Outcome after severe multiple trauma: a retrospective analysis

Abstract

Background: Aim of this study was to evaluate prognosis of severely injured patients.

Methods: All severely injured patients with an Injury Severity Score (ISS) ≥ 50 were identified in a 6-year-period between 2000 and 2005 in German Level 1 Trauma Center Murnau. Data was evaluated from German Trauma Registry and Polytrauma Outcome Chart of the German Society for Trauma Surgery and a personal interview to assess working ability and disability and are presented as average.

Results: 88 out of 1435 evaluated patients after severe polytrauma demonstrated an ISS ≥ 50 (6.5%), among them 23% women and 77% men. 66 patients (75%) had an ISS of 50-60, 14 (16%) 61-70, and 8 (9%) ≥ 70. In 27% of patients trauma was caused by motor bike accidents. 3.6 body regions were involved. Patients had to be operated 5.3 times and were treated 23 days in the ICU and stayed 73 days in hospital. Mortality rate was 36% and rate of multi-organ failure 28%. 15% of patients demonstrated severe senso-motoric dysfunction as well as residues of severe head injury. 25% recovered well or at least moderately. 29 out of 56 survivors answered the POLO-chart. A personal interview was performed with 13 patients. The state of health was at least moderate in 72% of patients. In 48% interpersonal problems and in 41% severe pain was observed. In 57% of patients problems with working ability regarding duration, as well as quantitative and qualitative performance were observed. Symptoms of post-traumatic stress disorder were found in 41%. The more distal the lesions were located (foot/ankle) the more functional disability affected daily life. In only 15%, working ability was not impaired. 8 out of 13 interviewed patients demonstrated complete work disability.

Conclusions: Even severely injured patients after multiple trauma have a good prognosis. The ISS is an established tool to assess severity and prognosis of trauma, whereas prediction of clinical outcome cannot be deducted from this score.

Figure 1

Mechanism of Injury: In 27% trauma was caused by motor bike accidents, in 35% by car accidents, in 5% by bicycle accidents and in 16% by fall from a height. In 18%, other mechanisms were causative. Compared with other studies this is a rather high amount. Trauma Center Murnau is located in a holiday region near the Bavarian Alpes, where different kind of sports can be performed including fun sports like paragliding or mountain biking leading to a huge number of different injury mechanisms.

Figure 2

Incidence of organ failure: Kind of organ failure is a pivotal parameter for prognosis and outcome in severely multiple-injured patients. Lesions of circulation, airway, coagulation and central nerve system (CNS) play a decisive role in severely multiple-injured patients.

Figure 3

Incidence of involved body regions: Injury pattern was very specific in patients with ISS ≥ 50. Mean incidence of involved body regions was significantly higher in patients with ISS ≥ 50 compared with patients with ISS < 50.

Figure 4

Common patterns of injury: In patients with ISS ≥ 50 combined lesions of chest/lower extremities and chest/spinal cord occur significantly more often than in patients with ISS < 50 (mean; p-value < 0.05).

Figure 5

Pain during recent 4 weeks: A multi-dimensional evaluation using the POLO Chart questionnaire was performed in 29 out of 56 survivors to get an impression of health-based quality of life state. Time of evaluation was 3.6 years after trauma on average (range 18-78 months). Pain in recent four weeks was evaluated by using a score from “none” to “strong”.