Citation

Driessen MLS, Sturms LM, van Zwet EW, Bloemers FW, Ten Duis HJ, Edwards MJR, Den Hartog D, de Jongh MAC, Leenhouts PA, Poeze M, Schipper IB, Spanjersberg WR, Wendt KW, de Wit RJ, van Zutphen SWAM, Leenen LPH. J. Trauma Acute Care Surg. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000003071

PMID

unavailable

Abstract

BACKGROUND: The Berlin polytrauma definition (BPD) was established to identify polytrauma patients with a high risk of mortality. The definition includes injuries with an Abbreviated Injury Score of ≥3 in ≥2 body regions (2AIS≥3) combined with the presence of ≥1 physiological risk factors (PRF). The PRFs are based on age, Glasgow Coma Scale, hypotension, acidosis, and coagulopathy at specific cutoff values. This study evaluates and compares the BPD with two other polytrauma definitions used to identify patients with high resource utilization and mortality risk, using data from the Dutch National Trauma Register (DNTR).

METHODS: The evaluation was performed based on 2015-2018 DNTR data. First, patient characteristics for 2AIS≥3, ISS≥16 and BPD patients were compared. Second, the PRFs prevalence and odds ratios of mortality for 2AIS≥3 patients were compared with those from the Deutsche Gesellschaft für Unfallchirurgie Trauma Register (DGU-TR). Subsequently, the association between PRF and mortality was assessed for 2AIS≥3-DNTR patients and compared with those with an ISS≥16.

RESULTS: The DNTR recorded 300,649 acute trauma admissions. A total of 15,711 patients sustained an ISS≥16, and 6263 patients had suffered an 2AIS≥3 injury. All individual PRFs were associated with a mortality of >30% in 2AIS≥3-DNTR patients. The increase in PRFs was associated with a significant increase in mortality for both 2AIS≥3 and ISS≥16 patients. A total of 4264 patients met the BPDs criteria. Overall mortality (27.2%), ICU admission (71.2%) and length of stay were the highest for the BPD group.

CONCLUSION: This study confirms that the BPD identifies high-risk patients in a population-based registry. The addition of PRFs to the anatomical injury scores improves the identification of severely injured patients with a high risk of mortality. Compared to the ISS≥16 and 2AIS≥3 polytrauma definitions, the BPD showed to improve the accuracy of capturing patients with a high medical resource need and mortality rate. LEVEL OF EVIDENCE: Retrospective study, level III.

Language: en