Elsevier

Injury

Volume 44, Issue 8, August 2013, Pages 1015-1021
Injury

Epidemiology of extremity injuries in multiple trauma patients

https://doi.org/10.1016/j.injury.2012.12.007Get rights and content

Abstract

Background

Previous studies have suggested that distinct extremity injuries are associated with worse outcome following major trauma. The aim of the present study was to determine epidemiological data of extremity injuries in multiple trauma patients with respect to prevalence, injury pattern, specific mechanisms of injury and their impact on mortality.

Methods

The Trauma Register of the German Society for Trauma Surgery anonymously documents data on critically injured patients since 1993. Trauma cases documented between 2002 and 2009, older than 16 years of age and with an ISS  16 were divided into those with AIS  2 and those without a significant extremity injury. The groups were compared with respect to injury pattern, treatment characteristics and mortality.

Results

More than half of the 24,885 patients (58.6%) had a significant extremity injury. On average patients with relevant extremity injuries sustained on average 2.1 fractures per case and 4.9% even sustained five or more extremity injuries. Fractures of the femur (16.5%), the tibia (12.6%) and the clavicle (10.4%) were the most common fractures. Patients without significant extremity injury had a significantly lower Glasgow Coma Scale at scene, a more severe brain injury and a higher 30-day- and in-hospital-mortality. In contrast, patients with significant extremity injuries had a higher rate of severe chest trauma, a higher rate of red cell blood transfusion as well a massive blood transfusion, more operative procedures and a longer ICU and in-hospital length of stay.

Conclusions

Multiple injured patients with and without significant extremity injuries can be regarded as two different populations with respect to early posttraumatic course and survival. Those without extremity injury had more severe head injuries and a higher mortality. However, significant extremity injury was associated with worse outcomes including a higher number of operative procedures, a higher rate of blood transfusion and a longer hospital length of stay.

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.

References (19)

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Committee on Emergency Medicine, Intensive and Trauma Care (Sektion NIS) of the German Society for Trauma Surgery (DGU).

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