Renal failure. Would you like email updates of new search results? The proportion of female polytrauma patients showed an increase with increasing age (25.2% vs. 44.6%). Cause-specific mortality was stratified in brain injury, thoracic injury, abdominal injury, death by exsanguination, multiple organ dysfunction syndrome (MODS, definitions used by the included articles are shown in Table 1), acute respiratory distress syndrome (ARDS, Table 1), sepsis (Table 1), and death from a cardiac cause. Part of The lowest score was five points [37]. Objectives: 2000;355:1771–5. Increasing to 26.4% by the year 2040 [1]. Bookshelf Shock. Click through the PLOS taxonomy to find articles in your field. A retrospective study of 130 consecutive multiple trauma patients in an intensive care unit. If a primary surgical procedure exceeded 6 hours in multiple trauma patients with an ISS of 25 points, patients demonstrated a significantly elevated ventilation time, an increased mortality, and a higher incidence of death from MOF in comparison with patients that were injured comparably, but were submitted to shorter primary operative procedures. Requests may be sent to secretariaatlnaz@lnaz.nl. hysiatrists perform a thorough evaluation and make referrals to other rehabilitation disciplines and/or medical services as needed. A p value < 0.05 was considered statistically significant. All authors read and approved the final manuscript. Supervision, European Journal of Trauma and Emergency Surgery. The included articles were divided into subgroups representing the continent of the study population. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Articles were excluded when no full text was available; when title, abstract, or full text was not in English, German, French, Spanish, or Dutch; when only a specific subset of trauma patients was researched, e.g., solely severe thoracic trauma; when all included patients suffered from a specific condition e.g., sepsis; and when it concerned reviews or conference abstracts. Investigation, This systematic review of all-cause mortality in polytrauma patients admitted to the ICU showed that over the last 35 years all-cause mortality decreased by approximately 1.8% per year. Privacy This research’s aim was subdivided in assessing (1) changes in the specific causes of death and (2) differences between geographical locations. Writing – review & editing, Affiliation Rayyan-a web and mobile app for systematic reviews. -, Zentralbl Chir. Multiple organ dysfunction syndrome (MODS) was reported as the main cause of death in several studies until the end of the last century [13, 14, 17]. Die konservative Behandlung. HHS Vulnerability Disclosure, Help All data on injured ER patients who were admitted, transferred or died within 48 hours of an accident was collected retrospectively going back to 2007. Article  An official website of the United States government. Polytrauma patients nowadays tend to be older due to the growth of the elderly population and its improved mobility. Akt Traumatol 33: 157–164, Kathrein A, Huber B, Waldegger M, Freund MC, Daniaux H (1999) Die Behandlung von Verletzungen der Brust- und Lendenwirbelsäule bei Kindern. The treatment of severe and multiple injuries in intensive care unit: report of 80 cases. here. Annali italiani di chirurgia. The established concept of “damage control” and criteria regarding the optimal time and manner for operative treatment of the injured spine in the polytrauma setting is presented and discussed. Introduction The management of polytrauma patients with orthopaedic injuries is a complex and dynamic process that requires a robust understanding of the pathophysiology of the response to trauma and indicators of patient status. He suggested a trimodal distribution of immediate, early, and late deaths following trauma with the late deaths occurring several days to weeks after the initial injury. have hearing loss. Emergency Care Network Northern Netherlands (AZNN), Northern Netherlands Trauma Registry, Groningen, The Netherlands, Roles Lansink KW, Leenen LP. Data curation, Eleven studies scored the maximum number of points [19, 22, 23, 27, 29,30,31,32, 41,42,43]. To give more insight into the physical state on arrival, we categorized the data according to the GCS into intubated and sedated GCS scores, and legitimate GCS scores (without intubation and sedation). FOIA Individually adjusted surgical "damage control" and "immune control" are important interactive concepts in polytrauma management. 1995;38:185–93. 1980;140:144–50. Advanced trauma life support study: quality of diagnostic and therapeutic procedures. The assessment scale seems a reliable method for rating trainees’ performances ‘directly’ as well as ‘indirectly”, while both IR and CV was demonstrated in both rating methods. The overall hospital mortality of the older polytrauma patients was twice as high as compared to that of the younger group (A: 9%; B: 19%, p < 0.001). Factors affecting outcome after chest injury. Secondly, data on trauma mechanisms has been included in the Dutch Trauma Registry since 2014, therefore the population size for this parameter covered only one year instead of five (n = 4,218 vs. n = 25,304). PubMed  First, the term “polytrauma”, one of our inclusion criteria, has always been a topic of debate in literature [35, 55]. Fortschr Röntgenstr 176: 1142–1150, Anderson LD, D’Alonzo RT (1974) Fractures of the odontoid process of the axis. This will help to apply new findings to the right patients and in comparing study results more accurately. Surgery. Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3585 GA, Utrecht, The Netherlands, Johanna M. M. van Breugel, Menco J. S. Niemeyer, Roderick M. Houwert, Luke P. H. Leenen & Karlijn J. P. van Wessem, Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands, You can also search for this author in Methodology, Pattern of organ failure following severe trauma. One might argue that this difference in proportion of older trauma patients might be caused by a different age cut-off point. We suspect that more studies reported all-cause mortality, but if these numbers were not reported in the title or abstract, these articles were not identified by our search (Fig. Clin Orthop 318: 25–35, Harris MB, Kronlage SC, Carboni PA, Robert KQ, Menmuir B, Ricciardi JE, Chutkan NB (2000) Evaluation of the cervical spine in the polytrauma patient. World J Emerg Surg 15, 55 (2020). Lecky F, Woodford M, Yates DW. 2005 Jun;36(6):691-709. doi: 10.1016/j.injury.2004.12.037. Injury. statement and Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Trauma-adjusted surgical techniques are crucial to limit the systemic response known to put remote organs at risk. This is a preview of subscription content, access via in 2014 included 31,154 polytrauma patients and found age to be a predictive variable for developing multi-organ failure (MOF). Occupational Therapists provide services to improve the patient’s ability to accomplish everyday tasks associated with a maximum level of safe independence. Either patients were not consecutively included or the inclusion process was not clearly described in these articles. Definition Poly-trauma means a syndrome of multiple injuries with systemic traumatic reactions which may lead to dysfunction or failure of remote organs and vital systems. Readjustment counseling and outreach services are available free of charge at Vet Centers to all veterans who served in any combat zone. J Trauma Acute Care Surg. However, this did not result in additional relevant articles. Zentralbl Chir 121: 924–942. Injury. 1995;38:70–8. Die zügige und möglichst genaue Einschätzung des vorliegenden, The human face is the first focus of human interaction and a source of man’s fascination. All-cause and cause-specific mortality rates were extracted as well as trauma mechanism of each patient. Five studies did not clearly describe how they obtained data on the cause of death [12, 13, 20, 21, 25]. Article  2. Myocardial Injury Is Associated with the Incidence of Major Adverse Cardiac Events in Patients with Severe Trauma. Klingebiel FK, Hasegawa M, Strähle O, Kalbas Y, Teuben M, Halvachizadeh S, Kumabe Y, Pape HC, Pfeifer R; SICOT Trauma Research Group. Thirty studies published between 1985 and 2018 were included in this review with a total of 82,272 patients. The purpose of this review is to identify and evaluate the published definitions of the term "polytrauma". All data on injury mechanism is presented in Table 1. https://doi.org/10.1371/journal.pone.0190587.t001. Clin Orthop 203: 244–257, PubMed  Fourteen articles reported complete data and were included in this analysis (North America (USA): n = 1 [19], South America: n = 1 [41], Asia: n = 2 [20, 21], Europe: n = 10 [12,13,14,15,16,17, 22, 23, 32, 34]). [Pathophysiology of multiple trauma : intensive care medicine and timing of treatment]. All available information was included in our analysis of all-cause mortality. Formal analysis, Injury Severity Score (ISS), are is also registered in the DTR [16,17]. Correspondence to Schweiz Med Wochenschr 130: 816–828, Kossmann T, Trease L, Freedman I, Malham G (2004) Damage control surgery for spine trauma. There was no indication for selection bias in all 30 studies except for three [33, 34, 37]. 2013;74:774–9. Recognizing early on the importance of providing coordinated and comprehensive rehabilitation services to support recovery from polytrauma, VA developed a specialized Polytrauma System of Care. The older patients represented 47.8% of the polytrauma population. Weighted averages based on the study population of each study resulted in 14.4% all-cause mortality for Europe, 22.6% for South America, 9.6% for North America, and 18.5% for Asia. J Bone Joint Surg Am 84: 124–132, Edwards MJR, Frankema SPG, Kruit MC, Bode PJ, Breslau PJ, Vugt AB van (2001) Efficiency of a standardized diagnostic protocol in trauma management. Speech-Language Pathologists provide both diagnostic and rehabilitative services while educating the patient and the family. -, Unfallchirurg. Further research is needed to define other possible factors influencing the mortality among the older polytrauma patient. At the turn of the century, this altered and brain injury often became the leading cause of death. Google Scholar, Bracken MB, Shepard MJ, Collins WF et al. In the DTR anatomical injury characteristics are classified by means of the Abbreviated Injury Scale (AIS). These results are displayed in Table 5, showing that older polytrauma patients with a minimal GCS score had more severe head injuries. Trauma Surg Acute Care Open. The discrepancies between the results of Giannoudis et al. Although this study showed no difference in injury severity between the two groups, we can conclude that it takes a smaller impact for the elderly to develop a polytrauma state compared to their younger counterparts. A shift from MODS to brain-related death was observed. Eur Rev Med Pharmacol Sci. In der prähospitalen Phase der Versorgung von schwer verletzten Patienten wird die durch den Notarzt erfasste Gesamtverletzungsschwere gut eingeschätzt und korreliert mit den eingeleiteten Therapien, der Auswahl der Zielklinik als auch dem innerklinischen Verlauf sowie dem Outcome des Patienten. Diese etablierten Kriterien hinsichtlich des Zeitpunktes und der Art der operativen Versorgung von Wirbelsäulenverletzungen bei polytraumatisierten Patienten sollen nachfolgend vorgestellt und diskutiert werden. Thirty studies, which reported mortality rates for 82,272 patients, were included and showed a decrease of 1.8% (95% CI 1.6–2.0%) in all-cause mortality per year since 1966. Part of Springer Nature. Physiatrists oversees all rehabilitation treatment programs. There have been no changes in the ratio of blunt and penetrating trauma over time (Fig. The polytrauma patient in the intensive care unit. 4a). europsychologists are clinical or counseling psychologist with specialized training in studying brain behavior relationships. Before Our findings suggest that there is a relative increase (in relation to a decrease in other causes of mortality) in exsanguination once admitted to the ICU. The proportion of females in the younger group was 25.2%, in the older group it was 44.6%. reported a relatively low mortality (6%) for its time period (1988) [27]. Zentralbl Chir 116: 1263–1272, White AA, Panjabi MM (1990) The problem of clinical instability in the human spine: A systemic approach. Copyright: © 2018 de Vries et al. Langenbecks Arch Surg 383: 220–227, Leitlinien-Kommission der DGU (2001) Leitlinie Polytrauma-Leitlinien für die Unfallchirurgische Diagnostik und Therapie der Deutschen Gesellschaft für Unfallchirurgie e.V. According to Nast-Kolb et al. Dichotomous variables’ means were tested using the Pearson Chi-square (with continuity correction) or Fischer’s Exact Test, depending on the expected count (>5: Pearson Chi-Square, <5: Fischer Exact) per cell. Di Saverio S, Gambale G, Coccolini F, et al. Langenbecks Arch Chir 1992 [Suppl]: 311–315, Rotondo MF, Schwab CW, McGonigal MD et al. Slim K, Nini E, Forestier D, et al. The aim of this study was to compare demographics, injury patterns, injury mechanisms and outcomes between younger and older polytrauma patients. Although the difference of intubation between younger and older trauma patients with a minimal GCS score were statistically significant, the differences were small (A: 91% vs. B: 87%). Mortality decreased with approximately 1.8% per year (95% confidence interval (CI) 1.6–2.0%, p < 0.001). The DTR is based on the Major Trauma Outcome Study (MTOS+) and includes patient demographics, vital signs on admission, injury mechanism, anatomical injury characteristics and outcome. Eur J Trauma Emerg Surg. Follow-up and prognosis of severe accidental trauma in the aged. Google Scholar. Article  However, in the elderly minor falls (<2m, <3m) are a more common cause of polytrauma [6,7]. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. [28]. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. University Park Press, Baltimore, Daniaux H, Wagner M, Kathrein A, Lang T (1999) Frakturen des thorakolumbalen Übergangs. 2017;43:423–30. Paffrath T, Lefering R, Flohe S, et al. Your US state privacy rights, Baker et al. The site is secure. The definition of polytrauma revisited: an international consensus process and proposal of the new ‘Berlin definition'. Potentially relevant papers were selected, and full texts were obtained. Length of stay on the ICU did not differ between the two groups. The present elderly generation shows a longer and increased mobility which contributes to a higher risk on injury. In the year 2015, 17.7% of the Dutch population was older than 65 years. 1. No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, Corrections, Expressions of Concern, and Retractions, https://doi.org/10.1371/journal.pone.0190587, http://www.ncbi.nlm.nih.gov/pubmed/3913506, http://www.ncbi.nlm.nih.gov/pubmed/12169925. Spine 26: 47–55, Article  2023 May 17. doi: 10.1007/s00264-023-05828-4. Lauwers LF, Rosseel P, Roelants A, et al. Considering these findings, it may be worthwhile to focus on preventative and therapeutic options for exsanguination in the ICU setting. Die Erhebung und wissenschaftliche Auswertung der Daten der frühen innerklinischen Versorgungsphase und des innerklinischen Verlaufes bis hin zur Entlassung der Patienten, sind wesentliche Voraussetzungen für die Entwicklung von Leitlinien, Empfehlungen und Standards. Methodology, Since this study is restricted to the DTR database, no information was available on cause of death and factors, such as comorbidities, that might have influenced the mortality rate. Solely the Berlin definition resulted in a patient number reflecting clinical reality, thus enabling a transparent evaluation of treatment results provided by different institutions and allowing objective comparison of published studies.

Zoo Duisburg Kommende Veranstaltungen, Articles V