Time-related predictors for adverse events in polytrauma patients undergoing stand-alone definitive surgery

TL;DR

This study identifies time-related factors that predict adverse events in polytrauma patients who undergo definitive surgery, aiming to improve triage and outcomes.

Contribution

The study introduces time-based predictors of adverse events in polytrauma patients undergoing definitive surgery, excluding damage control interventions.

Findings

Severe head injuries and elevated leucocyte count at admission predict systemic inflammatory response syndrome.

Elevated lactate levels on day one predict sepsis, while delayed surgeries correlate with increased sepsis risk.

Non-survivors show lower base excess and prothrombin time by day two post-admission.

Abstract

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.