How to clear polytrauma patients for fracture fixation: Results of a systematic review of the literature

Abstract text (incl. references and figure legends)

Introduction

Early patient assessment is relevant for surgical decision making in severely injured patients and early definitive surgery is known to be beneficial in stable patients. The aim of this systematic review is to extract parameters indicative of risk factors for adverse outcome, to improve decision making and identify patients who would benefit from early versus staged definitive surgical fixation.

Material & Methods

Following the PRISMA guidelines, a systematic review of peer-reviewed articles published between (2000 and 2022) was performed. The primary outcome was the pathophysiological response to polytrauma including coagulopathy, shock/haemorrhage, hypothermia and soft tissue to determine the treatment strategy. Articles using quantitative parameters to distinguish between stable and unstable patients were summarized. Two authors screened articles, discrepancies were resolved by consensus. Quantitative values for relevant parameters indicative of an unstable polytrauma patient were obtained.

Results

The initial systematic search using MeSH criteria yielded 1550 publications. Included were articles to the following topics: coagulopathy (n=37), haemorrhage/shock (n=7), hypothermia (n=11), soft tissue injury (n=24)). Thresholds for stable, borderline, unstable and in extremis conditions were defined according to the existing literature: Coagulopathy: International Normalized Ratio, viscoelastic methods (Rotem/TEG); Haemorrhage/shock: lactate, systolic blood pressure, haemoglobin; Hypothermia: degrees celsius; Soft tissue trauma: traumatic brain injury, thoracic/abdominal and musculoskeletal trauma.

Conclusion

In this systematic literature review, we summarize publications by focusing on different pathways that stimulate pathophysiological cascades and remote organ damage. We propose that these parameters can be used for clinical decision making within the concept of safe definitive surgery (SDS) in the treatment of severely injured patients.

References

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