Pape Hans-Christoph, Lefering Rolf, Butcher Nerida, Peitzman Andrew, Leenen Luke, Marzi Ingo, Lichte Philip, Josten Christoph, Bouillon Bertil, Schmucker Uli, Stahel Philip, Giannoudis Peter, Balogh Zsolt
From the Department of Orthopedics/Trauma (P.L.), Aachen University Medical Center; and Harald Tscherne Lab for Orthopaedic Trauma (H.-C.P., P.L.), Aachen; Institute for Research in Operative Medicine (IFOM) (R.L., B.B.), University of Witten/Herdecke, Witten; Department of Orthopaedics (R.L., B.B.) at Merheim, Cologne; and Department of Trauma, Hand, and Reconstructive Surgery (I.M.), J. W. von Goethe University, Frankfurt; Department of Orthopaedic Trauma (C.J.), University of Leipzig, Leipzig; and AUC-Academy for Trauma Surgery (U.S.), Munich, Germany; Department of Traumatology (N.B., Z.B.), John Hunter Hospital and University of Newcastle, Newcastle, Australia; Department of Surgery (A.P.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and Department of Orthopaedic Surgery (P.S.), Denver Health Medical Center, Denver, Colorado, Department of Trauma (L.L.), Utrecht University, Utrecht, the Netherlands; and Department of Trauma (P.G.), Academic Unit of the University of Leeds, West Yorkshire, United Kingdom.
J Trauma Acute Care Surg. 2014 Nov;77(5):780-786. doi: 10.1097/TA.0000000000000453.
The nomenclature for patients with multiple injuries with high mortality rates is highly variable, and there is a lack of a uniform definition of the term polytrauma. A consensus process was therefore initiated by a panel of international experts with the goal of assessing an improved, database-supported definition for the polytraumatized patient.
The consensus process involved the following: RESULTS: A total of 28,211 patients in the trauma registry met the inclusion criteria. The mean (SD) age of the study cohort was 42.9 (20.2) years (72% males, 28% females). The mean (SD) ISS was 30.5 (12.2), with an overall mortality rate of 18.7% (n = 5,277) and an incidence of 3% of penetrating injuries (n = 886). Five independent physiologic variables were identified, and their individual cutoff values were calculated based on a set mortality rate of 30%: hypotension (systolic blood pressure ≤ 90 mm Hg), level of consciousness (Glasgow Coma Scale [GCS] score ≤ 8), acidosis (base excess ≤ -6.0), coagulopathy (international normalized ratio ≥ 1.4/partial thromboplastin time ≥ 40 seconds), and age (≥70 years).
Based on several consensus meetings and a database analysis, the expert panel proposes the following parameters for a definition of "polytrauma": significant injuries of three or more points in two or more different anatomic AIS regions in conjunction with one or more additional variables from the five physiologic parameters. Further validation of this proposal should occur, favorably by mutivariate analyses of these parameters in a separate data set.
对于死亡率高的多发伤患者，其命名方式差异很大，并且缺乏对“多发伤”这一术语的统一界定。因此，一个国际专家小组启动了一个共识达成过程，目的是评估一种经数据库支持的、改进后的多发伤患者定义。
该共识达成过程包括以下内容：结果：创伤登记处共有28211名患者符合纳入标准。研究队列的平均（标准差）年龄为42.9（20.2）岁（男性占72%，女性占28%）。平均（标准差）损伤严重度评分（ISS）为30.5（12.2），总死亡率为18.7%（n = 5277），穿透伤发生率为3%（n = 886）。确定了五个独立的生理变量，并根据30%的设定死亡率计算了它们各自的临界值：低血压（收缩压≤90 mmHg）、意识水平（格拉斯哥昏迷量表[GCS]评分≤8）、酸中毒（碱剩余≤ -6.0）、凝血病（国际标准化比值≥1.4/活化部分凝血活酶时间≥40秒）和年龄（≥70岁）。
基于多次共识会议和数据库分析，专家小组提出以下“多发伤”定义参数：在两个或更多不同的解剖学简明损伤定级标准（AIS）区域中有三个或更多部位的严重损伤，同时伴有五个生理参数中的一个或多个其他变量。应进一步验证这一建议，最好通过在一个单独的数据集中对这些参数进行多变量分析来实现。
