauma

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