[Primary therapy of polytraumatized patients and reasons for early transfer to a specialty hospital]

Abstract

200 polytraumatized patients were treated at our institution between 1.1.1987 to 28.2.1989. 58 patients had been submitted from other hospitals. Reasons for submissions were complex cranio-facial-trauma in 27 patients, thoracic trauma in 9 patients and complex abdominal injury in 8. In 13 of 44 patients (29.5%), submitted in between the first 24 h after trauma, severe and partially life threatening injuries had not been diagnosed at the first hospital. Failures in decision making burden especially patients with cranio-facial injuries, in whom intraabdominal and thoracical injuries are often overseen. Patients with abdominal trauma were often submitted after an operative attempt demonstrating complex traumatisation which was underestimated at primary diagnosis. Polytraumatized patients need to have a multidisciplinary management performed by a specified crew with all diagnostic facilities available to avoid overestimation or neglection of additive injuries. Direct submission into a specified medical center is therefore recommended and seems preferable to submission after failed or insufficient primary therapy in inadequately equipped smaller hospitals.