Application status of the definition of polytrauma in clinical research-A review of the past decade

Background: The purpose of this study was to investigate the evolution and latest trends in the application of different polytrauma definitions in the past ten years of clinical research, by collecting published polytrauma study data.

Method: We conducted Pubmed, Embase and Ovid searches of literature on polytrauma, published between January 2008 and December 2018. The title, author name, definition of polytrauma, publishing date, country, type of article, and the name and impact factor of journal were recorded and analysed.

Results: Based on different definition of polytrauma, the selected articles were grouped into four categories: (1) definition of polytrauma based on ISS, (2) definition of polytrauma based on NISS, (3) definition of polytrauma based on AIS, (4) descriptive definition of polytrauma. The 321 selected articles were published in 56 journals, predominantly in European and American medical journals, led by Injury (n = 41), followed by Journal of Trauma and Acute Care Surgery (n = 27) and European Journal of Trauma and Emergency Surgery (n = 17). Germany had the largest number of publications, with 88 articles. All articles were clinical research. There were 88 multi-centre studies and 233 single-centre studies.

Conclusions: The definition of polytrauma in clinical research was still mainly based on ISS. The appearance of the “New Berlin Definition” provides a new direction for its development. However, all these varying definitions are inconsistent and a globally recognised definition of polytrauma should be established.

Polytrauma; Definition; Bibliometric analysis; ISS; NISS; AIS

[1] Schröter C, Urbanek F, Frömke C, Winkelmann M, Mommsen P, Krettek C, et al. Injury severity in polytrauma patients is underestimated using the injury severity score: a single-center correlation study in air rescue. European Journal of Trauma and Emergency Surgery. 2019; 45: 83-89.

[2] Butcher NE, D’Este C, Balogh ZJ. The quest for a universal definition of polytrauma. Journal of Trauma and Acute Care Surgery. 2014; 77: 620-623.

[3] Butcher N, Balogh ZJ. The definition of polytrauma: the need for international consensus. Injury. 2009; 40: S12-S22.

[4] Altieri R, Citarelli C, Cofano F, Zenga F, Ducati A, Garbossa D. Concomitant thoracic and spinal injuries in politraumatized patient, a frequent but few discussed entity. A case report. Journal of Universal Surgery. 2015; 5: 1-4.

[5] Osterwalder JJ. Could a regional trauma system in eastern Switzerland decrease the mortality of blunt polytrauma patients? A Prospective Cohort Study. the Journal of Trauma: Injury, Infection, and Critical Care. 2002; 52: 1030-1036.

[6] Keel M, Eid K, Labler L, Seifert B, Trentz O, Ertel W. Influence of injury pattern on incidence and severity of posttranmatic inflammatory compli-cations in severely injured patients. European Journal of Trauma.2006; 32: 387-395.

[7] Sikand M, Williams K, White C, Moran CG. The financial cost of treating polytrauma: Implications for tertiary referral centres in the United Kingdom. Injury. 2005; 36: 733-737.

[8] Biewener A, Aschenbrenner U, Rammelt S, Grass R, Zwipp H. Impact of helicopter transport and hospital level on mortality of polytrauma patients. The Journal of Trauma: Injury, Infection, and Critical Care. 2004; 56: 94-98.

[9] Fueglistaler P, Amsler F, Schüepp M, Fueglistaler-Montali I, Attenberger C, Pargger H, et al. Prognostic value of Sequential Organ Failure Assessment and Simplified Acute Physiology II score compared with trauma scores in the outcome of multiple-trauma patients. the American Journal of Surgery. 2010; 200: 204-214.

[10] Mica L, Simmen H, Werner CML, Plecko M, Keller C, Wirth SH, et al. Fresh frozen plasma is permissive for systemic inflammatory response syndrome, infection, and sepsis in multiple-injured patients. the American Journal of Emergency Medicine. 2016; 34: 1480-1485.

[11] Hildebrand F, Giannoudis P, Kretteck C, Pape H. Damage control: extremities. Injury. 2004; 35: 678-689.

[12] Pape H, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H. Appraisal of Early Evaluation of Blunt Chest Trauma: Development of a Standardized Scoring System for Initial Clinical Decision Making. the Journal of Trauma: Injury, Infection, and Critical Care. 2000; 49: 496-504.

[13] McLain RF. Functional Outcomes after Surgery for Spinal Fractures: Return to Work and Activity. Spine. 2004; 29: 470-477.

[14] Butcher NE, D’Este C, Balogh ZJ. The quest for a universal definition of polytrauma. Journal of Trauma and Acute Care Surgery. 2014; 77: 620-623.

[15] Butcher N, Balogh ZJ. AIS>2 in at least two body regions: a potential new anatomical definition of polytrauma. Injury. 2012; 43: 196-199.

[16] Wang X, Yu H, Nie C, Zhou Y, Wang H, Shi X. Road traffic injuries in China from 2007 to 2016: the epidemiological characteristics, trends and influencing factors. PeerJ. 2019; 7: e7423.

[17] Gao J, Gao Y, Zeng J, Wang J, He P, Wei G, et al. Polytrauma with thoracic and/or abdominal injuries: experience in 1 540 cases. Chinese Journal of Traumatology = Zhonghua Chuang Shang Za Zhi. 2006; 9: 108-114.

[18] Rau C, Wu S, Kuo P, Chen Y, Chien P, Hsieh H, et al. Polytrauma Defined by the New Berlin Definition: a Validation Test Based on Propensity-Score Matching Approach. International Journal of Environmental Research and Public Health. 2017; 14: 1045.

[19] Pape H, Lefering R, Butcher N, Peitzman A, Leenen L, Marzi I, et al. The definition of polytrauma revisited. Journal of Trauma and Acute Care Surgery. 2014; 77: 780-786.

[20] Kondo Y, Abe T, Kohshi K, Tokuda Y, Cook EF, Kukita I. Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score. Critical Care. 2011; 15: R191.