Pfeifer Roman, Klingebiel Felix Karl-Ludwig, Halvachizadeh Sascha, Kalbas Yannik, Pape Hans-Christoph
Department of Traumatology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
Injury. 2023 Feb;54(2):292-317. doi: 10.1016/j.injury.2022.11.008. Epub 2022 Nov 9.
Early patient assessment is relevant for surgical decision making in severely injured patients and early definitive surgery is known to be beneficial in stable patients. The aim of this systematic review is to extract parameters indicative of risk factors for adverse outcome. Moreover, we aim to improve decision making and separate patients who would benefit from early versus staged definitive surgical fixation.
Following the PRISMA guidelines, a systematic review of peer-reviewed articles in English or German language published between (2000 and 2022) was performed. The primary outcome was the pathophysiological response to polytrauma including coagulopathy, shock/haemorrhage, hypothermia and soft tissue injury (trauma, brain injury, thoracic and abdominal trauma, and musculoskeletal injury) to determine the treatment strategy associated with the least amount of complications. Articles that had used quantitative parameters to distinguish between stable and unstable patients were summarized. Two authors screened articles and discrepancies were resolved by consensus. Quantitative values for relevant parameters indicative of an unstable polytrauma patient were obtained.
The initial systematic search using MeSH criteria yielded 1550 publications deemed relevant to the following topics (coagulopathy (n = 37), haemorrhage/shock (n = 7), hypothermia (n = 11), soft tissue injury (n = 24)). Thresholds for stable, borderline, unstable and in extremis conditions were defined according to the existing literature as follows: Coagulopathy; International Normalized Ratio (INR) and viscoelastic methods (VEM)/Blood/shock; lactate, systolic blood pressure and haemoglobin, hypothermia; thresholds in degrees Celsius/Soft tissue trauma: traumatic brain injury, thoracic and abdominal trauma and musculoskeletal trauma.
In this systematic literature review, we summarize publications by focusing on different pathways that stimulate pathophysiological cascades and remote organ damage. We propose that these parameters can be used for clinical decision making within the concept of safe definitive surgery (SDS) in the treatment of severely injured patients.
早期患者评估对于重伤患者的手术决策至关重要，且已知早期确定性手术对病情稳定的患者有益。本系统评价的目的是提取表明不良结局风险因素的参数。此外，我们旨在改善决策制定，并区分哪些患者能从早期与分期确定性手术固定中获益。
遵循PRISMA指南，对2000年至2022年间发表的英文或德文同行评议文章进行系统评价。主要结局是对多发伤的病理生理反应，包括凝血病、休克/出血、体温过低和软组织损伤（创伤、脑损伤、胸腹部创伤和肌肉骨骼损伤），以确定并发症最少的治疗策略。总结了使用定量参数区分稳定和不稳定患者的文章。两名作者筛选文章，分歧通过协商解决。获得了表明不稳定多发伤患者的相关参数的定量值。
最初使用医学主题词（MeSH）标准进行的系统检索产生了1550篇与以下主题相关的出版物（凝血病（n = 37）、出血/休克（n = 7）、体温过低（n = 11）、软组织损伤（n = 24））。根据现有文献，将稳定、临界、不稳定和极度危急状态的阈值定义如下：凝血病；国际标准化比值（INR）和粘弹性方法（VEM）/血液/休克；乳酸、收缩压和血红蛋白、体温过低；摄氏度阈值/软组织创伤：创伤性脑损伤、胸腹部创伤和肌肉骨骼创伤。
在本系统文献综述中，我们通过关注刺激病理生理级联反应和远隔器官损伤的不同途径来总结出版物。我们建议这些参数可用于重伤患者安全确定性手术（SDS）概念下的临床决策。
