Abstract
Background
The impact of conventional laboratory data to identify polytrauma patients at risk
of complications is established. However, it has not been assessed in terms of prognostic
accuracy for systemic complications (ARDS, organ failure). We therefore assessed the
most predictive parameters for systemic complications and developed a scoring system
for early grading of polytrauma patients.
Methods
A population based trauma registry was used. Inclusion criteria: age >16 years, Abbreviated
Injury Score (AIS) of the abdomen or chest ≥3 points and treatment in an intensive
care unit, or Injury Severity Score (ISS) ≥16 points. The primary endpoint was hospital
mortality. Patients were graded according their risk of death: low risk of death (5-14%
mortality), intermediate risk patients (15-39% mortality) and high risk (>40%). Routine
clinical and laboratory parameters on admission were assessed to determine their specific
relevance to describe the risk profile of the patient. Based on these data, a scoring
system for the description of the clinical status was developed. Statistical analysis
included uniand multivariate analysis.
Results
11.436 patients were included, the mean ISS was 22.7 ± 11.2 points, 73% were male,
and 95.6% had blunt injuries. The most sensitive parameters were found to be the following
ones: systolic blood pressure, INR, thrombocytes, base deficit, NISS, packed red blood
cells administered. The multivariate analysis revealed the following threshold levels:
BP 76-90 mmHg: r = 0.249, OR 1.283: Base deficit 8-10 r = 0.474, OR 1.606; INR 1.4-2
r = 0.160, OR 1.174; NISS 35-39 r = 0.9, OR 2.46; pBRC 3-14: r = 0.671, OR 1.957.
The following ranges of score values were found to be associated with different patient
status: <6 points: stable patients; 6-11 points: borderline condition; >11 points:
unstable patients. When using this score, 80.6% were stable, 14.6% in a borderline
condition and 4.8% unstable.
Conclusion
We developed a scoring system to discriminate polytrauma patients on admission that
are at risk of systemic complications. Systolic blood pressure, INR, thrombocytes,
base deficit, NISS, packed red blood cells administered are able to provide a prognosis
of patients at risk of posttraumatic complications. Further prospective studies should
be performed to verify this new scoring system.
Keywords
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