Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3585 GA, Utrecht, The Netherlands.
Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
World J Emerg Surg. 2020 Sep 30;15(1):55. doi: 10.1186/s13017-020-00330-3.
Many factors of trauma care have changed in the last decades. This review investigated the effect of these changes on global all-cause and cause-specific mortality in polytrauma patients admitted to the intensive care unit (ICU). Moreover, changes in trauma mechanism over time and differences between continents were analyzed.
A systematic review of literature on all-cause mortality in polytrauma patients admitted to ICU was conducted. All-cause and cause-specific mortality rates were extracted as well as trauma mechanism of each patient. Poisson regression analysis was used to model time trends in all-cause and cause-specific mortality. Thirty studies, which reported mortality rates for 82,272 patients, were included and showed a decrease of 1.8% (95% CI 1.6-2.0%) in all-cause mortality per year since 1966. The relative contribution of brain injury-related death has increased over the years, whereas the relative contribution of death due to multiple organ dysfunction syndrome (MODS), acute respiratory distress syndrome, and sepsis decreased. MODS was the most common cause of death in North America, and brain-related death was the most common in Asia, South America, and Europe. Penetrating trauma was most often reported in North America and Asia.
All-cause mortality in polytrauma patients admitted to the ICU has decreased over the last decades. A shift from MODS to brain-related death was observed. Geographical differences in cause-specific mortality were present, which may provide region-specific learning possibilities resulting in improvement of global trauma care.
在过去的几十年中，创伤护理的许多因素发生了变化。本研究调查了这些变化对重症监护病房（ICU）收治的多发伤患者的全因和病因死亡率的影响。此外，还分析了随着时间的推移创伤机制的变化以及各大洲之间的差异。
对 ICU 收治的多发伤患者全因死亡率的文献进行了系统回顾。提取了全因和病因死亡率以及每位患者的创伤机制。采用泊松回归分析模型对全因和病因死亡率的时间趋势进行分析。纳入了 30 项研究，这些研究报告了 82272 例患者的死亡率，结果显示自 1966 年以来，全因死亡率每年下降 1.8%（95%CI 1.6-2.0%）。与脑损伤相关的死亡相对比例逐年增加，而与多器官功能障碍综合征（MODS）、急性呼吸窘迫综合征和脓毒症相关的死亡相对比例下降。MODS 是北美的主要死因，而亚洲、南美和欧洲的主要死因是与脑相关的死亡。北美最常报告穿透性创伤，亚洲和北美最常报告穿透性创伤。
过去几十年，ICU 收治的多发伤患者的全因死亡率有所下降。观察到从 MODS 到与脑相关的死亡的转变。病因死亡率存在地域差异，这可能为特定地区提供学习机会，从而改善全球创伤护理水平。
