Improved outcomes after polytrauma: Do we know the reasons?

Abstract

Many readers of INJURY have been involved in trauma care for more than 10 years. Over that period of time or longer, it has become apparent to most that the field has changed. While mechanisms of injury have largely stayed the same, injury prevention initiatives have produced some significant reductions in the incidence of particular injuries. 4 Cothren C.C. Moore E.E. Hedegaard H.B. Meng K. Epidemiology of urban trauma deaths: a comprehensive reassessment ten years later. J Surg Res. 2006; 130: 328 Abstract Full Text Full Text PDF Google Scholar Trauma treatments and the trauma care delivery environment have both changed over the past decade usually resulting in reduced mortality and shorter hospital stays. Prehospital care has involved more sophistication, 13 Macfarlane C. The advances and evidence base for prehospital care. Emerg Med J. 2003; 20: 114-115 Crossref PubMed Scopus (13) Google Scholar and specialised in-hospital care has developed new paradigms. 3 Bose D. Tejwani N.C. Evolving trends in the care of polytrauma patients. INJURY. 2006; 37: 20-29 Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar For the severely injured, “damage control” has become an accepted approach amongst most trauma care subspecialties. 16 Schwab C.W. Introduction: damage control at the start of the 21st century. INJURY. 2004; 35: 639-642 Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar A multidisciplinary approach to trauma care has become common and early directed rehabilitation accepted as associated with better outcomes. 5 Curtis K. Zou Y. Morris R. Black D. Trauma case management: improving patient outcomes. INJURY. 2006; 37: 626-632 Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar , 17 Sirois M.-J. Lavoie A. Dionne C.E. Impact of transfer delays to rebilitation in patients with severe trauma. Arch Phys Med Rehab. 2004; 85: 184-191 Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar While these advances are all positive, the trauma patient is becoming older and has more comorbidities. Despite the age of the patients and their comorbidities, outcomes are generally as good or better than in previous decades but the mode of death is different. In contrast to Trunkey's seminal paper on the trimodal pattern of death, 18 Trunkey D.D. Trauma Sci Am. 1983; 249: 28-35 Crossref PubMed Scopus (653) Google Scholar in the prehospital, early and later hospital phases of care, death from trauma has increasingly occurred early and the incidence of multiple organ failure decreased. 9 Demetriades D. Kimbrell B. Ali S. et al. Trauma deaths in a mature urban trauma system: is “trimodal” system a valid concept?. J Am Coll Surg. 2005; 201: 343-348 Abstract Full Text Full Text PDF PubMed Scopus (186) Google Scholar , 14 Pang J-M, Civil I, Ng A, et al. Is the trimodal pattern of death after trauma a dated concept in the 21st century? Trauma deaths in Auckland 2004. INJURY, doi:10.1016/j.injury.2007.05.022, in press. Google Scholar , 15 Sauaia A. Moore F.A. Moore E.E. et al. Epidemiology of trauma deaths: a reassessment. J Trauma. 1995; 38: 185-193 Crossref PubMed Scopus (1485) Google Scholar