van Wessem Karlijn J P, Benders Kim E M, Leenen Luke P H, Hietbrink Falco
Department of Trauma Surgery, University Medical Center Utrecht, Suite G04.232, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Eur J Trauma Emerg Surg. 2024 Dec;50(6):3083-3094. doi: 10.1007/s00068-024-02653-1. Epub 2024 Sep 17.
Advances in trauma care have attributed to a decrease in mortality and change in cause of death. Consequently, exsanguination and traumatic brain injury (TBI) have become the most common causes of death. Exsanguination decreased by early hemorrhage control strategies, whereas TBI has become a global health problem. The aim of this study was to investigate trends in injury severity,physiology, treatment and mortality in the last decade.
In 2014, a prospective cohort study was started including consecutive severely injured trauma patients > 15 years admitted to a Level-1 Trauma Center ICU. Demographics, physiology, resuscitation, and outcome parameters were prospectively collected.
Five hundred and seventy-eight severely injured patients with predominantly blunt injuries (94%) were included. Seventy-two percent were male with a median age of 46 (28-61) years, and ISS of 29 (22-38). Overall mortality rate was 18% (106/578) with TBI (66%, 70/106) being the largest cause of death. Less than 1% (5/578) died of exsanguination. Trend analysis of the 10-year period revealed similar mortality rates despite an ISS increase in the last 2 years. No significant differences in demographics,and physiology in ED were noted. Resuscitation strategy changed to less crystalloids and more FFP. Risk factors for mortality were age, brain injury severity, base deficit, hypoxia, and crystalloid resuscitation.
TBI was the single largest cause of death in severely injured patients in the last decade. With an aging population TBI will increase and become the next epidemic in trauma. Future research should focus on brain injury prevention and decreasing the inflammatory response in brain tissue causing secondary damage, as was previously done in other parts of the body.
创伤护理的进展已使死亡率降低且死亡原因发生了变化。因此，失血和创伤性脑损伤（TBI）已成为最常见的死亡原因。通过早期出血控制策略，失血情况有所减少，而TBI已成为一个全球性的健康问题。本研究的目的是调查过去十年中损伤严重程度、生理状况、治疗及死亡率的趋势。
2014年启动了一项前瞻性队列研究，纳入连续入住一级创伤中心重症监护病房的15岁以上严重创伤患者。前瞻性收集人口统计学、生理状况、复苏及结局参数。
纳入了578例主要为钝性损伤（94%）的严重受伤患者。72%为男性，中位年龄46（28 - 61）岁，损伤严重度评分（ISS）为29（22 - 38）。总体死亡率为18%（106/578），其中TBI（66%，70/106）是最大的死亡原因。死于失血的患者不到1%（5/578）。对这10年期间的趋势分析显示，尽管过去两年ISS有所增加，但死亡率相似。在急诊室，人口统计学和生理状况方面未发现显著差异。复苏策略转变为减少晶体液使用量，增加新鲜冰冻血浆使用量。死亡的危险因素包括年龄、脑损伤严重程度、碱缺失、缺氧及晶体液复苏。
在过去十年中，TBI是严重受伤患者的单一最大死亡原因。随着人口老龄化，TBI将会增加并成为创伤领域的下一个流行问题。未来的研究应像此前在身体其他部位所做的那样，聚焦于脑损伤预防以及减少导致继发性损伤的脑组织炎症反应。
