Epidemiology of extremity injuries in multiple trauma patients
Introduction
The injury pattern in patients sustaining multiple injuries highly influences mortality, posttraumatic course, physical and psychosocial outcome and posttraumatic quality of life. Mortality is mainly determined by severity of head injury while exsanguination represents the second leading cause of death.1, 2 Patients with head injury show an up to threefold increased mortality when compared to patients without head injury.1 Nevertheless, additional extremity injuries mainly affect the functional outcome and quality of life after polytrauma.2, 3, 4, 5 Patients with lower as well as those with upper extremity injuries often continue to have severe functional restrictions. Especially those with injuries below the knee experience pain and present with an impaired ability to walk and a decreased quality of life already in the short-term.2, 4, 5 In a long-term follow-up Pape et al. showed that a traumatic lower extremity amputation, the presence of two or more articular injuries, lower extremity injuries and a combination of shaft and articular injuries were predictors of a worse clinical outcome after polytrauma.3 Furthermore, patients with extremity injuries commonly survive with good or excellent clinical outcomes if isolated injury is sustained (e.g. acromio-clavicular joint separation), however patient outcome becomes significantly poorer if the same injury is present in a polytrauma patient.6 Although the role of extremity injuries with respect to morbidity and mortality is frequently underestimated, their therapy plays a major role in the management of the multiple injured patient. However, until now little epidemiological data exist on extremity injuries in multiple trauma patients.
Thus, using a large, representative nationwide trauma registry, the aim of the present study was to describe the epidemiological patterns of extremity injuries in multiple trauma patients with respect to prevalence, injury pattern, specific mechanisms of injury and their impact on mortality.
Section snippets
The Trauma Register of the German Society for Trauma Surgery (TR-DGU)
The TR-DGU was founded in 1993 by the German Society for Trauma Surgery (DGU, Deutsche Gesellschaft für Unfallchirurgie) for anonymous and standardised documentation of data on critically injured patients.7 Until 2009, data from a total of 51,425 trauma patients have been entered into the registry. In 2002, an online documentation system was introduced including multiple plausibility and completeness checks. Currently, 218 hospitals are actively contributing data to the TR-DGU, mostly from
Results
Based on the inclusion criteria, a total of 24,885 patients were identified, comprising the analysed study population. Table 1 depicts the basic parameters of the study population that shows the general features of a severely injured trauma population (ISS 29 SD 12; mortality 18.3%). Fig. 1 displays the frequencies of different injury patterns with respect to the presence of upper and lower extremity injuries or the absence of any extremity injury. In summary, 24,885 patients sustained a total
Discussion
The purpose of the present investigation was to establish valid data on the epidemiology of extremity injuries in severely injured patients using a large, representative nationwide trauma registry and to assess extremity injuries with respect to prevalence, injury pattern, trauma mechanism and their impact on mortality. Data on prevalence, severity and outcome are essential to sufficiently consider and allocate existing resources both in the clinical setting and in trauma research.
The first
Conflict of interest statement
All the authors, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.
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2023, Chinese Journal of Traumatology - English EditionThe impact of upper-extremity injuries on polytrauma patients at a level 1 trauma center
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Lister Revisited - Skin Antisepsis before Fracture Fixation.
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