TraumaNetwork, Trauma Registry of the DGU®, Whitebook, S3 Guideline on Treatment of Polytrauma/Severe Injuries - An Approach for Validation by a Retrospective Analysis of 2304 Patients (2002-2011) of a Level 1 Trauma Centre

• Published in: Zentralblatt fur Chirurgie Vol. 142; no. 2; p. 199
• Main Authors: Schoeneberg, C, Schilling, M, Keitel, J, Kauther, M D, Burggraf, M, Hussmann, B, Lendemans, S
• Format: Journal Article
• Language: German
• Published: Germany 01-04-2017
• Subjects: Adult; Aged; Craniocerebral Trauma - mortality; Craniocerebral Trauma - therapy; Female; Germany; Guideline Adherence - statistics & numerical data; Hospital Mortality; Humans; Information Services - statistics & numerical data; Injury Severity Score; Male; Middle Aged; Multiple Trauma - diagnostic imaging; Multiple Trauma - mortality; Multiple Trauma - therapy; Registries - statistics & numerical data; Retrospective Studies; Survival Analysis; Tomography, X-Ray Computed - utilization; Trauma Centers - statistics & numerical data; Utilization Review - statistics & numerical data; Whole Body Imaging - utilization
• ISSN: 1438-9592
• DOI: 10.1055/s-0033-1360225

In the last decades, a reduction in mortality in severely injured patients with an ISS ≥ 16 could be observed. Some authors report a death rate of about 22 %. Moreover, there were some new insights in the last years such as the reduction in mortality by use of whole-body CT and the introduction of the S3 guideline of the German Society of Trauma Surgery "Treatment of Patients with Severe and Multiple Injuries" have supported the evidence-based treatment of severely injured patients.
A retrospective analysis of 2304 patients was performed between 2002 and 2011. The data of the authors' clinic for the trauma registry of the DGU® were used. After applying the inclusion criteria, ISS ≥ 16 and primary transfer from the accident site, 968 patients remained.
In the study population, a mean ISS of 29.81 and a mean GCS of 9.42 were found. The average age was 46.04 years. The mortality rate was 28.7 %. A significant difference between decedents and survivors was found at the ISS, GCS, RTS, new ISS, TRISS, RISC, AIS head, AIS skin, RR pre-clinical, pre-clinical heart rate and age. To test whether the lethality was reduced by the increased use of whole-body CT, a division into a group prior to and from 2009 was performed. Results revealed a significant increase in the whole-body CT rate from 56.96 to 71.7 %. The mortality rate declined from 32.3 to 24.5 %. In the same way it was verified whether the S3 guideline had an impact on mortality. Therefore, a division into groups before and from 2011 was conducted. Here, the mortality rate decreased from 30.4 to 18.4 %. In addition, a comparison between 2010 and 2011 was performed. Overall, there were statistically significant differences in the trauma room time, the surgical time, the volume infused, the rate of multiple organ failure and the rate of whole-body CTs performed.
In the period from 2002 to 2011 a mortality rate of 28.7 % was found. The higher rate in comparison to published data is most likely explained by the high rate of serious and severe head injuries. The increased use of whole-body CT and the introduction of the S3 guideline led to a significant decrease in mortality in the authors' patient population. This is due particularly to the accelerating of the treatment of severely injured patients, the reduction of the infused volume, shortened surgical phase within the first 24 hours and the increased use of whole-body CT.