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Abstract
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During the last 15 years considerable international collaborative effort was invested to define polytrauma in a reproducible standardised fashion. In qualitative language polytrauma means severe injuries to multiple body regions, which are associated with physiological compromise and inflammatory response leading to dysfunction and failure of uninjured organs with high risk of complications and mortality. Our expert consensus quantified this concept via the well-established Abbreviated Injury Scale (AIS) and some physiological confounders.
The validated anatomical cut-off to define polytrauma is at least two AIS body regions affected with the score above two in each (2x AIS>2 or 'Newcastle' Definition of Polytrauma). This means an Injury Severity Score (ISS) of 18 or more but always from at least two severely injured body regions. We found that this cut-off is consistently associated with systemic inflammatory response syndrome (SIRS) and greater than 10% in-hospital mortality and incidence of postinjury multiple organ failure (MOF). This definition is very easy to apply in retrospect and can be monitored within and among trauma systems, regions, countries and continents from universally collected registry data.
The consensus group went further to identify the sickest of the population (Berlin Definition) with specifying non-anatomical confounders (age, level of consciousness, hypotension, acidosis and coagulopathy) in addition to the 'Newcastle' Definition. In short, Berlin Definition is equal to Newcastle anatomical criteria plus at least one physiological confounder (Berlin = Newcastle + confounders). Statistical modelling showed that the addition of physiological parameters to the 'Newcastle' Definition categorised polytrauma patients with increasing stepwise mortality. Polytrauma patients with two confounders in addition to the 'Newcastle' anatomical criteria have over 30% mortality.
The identification of the cut-off from where the anatomical injury is associated with SIRS, physiological compromise and high risk for bystander organ injury is more than a theoretical exercise. Defining polytrauma defines the disease, which is the target to treat by trauma clinicians. The human mind keeps trying to simplify complex problems, that are difficult to comprehend, which led to the approach to discuss, code, manage and research individual injuries for the last five decades instead of approaching the actual disease. Frequently the efforts exhausted at the level of generating new acronyms for the care of the same unsolved problem every five years.
Language: en |