Citation

Butcher N, Balogh ZJ. Injury 2012; 43(2): 196-199.

Affiliation

Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia.

Copyright

(Copyright © 2012, Elsevier Publishing)

DOI

10.1016/j.injury.2011.06.029

PMID

21741649

Abstract

BACKGROUND: The term 'polytrauma' lacks a universally accepted, validated definition. In clinical trials the commonly applied injury severity based anatomical score cut-offs are ISS>15, ISS>17 and a recently recommended AIS>2 in at least two body regions (2×AIS>2). PURPOSE: To compare the outcomes of clinically defined polytrauma patients with those defined based on anatomical scores. MATERIAL AND METHODS: A prospective observational study on all trauma team activation patients over a 7-month period presenting at a level-1 trauma centre were included in the study. The prospective data collection included AIS in each body region, ISS, ICU length of stay (LOS), multiple organ failure (MOF) and mortality. RESULTS: 336 patients met inclusion criteria (age: 41±20, 74% male, ISS: 15±11, NISS: 19±15, MOF: 3%, mortality: 4%, 25% ICU admission). ISS>15: 13 deaths (10%), 71 (54%) required ICU admission and 10 (8%) developed MOF. ISS>17 captured 11 deaths (11%), with 63 (62%) requiring ICU admission and 10 (10%) developing MOF. Defining as (2×AIS>2): 8 deaths (13% of the group), with 43 patients requiring ICU admission (67%) and 9 (14%) developing MOF. When examining the performance of these three approaches, the ISS>15 and the ISS>17 captured statistically the same amount of clinically defined polytrauma patients (p=0.4106), while the 2×AIS>2 definition captured significantly more polytrauma patients than ISS>15 (p=0.0251) and ISS>17 (p=0.0019). CONCLUSION: 2×AIS>2 captured the greatest percentage of the worst outcomes and significantly larger % of the clinically defined polytrauma patients. 2×AIS>2 has higher accuracy and precision in defining polytrauma than ISS>15 and ISS>17. This simple, retrospectively also reproducible criteria warrants larger scale validation.

Language: en