Sascha Halvachizadeh (Zurich / CH), Felix Karl Ludwig Klingebiel (Zurich / CH), Yannik Kalbas (Zurich / CH), Till Berk (Zurich / CH), Valentin Neuhaus (Zurich / CH), Hans-Christoph Pape (Zurich / CH), Roman Pfeifer (Zurich / CH)
Abstract text (incl. references and figure legends)
Introduction
Timing of fracture fixation in polytrauma patient is subject to major controversies. The goal of this study was to define variables that predict the treatment strategy in polytrauma patients.
Methods
Retrospective cohort study included polytrauma patients, ISS of 16 points and above, primary admission and requirement for the ICU. primary outcome was surgical treatment strategy: immediate definitive surgery (IDS, last osteosynthesis within 12 hours of admission), safe definitive surgery (SDS, first definitive osteosynthesis within 48 hours), and delayed definitive surgery (DDS, first definitive osteosynthesis after 48 hours of admission, or no surgical intervention). Variables of interest included in the prediction model were: injury severity (abbreviated injury scale, AIS), and pathophysiologic parameters at admission of the four vicious cycles (hemorrhagic shock, coagulopathy, hypothermia, and soft tissue trauma).
Results
Out of 813 patients, 48 (5.9%) had IDS, 362 (44.5%) SDS, and 403 (49.6%) DDS. The mean age of patients was 55.4 (SD 20.5) years, mean injury severity score (ISS) was 23.0 (SD 11.5) points, and overall mortality was 27.3%. Increased AIS spine was associated with IDS (OR 1.8, 95%CI 1.2 to 2.7, p < 0.001); increased AIS of the extremity was associated with SDS (upper extremity: OR 2.3, 95%CI 1.5 to 3.4, p < 0.001, lower extremity: 1.4, 95%CI 1.1 to 1.8, p = 0.002); increased AIS head was associated with DDS (OR 1.4, 95%CI 1.3 to 1.6). The prediction of SDS was highest when all physiologic parameters including hemorrhagic shock, temperature, coagulation, and soft tissue were taken into consideration (AUC 0.8, 95%CI 0.7 to 0.9).
Conclusion
SDS is a frequently used surgical treatment straty in resuscitated polytrauma patients. The treating trauma surgeon bases the decision for treatment strategy on injury distribution, local and systemic injury severity, and on the pathophysiologic response after trauma.
Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)
None