Das Schädelhirntrauma dominiert die systemische Entzündungsreaktion im posttraumatischen Verlauf

Abstract

Aim/Background: Severe trauma causes a systemic inflammatory response which may lead to multiple organ failure (MOF). The aim of this study was to evaluate the influence of the injury pattern on the incidence and severity of posttraumatic inflammatory complications. Methods: A total of 1273 patients with an injury severity score (ISS) ≥ 9 points, age > 16 years, and survival of ≥ 3 days were included in this retrospective study. Outcomes included different grades of systemic inflammatory response syndrome (SIRS), sepsis, and MODS (Goris score), as well as mortality. Logistic regression analysis was performed by SPSS-software to test injury pattern as well as age, sex, and ISS as risk factors. Results: Severe non-infectious SIRS occurred in 23%, sepsis in 14% and severe MODS in 14% of enrolled patients. Severe traumatic head injury was seen in 49% and the overall mortality rate was 7%. Severe head injury and a high ISS represented the most potent risk factors for severe SIRS. Complex injuries of extremities, pelvis or abdomen, as well as the ISS and male sex were predictors for sepsis. Severe MODS could be predominantly observed in patients with high ISS, male sex, severe head or abdominal injuries. A high mortality was determined by severe head injury, high ISS and progressive age. Conclusion: Severe head injury dominates non-infectious systemic inflammation, multiple organ failure, as well as late mortality. Septic complications were determined by abdominal and skeletal injuries. The incidence of life-threatening inflammatory complications during the posttraumatic course can be associated with distinct injury pattern.