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Review
. 2025 Apr 11;51(1):171.
doi: 10.1007/s00068-025-02852-4.

ESTES recommendations for the treatment of polytrauma-a European consensus based on the German S3 guidelines for the treatment of patients with severe/multiple injuries

Cristina Rey Valcarcel  1 , Dan Bieler  2 , Gary A Bass  3 , Christine Gaarder  4 , Frank Hildebrand  5 ; ESTES Polytrauma Consensus Group
Collaborators, Affiliations
Review

ESTES recommendations for the treatment of polytrauma-a European consensus based on the German S3 guidelines for the treatment of patients with severe/multiple injuries

Cristina Rey Valcarcel et al. Eur J Trauma Emerg Surg. .

Abstract

Introduction: Considerable heterogeneity exists in the configuration and implementation maturity of trauma systems across European healthcare settings, and the opportunities for guideline-informed high-quality care varies considerably. Therefore, the European Society of Trauma and Emergency Surgery (ESTES), with its constituent national societies, has developed comprehensive consensus recommendations for care-context appropriate treatment of polytrauma patients in Europe, from the pre-hospital setting to the first surgical phase.

Methods: Adhering to the RAND/UCLA Appropriateness Method (RAM), ESTES conducted a three-round modified Delphi consensus. National society expert delegates assessed Grade of Recommendation (GoR) A and Good Clinical Practice Points (GPP) elements of the German Society of Trauma Surgery (DGU) "S3 guidelines for polytrauma/severe injury management" for appropriateness and implementability within their respective healthcare systems.

Results: In the first consensus round, 82 GoR A and 57 GPP recommendations were analysed. Of these, seven GPP were rephrased for clarity and four were removed due to redundancy or conflicting content. Consequently, 135 recommendations (82 GoR A and 53 GPP) remained, with 128 (77 GoR A and 51 GPP) deemed appropriate and necessary, and seven as uncertain due to expert disagreement.

Conclusion: These ESTES recommendations constitute the first cohesive Europe-wide framework for managing the polytrauma patient from the prehospital setting to the end of the first surgical phase. They serve as a foundational tool for the development of national guidelines, particularly in regions with evolving trauma systems, and promote alignment towards a uniform standard-of-care across Europe.

Keywords: Consensus; Guidelines; Injury; Polytrauma; Recommendations.

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Conflict of interest statement

Declarations. Conflicts of interest: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Countries with their national societies involved in the consensus
Fig. 2
Fig. 2
Consensus flow chart
See this image and copyright information in PMC

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