Vetter Philipp, Niggli Cédric, Hambrecht Jan, Pape Hans-Christoph, Mica Ladislav
Department of Trauma Surgery, University Hospital Zurich, 8091, Zurich, Switzerland.
J Clin Orthop Trauma. 2025 Apr 16;66:103017. doi: 10.1016/j.jcot.2025.103017. eCollection 2025 Jul.
Timely triage is crucial for polytrauma patients. Those with lower injury severity and physiological stress typically undergo isolated definitive surgery, but predictors for adverse events (AEs) in this group remain unclear. This study aims to identify time-related predictors of AEs in polytrauma patients undergoing stand-alone definitive surgery, excluding damage control interventions.
We analyzed a trauma database spanning from 1996 to 2022, including 3653 patients. The focus was on individuals aged ≥16 years with an Injury Severity Score (ISS) ≥16 who underwent definitive orthopedic surgery. Injury and physiological parameters were recorded at admission and on the first and second days post-admission. Documented AEs included systemic inflammatory response syndrome (SIRS), sepsis, and mortality.
Among the 276 patients (mean age: 45.0 years with confidence interval, CI, 42.7-47.2 years; 71.7 % male; median ISS: 27 with interquartile range: 20-34), the incidence of SIRS was 79 % (n = 218), sepsis 13.8 % (n = 38), and mortality 4 % (n = 11). Upon admission, severe head and facial injuries and elevated leucocyte count (LC) predicted SIRS. Predictors for sepsis included ISS, heart rate, pH, and prothrombin time (PT), while non-survivors were older, with more severe head injuries and lower base excess (BE). On day one, elevated lactate levels were noted in both septic patients and non-survivors; LC predicted sepsis. By day two, higher lactate persisted in both groups, with non-survivors also showing reduced BE and PT. Primary (admission day) and multiple surgeries correlated with SIRS, whereas delayed surgeries were associated with sepsis. No surgical factors were correlated with mortality.
Injury severity, physiological and surgical factors are associated with AEs in polytrauma patients undergoing definitive surgery. These findings with re-evaluation may help guide decision-making to minimize the risk of AEs.
Cohort-study, Level of Evidence = III.
No. StV: 1-2008.
及时分诊对多发伤患者至关重要。损伤严重程度较低且生理应激较小的患者通常接受单独的确定性手术，但该组患者不良事件（AE）的预测因素仍不明确。本研究旨在确定接受单独确定性手术（不包括损伤控制干预）的多发伤患者中与时间相关的AE预测因素。
我们分析了一个涵盖1996年至2022年的创伤数据库，包括3653例患者。重点关注年龄≥16岁、损伤严重程度评分（ISS）≥16且接受确定性骨科手术的患者。在入院时以及入院后第一天和第二天记录损伤和生理参数。记录的AE包括全身炎症反应综合征（SIRS）、脓毒症和死亡率。
在276例患者中（平均年龄：45.0岁，置信区间[CI]为42.7 - 47.2岁；71.7%为男性；ISS中位数：27，四分位间距：20 - 34），SIRS发生率为79%（n = 218），脓毒症为13.8%（n = 38），死亡率为4%（n = 11）。入院时，严重的头面部损伤和白细胞计数（LC）升高可预测SIRS。脓毒症的预测因素包括ISS、心率、pH值和凝血酶原时间（PT），而非幸存者年龄较大，头部损伤更严重且碱剩余（BE）较低。在第一天，脓毒症患者和非幸存者的乳酸水平均升高；LC可预测脓毒症。到第二天，两组患者的乳酸水平均持续升高，非幸存者的BE和PT也降低。初次手术（入院当天）和多次手术与SIRS相关，而延迟手术与脓毒症相关。没有手术因素与死亡率相关。
损伤严重程度、生理和手术因素与接受确定性手术的多发伤患者的AE相关。这些经重新评估的发现可能有助于指导决策，以将AE风险降至最低。
队列研究，证据水平 = III。
编号StV：1 - 2008。
