Severe isolated injuries have a high impact on resource use and mortality: a Dutch nationwide observational study

Mitchell L S Driessen¹, Mariska A C de Jongh², Leontien M Sturms³, Frank W Bloemers⁴, Henk Jan Ten Duis⁵, Michael J R Edwards⁶, Dennis den Hartog⁷, Peter A Leenhouts⁸, Martijn Poeze⁹, Inger B Schipper¹⁰, Richard W Spanjersberg¹¹, Klaus W Wendt¹², Ralph J de Wit¹³, Stefan W A M van Zutphen¹⁴, Luke P H Leenen¹⁵

Affiliations

¹ Dutch Network Emergency Care ((LNAZ)), Newtonlaan 115, 3584 BH, Utrecht, The Netherlands. mls.driessen@lnaz.nl.
² Network Emergency Care Brabant, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands.
³ Dutch Network Emergency Care ((LNAZ)), Newtonlaan 115, 3584 BH, Utrecht, The Netherlands.
⁴ Department of Surgery, Amsterdam University Medical Center, Location VU, P.O. Box 1081 HV, Amsterdam, The Netherlands.
⁵ , Groningen, The Netherlands.
⁶ Department of Trauma Surgery, Radboud University Medical Center, 618., P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
⁷ Trauma Research Unit, Department of Surgery, Erasmus MC, Rotterdam, P.O. Box 3000 CA, Rotterdam, The Netherlands.
⁸ Department of Surgery, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands.
⁹ Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
¹⁰ Department of Trauma Surgery, Leiden University Medical Center, P.O Box 9600, 2300 RC, Leiden, The Netherlands.
¹¹ Department of Trauma Surgery, Isala Hospitals, Zwolle, The Netherlands.
¹² Department of Trauma Surgery, University Medical Center Groningen, P.O Box 30.001, 9700 RB, Groningen,, The Netherlands.
¹³ Department of Trauma Surgery, Medical Spectrum Twente, P.O. Box 50000, 7500 KA, Enschede, The Netherlands.
¹⁴ Department of Surgery, Elisabeth Two Cities Hospital, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands.
¹⁵ Department of Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.

PMID: 35445813
DOI: 10.1007/s00068-022-01972-5

Observational Study

Severe isolated injuries have a high impact on resource use and mortality: a Dutch nationwide observational study

Mitchell L S Driessen et al. Eur J Trauma Emerg Surg. 2022 Oct.

. 2022 Oct;48(5):4267-4276.

doi: 10.1007/s00068-022-01972-5. Epub 2022 Apr 21.

Authors

Affiliations

¹ Dutch Network Emergency Care ((LNAZ)), Newtonlaan 115, 3584 BH, Utrecht, The Netherlands. mls.driessen@lnaz.nl.
² Network Emergency Care Brabant, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands.
³ Dutch Network Emergency Care ((LNAZ)), Newtonlaan 115, 3584 BH, Utrecht, The Netherlands.
⁴ Department of Surgery, Amsterdam University Medical Center, Location VU, P.O. Box 1081 HV, Amsterdam, The Netherlands.
⁵ , Groningen, The Netherlands.
⁶ Department of Trauma Surgery, Radboud University Medical Center, 618., P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
⁷ Trauma Research Unit, Department of Surgery, Erasmus MC, Rotterdam, P.O. Box 3000 CA, Rotterdam, The Netherlands.
⁸ Department of Surgery, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands.
⁹ Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
¹⁰ Department of Trauma Surgery, Leiden University Medical Center, P.O Box 9600, 2300 RC, Leiden, The Netherlands.
¹¹ Department of Trauma Surgery, Isala Hospitals, Zwolle, The Netherlands.
¹² Department of Trauma Surgery, University Medical Center Groningen, P.O Box 30.001, 9700 RB, Groningen,, The Netherlands.
¹³ Department of Trauma Surgery, Medical Spectrum Twente, P.O. Box 50000, 7500 KA, Enschede, The Netherlands.
¹⁴ Department of Surgery, Elisabeth Two Cities Hospital, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands.
¹⁵ Department of Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.

PMID: 35445813
DOI: 10.1007/s00068-022-01972-5

Abstract

Purpose: The Berlin poly-trauma definition (BPD) has proven to be a valuable way of identifying patients with at least a 20% risk of mortality, by combining anatomical injury characteristics with the presence of physiological risk factors (PRFs). Severe isolated injuries (SII) are excluded from the BPD. This study describes the characteristics, resource use and outcomes of patients with SII according to their injured body region, and compares them with those included in the BPD.

Methods: Data were extracted from the Dutch National Trauma Registry between 2015 and 2019. SII patients were defined as those with an injury with an Abbreviated Injury Scale (AIS) score ≥ 4 in one body region, with at most minor additional injuries (AIS ≤ 2). We performed an SII subgroup analysis per AIS region of injury. Multivariable linear and logistic regression models were used to calculate odds ratios (ORs) for SII subgroup patient outcomes, and resource needs.

Results: A total of 10.344 SII patients were included; 47.8% were ICU admitted, and the overall mortality was 19.5%. The adjusted risk of death was highest for external (2.5, CI 1.9-3.2) and for head SII (2.0, CI 1.7-2.2). Patients with SII to the abdomen (2.3, CI 1.9-2.8) and thorax (1.8, CI 1.6-2.0) had a significantly higher risk of ICU admission. The highest adjusted risk of disability was recorded for spine injuries (10.3, CI 8.3-12.8). The presence of ≥ 1 PRFs was associated with higher mortality rates compared to their poly-trauma counterparts, displaying rates of at least 15% for thoracic, 17% for spine, 22% for head and 49% for external SII.

Conclusion: A severe isolated injury is a high-risk entity and should be recognized and treated as such. The addition of PRFs to the isolated anatomical injury criteria contributes to the identification of patients with SII at risk of worse outcomes.

Keywords: Isolated injury; Outcome; Physiological risk factor; Resources; Scales and system of injury.

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References

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Severe isolated injuries have a high impact on resource use and mortality: a Dutch nationwide observational study

Affiliations

Severe isolated injuries have a high impact on resource use and mortality: a Dutch nationwide observational study

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources