Polytrauma: Definition of the Problem and Management Strategy (Review)

Abstract

Polytrauma is a highly relevant problem from both scientific and clinical perspectives due to its high mortality rate (>20% in young and middle-aged individuals and >45% in the elderly). The lack of consensus in the definition of polytrauma complicates data collection and comparison of available datasets. In addition, selection of the most appropriate management strategy determining the quality of medical care and magnitude of invested resources can be challenging.Aim of the review. To revisit the current definition of polytrauma and define the perspective directions for the diagnosis and management of patients with polytrauma.Material and methods. Based on the data of 93 selected publications, we studied the mortality trends in the trauma and main causes of lethal outcomes, analyzed the polytrauma severity scales and determined their potential flaws, examined the guidelines for choosing the orthosurgical strategy according to the severity of the patient’s condition.Results. The pattern of mortality trends in trauma directly depends on the adequacy of severity assessment and the quality of medical care. The Berlin definition of polytrauma in combination with a mCGS/PTGS scale most accurately classifies polytrauma into four severity groups. For the «stable» patients, the use of primary definitive osteosynthesis with internal fixation (early total care, or ETC) is the gold standard of treatment. For the «borderline» and «unstable» groups, no definitive unified strategy has been adopted. Meanwhile, in «critical» patients, priority is given to general stabilization followed by delayed major surgery (damage control orthopaedics, or DCO), which increases survival.Conclusion. The use of artificial intelligence and machine learning, which have been employed for more specific goals (predicting mortality and several common complications), seems reasonable for planning the management strategy in the «controversial» groups. The use of a clinical decision support system based on a unified patient registry could improve the quality of care for polytrauma, even by less experienced physicians.