Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia.
Injury. 2012 Feb;43(2):196-9. doi: 10.1016/j.injury.2011.06.029. Epub 2011 Jul 13.
The term 'polytrauma' lacks a universally accepted, validated definition. In clinical trials the commonly applied injury severity based anatomical score cut-offs are ISS > 15, ISS > 17 and a recently recommended AIS > 2 in at least two body regions (2 × AIS > 2).
To compare the outcomes of clinically defined polytrauma patients with those defined based on anatomical scores.
A prospective observational study on all trauma team activation patients over a 7-month period presenting at a level-1 trauma centre were included in the study. The prospective data collection included AIS in each body region, ISS, ICU length of stay (LOS), multiple organ failure (MOF) and mortality.
336 patients met inclusion criteria (age: 41 ± 20, 74% male, ISS: 15 ± 11, NISS: 19 ± 15, MOF: 3%, mortality: 4%, 25% ICU admission). ISS > 15: 13 deaths (10%), 71 (54%) required ICU admission and 10 (8%) developed MOF. ISS > 17 captured 11 deaths (11%), with 63 (62%) requiring ICU admission and 10 (10%) developing MOF. Defining as (2 × AIS > 2): 8 deaths (13% of the group), with 43 patients requiring ICU admission (67%) and 9 (14%) developing MOF. When examining the performance of these three approaches, the ISS > 15 and the ISS > 17 captured statistically the same amount of clinically defined polytrauma patients (p = 0.4106), while the 2 × AIS > 2 definition captured significantly more polytrauma patients than ISS > 15 (p = 0.0251) and ISS > 17 (p = 0.0019).
2 × AIS > 2 captured the greatest percentage of the worst outcomes and significantly larger % of the clinically defined polytrauma patients. 2 × AIS > 2 has higher accuracy and precision in defining polytrauma than ISS > 15 and ISS > 17. This simple, retrospectively also reproducible criteria warrants larger scale validation.
“多发伤”一词缺乏普遍接受和经过验证的定义。在临床试验中，常用的损伤严重程度基于解剖学评分的截断值为 ISS＞15、ISS＞17 和最近推荐的至少两个身体区域的 AIS＞2（2×AIS＞2）。
比较临床定义的多发伤患者与基于解剖学评分定义的患者的结果。
对在一级创伤中心接受创伤团队激活的所有患者进行了一项前瞻性观察研究，在 7 个月的时间内纳入了这项研究。前瞻性数据收集包括每个身体区域的 AIS、ISS、ICU 住院时间（LOS）、多器官衰竭（MOF）和死亡率。
336 名患者符合纳入标准（年龄：41±20 岁，74%为男性，ISS：15±11，NISS：19±15，MOF：3%，死亡率：4%，25%入住 ICU）。ISS＞15：13 例死亡（10%），71 例（54%）需要入住 ICU，10 例（8%）发生 MOF。ISS＞17 捕获 11 例死亡（11%），63 例（62%）需要入住 ICU，10 例（10%）发生 MOF。定义为（2×AIS＞2）：8 例死亡（占该组的 13%），43 例患者需要入住 ICU（67%），9 例（14%）发生 MOF。当检查这三种方法的性能时，ISS＞15 和 ISS＞17 统计学上捕获了相同数量的临床定义多发伤患者（p=0.4106），而 2×AIS＞2 定义捕获了明显更多的多发伤患者比 ISS＞15（p=0.0251）和 ISS＞17（p=0.0019）。
2×AIS＞2 捕获了最严重结局的最大百分比，并显著增加了临床定义多发伤患者的比例。2×AIS＞2 在定义多发伤方面比 ISS＞15 和 ISS＞17 具有更高的准确性和精度。这种简单的、回顾性也可重复的标准需要更大规模的验证。
