Very early posttraumatic serum alterations are significantly associated to initial massive RBC substitution, injury severity, multiple organ failure and adverse clinical outcome in multiple injured patients

Background: Sepsis and multiple organ failure (MOF) remain one of the main causes of death after multiple trauma. Trauma- and infection-associated immune reactions play an important role in the pathomechanism of MOF, but the exact pathways remain unknown. Spinal cord injury (SCI) may lead to an altered immune response, and some studies suggest a prognostic advantage for such patients having sepsis or multiple trauma. Yet these findings need to be evaluated in larger cohorts of trauma patients. Methods: Retrospective, multicenter study, using the data of the TraumaRegister DGU. Patients with and without SCI surviving the initial first 72 hours after trauma were matched according to injury pattern and age. Comparative analysis considered morbidity (sepsis, MOF) and hospital mortality. Results: The study population included 800 matched pairs. As intended by the matching process, patients with cervical SCI had an otherwise comparable injury pattern but a higher severity of trauma (mean Injury Severity Score: 36 vs 29, mean number of diagnosis: 5.6 vs 4.4). They had a higher rate of sepsis (15.9% vs 10.9%, P = .005) and MOF (35.9% vs 24.1%, P < .001) while mortality revealed no significant difference (9.5% vs 9.9%, P = .866). Conclusions: Cervical SCI leads to an increased rate of sepsis and MOF but appears to be favorable with respect to outcome of sepsis and MOF following multiple trauma. Further research should focus on the pathomechanisms and the possible arising therapeutic options.

Download Full-text

Predictive effect of the injury severity score on the development of multiple organ failure among young adults and elderly patients

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2004.07.407 ◽

2004 ◽

Vol 44 (4) ◽

pp. S127

Author(s):

A.A. Baez ◽

E.M. Giraldez ◽

M.D. Sztajnkrycer

Keyword(s):

Young Adults ◽

Elderly Patients ◽

Injury Severity Score ◽

Multiple Organ Failure ◽

Organ Failure ◽

Severity Score ◽

Injury Severity ◽

Multiple Organ ◽

Predictive Effect

Download Full-text

Surgical Stabilization of Clavicle Fractures Reduces Organ Failure Rates in Multiply-injured Patients with Thoracic Trauma: An Analysis Based on the TraumaRegister DGU®.

10.21203/rs.3.rs-76223/v1 ◽

2020 ◽

Author(s):

Helge Eberbach ◽

Rolf Lefering ◽

Sven Hager ◽

Klaus Schumm ◽

Lisa Bode ◽

...

Keyword(s):

Multiple Organ Failure ◽

Organ Failure ◽

Thoracic Trauma ◽

Clavicle Fracture ◽

Length Of Hospital Stay ◽

Multiple Organ ◽

Multiply Injured Patients ◽

Lung Failure ◽

Clavicle Fractures ◽

Injured Patients

Abstract Introduction: Thoracic trauma has decisive influence on the outcome of multiply-injured patients and is often associated with clavicle fractures. The affected patients are prone to lung dysfunction and multiple organ failure. The aim of this study is to investigate the influence of surgical stabilization of clavicle fractures in patients with thoracic trauma on specific outcome parameters.Methods: A multi-center, retrospective analysis of patient records documented in the TraumaRegister DGU® between 2009 and 2015 was performed. The inclusion criteria were multiply-injured patients with thoracic trauma and associated clavicle fracture, maximum AIS severity ≥ 3 and admission to the intensive care unit. The influence of operative vs. non-operative clavicular fracture treatment and timing of surgery on lung failure, multiple organ failure, sepsis, length of ICU stay, intubation time and length of hospital stay was assessed by regression analysis.Results: A total of 3,209 patients were included in the analysis. In 1,362 patients (42%) the clavicle fracture was treated operatively after 7.1 ± 5.3 days. Surgically treated patients had a significant reduction in lung failure (p = 0.013, OR = 0.74), multiple organ failure (p = 0.001, OR = 0.64), intubation time (p = 0.004; -1.81 days) and length of hospital stay (p = 0.014; -1.51 days) compared to non-operative treatment. Moreover, surgical fixation of the clavicle within five days following hospital admission significantly reduced the rates of lung failure (p = 0.01, OR = 0.62), multiple organ failure (p = 0.01, OR = 0.59) and length of hospital stay (p = 0.01; -2.1 days).Conclusions: Based on our results, multiply-injured patients with thoracic trauma and concomitant clavicle fracture seem to benefit significantly from surgical stabilization of a clavicle fracture, especially when surgery is performed within the first five days after hospital admission.

Download Full-text

Incidence of Septic Complications and Multiple Organ Failure in Severely Injured Patients Is Sex Specific

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-200005000-00019 ◽

2000 ◽

Vol 48 (5) ◽

pp. 932-937 ◽

Cited By ~ 158

Author(s):

Andreas Oberholzer ◽

Marius Keel ◽

Ren?? Zellweger ◽

Ursula Steckholzer ◽

Otmar Trentz ◽

...

Keyword(s):

Multiple Organ Failure ◽

Organ Failure ◽

Multiple Organ ◽

Severely Injured ◽

Severely Injured Patients ◽

Septic Complications ◽

Injured Patients

Download Full-text

Thromboembolic complications among multiple injured patients with pelvic injuries: identifying risk factors for possible patient-tailored prophylaxis

World Journal of Emergency Surgery ◽

10.1186/s13017-021-00388-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Tim Kirchner ◽

Rolf Lefering ◽

Richard Sandkamp ◽

Helge Eberbach ◽

Klaus Schumm ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Injury Severity ◽

Acetabular Fractures ◽

Thromboembolic Risk ◽

Pelvic Injuries ◽

Multiple Injured ◽

Independent Risk Factors ◽

Injured Patients ◽

Multiple Injured Patients

Abstract Background Patients with pelvic and/or acetabular fractures are at high risk of developing thromboembolic (TE) complications. In our study we investigate TE complications and the potential negative effects of concomitant pelvic or acetabular injuries in multiple injured patients according to pelvic/acetabular injury severity and fracture classification. Methods The TraumaRegister DGU® was analyzed between 2010 and 2019. Multiple injured patients with pelvic and/or acetabular fractures with ISS ≥ 16 suffering from TE complications were identified. We conducted a univariate and multivariate analysis with TE events as independent variable to examine potential risk factors and contributing factors. Results 10.634 patients met our inclusion criteria. The overall TE incidence was 4.9%. Independent risk factors for the development of TE complications were sepsis, ≥ 10 operative interventions, mass transfusion (≥ 10 PRBCs), age ≥ 65 years and AISAbdomen ≥ 3 (all p < 0.001). No correlation was found for overall injury severity (ISS), moderate traumatic brain injury, additional injury to lower extremities, type B and C pelvic fracture according to Tile/AO/OTA and closed or open acetabular fracture. Conclusions Multiple injured patients suffering from pelvic and/or acetabular fractures are at high risk of developing thromboembolic complications. Independent risk factors for the development of thromboembolic events in our study cohort were age ≥ 65 years, mass transfusion, AISAbdomen ≥ 3, sepsis and ≥ 10 surgery procedures. Among multiple injured patients with acetabular or pelvic injuries the severity of these injuries seems to have no further impact on thromboembolic risk. Our study, however, highlights the major impact of early hemorrhage and septic complications on thromboembolic risk in severely injured trauma patients. This may lead to individualized screening examinations and a patient-tailored thromboprophylaxis in high-risk patients for TE. Furthermore, the number of surgical interventions should be minimized in these patients to reduce thromboembolic risk.

Download Full-text

Neutrophils are primed for cytotoxicity and resist apoptosis in injured patients at risk for multiple organ failure

Surgery ◽

10.1016/s0039-6060(99)70155-8 ◽

1999 ◽

Vol 126 (2) ◽

pp. 198-202 ◽

Cited By ~ 78

Author(s):

Walter L. Biffl ◽

Ernest E. Moore ◽

Garret Zallen ◽

Jeffrey L. Johnson ◽

Julie Gabriel ◽

...

Keyword(s):

At Risk ◽

Multiple Organ Failure ◽

Organ Failure ◽

Multiple Organ ◽

Patients At Risk ◽

Injured Patients

Download Full-text

Early Spinal Injury Stabilization in Multiple-Injured Patients: Do All Patients Benefit?

Journal of Clinical Medicine ◽

10.3390/jcm9061760 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1760 ◽

Cited By ~ 1

Author(s):

Philipp Kobbe ◽

Patrick Krug ◽

Hagen Andruszkow ◽

Miguel Pishnamaz ◽

Martijn Hofman ◽

...

Keyword(s):

Length Of Stay ◽

Spinal Surgery ◽

Independent Risk Factor ◽

Injury Severity ◽

Spinal Injury ◽

Spine Injury ◽

Spinal Stabilization ◽

Multiple Injured ◽

Injured Patients ◽

Multiple Injured Patients

Background: Thoracolumbar spine fractures in multiple-injured patients are a common injury pattern. The appropriate timing for the surgical stabilization of vertebral fractures is still controversial. The purpose of this study was to analyse the impact of the timing of spinal surgery in multiple-injured patients both in general and in respect to spinal injury severity. Methods: A retrospective analysis of multiple-injured patients with an associated spinal trauma within the thoracic or lumbar spine (injury severity score (ISS) >16, age >16 years) was performed from January 2012 to December 2016 in two Level I trauma centres. Demographic data, circumstances of the accident, and ISS, as well as time to spinal surgery were documented. The evaluated outcome parameters were length of stay in the intensive care unit (ICU) (iLOS) and length of stay (LOS) in the hospital, duration of mechanical ventilation, onset of sepsis, and multiple organ dysfunction syndrome (MODS), as well as mortality. Statistical analysis was performed using SPSS. Results: A total of 113 multiple-injured patients with spinal stabilization and a complete dataset were included in the study. Of these, 71 multiple-injured patients (63%) presented with an AOSpine A-type spinal injury, whereas 42 (37%) had an AOSpine B-/C-type spinal injury. Forty-nine multiple-injured patients (43.4%) were surgically treated for their spinal injury within 24 h after trauma, and showed a significantly reduced length of stay in the ICU (7.31 vs. 14.56 days; p < 0.001) and hospital stay (23.85 vs. 33.95 days; p = 0.048), as well as a significantly reduced prevalence of sepsis compared to those surgically treated later than 24 h (3 vs. 7; p = 0.023). These adverse effects were even more pronounced in the case where cutoffs were increased to either 72 h or 96 h. Independent risk factors for a delay in spinal surgery were a higher ISS (p = 0.036), a thoracic spine injury (p = 0.001), an AOSpine A-type spinal injury (p = 0.048), and an intact neurological status (p < 0.001). In multiple-injured patients with AOSpine A-type spinal injuries, an increased time to spinal surgery was only an independent risk factor for an increased LOS; however, in multiple-injured patients with B-/C-type spinal injuries, an increased time to spinal surgery was an independent risk factor for increased iLOS, LOS, and the development of sepsis. Conclusion: Our data support the concept of early spinal stabilization in multiple-injured patients with AOSpine B-/C-type injuries, especially of the thoracic spine. However, in multiple-injured patients with AOSpine A-type injuries, the beneficial impact of early spinal stabilization has been overemphasized in former studies, and the benefit should be weighed out against the risk of patients’ deterioration during early spinal stabilization.

Download Full-text