1. “Dr. Josip Benčević” General Hospital, Slavonski Brod
Department of Aensthesiology, Reanimatology and Intensive Care
POLYTRAUMA CARE IN ICU
I. Matić, M. Jurjević, B. Hrečkovski, I. Lučić

2. Definition
Polytrauma is defined as two or more injuries to physical regions or organ systems, one of which may be life threatening
A syndrome of multiple injuries of defined severity [injury severity score (ISS) ≥ 16] with consecutive systemic reactions, which may lead to dysfunction of remote organs
Champion HR. J Trauma. 1990
R. Lefering. European Journal of Trauma 2002

3. Clinical prognosis Improved survival using ATLS
Improved clinical outcome using advanced
treatment methods
Zander et al

4. Importance
Leading cause of death
Quality of treatment – best indicator od medical care in a specific region
High mortality, long-lasting treatment and rehabilitation with substantial expenses
High incidence of invalidity
McKeown DW. Intensive Care Britain 1994

5. Goals of polytrauma care
Mortality reduction through increased quality and reduced diagnostic time, improved surgical technique and shock treatment, using precise algorithms and adequate therapy and monitoring.
Russel R. J Trauma. 2004
Edwin A. CCM. 2006

6. Scoring systems assesment of injury severity
based on exact numbering of specific injuries
assesment of injury severity
different injuries combined in a single score
used as a language for communication in literature
results are comparable
prognosis – survival probability for a specific score result

7. Scoring systems
GCS (Glasgow Coma Score) – eye opening, best motorical and verbal response
RTS (Revised Trauma Score) – physiological score.
Sum of GCS, systolic BP and respiratory frequency
ISS (Injury Severity Score) – anatomical score.
Based on the AIS (Abbreviated Injury Scale) The 3 most severely injured body regions have their score squared and added together to produce the ISS score .
TRISS = RTS + ISS
NISS – new ISS – three most severe injuries squared regardless of the body region
Senkowski CK et al. J Am Call Surg 1999
Aharonson DL. J Trauma. 2006

8. Patients and methods Retrospective study
ICU - “Dr. J. Benčević” General Hospital, Sl. Brod
Multi-disciplinary ICU, total 560 patients
67 (11,96%) polytrauma patients

9. Patients and methods Monitoring: GCS ECG, RR, pulse-oksimetry
Blood gases, ventilation parameters
Blood samples, microbiology cultures
diuresis
Ultrasound, RTG, CT
Central venous catheter, arterial line,PICCO …
ICP, IAP

10. Patients and methods General data (sex, age)
Time from injury to ICU admittance
Procedures performed before ICU arrival (venous access, intubation, cardio-pulmonary resuscitation)
Procedures performed immediately on ICU arrival

11. Patients and methods Severity of injury was assesed using:
GCS, RTS, ISS, TRISS and NISS
Based on ISS and NISS score patients were divided in 4 groups (0-15, 16-26, 27-44, >45 points).

12. Patients and methods ICU treatment:
Number of surgicaly treated patients
Time from ICU arrival to surgery
Patients that had to be transferred to a tertiary centre for treatment continuation
Application of mechanical ventilation (MV) as well as total MV duration
Incidence of hospital pneumonia and life-threathening complications
Need for tracheostomy
ICU mortality
Time spent in ICU

13. Results Gender : male n (%) female n (%) 56 (83.6) 11 (16.4)
Age (years):
39.4 (5 – 94)
Time from injury to ICU admittance:
1 (0.5 – 2) h
Procedures performed before ICU arrival :
Venous access n (%)
Intubation n (%)
CPR n (%)
15 (22.3)
2 (2.9)
Procedures performed immediately on ICU arrival:
67 (100)
41 (61.2)

14. Results Age – 39.4 (5-94) years <10 11-30 31-50 51-70 >70
5 (7.5%)
23 (34.3%)
17 (25.4%)
15 (22.4%)
7 (10.4%)

15. Results GCS 9.97 (3 – 15) (≤8 = 28 patients – 41.8 %)
Systolic blood pressure mmHg
125.9 (0 – 250)
Respiratory frequency n/min
11.25 (0 – 25)
RTS score:
9.7 (0 –12)
ISS score:
24 (3 – 75)
TRISS score:
34 (16 – 79)
NISS score:
31.7 (6 – 75)

16. Results ISS score: 24 (3 – 75) ≤15 16-26 27-44 >45 22 (32.8%)
11 (16.4%)
30 (44.8%)
4 (6%)
RTS score: 9.7 (0 –12)
0-6
7-10
11-12
11 (16.4%)
18 (26.9%)
38 (56.7%)
NISS score: (6 – 75)
≤15
16-26
27-44
>45
17 (25.4%)
13 (19.4%)
20 (29.8%)

17. Results Surgically treated n (%): 36 (53.7) Time to surgery:
1.2 (1 – 6) h
Transfer to tertiary centre n (%):
4 (6)
Mechanical ventilation n (%):
51 (76.1)
Mechanical ventilation duration:
3.57d (6h – 34d)
Hospital pneumonia n (%):
6 (9)
Life threathening complications n (%):
13 (19.4)
Tracheostomy n (%):
ICU mortality n (%):
9 (13.4)
Time spent in ICU:
5d (1 h – 34 d)

18. Mortality rates in 3 age groups for diff. ISS
Dob
(godine)
ISS=15
(%)
ISS=25
ISS=35
ISS=45
ISS=55
0 – 49 3 8 32 61 89
50 – 69 5 21 56 68
100
> 70 16 45 82
( patients in a retrospective study, 10 hospitals, 5 years)
J Trauma. 2006

19. Discussion German Surgery Congress 2001.:
5353 polytrauma patients (median age - 38 years)
ISS 24.8
Time to MD arrival 22.4 min, stay 32.9 min, transport 18.3 min
intubated 58.3 %
Hospital stay 31.1 dan

20. Conclusion
Polytrauma patients require long-lasting treatment and substantial financial resources
Mortality and invalidity reduction can be achieved only through application of specific algorithms, quality diagnostic and monitoring and a multidisciplinary therapeutic approach.

21. Thank you