The definition of polytrauma: the need for international consensus

  • Nerida Butcher
    Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
    Search for articles by this author
  • Zsolt J Balogh
    Corresponding author. Zsolt J. Balogh, MD, PhD, FRACS, Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Locked bag 1, Hunter Region Mail Centre, Newcastle NSW 2300, Australia. Tel.: +61 2 49214259; fax: +61 2 49214274.
    Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.


      INTRODUCTION: Polytrauma patients represent the ultimate challenge to trauma care and the optimisation of their care is a major focus of clinical and basic science research. A universally accepted definition for polytrauma is vital for comparing datasets and conducting multicentre trials. The purpose of this review is to identify and evaluate the published definitions of the term “polytrauma”.
      MATERIALS AND METHODS: A literature search was conducted for the time period January 1950−August 2008. The Medline, Embase and Cochrane Library databases were searched using the keyword “polytrauma”. Articles were evaluated without language exclusion for the occurrence of the word “polytrauma” in the text and the presence of a subsequent definition. Relevant online resources and medical dictionaries were also reviewed.
      RESULTS: A total of 1,665 publications used the term polytrauma, 47 of which included a definition of the term. The available definitions can be divided into eight groups according to the crux of the definition. No uniformly used consensus definition exists. None of the existing definitions were found to be validated or supported by evidence higher than Level 4.
      CONCLUSION: 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.


      To read this article in full you will need to make a payment
      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. American Association for the Surgery of Trauma [AAST Website]. 2007. Available at: Accessed July 9, 2008.

      2. American College of Surgeons [ACS website]. 2002. Available at: Accessed July 9, 2008.

        • Asehnoune K.
        • Édouard A.
        Inflammatory response and polytrauma: an update.
        Reanimation. 2006; 15: 568-575
        • Balogh Z.
        • Offner P.J.
        • Moore E.E.
        • et al.
        NISS predicts postinjury multiple organ failure better than the ISS.
        J Trauma. 2000; 48: 624-627
        • Balogh Z.
        • Varga E.
        • Tomka J.
        • et al.
        The New Injury Severity Score Is a Better Predictor of Extended Hospitalization and Intensive Care Unit Admission Than the Injury Severity Score in Patients With Multiple Orthopaedic Injuries.
        J Orth Trauma. 2003; 17: 508-512
        • Barbieri S.
        • Michieletto E.
        • Feltracco P.
        • et al.
        Prognostic systems in intensive care: TRISS, SAPS II, APACHE II.
        Minerva Anestesiologica. 2001; 67: 519-538
        • Biewener A.
        • Aschenbrenner U.
        • Rammelt S.
        • et al.
        Impact of helicopter transport and hospital level on mortality of polytrauma patients.
        J Trauma. 2004; 56: 94-98
        • Blacker D.J.
        • Wijdicks E.F.
        Clinical characteristics and mechanisms of stroke after polytrauma.
        Mayo Clinic Proceedings. 2004; 79: 630-635
      3. Black's Medical Dictionary, 39th ed. London UK: A & C Black 1999.

        • Bone L.B.
        • Babikian G.
        • Stegemann P.M.
        Femoral canal reaming in the polytrauma patient with chest injury. A clinical perspective.
        Clinical Orthopaedics & Related Research. 1995; 318: 91-94
        • Border J.R.
        • LaDuca J.
        • Seibel R.
        Priorities in the Management of the Patient with Polytrauma.
        Progress in Surgery. 1975; 14: 84-120
        • Brenneman F.D.
        • Boulonger B.R.
        • McLellan B.A.
        • et al.
        Measuring injury severity: timefor a change?.
        J Trauma. 1998; 44: 580-582
      4. Centers for Disease Control and Prevention. [CDC Website]. June 30, 2008. Available at: Accessed July 8, 2008.

        • Cerra F.B.
        • Mazuski J.
        • Teasley K.
        • et al.
        Nitrogen retention in critically ill patients is proportional to the branched chain amino acid load.
        Critical Care Medicine. 1983; 11: 775-778
      5. Concise medical dictionary, 6TH ed. Oxford UK: Oxford University Press 200.3.

        • Deby-Dupont G.
        • Haas M.
        • Pincemail J.
        • et al.
        Immunoreactive trypsin in the adult respiratory distress syndrome.
        Intensive Care Medicine. 1984; 10: 7-12
        • Dick W.F.
        • Baskett P.J.
        Recommendations for uniform reporting of data following major trauma — the Utstein styleAreport of a Working Party of the International Trauma Anaesthesia and Critical Care Society (ITACCS).
        Resuscitation. 1999; 42: 81-100
      6. Dorlan's Illustrated Medical Dictionary, 30th ed. W.B. Saunders Co., Philadelphia. 2003: 1486.

        • Faist E.
        • Baue A.E.
        • Dittmer H.
        • et al.
        Multiple organ failure in polytrauma patients.
        J Trauma. 1983; 23: 775-787
      7. German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie) [DGU Website].August 25, 2004.Available at: Accessed July 9, 2008.

      8. Guideline Committee of the German Registered Society for Trauma Surgery, in collaboration with The Polytrauma Association of the German Registered Society for Trauma Surgery. Recommended Guidelines for Diagnostics and Therapy in Trauma Surgery: Recommended Guidelines for Polytrauma. European Journal of Trauma. 2001 27:137–150.

        • Heberer G.
        • Becker H.M.
        • Dittmer H.
        • et al.
        Vascular injuries in polytrauma.
        World Journal of Surgery. 1983; 1: 68-79
        • Hebert J.S.
        • Burnham R.S.
        The effect of polytrauma in persons with traumatic spine injury. A prospective database of spine fractures.
        Spine. 2000; 25: 55-60
        • Hildebrand F.
        • Giannoudis P.
        • Kretteck C.
        • Pape H.
        Damage control: extremities.
        Injury. 2004; 35: 678-689
        • Keel M.
        • Eid K.
        • Labler L.
        • et al.
        Influence of injury pattern on incidence and severity of posttraumatic inflammatory complications in severely injured patients.
        European Journal of Trauma. 2006; 32: 387-395
        • Keel M.
        • Trentz O.
        Pathophysiology of polytrauma.
        Injury. 2005; 36: 691-709
      9. Korošec Jagodič H, Jagodič K, Podbregar M. Long-term outcome and quality of life of patients treated in surgical intensive care: a comparison between sepsis and trauma. Critical Care (London, England). 2006 10:R134.

        • Kroupa J.
        Definition of Polytrauma and Polytraumatism.
        Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca. 1990; 57: 347-360
      10. Lew HL. Rehabilitation needs of an increasing population of patients: Traumatic brain injury, polytrauma, and blastrelated injuries. Journal of Rehabilitation Research & Development. 2005 42: xiii–xvi.

        • Linsenmaier U.
        • Krotz M.
        • Hauser H.
        • et al.
        Whole-body computed tomography in polytrauma: techniques and management.
        European Radiology. 2002; 12: 1728-1740
        • Loder R.T.
        Pediatric polytrauma: orthopaedic care and hospital course.
        Journal of Orthopaedic Trauma. 1987; 1: 48-54
        • Martins W.D.
        • Westphalen F.H.
        • Westphalen V.P.
        • et al.
        Multiple dentoalveolar traumatic lesions: report of a case and proposition of dental polytrauma as a new term.
        Journal of Contemporary Dental Practice. 2004; 5: 139-147
        • Marx A.B.
        • Campbell R.
        • Harder F.
        Polytrauma in the elderly.
        World Journal of Surgery. 1986; 10: 330-335
        • Matthes G.
        • Stengel D.
        • Seifert J.
        • et al.
        Blunt liver injuries in polytrauma: results from a cohort study with the regular use of whole-body helical computed tomography.
        World Journal of Surgery. 2003; 27: 1124-1130
        • Matthes G.
        • Stengel D.
        • Bauwens K.
        • et al.
        Predictive factors of liver injury in blunt multiple trauma.
        Langenbecks Archives of Surgery. 2006; 391: 350-354
        • McLain R.F.
        • Benson D.R.
        Urgent surgical stabilization of spinal fractures in polytrauma patients.
        Spine. 1999; 24: 1646-1654
        • McLain R.F.
        Functional outcomes after surgery for spinal fractures: return to work and activity.
        Spine. 2004; 29: 470-477
      11. Merriam-Webster's medical dictionary. Springfield MA: Merriam-Webster; 2005.

      12. Mittlmeier TH, Khodadadyan C, Haas NP Grundsätze der Akutversorgung. In: Mutschler W, Hass NP (Hrsg) Praxis der Unfallchirurgie. Stuttgart New York: Thieme, 1999: 85.

        • Moore F.A.
        • Moore E.E.
        Evolving concepts in the pathogenesis of postinjury multiple organ failure.
        Surg Clin North Am. 1995; 75: 257-277
      13. Mosby's Medical Dictionary, 7th ed. St. Louis: Mosby, 2002.

      14. National Library for Health [database online]. Coventry, UK: NHS Institute for Innovation and Improvement; 2008. Updated June 30, 2008.

      15. Oestern HJ, Dürig M. Polytrauma. In: Henne- Bruns D, Dürig M, Kremer B (Hrsg) Chirurgie, Stuttgart, New York: Thieme. 2001:1241.

        • Osler T.
        • Baker S.P.
        • Long W.
        Amodification of the injury severity score that both improves accuracy and simplifies scoring.
        J Trauma. 1997; 43: 922-925
        • Osterwalder J.J.
        Could a regional trauma system in eastern Switzerland decrease the mortality of blunt polytrauma patients? A prospective cohort study.
        J Trauma. 2002; 52: 1030-1036
        • Ott R.
        • Kramer R.
        • Martus P.
        • et al.
        Prognostic value of trauma scores in pediatric patients with multiple injuries.
        J Trauma. 2000; 49: 729-736
      16. Oxford Centre for Evidence-based Medicine Levels of Evidence. May 2001 [CEBM website]. Available at: Accessed August 30, 2008.

        • Pape H.C.
        • Remmers D.
        • Rice J.
        • et al.
        Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making.
        J Trauma. 2000; 49: 496-504
        • Pape H.C.
        • Rixen D.
        • Morley J.
        Impact of the Method of Initial Stabilization for Femoral Shaft Fractures in Patients With Multiple Injuries at Risk for Complications (Borderline Patients).
        Annals of Surgery. 2007; 246: 491-501
        • Pape H.C.
        • Zelle B.
        • Lohse R.
        • et al.
        Evaluation and outcome of patients after polytrauma−can patients be recruited for long-term follow-up?.
        Injury. 2006; 37: 1197-1203
        • Pepe P.E.
        Shock in polytrauma.
        BMJ. 2003; 327: 1119-1120
        • Reff R.B.
        The use of external fixation devices in the management of severe lower-extremity trauma and pelvic injuries in children.
        Clinical Orthopaedics & Related Research. 1984; 188: 21-33
        • Rohde H.
        • Lorenz W.
        • Fischer M.
        Sequential trial on cimetidine prophylaxis in severe polytrauma.
        Z-Gastroenterol. 1980; 18: 238-329
      17. Royal Australasian College of Surgeons [RACS website]. 2008. Available at: cfm?Section=Home. Accessed July 9, 2008.

      18. Royal College of Physicians and Surgeons of Canada [RCPSC website]. 2008. Available at: Accessed July 9, 2008.

      19. Royal College of Surgeons of England [RCSENG website]. 2008. Available at: Accessed July 9, 2008.

        • Schalamon J.
        • v Bismarck S.
        • Schober P.H.
        • Höllwarth M.E.
        Multiple trauma in pediatric patients.
        Pediatric Surgery International. 2003; 19: 417-423
        • Schweiberer L.
        • Dambe L.T.
        • Klapp F.
        Die Mehrfachverletzung. Schweregrad und therapeutische Richtlinien.
        Chirurg. 1978; 49: 608
        • Sigford B.J.
        To care for him who shall have borne the battle and for his widow and his orphan” (Abraham Lincoln): the Department of Veterans Affairs polytrauma system of care.
        Archives of Physical Medicine & Rehabilitation. 2008; 89: 160-162
        • Sikand M.
        • Williams K.
        • White C.
        • et al.
        The financial cost of treating polytrauma: implications for tertiary referral centres in the United Kingdom.
        Injury. 2005; 36: 733-737
        • Stahel P.F.
        • Heyde C.E.
        • Ertel W.
        Current Concepts of Polytrauma Management.
        European Journal of Trauma. 2005; 31: 33
      20. Stedman's medical dictionary, 27th ed. Baltimore, MD: Lippincott Williams & Wilkins. 2000.

      21. Tool SB, Burt RL, Tomlinson EC. Proceedings: National Conference on the Prevention of Primary and Secondary Disabilities June 6−8, 1991 Atlanta, Georgia [CDC Website]. Available at: nces/1991/1991_3ExecSumWorkPaper.pdf. Accessed August 30, 2008.

      22. Trentz O. Polytrauma: pathophysiology, priorities, and management. In: Rüedi TP, Murphy WM, (eds). AO principles of fracture management. Stuttgart, New York: Thieme. 2000:661-673.

        • Tscherne H.
        • Oestern H.J.
        • Sturm J.A.
        Stress tolerance of patients with multiple injuries and its significance for operative care.
        Langenbeck Arch Chir. 1984; 364: 71-77
      23. United States Department of Veterans Affairs: Polytrauma Centre, Definitions [VA website] December 19, 2007. Available at: asp#polytrauma. Accessed July 8, 2008.

      24. World Health Organisation. International Statistical Classification of Diseases and Related Health Problems 10th Revision Version for 2007 [WHO website]. April 5, 2006. Available at: Accessed July 8, 2008.

        • Zelle B.A.
        • Brown S.R.
        • Panzica M.
        • et al.
        The impact of injuries below the knee joint on the long-term functional outcome following polytrauma.
        Injury. 2005; 36: 169-177