Sascha Halvachizadeh (Zurich / CH), Roman Pfeifer (Zurich / CH), Felix Karl-Ludwig Klingebiel (Zurich / CH), Yannik Kalbas (Zurich / CH), Valentin Neuhaus (Zurich / CH), Till Berk (Aachen / DE), Hans-Christoph Pape (Zurich / CH)
Background:
The optimal timing for surgery in multi-injury patients is debated, with various strategies proposed but limited focus on how injury distribution affects decisions. This study examines the impact of injury distribution on surgical strategies and outcomes.
Methods:
In this retrospective cohort study, patients admitted to a Level I trauma center with an Injury Severity Score (ISS) of ≥16 who required surgery were included. Surgical strategies were categorized as early total care (ETC, 48 hours). Outcomes were analyzed using univariate and multivariate methods.
Results:
Among 1,471 patients (mean age: 55.6 years; mean ISS: 23.1), 5.8% received ETC, 45.2% SDS, and 49% DC, with mortality rates of 22.4%, 16.1%, and 39.7%, respectively. Nonlethal abdominal and spinal injuries were linked to ETC, while extremity injuries were associated with SDS. Severe traumatic brain injury (TBI) was linked to DC. After adjusting for injury severity, mortality was 30% lower in SDS than in DC.
Conclusion:
Injury distribution significantly influences surgical timing. Spinal and nonlethal abdominal injuries favor early surgery, while severe TBI leads to delayed care. Physiological stability plays a key role in determining surgical strategy.
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