Trauma Team Activation: Which Surgical Capability Is Immediately Required in Polytrauma? A Retrospective, Monocentric Analysis of Emergency Procedures Performed on 751 Severely Injured Patients
Abstract
1. Introduction
2. Materials and Methods
3. Results
3.1. Study Population
3.2. Injury Mechanism, Severity, and Distribution
3.3. Most Common ESI
3.4. Complications
4. Discussion
- 1.
- Most polytrauma patients required an emergency surgical intervention within 24 h of admission;
- 2.
- Chest tube insertion, damage-control laparotomy, placing an external fixator on the extremities, and insertion of an intracranial pressure probe accounted for the most common potentially life-saving emergency surgical interventions;
- 3.
- Morbidity and mortality were not affected by emergency surgical interventions.
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Haagsma, J.A.; Graetz, N.; Bolliger, I.; Naghavi, M.; Higashi, H.; Mullany, E.C.; Abera, S.F.; Abraham, J.P.; Adofo, K.; Alsharif, U.; et al. The global burden of injury: Incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj. Prev. 2016, 22, 3–18. [Google Scholar] [CrossRef]
- Driscoll, P.A.; Vincent, C.A. ORGANIZING AN EFFICIENT TRAUMA TEAM. Injury-Int. J. Care Inj. 1992, 23, 107–110. [Google Scholar] [CrossRef]
- Haas, B.; Stukel, T.A.; Gomez, D.; Zagorski, B.; De Mestral, C.; Sharma, S.V.; Rubenfeld, G.D.; Nathens, A.B. The mortality benefit of direct trauma center transport in a regional trauma system: A population-based analysis. J. Trauma Acute Care Surg. 2012, 72, 1510–1515; discussion 1515–1517. [Google Scholar] [CrossRef]
- Gillott, A.R.; Thomas, J.M.; Forrester, C. Development of a statewide trauma registry. J. Trauma 1989, 29, 1667–1672. [Google Scholar] [CrossRef]
- Cameron, P.A.; Gabbe, B.J.; McNeil, J.J.; Finch, C.F.; Smith, K.L.; Cooper, D.J.; Judson, R.; Kossmann, T. The trauma registry as a statewide quality improvement tool. J. Trauma 2005, 59, 1469–1476. [Google Scholar] [CrossRef] [PubMed]
- Jensen, K.O.; Heyard, R.; Schmitt, D.; Mica, L.; Ossendorf, C.; Simmen, H.P.; Wanner, G.A.; Werner, C.M.L.; Held, L.; Sprengel, K. Which pre-hospital triage parameters indicate a need for immediate evaluation and treatment of severely injured patients in the resuscitation area? Eur. J. Trauma Emerg. Surg. 2019, 45, 91–98. [Google Scholar] [CrossRef]
- Ringen, A.H.; Hjortdahl, M.; Wisborg, T. Norwegian trauma team leaders--training and experience: A national point prevalence study. Scand. J. Trauma Resusc. Emerg. Med. 2011, 19, 54. [Google Scholar] [CrossRef] [PubMed]
- Champion, H.R.; Sacco, W.J.; Copes, W.S. Improvement in outcome from trauma center care. Arch. Surg. 1992, 127, 333–338, discussion 338. [Google Scholar] [CrossRef] [PubMed]
- Wang, C.-J.; Yen, S.-T.; Huang, S.-F.; Hsu, S.-C.; Ying, J.C.; Shan, Y.-S. Effectiveness of trauma team on medical resource utilization and quality of care for patients with major trauma. BMC Health Serv. Res. 2017, 17, 505. [Google Scholar] [CrossRef] [PubMed]
- Waydhas, C.; Trentzsch, H.; Hardcastle, T.C.; Jensen, K.O.; Group, W.-T.T.S. Survey on worldwide trauma team activation requirement. Eur. J. Trauma Emerg. Surg. 2020. [Google Scholar] [CrossRef] [PubMed]
- Ciesla, D.J.; Moore, E.E.; Cothren, C.C.; Johnson, J.L.; Burch, J.M. Has the trauma surgeon become house staff for the surgical subspecialist? Am. J. Surg. 2006, 192, 732–737. [Google Scholar] [CrossRef]
- Achatz, G.; Perl, M.; Stange, R.; Mutschler, M.; Jarvers, J.S.; Munzberg, M. How many generalists and how many specialists does othopedics and traumatology need? Unfallchirurg 2013, 116, 29–33. [Google Scholar] [CrossRef]
- Watson, J.J.; Nielsen, J.; Hart, K.; Srikanth, P.; Yonge, J.D.; Connelly, C.R.; Kemp Bohan, P.M.; Sosnovske, H.; Tilley, B.C.; van Belle, G.; et al. Damage control laparotomy utilization rates are highly variable among Level I trauma centers: Pragmatic, Randomized Optimal Platelet and Plasma Ratios findings. J. Trauma Acute Care Surg. 2017, 82, 481–488. [Google Scholar] [CrossRef]
- Moore, T.A.; Simske, N.M.; Vallier, H.A. Fracture fixation in the polytrauma patient: Markers that matter. Injury 2019, 51, S10–S14. [Google Scholar] [CrossRef]
- von Elm, E.; Altman, D.G.; Egger, M.; Pocock, S.J.; Gotzsche, P.C.; Vandenbroucke, J.P.; Initiative, S. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. Int. J. Surg. 2014, 12, 1495–1499. [Google Scholar] [CrossRef] [PubMed]
- Baker, S.P.; O’Neill, B.; Haddon, W.; Long, W.B. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J. Trauma 1974, 14, 187–196. [Google Scholar] [CrossRef]
- Haasper, C.; Junge, M.; Ernstberger, A.; Brehme, H.; Hannawald, L.; Langer, C.; Nehmzow, J.; Otte, D.; Sander, U.; Krettek, C.; et al. The Abbreviated Injury Scale (AIS). Unfallchirurg 2010, 113, 366–372. [Google Scholar] [CrossRef] [PubMed]
- Teasdale, G.; Jennett, B. Assessment of coma and impaired consciousness: A practical scale. Lancet 1974, 304, 81–84. [Google Scholar] [CrossRef]
- Schulz-Drost, S.; Finkbeiner, R.; Lefering, R.; Grosso, M.; Krinner, S.; Langenbach, A.; Dgu, T.T. Lung Contusion in Polytrauma: An Analysis of the TraumaRegister DGU. Thorac. Cardiovasc. Surg. 2019. [Google Scholar] [CrossRef]
- Heim, C.; Bosisio, F.; Roth, A.; Bloch, J.; Borens, O.; Daniel, R.T.; Denys, A.; Oddo, M.; Pasquier, M.; Schmidt, S.; et al. Is trauma in Switzerland any different? Epidemiology and patterns of injury in major trauma—A 5-year review from a Swiss trauma centre. Swiss Med. Wkly. 2014, 144, w13958. [Google Scholar] [CrossRef] [PubMed]
- Pape, H.C.; Giannoudis, P.V.; Krettek, C.; Trentz, O. Timing of fixation of major fractures in blunt polytrauma: Role of conventional indicators in clinical decision making. J. Orthop. Trauma 2005, 19, 551–562. [Google Scholar] [CrossRef]
- Vallier, H.A.; Wang, X.F.; Moore, T.A.; Wilber, J.H.; Como, J.J. Timing of Orthopaedic Surgery in Multiple Trauma Patients: Development of a Protocol for Early Appropriate Care. J. Orthop. Trauma 2013, 27, 543–551. [Google Scholar] [CrossRef]
- Halvachizadeh, S.; Baradaran, L.; Cinelli, P.; Pfeifer, R.; Sprengel, K.; Pape, H.-C. How to detect a polytrauma patient at risk of complications: A validation and database analysis of four published scales. PLoS ONE 2020, 15, e0228082. [Google Scholar] [CrossRef]
- Hildebrand, F.; Lefering, R.; Andruszkow, H.; Zelle, B.A.; Barkatali, B.M.; Pape, H.C. Development of a scoring system based on conventional parameters to assess polytrauma patients: PolyTrauma Grading Score (PTGS). Injury 2015, 46 (Suppl. S4), S93–S98. [Google Scholar] [CrossRef]
- Blencowe, N.S.; Strong, S.; Blazeby, J.; Daniels, R.; Peden, C.; Lim, J.; Messenger, D.; Stark, H.; Richards, S.; Rogers, C.; et al. Multicentre observational study of adherence to Sepsis Six guidelines in emergency general surgery. Br. J. Surg. 2017, 104, E165–E171. [Google Scholar] [CrossRef]
- Roberts, D.J.; Bobrovitz, N.; Zygun, D.A.; Ball, C.G.; Kirkpatrick, A.W.; Faris, P.D.; Stelfox, H.T. Indications for use of damage control surgery and damage control interventions in civilian trauma patients: A scoping review. J. Trauma Acute Care Surg. 2015, 78, 1187–1196. [Google Scholar] [CrossRef] [PubMed]
- Refaely, Y.; Koyfman, L.; Friger, M.; Ruderman, L.; Saleh, M.A.; Sahar, G.; Shaked, G.; Klein, M.; Brotfain, E. Clinical Outcome of Urgent Thoracotomy in Patients with Penetrating and Blunt Chest Trauma: A Retrospective Survey. Thorac Cardiovasc. Surg. 2018, 66, 686–692. [Google Scholar] [CrossRef]
- Beshay, M.; Mertzlufft, F.; Kottkamp, H.W.; Reymond, M.; Schmid, R.A.; Branscheid, D.; Vordemvenne, T. Analysis of risk factors in thoracic trauma patients with a comparison of a modern trauma centre: A mono-centre study. World J. Emerg. Surg. 2020, 15, 45. [Google Scholar] [CrossRef] [PubMed]
- Vassallo, J.; Fuller, G.; Smith, J.E.J. Relationship between the Injury Severity Score and the need for life-saving interventions in trauma patients in the UK. Emerg. Med. J. 2020, 37, 502–507. [Google Scholar] [CrossRef]
- Pape, H.; Leenen, L. Polytrauma management-What is new and what is true in 2020? J. Clin. Orthop. Trauma 2020, 12, 88–95. [Google Scholar] [CrossRef] [PubMed]
- Brenner, M.; Hicks, C. Major Abdominal Trauma: Critical Decisions and New Frontiers in Management. Emerg. Med. Clin. N. Am. 2018, 36, 149–160. [Google Scholar] [CrossRef] [PubMed]
- Kuza, C.; Hirji, S.; Englum, B.; Ganapathi, A.; Speicher, P.; Scarborough, J.E. Pancreatic injuries in abdominal trauma in US adults: Analysis of the National Trauma Data Bank on Management, Outcomes, and Predictors of Mortality. Scand. J. Surg. 2020, 109, 193–204. [Google Scholar] [CrossRef]
- Ferrah, N.; Cameron, P.; Gabbe, B.; Fitzgerald, M.; Martin, K.; Beck, B. Trends in the nature and management of serious abdominal trauma. World J. Surg. 2019, 43, 1216–1225. [Google Scholar] [CrossRef]
- Horst, K.; Andruszkow, H.; Weber, C.D.; Pishnamaz, M.; Herren, C.; Zhi, Q.; Knobe, M.; Lefering, R.; Hildebrand, F.; Pape, H.C. Thoracic trauma now and then: A 10 year experience from 16,773 severely injured patients. PLoS ONE 2017, 12, e0186712. [Google Scholar] [CrossRef] [PubMed]
- Halvachizadeh, S.; Mica, L.; Kalbas, Y.; Lipiski, M.; Canic, M.; Teuben, M.; Cesarovic, N.; Rancic, Z.; Cinelli, P.; Neuhaus, V. Zone-dependent acute circulatory changes in abdominal organs and extremities after resuscitative balloon occlusion of the aorta (REBOA): An experimental model. Eur. J. Med Res. 2021, 26, 10. [Google Scholar] [CrossRef] [PubMed]
- Teuben, M.; Spijkerman, R.; Blokhuis, T.; Pfeifer, R.; Teuber, H.; Pape, H.-C.; Leenen, L. Nonoperative management of splenic injury in closely monitored patients with reduced consciousness is safe and feasible. Scand. J. Trauma Resusc. Emerg. Med. 2019, 27, 108. [Google Scholar] [CrossRef] [PubMed]
- Raza, M.; Abbas, Y.; Devi, V.; Prasad, K.V.; Rizk, K.N.; Nair, P.P. Non operative management of abdominal trauma—A 10 years review. World J. Emerg. Surg. 2013, 8, 14. [Google Scholar] [CrossRef]
- Markogiannakis, H.; Sanidas, E.; Messaris, E.; Michalakis, I.; Kasotakis, G.; Melissas, J.; Tsiftsis, D. Management of blunt hepatic and splenic trauma in a Greek level I trauma centre. Acta Chir. Belg. 2006, 106, 566–571. [Google Scholar] [CrossRef]
- Austin, M.T.; Diaz, J.J.; Feurer, I.D.; Miller, R.S.; May, A.K.; Guillamondegui, O.D.; Pinson, C.W.; Morris, J.A. Creating an emergency general surgery service enhances the productivity of trauma surgeons, general surgeons and the hospital. J. Trauma 2005, 58, 906–910. [Google Scholar] [CrossRef]
- Demetriades, D.; Velmahos, G. Technology-driven triage of abdominal trauma: The emerging era of nonoperative management. Annu. Rev. Med. 2003, 54, 1–15. [Google Scholar] [CrossRef]
- Groven, S.; Gaarder, C.; Eken, T.; Skaga, N.O.; Naess, P.A. Abdominal injuries in a major Scandinavian trauma center—Performance assessment over an 8year period. J. Trauma Manag. Outcomes 2014, 8, 9. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Pfeifer, R.; Kalbas, Y.; Coimbra, R.; Leenen, L.; Komadina, R.; Hildebrand, F.; Halvachizadeh, S.; Akhtar, M.; Peralta, R.; Fattori, L.; et al. Indications and interventions of damage control orthopedic surgeries: An expert opinion survey. Eur. J. Trauma Emerg. Surg. 2020. [Google Scholar] [CrossRef] [PubMed]
ESI | Non-ESI | p-Value | |
---|---|---|---|
n | 711 | 40 | |
Age (years) | 38.0 (25, 56) | 62 (43, 75) | <0.001 |
Male, n (%) | 530 (74.5) | 28 (70.0) | n.s. |
ISS (points) | 38 (29, 45) | 34 (27, 38) | 0.043 |
GCS (points) | 7 (3, 13) | 11 (6, 14) | <0.001 |
Lactate admission (mmol/L) | 3 (2, 5) | 3 (1, 4) | n.s. |
MAP admission (mmHg) | 85 (70, 100) | 95 (75, 107) | n.s. |
Heartrate admission (1/min) | 100 (84, 115) | 85 (74, 104) | 0.011 |
Hematocrit admission (%) | 30 (22, 36) | 36 (32, 39) | <0.001 |
Hemoglobin admission (g/L) | 10 (8, 12) | 12 (10, 14) | 0.015 |
Base excess admission (mmol/L) | −6/−9, −3) | −5 (−7, −2) | 0.104 |
Body temperature (°C) | 35 (34, 36) | 35 (35, 37) | 0.49 |
ESI | Non-ESI | ||
---|---|---|---|
n | 711 | 40 | |
AIS Head (points), n (%) | <0.001 | ||
3 | 122 (17.2) | 12 (30.0) | |
4 | 149 (21.0) | 7 (17.5) | |
5 | 228 (32.1) | 7 (17.5) | |
6 | 6 (0.8) | 4 (10.0) | |
AIS Face (points), n (%) | 0.075 | ||
3 | 72 (10.2) | 10 (25.0) | |
4 | 27 (3.8) | 1 (2.5) | |
5 | 2 (0.3) | 0 (0.0) | |
AIS Thorax (points), n (%) | 0.723 | ||
3 | 368 (51.8) | 23 (57.5) | |
4 | 137 (19.3) | 5 (12.5) | |
5 | 54 (7.6) | 2 (5.0) | |
6 | 2 (0.3) | 0 (0.0) | |
AIS Abdomen (points), n (%) | 0.007 | ||
3 | 72 (0.2) | 8 (20.0) | |
4 | 139 (19.7) | 2 (5.0) | |
5 | 90 (12.7) | 1 (2.5) | |
AIS Spine (points), n (%) | 0.464 | ||
3 | 95 (13.5) | 8 (20.0) | |
4 | 11 (1.6) | 0 (0.0) | |
5 | 23 (3.3) | 0 (0.0) | |
6 | 1 (0.1) | 0 (0.0) | |
AIS Extremity (points), n (%) | 0.007 | ||
3 | 249 (35.4) | 6 (15.0) | |
4 | 66 (9.4) | 1 (2.5) | |
5 | 31 (4.4) | 0 (0.0) | |
AIS Pelvis (points), n (%) | 0.318 | ||
3 | 117 (6.7) | 7 (17.5) | |
4 | 28 (4.0) | 0 (0.0) | |
5 | 15 (2.1) | 0 (0.0) | |
AIS Integument (points), n (%) | 0.055 | ||
3 | 20 (2.9) | 1 (2.5) | |
4 | 6 (0.9) | 0 (0.0) | |
5 | 2 (0.3) | 1 (2.5) |
Emergency Thoracotomy, n (%) | 341 (41.0) | |
Chest tube | 191 (56.0) | |
Open CPR | 35 (10.3) | |
Thoracic packing | 24 (7.0) | |
Emergency Laparotomy, n (%) | 187 (22.5) | |
Abdominal packing | 98 (52.4) | |
Splenectomy | 63 (33.7) | |
Pelvic packing | 34 (18.2) | |
External Fixation, n (%) | 167 (20.1) | |
Upper extremity | 40 (23.9) | |
Lower extremity | 134 (80.2) | |
Pelvis | 20 (12.0) | |
ICP monitor, n (%) | 137 (16.5) |
ESI | Non-ESI | p-Value | |
---|---|---|---|
711 | 40 | ||
Infection, n (%) | 294 (41.5) | 15 (38.5) | n.s. |
Pneumonia, n (%) | 195 (28.8) | 12 (34.3) | n.s. |
Sepsis, n (%) | 170 (24.1) | 9 (23.1) | n.s. |
Bacteremia, n (%) | 85 (12.8) | 3 (8.6) | n.s. |
In-hospital mortality, n (%) | 248 (34.8) | 11 (27.5) | n.s. |
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Schmitt, D.; Halvachizadeh, S.; Steinemann, R.; Jensen, K.O.; Berk, T.; Neuhaus, V.; Mica, L.; Pfeifer, R.; Pape, H.C.; Sprengel, K. Trauma Team Activation: Which Surgical Capability Is Immediately Required in Polytrauma? A Retrospective, Monocentric Analysis of Emergency Procedures Performed on 751 Severely Injured Patients. J. Clin. Med. 2021, 10, 4335. https://doi.org/10.3390/jcm10194335
Schmitt D, Halvachizadeh S, Steinemann R, Jensen KO, Berk T, Neuhaus V, Mica L, Pfeifer R, Pape HC, Sprengel K. Trauma Team Activation: Which Surgical Capability Is Immediately Required in Polytrauma? A Retrospective, Monocentric Analysis of Emergency Procedures Performed on 751 Severely Injured Patients. Journal of Clinical Medicine. 2021; 10(19):4335. https://doi.org/10.3390/jcm10194335
Chicago/Turabian StyleSchmitt, Daniel, Sascha Halvachizadeh, Robin Steinemann, Kai Oliver Jensen, Till Berk, Valentin Neuhaus, Ladislav Mica, Roman Pfeifer, Hans Christoph Pape, and Kai Sprengel. 2021. "Trauma Team Activation: Which Surgical Capability Is Immediately Required in Polytrauma? A Retrospective, Monocentric Analysis of Emergency Procedures Performed on 751 Severely Injured Patients" Journal of Clinical Medicine 10, no. 19: 4335. https://doi.org/10.3390/jcm10194335
APA StyleSchmitt, D., Halvachizadeh, S., Steinemann, R., Jensen, K. O., Berk, T., Neuhaus, V., Mica, L., Pfeifer, R., Pape, H. C., & Sprengel, K. (2021). Trauma Team Activation: Which Surgical Capability Is Immediately Required in Polytrauma? A Retrospective, Monocentric Analysis of Emergency Procedures Performed on 751 Severely Injured Patients. Journal of Clinical Medicine, 10(19), 4335. https://doi.org/10.3390/jcm10194335