Lefering Rolf, Paffrath Thomas, Linker Ralph, Bouillon Bertil, Neugebauer Edmund A M
Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany.
J Trauma. 2008 Nov;65(5):1036-43; discussion 1043-4. doi: 10.1097/TA.0b013e318184ee48.
Severe head injury (HI) is known to be a major determinant of mortality in patients with multiple injuries but additional injuries also contribute to the clinical outcome. The Trauma Registry of the German Society for Trauma Surgery offers sufficient data for comparative outcome analysis in relation to the injury pattern.
A total of 21,356 cases from Trauma Registry of the German Society for Trauma Surgery with complete data for pattern of injury (Abbreviated Injury Scale [AIS], Injury Severity Score), the incidence of hospital mortality, organ failure, sepsis, duration of hospital stay, and intubation-free days. Maximum AIS severity of HI, including brain, skull, face, and cervical spine, and injuries to the torso and/or extremities (TEI) were used for comparative subgroup analysis.
Overall mortality rate was 13.7% (mean age, 41.3 years; 72.6% men; mean Injury Severity Score, 24.4). Patients with relevant HI (AISHI >/=3) were found to have a higher mortality rate (22.1%) than patients with relevant TEI (12.9%). In all HI severity subgroups mortality increased consistently by about 5% with TEI of grade 4, and by 15% with TEI of grade 5, but no increase is observed for lower severity grades. The incidence of organ failure (overall 31.4%), multiple organ failure (15.0%), and sepsis (9.9%) are mainly influenced by the severity of TEI. Intubation-free days are equally influenced by both types of injuries of grade 3 or higher.
Mortality in patients with severe trauma is mainly determined by the severity of HI, while TEI contribute consistently only from AIS grade 4 or higher.
严重颅脑损伤（HI）是多发伤患者死亡的主要决定因素，但其他损伤也会影响临床结局。德国创伤外科学会创伤登记处提供了足够的数据，可用于根据损伤模式进行比较性结局分析。
德国创伤外科学会创伤登记处共有21356例病例，其损伤模式（简明损伤定级标准[AIS]、损伤严重程度评分）、医院死亡率、器官衰竭、脓毒症、住院时间和无插管天数的数据完整。HI的最大AIS严重程度，包括脑、颅骨、面部和颈椎，以及躯干和/或四肢损伤（TEI）用于比较亚组分析。
总体死亡率为13.7%（平均年龄41.3岁；男性占72.6%；平均损伤严重程度评分为24.4）。发现有相关HI（AISHI≥3）的患者死亡率（22.1%）高于有相关TEI的患者（12.9%）。在所有HI严重程度亚组中，4级TEI使死亡率持续增加约5%，5级TEI使死亡率增加15%，但较低严重程度等级未见死亡率增加。器官衰竭（总体发生率31.4%）、多器官衰竭（15.0%）和脓毒症（9.9%）的发生率主要受TEI严重程度影响。3级或更高等级的两种损伤对无插管天数的影响相同。
严重创伤患者的死亡率主要由HI严重程度决定，而TEI仅在AIS 4级或更高等级时持续影响死亡率。
