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Tissue trauma leads to a severity-dependent activation of plasma and cellular systems. This response can be recorded by determining parameters which represent the activation state of these systems. In severely injured patients with multiple trauma three out of 14 parameters measured at the time of admission proved to be indicators of subsequent septic complications with a high degree of accuracy: Fibrinopeptide A (FPA — the first split product of fibrinogen), the C3 split product C3a, and the elastase-α1 proteinase inhibitor-complex (Eα1 PI).
In a second series of multiply-injured patients with femoral fractures who did not develop clinical sepsis (N = 25) these parameters were measured continuously to evaluate the influence of injury severity and of therapeutic strategy on the further course. We found a strong correlation between injury severity (ISS) and the degree of activation. The signs of activation decreased rapidly following immediate operative fixation, and remained elevated or even increased after primary femoral traction and secondary stabilization. The operative procedure did not cause any additional activation.
Complications such as infection or the formation of haematomas were reflected by raised parameter levels
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- Hospital trauma index.Bull. Am. Coll. Surg. 1980; 65: 32
- The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care.J. Trauma. 1974; 14: 187
- The gut origin septic states in blunt multiple trauma (ISS = 40) in the ICU.Ann. Surg. 1987; 206: 427
- Plasma fibronectin and complement in surgical patients.Br. J. Surg. 1984; 71: 718
- Comparison of trauma assessment scores and their use in prediction of infection and death.Ann. Surg. 1989; 208: 541
- Duration of preventive antibiotic administration for open extremity fractures.Arch. Surg. 1988; 123: 333
- Freisetzung von granulozytärer Elastase und Plasmaproteinveränderungen nach traumatisch-hämorrhagischem Schock.Unfallchirurg. 1986; 89: 160
- Released granulocytic elastase: an indicator of pathobiochemical alterations in septicemia after abdominal surgery.Surgery. 1985; 98: 892
- Molecular markers of hemostatic disorders.Clin. Chem. 1983; 29: 1641
- Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient.J. Trauma. 1982; 22: 895
- Multiple-organ failure and sepsis without bacteria.Arch. Surg. 1986; 121: 897
- Incidence of ARDS in patients with multiple musculoskeletal injuries: effect of early operative stabilization of fractures.J. Trauma. 1985; 25: 375
- Comparative effect of circulating bacterial or non-bacterial particulates on plasma fibronectin.Circ. Shock. 1986; 19: 357
- Pulmonary and cardiovascular consequences of immediate fixation or conservative management of long-bone fractures.Arch. Surg. 1986; 121: 992
- A comparison of mortality of patients with multiple injuries according to method of fracture treatment.J. Bone Joint Surg. 1981; 63B: 456
- The surgical intensive care unit: current concepts in infection.Surg. Clin. North Am. 1980; 60: 117
- Post-traumatic complications and inflammatory mediators.Arch. Surg. 1986; 121: 886
- Prevention of fat embolism by early internal fixation of fractures in patients with multiple injuries.Injury. 1976; 8: 110
- Vermeidung posttraumatischer Komplikationen durch frühe definitive Versorgung von Polytraumatisierten mit Frakturen des Bewegungsapparats.Helv. Chir. Acta. 1975; 42: 507
- Gut barrier function and the surgeon.Br. J. Surg. 1990; 77: 487
- The overwhelming inflammatory response and the role of endotoxin in early sepsis.Prog. Clin. Biol. Res. 1989; 308: 371
- Monitoring of the inflammatory response in early peritonitis.Am. J. Surg. 1989; 157: 567
- Blunt multiple trauma (ISS 36), femur traction, and the pulmonary failureseptic state.Ann. Surg. 1985; 202: 283
- Interaction of prostaglandins, activated complement, and granulocytes in clinical sepsis and hypotension.Surgery. 1986; 99: 744
- The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients.Intensive Care Med. 1984; 10: 185
Accepted: February 14, 1991
© 1991 Published by Elsevier Inc.