Regel G, Lobenhoffer P, Lehmann U, Pape H C, Pohlemann T, Tscherne H
Unfallchirurgische Klinik, Medizinische Hochschule Hannover.
Unfallchirurg. 1993 Jul;96(7):350-62.
The treatment data on 3,406 patients with multiple injuries were analyzed retrospectively from the viewpoint of quality control. The diagnosis, therapy, complications and course were documented and the treatment results of two decades (1972-1981 and 1982-1991) compared. Young people with an average age of 31 years were mostly affected: 86% had fractures (40% open injuries), 69% head injuries and 62% thoracic trauma. Head injury together with thoracic trauma was the most frequent injury combination and affected the duration of ventilation therapy and the intensive care course. The relationship between the kind and severity of injury [categorized according to the Hannover Polytrauma Score (PTS)] and the lethality rate was significant. Preclinical treatment (infusion, intubation, thoracic tube) has increased in the past decade, and rescue time has been shortened. For the initial clinical diagnosis, ultrasound and the CT scan have been used more frequently. In patient treatment the elimination of massive hemorrhage still has first priority. Primary stabilization of long tubular bones, mostly of the lower limb, is aspired for. Volume therapy has changed over the last decade, so the risk of acute renal failure has been nearly eliminated. Nowadays late complications, e.g., multiorgan failure, are well in the foreground. Today at Hannover Medical School the average intensive care time is 13.7 days and the hospitalization time 31 days. When the two decades were compared, mortality was seen to have declined from 40% to 18%. In the future if the mortality rate is to be reduced further, this can only be done by treating the cause of post-traumatic organ failure.
