El Mestoui Zainab, Jalalzadeh Hamid, Giannakopoulos Georgios F, Zuidema Wietse P
Department of Trauma Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
Eur J Emerg Med. 2017 Feb;24(1):49-54. doi: 10.1097/MEJ.0000000000000293.
Earlier studies assessing mortality in polytrauma patients have focused on improving trauma care and reducing complications during hospital stay. The same studies have shown that the complication rate in these patients is high, often resulting in death. The aim of this study was to assess the incidence and causes of mortality in polytrauma patients in our institute. Secondarily, we assessed the donation and autopsy rates and outcome in these patients.
All polytrauma patients (injury severity score≥16) transported to and treated in our institute during a period of 6 years were retrospectively analyzed. We included all patients who died during hospital stay. Prehospital and in-hospital data were collected on patients' condition, diagnostics, and treatment. The chance of survival was calculated according to the TRISS methodology. Patients were categorized according to the complications during treatment and causes of death. Logistic regression analysis was used to design a prediction model for mortality in major trauma. A statistical analysis was carried out.
Of the 1073 polytrauma patients who were treated in our institute during the study period, 205 (19.1%) died during hospital stay. The median age of the deceased patients was 58.8 years and 125 patients were men. Their mean injury severity score was 30.4. The most common mechanism of injury involved fall from height, followed by bicycle accidents. Almost 50% of the patients underwent an emergency intervention. Almost 92% of the total population died because of the effects of the accident (primary trauma). Of these, 24% died during primary assessment in the emergency department. Most patients died because of the effects of severe head injury (63.4%), followed by exsanguination (17.6%). The most common type of complications causing death during treatment was respiratory failure (6.3%), followed by multiple organ failure (1.5%). Autopsy was performed in 10.4%. Organ donation procedure was performed in 14.5%. Permission for donation was not provided in almost 20% of the population.
The mortality rate in polytrauma patients in our institute is considerable and comparable with the international literature. Most patients die because of the effects of the accident (primary trauma). Autopsy and organ donation rates are low in our institution and leave room for substantial improvements in the future.
早期评估多发伤患者死亡率的研究主要集中在改善创伤护理和降低住院期间的并发症发生率。这些研究表明，此类患者的并发症发生率很高，常常导致死亡。本研究旨在评估我院多发伤患者的死亡率及其发生原因。其次，我们评估了这些患者的捐赠率、尸检率及预后情况。
对我院6年间收治的所有多发伤患者（损伤严重度评分≥16）进行回顾性分析。纳入所有住院期间死亡的患者。收集患者院前及院内的病情、诊断及治疗数据。根据TRISS方法计算生存概率。根据治疗期间的并发症及死亡原因对患者进行分类。采用逻辑回归分析建立严重创伤死亡率的预测模型，并进行统计学分析。
在研究期间我院收治的1073例多发伤患者中，205例（19.1%）在住院期间死亡。死亡患者的中位年龄为58.8岁，男性125例。他们的平均损伤严重度评分为30.4。最常见的致伤机制是高处坠落，其次是自行车事故。近50%的患者接受了紧急干预。几乎92%的患者死于事故影响（原发性创伤）。其中，24%在急诊科初次评估时死亡。大多数患者死于严重颅脑损伤（63.4%），其次是失血（17.6%）。治疗期间导致死亡的最常见并发症类型是呼吸衰竭（6.3%），其次是多器官功能衰竭（1.5%）。尸检率为10.4%。器官捐献率为14.5%。近20%的患者未给予捐献许可。
我院多发伤患者的死亡率较高，与国际文献报道相当。大多数患者死于事故影响（原发性创伤）。我院的尸检率和器官捐献率较低，未来有很大的改进空间。
