Epidemiology of extremity injuries in multiple trauma patients
Epidemiology of extremity injuries in multiple trauma patients
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DOI：
10.1016/j.injury.2012.12.007
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发表时间：
2013-08-01
影响因子：
2.5
通讯作者：
Wafaisade, Arasch
中科院分区：
文献类型：
--
作者：
Banerjee, Marc;Bouillon, Bertil;Wafaisade, Arasch
背景：先前的研究表明，在严重创伤后，不同的四肢损伤与更差的预后相关。本研究的目的是确定多发伤患者四肢损伤的流行病学数据，包括患病率、损伤类型、特定损伤机制及其对死亡率的影响。
方法：德国创伤外科学会创伤登记处自1993年起匿名记录重伤患者的数据。将2002年至2009年间记录的、年龄大于16岁且损伤严重度评分（ISS）≥16的创伤病例分为简明损伤定级标准（AIS）≥2（有明显四肢损伤）组和无明显四肢损伤组。对两组的损伤类型、治疗特点和死亡率进行比较。
结果：在24885名患者中，超过一半（58.6%）有明显的四肢损伤。有相关四肢损伤的患者平均每例有2.1处骨折，4.9%的患者甚至有五处或更多四肢损伤。股骨骨折（16.5%）、胫骨骨折（12.6%）和锁骨骨折（10.4%）是最常见的骨折。无明显四肢损伤的患者在现场的格拉斯哥昏迷评分明显更低，脑损伤更严重，30天死亡率和住院死亡率更高。相比之下，有明显四肢损伤的患者严重胸部创伤发生率更高，红细胞输血率以及大量输血率更高，手术次数更多，重症监护病房（ICU）住院时间和总住院时间更长。
结论：有和无明显四肢损伤的多发伤患者在创伤后早期病程和生存方面可被视为两个不同的群体。无四肢损伤的患者头部损伤更严重，死亡率更高。然而，明显的四肢损伤与更差的预后相关，包括手术次数更多、输血率更高以及住院时间更长。（C）2012爱思唯尔有限公司。保留所有权利。
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. (C) 2012 Elsevier Ltd. All rights reserved.