The definition of polytrauma revisited

Pape, Hans-Christian; Lefering, Rolf; Butcher, Nerida E.; Peitzman, Andrew; Leenen, Luke P. H.; Marzi, Ingo; Lichte, Philip; Josten, Christoph; Bouillon, Bertil; Schmucker, Uli; Stahel, Philip F.; Giannoudis, Peter V.; Balogh, Zsolt J.

doi:10.1097/ta.0000000000000453

Cited by 284 publications

(169 citation statements)

References 25 publications

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“…In this regard, multiple observational cohort studies from the orthopedic trauma group at MetroHealth in Cleveland have shown that early pelvic fracture fixation in stable or borderline resuscitated patients within 24 h of admission reduces the risk of complications and improves outcomes [139, 141, 144, 145]. Recently, a new definition of politrauma has been proposed by an international consensus group, which is based on injury severity and derangement of physiological parameters [153]. This new politrauma definition in conjunction with recently established grading systems [141] may provide further guidance towards the “ideal” timing of definitive pelvic fracture fixation, pending future validation studies.…”

Section: Methodsmentioning

confidence: 99%

Pelvic trauma: WSES classification and guidelines

et al. 2017

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Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.

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Section: Methodsmentioning

confidence: 99%

Pelvic trauma: WSES classification and guidelines

et al. 2017

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“…The global incidence rate is estimated at approximately 23 SCI cases per one million which equals to almost 180,000 new cases per annum [17, 18]. Apart from isolated TBI or SCI which occur quite rarely, it is also possible that these two conditions are concomitant and also accompanied by injuries to other body parts (extracranial or extraspinal injuries) which then means a multiple trauma in a patient [19–24]. CNS trauma and associated extracranial and extraspinal injuries give an image of a debilitating condition, which does not only create physical and emotional costs for individuals.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the Role of CX3CL1 (Fractalkine) and Its Receptor CX3CR1 in Traumatic Brain and Spinal Cord Injury: Insight into Recent Advances in Actions of Neurochemokine Agents

et al. 2016

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CX3CL1 (fractalkine) is the only member of the CX3C (delta) subfamily of chemokines which is unique and combines the properties of both chemoattractant and adhesion molecules. The two-form ligand can exist either in a soluble form, like all other chemokines, and as a membrane-anchored molecule. CX3CL1 discloses its biological properties through interaction with one dedicated CX3CR1 receptor which belongs to a family of G protein-coupled receptors (GPCR). The CX3CL1/CX3CR1 axis acts in many physiological phenomena including those occurring in the central nervous system (CNS), by regulating the interactions between neurons, microglia, and immune cells. Apart from the role under physiological conditions, the CX3CL1/CX3CR1 axis was implied to have a role in different neuropathologies such as traumatic brain injury (TBI) and spinal cord injury (SCI). CNS injuries represent a serious public health problem, despite improvements in therapeutic management. To date, no effective treatment has been determined, so they constitute a leading cause of death and severe disability. The course of TBI and SCI has two consecutive poorly demarcated phases: the initial, primary injury and secondary injury. Recent evidence has implicated the role of the CX3CL1/CX3CR1 axis in neuroinflammatory processes occurring after CNS injuries. The importance of the CX3CL1/CX3CR1 axis in the pathophysiology of TBI and SCI in the context of systemic and direct local immune response is still under investigation. This paper, based on a review of the literature, updates and summarizes the current knowledge about CX3CL1/CX3CR1 axis involvement in TBI and SCI pathogenesis, indicating possible molecular and cellular mechanisms with a potential target for therapeutic intervention.

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“…They focused on the number of injuries, body regions or organ systems involved [8, 9], pattern or mechanism of injury [10, 11], injuries representing a threat to life [12, 13], ISS [14, 15], and threat to life plus ISS [16]. Since then, even further definitions have been published, wholly or partially based on the AIS [17, 18]. At present, the ISS is used as a standard classification of multiple trauma in the United States, many European countries, and Australia [17].…”

Section: Introductionmentioning

confidence: 99%

Does the applied polytrauma definition notably influence outcome and patient population? – a retrospective analysis

Frenzel

Krenn

Heinz

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundAlthough the term “polytrauma” has been in use for decades, no generally accepted definition exists. The aim of this study was to demonstrate that different polytrauma definitions applied to a specific patient population result in diverse subgroups of individuals, who in turn present a varying outcome.MethodsAll patients (≥18 years) treated at our level I trauma center within a time period of three years were classified according to 11 selected polytrauma definitions and included in our study, if they were rated “polytraumatized” by at least one of these definitions. All patients, who met the criteria of a certain definition, were combined to the relevant definition-positive group, thus resulting in 11 patient subgroups. Their demographic data (number of patients, mean patient age, mean Injury Severity Score value, median number of ventilator days, median length of stay at the intensive care unit and at the hospital, mortality rate and odds ratio) were statistically compared.ResultsThree hundred seventy-five patients (73% male) with a mean age of 47 years met the inclusion criteria and were allocated to the relevant subgroups; their patient number varied from 55 to 346 and their mean Injury Severity Score value ranged from 4 to 75. Not surprisingly, all examined parameters were subject to variations. Whereas most definition-positive groups showed a mortality rate of about 21% to 30%, 18% of the individuals, who met the criteria according to Blacker, and 40% of the polytrauma victims according to Schalamon died. The Pape 1-, Schalamon-, and Berlin-positive groups presented a significant odds ratio with regard to mortality that considerably exceeded 1.DiscussionA polytrauma definition can only be a reliable tool in classifying trauma victims if it provides a significant odds ratio with regard to mortality that considerably exceeds 1 and if it succeeds in capturing patients with multiple severe injuries and a higher mortality rate without reducing the number of polytraumatized patients to a not representatively small number.ConclusionsSolely the Berlin definition resulted in a patient number reflecting clinical reality, thus enabling a transparent evaluation of treatment results provided by different institutions and allowing objective comparison of published studies.

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The definition of polytrauma revisited

Cited by 284 publications

References 25 publications

Pelvic trauma: WSES classification and guidelines

Pelvic trauma: WSES classification and guidelines

Analysis of the Role of CX3CL1 (Fractalkine) and Its Receptor CX3CR1 in Traumatic Brain and Spinal Cord Injury: Insight into Recent Advances in Actions of Neurochemokine Agents

Does the applied polytrauma definition notably influence outcome and patient population? – a retrospective analysis

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