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. 2018 Apr 17:2018:7320158.
doi: 10.1155/2018/7320158. eCollection 2018.

A Novel Approach to Identify Polytraumatized Patients in Extremis

Lukas L Negrin  1 , Anna Antoni  1 , Stefan Hajdu  1 , Thomas Heinz  1
Affiliations

A Novel Approach to Identify Polytraumatized Patients in Extremis

Lukas L Negrin et al. Biomed Res Int. .

Abstract

Introduction: Due to the fact that early objective identification of polytraumatized patients in extremis is crucial for carrying out immediate life-saving measures, our objectives were to provide and scrutinize a definition that results in a particularly high mortality rate and to identify predictors of mortality in this group.

Materials and methods: A polytraumatized patient (ISS ≥ 16) was classified "in extremis" if five out of seven parameters (arterial paCO2 > 50 mmHg, hemoglobin < 9.5 g/dl, pH value < 7.2, lactate level > 4 mmol/l, base excess < -6 mmol/l, shock index > 1, and Horowitz index < 300) were met. By applying this definition, polytraumatized patients (age ≥ 18 years), admitted to our level I trauma center within a time period of three years, were retrospectively allocated to the "in extremis" group and to an age-, gender-, and ISS-matched "non-in extremis" group for comparison.

Results: Out of 64 polytraumatized patients (mean ISS, 43.6), who formed the "in extremis" group, 36 patients (56.3%) died, thus revealing a threefold higher mortality rate than in the matched group (18.9%). Within the "in extremis" group, age and ISS were identified as predictors of mortality.

Conclusion: Our definition might serve as a valuable early warning score or at least an impetus for defining polytraumatized patients in extremis in clinical practice.

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Figures

Figure 1
Figure 1
Allocation of polytraumatized patients admitted to our level I trauma center during the observational period.
Figure 2
Figure 2
Kaplan-Maier curve referring to the “in extremis” group.
Figure 3
Figure 3
Distribution of age (a) and ISS (b) in the “in extremis” group.
Figure 4
Figure 4
ROC curve for age and mortality (a) and for the ISS value and mortality (b) in the “in extremis” group.
See this image and copyright information in PMC

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