Multiple Injury Patients Research Articles

Comparison of Management of Multiple Knee Ligaments Injury: A Clinical Study

Background: Multiple ligament knee injuries (MLKI) are usually the result of knee dislocations following either high energy motor vehicle accidents or low velocity sport injuries. Hence; we planned the present study to assess and compare two different management protocols for treating patients with multiple knee ligament injuries. Methods: The present study involved comparison of two different methods of management of multiple knee ligament injuries. A total of 20 patients with multiple ligament injured knee were included in the present study. All the patients were broadly divided into two study groups as follows: Group 1: Included patients who were treated with one-stage process .i.e. all ruptured ligaments were repaired or reconstructed at a single stage of operation. Group 2: Included patients who were treated with staged processes .i.e. the entire surgical procedure was carried out in multiple stages Complete follow-up details of all the subjects were obtained. Knee injury and osteoarthritis outcome score during follow-up was used for assessment of results. Results: Mean age of the subjects of group 1 and group 2 was 39.5 years and 36.4 years respectively. While comparing the sports and knee symptoms of the knee injury and osteoarthritis outcome score during follow-up, significant results were obtained.Conclusion: Surgical treatment protocol is reliable mode of treatment for treating multiple ligament injury patients.

Aetiological spectrum, injury characteristics and treatment outcome of multiple injuries at a tertiary care hospital in Tanzania

Background: Multiple injuries constitute a public health problem and contribute significantly to high morbidity, mortality and long-term disabilities worldwide. This study describes the etiological spectrum, injury characteristics and treatment outcome of multiple injuries at a tertiary care hospital in Tanzania.Methods: This was a descriptive prospective study involving multiple injury patients admitted to Bugando Medical Centre (BMC) from March 2013 to June 2013 inclusive.Results: Out of 712 trauma patients who were admitted to BMC during the study period, 150 (21.1%) had multiple injuries. Their male to female ratio was of 2.3:1. The majority of patients were in the second decade of life. Road traffic accidents (RTAs) were the most common (93.3%) cause of injury. The majority of patients, 142 (94.7%) sustained blunt injuries. Twelve (8.0%) patients had pre-hospital care. The limbs (89.2%) and the head (78.7%) were the most common body regions injured. The majority of patients (85.3%) sustained severe injuries (ISS ≥ 16). Out of 150 patients, 46 (30.7%) had 65 missed injuries. A total of 142 (94.7%) patients were treated surgically. Wound debridement (87.3%) was the most common surgical procedure performed. The complication and mortality rates were 54.7% and 38.7%, respectively. The overall median length of hospital stay (LOS) was 23 days. Co-morbid illness, HIV positivity, CD4 count (≤ 200 cells/μl), severe trauma (ISS ≥ 16), admission Systolic Blood Pressure < 90 mmHg, missed injuries and surgical site infection significantly influenced mortality (P < 0.001). Patients who developed complications and those who had long bone fractures stayed longer in the hospital (p < 0.001).Conclusion: Road traffic accidents remain a major cause of multiple injuries at BMC and contribute significantly to unacceptably high morbidity and mortality. Urgent preventive measures targeting at reducing the occurrence of road traffic accidents is necessary to reduce the incidence of multiple injuries in our centre.

Damage Control Orthopedics

Purpose of Review This review focuses on the concept of damage control orthopedics (DCO), the staged procedure to prevent the multiple injury patients from additional unnecessary trauma by postponable extensive surgery.

Incidence and risk factors for complications after definitive skeletal fixation of lower extremity in multiple injury patients: a retrospective chart review

Background: The management of multiple injuries is complex. Type and timing of treatment for lower extremity fractures is a controversial subject. Although many studies have demonstrated the safety and effectiveness of early treatment, others have suggested that early definitive stabilization may cause complications, especially with chest and head injuries. The aim of this study was to determine the complications and effects of timing of fixation, and investigate risk factors for complications in multiple injuries patients with lower extremity fractures. Methods: A Retrospective chart review from Khon Kaen Trauma Registry between 2008 and 2015 were collected. All major complications were identified and collected for example acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and sepsis. The time to definitive skeletal fixation from initial injury was identified and analyzed with multiple logistic regression. Results: 1224 multiple injuries patients with lower extremity fractures were identified. The mean age was 34±19.5 years, 74.4% were male and 25.6% female. The mean time from initial injury to definitive operation was 55.7±53.9 hours. Complications occurred with 178 patients (14.5%), the most common of which were pneumonia, ARDS and AKI. After adjusting for sex, severity of injury, we found that the operation within 24-48 hours complication was 6.67 times less common than in the early treatment group (less than 24 hours) (95% CI: 3.03 to 10.00, P-value< 0.001). Conclusions: About 15% of the multiple injuries patients with lower extremity fracture had major complications. The optimal time for definitive fixation in lower extremity fractures to reduce complications was within 24-48 hours. We found that if we operated too early (before 24 hours) or more than 48 hours after the injury it could increase the morbidity and mortality.

Incidence and risk factors for complications after definitive skeletal fixation of lower extremity in multiple injury patients: a retrospective chart review.

Background: The management of multiple injuries is complex. Type and timing of treatment for lower extremity fractures is a controversial subject. Although many studies have demonstrated the safety and effectiveness of early treatment, others have suggested that early definitive stabilization may cause complications, especially with chest and head injuries. The aim of this study was to determine the complications and effects of timing of fixation, and investigate risk factors for complications in multiple injuries patients with lower extremity fractures. Methods: A Retrospective chart review from Khon Kaen Trauma Registry between 2008 and 2015 were collected. All major complications were identified and collected for example acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and sepsis. The time to definitive skeletal fixation from initial injury was identified and analyzed with multiple logistic regression. Results: 1224 multiple injuries patients with lower extremity fractures were identified. The mean age was 34±19.5 years, 74.4% were male and 25.6% female. The mean time from initial injury to definitive operation was 55.7±53.9 hours. Complications occurred with 178 patients (14.5%), the most common of which were pneumonia, ARDS and AKI. After adjusting for sex, severity of injury, we found that the operation within 24-48 hours complication was 6.67 times less common than in the early treatment group (less than 24 hours) (95% CI: 3.03 to 10.00, P-value< 0.001). Conclusions: About 15% of the multiple injuries patients with lower extremity fracture had major complications. The optimal time for definitive fixation in lower extremity fractures to reduce complications was within 24-48 hours. We found that if we operated too early (before 24 hours) or more than 48 hours after the injury it could increase the morbidity and mortality.

Risk factor analysis on ventilator associated pneumonia among multiple injury patients with mechanical ventilation in comprehensive ICU

Objective To explore the risk factors of VAP among multiple injury patients in comprehensive ICU so as to provide the basis for prevention and cure of VAP. Methods The retrospective analysis was made to the clinical data from 126 patients with mechanical ventilation for over 48 hours in ICU at the Third People's Hospital of Zhenjiang, the Affiliated Hospital of Jiangsu University, from January 2014 to December 2015. The Logistic regression analysis was performed to research related data in order to identify the risk factors of VAP. Results In 126 patients, there were 37 (29.37%) patients with VAP. Single factor analysis showed that the risk factors were the time of mechanical ventilation, score of the injury severity scale (ISS) , time of being admitted to ICU, coma, sedation and analgesia, hormone use, medical history of chronic lung disease, combined antibiotic (>2 kinds) , craniocerebral trauma, thoracic injury, spinal injury with significant differences (t/χ2=3.382, 20.241, 4.212, 29.837, 7.616, 5.322, 4.384, 8.246, 5.677, 15.394, 4.864; P 2 kinds) , medical history of chronic lung disease, craniocerebral trauma, thoracic injury (OR=3.897, 6.697, 5.506, 5.104, 10.984, 4.911, 6.046; P<0.05) . Conclusions The incidence of VAP is high among multiple injury patients in comprehensive ICU. The monitor of risk factors of VAP in multiple injury patients should be enhanced. Moreover, the effective intervention on prevention and cure of VAP should be taken for patients with long time of mechanical ventilation, high score of ISS, coma, combined antibiotic (>2 kinds) , medical history of chronic lung disease, craniocerebral trauma, thoracic injury and so on so as to reduce the incidence of VAP. Key words: Intensive care units; Pneumonia, ventilator-associated; Multiple injury; Risk factors

Neuro, trauma, or med/surg intensive care unit: Does it matter where multiple injuries patients with traumatic brain injury are admitted? Secondary analysis of the American Association for the Surgery of Trauma Multi-Institutional Trials Committee decompressive craniectomy study.

Patients with nontraumatic acute intracranial pathology benefit from neurointensivist care. Similarly, trauma patients with and without traumatic brain injury (TBI) fare better when treated by a dedicated trauma team. No study has yet evaluated the role of specialized neurocritical (NICU) and trauma intensive care units (TICU) in the management of TBI patients, and it remains unclear which TBI patients are best served in NICU, TICU, or general (Med/Surg) ICU. This study is a secondary analysis of The American Association for the Surgery of Trauma Multi-Institutional Trials Committee (AAST-MITC) decompressive craniectomy study. Twelve Level 1 trauma centers provided clinical data and head computed tomography (CT) scans of patients with Glasgow Coma Scale score of 13 or less and CT evidence of TBI. Non-ICU admissions were excluded. Multivariate logistic regression was performed to measure the association between ICU type and survival and calculate the probability of death for increasing Injury Severity Score (ISS). Multiple injuries patients (ISS > 15) with TBI and isolated TBI patients (other Abbreviated Injury Scale score < 3) were analyzed separately. There were 3641 patients with CT evidence of TBI with 2951 admitted to an ICU. Before adjustment, patient demographics, injury severity, and survival differed significantly by unit type. After adjustment, unit type, age, and ISS remained independent predictors of death. Unit type modified the effect of ISS on mortality. TBI multiple injuries patients admitted to a TICU had improved survival across increasing ISS. Survival for isolated TBI patients was similar between TICU and NICU. Med/surg ICU carried the greatest probability of death. Multiple injuries patients with TBI have lower mortality risk when admitted to a trauma ICU. This survival benefit increases with increasing injury severity. Isolated TBI patients have similar mortality risk when admitted to a neuro ICU compared with a trauma ICU. Med/surg ICU admission carries the highest mortality risk. Therapeutic study, level IV.

Neurogenic bowel dysfunction translation and linguistic validation to classical Arabic

To translate and linguistically validate in classical Arabic the French version of the neurogenic bowel dysfunction (NBD). The Arabic translation was obtained using the “forward translation/backward translation” method. Multiple sclerosis patients and spinal cord injury patients were included. Clinical measures involved the evaluation of the intestinal and anorectal dysfunction. Patients were asked to respond to a questionnaire twice within a 15-day interval. An item-by-item analysis was conducted. Construct validity was investigated using the spearman rank correlation coefficient. The internal consistency of each factor was assessed by the Cronbach alpha coefficient. Twenty-three patients with colorectal disorders secondary to neurological disease were included, the average age was 40.79 ± 9.16 years and the sex ratio was 1.85. The questionnaire was feasible and acceptable, no items were excluded. The Spearman correlation was of 0.842. Internal consistency was judged as good through the Cronbach's alpha which was of 0.896. The Arabic version of NBD was reproducible and construct validity was satisfactory. The study of sensitivity to change with a larger number of patients will be the subject be further work.

Analysis of fluid resuscitation in critically injured patients—A central role of saline solutions

Abstract Objective Multiple injury patients are mostly in the productive age group and are at high risk of dying by exsanguination. In this study, the focus was set on fluid resuscitation, death, and outcome of critically injured patients. Methods In total, 2956 patients were included in this sample. The inclusion criteria were age ≥ 16 years and injury severity score ≥ 16. The sample was divided into groups of patients who died within 72 hours of injury and those who survived. Differences between the groups were measured by analysis of variance and Kruskal–Wallis test for parametric data. Independent predictors were analyzed by logistic regression, and the predictive quality was analyzed by receiver operating curves. The given volumina were normalized according the Trauma Score—Injury Severity Score of each patient. All analyses were performed using SPSS. Results The binary logistic regression revealed the given amount of saline solutions and colloids within the first 48 hours as independent predictors of survival ( p p = 0.003). The receiver operating curves revealed that the area under the curve increased as a function of time, and after 48 hours it was 0.825 for saline solutions and 0.702 for colloids for survival. Conclusion Fluid resuscitation does not negatively influence survival; however, the amount of fluids given within the first 24 hours after trauma is an independent predictor of survival with very good predictive quality.

Submental intubation: experience with 30 cases

IntroductionWhen a patient has multiple injuries, involving serious fractures in the maxillofacial region and base of skull, a tracheostomy is often performed to approach the different affected facial thirds simultaneously. Submental intubation offers an alternative to this type of airway management, involving a decreased risk for the patient due to its safety and versatility in treating nasal fractures and re-establishment of dental occlusion. MaterialsA total of 30 patients with different degrees of involvement of the facial thirds (superior, middle and inferior) were treated by our team, performing a submental intubation to maintain the airway. These fractures affected nasal bones and dental occlusion. ResultsIn all cases we accomplished an adequate reduction of nasal fractures and obtained an accurate dental occlusion, with no incidents during or after this intubation. ConclusionsSubmental intubation is a good alternative to treat multiple injury patients who have nasal and oral cavities involvement, avoiding the use of tracheostomy in cases that do not need it.

Efecto de la transfusión sanguínea en la mortalidad en politraumatismo

IntroductionManagement of trauma patient is the greatest challenge in orthopaedic emergency care. Its proper diagnosis and early management, including blood transfusion, is critical for patient outcome. Materials and methodsA prospective cohort study was conducted on all multiple injury patients between 18 and 59 years old admitted to the San José Hospital and University Children's San José Hospital with multiple trauma (ISS>17). They were followed-up until either discharge or death. Their demographic and clinical data were analysed in a database using descriptive statistics. ResultsA total of 97 patients were included, with mean age 38 years ± 12. The distribution multiple trauma was mild (78, 80%), moderate (12, 12%), and severe (7, 8%). All trauma patients suffered damage to limbs and pelvis, 75 (77%) closed brain trauma, 60 (61%) abdominal-pelvic, and 57 (58%) cardiovascular. Trauma causes included accidents (71, 73%), or falling from height (28, 27%). Initial haemoglobin was 12.8g/dl ± 2.1. There were more patients admitted to ICU in the transfusion group <6 h versus >24 h (68% vs 37%), but lower mortality (0% vs 60%). The mortality in the severe multiple injuries group was 85%. As the transfusion volume received increased, so did the number of patients in ICU. Among those who died, the highest proportion received transfusion (83% vs 17%). ConclusionHigher mortality was found among those patients transfused and in those who received a late transfusion. Evidence level: II.

损伤控制外科理论在重型颅脑损伤伴多发伤患者救治中的应用

目的：探讨损伤控制外科(DCS)理念在重型颅脑损伤伴多发伤患者救治中的应用。方法：回顾性分析采用DCS理念救治的69例重型颅脑损伤伴多发伤患者的临床资料，总结应用DCS理念救治重型颅脑损伤伴多发伤患者的临床效果。结果：本组69例患者，随访6个月，按格拉斯哥结局量表(GOS)分级：恢复良好31例；中度残疾8例；重度残疾19例；植物状态5例；死亡6例。结论：应用DCS理念针对重型颅脑损伤伴多发伤患者及时给予救治，明显提高救治成功率，降低死亡率。 Objective: To discuss the application of damage control surgery (DCS) in the treatment of severe traumatic brain injury combined with multiple injuries. Methods: The clinical data of 69 severe traumatic brain injury combined with multiple injuries patients who were treated with DCS were reviewed retrospectively. The concept and complications of DCS in treatment of severe traumatic brain injury combined with multiple injuries patients are summarized. Results: There are 69 patients, who’ve been followed up for 6 months. According to Glasgow outcome score method, 31 cases recovered well, 8 cases were moderate disability, 19 cases were severe disability, 4 cases were in vegetative state, and 6 cases died. Conclusions: Application of damage control surgery in severe traumatic brain injury combined with multiple injuries can improve the rescue efficiency and decrease the mortality.

Intubación submental: experiencia con 30 casos

IntroductionWhen a patient has multiple injuries, involving serious fractures in the maxillofacial region and base of skull, a tracheostomy is often performed to approach the different affected facial thirds simultaneously. Submental intubation offers an alternative to this type of airway management, involving a decreased risk for the patient due to its safety and versatility in treating nasal fractures and re-establishment of dental occlusion. MaterialsA total of 30 patients with different degrees of involvement of the facial thirds (superior, middle and inferior) were treated by our team, performing a submental intubation to maintain the airway. These fractures affected nasal bones and dental occlusion. ResultsIn all cases we accomplished an adequate reduction of nasal fractures and obtained an accurate dental occlusion, with no incidents during or after this intubation. ConclusionsSubmental intubation is a good alternative to treat multiple injury patients who have nasal and oral cavities involvement, avoiding the use of tracheostomy in cases that do not need it.

The history and development of trauma and emergency care in England

In the last decade, trauma care has become its own speciality. The creation of major trauma centres across the UK highlighted a clear clinical need to advance services for multiple injury patients who are known to have poor prognostic outcome. The story of trauma care development goes back well before the creation of the National Health Service (NHS). Although originally grouped with emergency medicine, the two have developed into their own distinct branches. This paper highlights key milestones and relationships in the development of trauma medicine alongside emergency medicine, from ancient times to present day, as well as the factors that have made them distinct. Reviewing the past can help medicine move forward.

The Flatness Index of Inferior Vena Cava is Useful in Predicting Hypovolemic Shock in Severe Multiple-Injury Patients

BackgroundComputed tomography (CT) signs of hypovolemic shock have been reported previously. Whether these signs can be used to clinically predict hypovolemic shock remains unclear. ObjectiveTo investigate the predictive value of CT signs for hypovolemic shock in severe multiple-injury patients. MethodsThe clinical and multi-slice spiral CT (MSCT) data from 63 severe multiple-injury patients admitted to our trauma center from January 2008 to December 2011 were reviewed. The caliber of the inferior vena cava (IVC) and abdominal aorta, and mean CT value of the abdominal organs in both the early and the delayed phases were measured. The patients were divided into two groups, a shock group (n = 34) and a stable group (n = 29), based on the occurrence of hypovolemic shock within 24 h after the CT scan. Receiver operating characteristic curve (ROC) analysis was performed to assess the predictive accuracy of these signs for hypovolemic shock. ResultsThe shock group, compared to the stable group, had a higher Injury Severity Score (30 ± 8 vs. 22 ± 6, respectively, p < 0.001), shock index (1.17 ± 0.37 vs. 0.96 ± 0.33, respectively, p = 0.019), and lactate level (3.27 ± 0.69 mmol/L vs. 2.56 ± 0.89 mmol/L, respectively, p = 0.001). Among all the CT signs, the flatness index of IVC had the largest area under the curve (0.833) in ROC analysis, with sensitivity of 73.5% and specificity of 86.2%, higher than traditional indices and other CT signs. The optimal diagnostic cutoff value for the flatness index of IVC was 3.02. ConclusionMSCT can provide useful information for predicting hyovolemic shock in severe multiple-injury patients. An IVC flatness index > 3.02 suggests the presence of hypovolemic shock in severe multiple-injury patients.

Intrathecal baclofen in multiple sclerosis and spinal cord injury: complications and long-term dosage evolution

Objective: To investigate the long-term dosage evolution and complication rate of intrathecal baclofen use in multiple sclerosis and spinal cord injury patients, based on a large population with a long follow-up. Design: Retrospective data analysis Setting: Academic hospital Subjects: Patients with multiple sclerosis (n = 81) or spinal cord injury (n = 49) having an intrathecal baclofen pump implanted at the University Hospitals Leuven between 1988 and 2009. Intervention: Medical records review of included patients in August 2010. Main measures: Complications linked to intrathecal baclofen therapy. Daily baclofen dosage after 3 and 6 months, and yearly thereafter. Data on dosage evolution were analysed using a mixed-effect linear model. Results: In 130 patients with a mean follow-up of 63 months, comprising 797 pump years, 104 complications were recorded. This corresponds to a complication rate of 0.011 per month, equally divided among both groups. Seventy-eight of these complications were catheter related. The mean dosage of baclofen stabilizes two years after implantation at 323 µg/day in the multiple sclerosis population. In spinal cord injury patients the daily dose only stabilizes after five years at a significantly higher dosage (504 µg/day). No significant increase in dosage is seen in the long term. Conclusions: In multiple sclerosis and spinal cord injury patients, intrathecal baclofen therapy has a complication rate of 1% per month. Complications are mainly due to catheter-related problems (74%). The intrathecal baclofen dosage stabilizes in the long term, indicating that long-term tolerance, defined as progressive diminution of the susceptibility to the effects of a drug, is not present.

Taponamiento cardíaco tras punción esternal. Utilidad de la ecografía focussed assessment with sonography for trauma

One of the aims of the medical profession is to be able to detect complications in patients during diagnostic tests and treatments. The early diagnosis of these complications can prevent a fatal outcome. The diagnosis is often based on clinical symptoms and supported by complementary tests. Diagnostic tests have been developed in the last few years that are rapid and easy to use, as well as being cost effective and minimally invasive.Focussed assessment with sonography for trauma ultrasound (echo-FAST) was introduced in the 1990s in the field of resuscitation as a test for the rapid detection of intra-abdominal and pericardial fluid in multiple injury patients, but its uses in other cases not involving trauma still raise doubts and controversy.A case is presented of a patient subjected to a sternal puncture for a bone marrow aspirate, who had a complication of a secondary cardiac tamponade, which was diagnosed early using echo-FAST.

The development of clinical nursing practice guideline for initial assessment in multiple injury patients admitted to trauma ward

Summary Background Missed diagnoses are very common in patients with multiple injuries. To help nurses identify missed injuries, this study aimed to develop and evaluate a clinical nursing practice guideline (CNPG) for the initial assessment of multiply injured patients admitted to the trauma ward in a provincial hospital in southern Thailand. Method The CNPG was developed using evidence-based knowledge of trauma assessment and the Advanced Trauma Life Support guideline. The CNPG was used by 18 nurses working in the trauma ward. They implemented the CNPG with 34 multiply injured patients. The outcome measures of the CNPG use were the nurses' self-reported compliance with the use of the CNPG, the nurses' satisfaction with using the CNPG, and the percentage of missed injuries detected as a result of the use of the CNPG. Results Most nurses (83.33%) reported complying with the CNPG and 72.2% of them indicated that their satisfaction with using the CNPG was at a high level. Missed injuries were discovered at a rate of 14.6% of the total injuries diagnosed in the injured patients within 24h of ward admission. Conclusion Further research needs to be conducted to establish if the CNPG could be more widely applied to improve the quality of care and increase the safety of those with multiple injuries.

Morphological Abnormalities of the Recto-Anal Inhibitory Reflex Reflects Symptom Pattern in Neurogenic Bowel

Bowel dysfunction amongst multiple sclerosis (MS) and spinal cord injury (SCI) patients often manifests as fecal incontinence (FI) or constipation, but the pathophysiology is poorly understood. Anorectal physiology provides an objective assessment of lower bowel functions and is increasingly being used in clinical practice. The purpose of this study was to correlate symptoms of bowel dysfunction in patients with spinal cord disease with findings in anorectal physiology. We hypothesized that specific abnormalities will correlate with symptoms: prolonged recto-anal inhibitory reflex in patients with incontinence and decreased rectal mucosal blood flow in patients with constipation. Forty-nine patients with MS (35 with predominant FI and 14 constipation), 46 supraconal SCI (mixed symptom load), and 21 healthy volunteers matched for age and sex were studied. Subjects completed validated constipation and FI symptom questionnaires. Patients underwent standard anorectal physiology, including assessment of rectal mucosal blood flow and recto-anal inhibitory reflex (RAIR). Severity of constipation correlates significantly with distension sensitivity (urge volume [r = 0.68, p = 0.002] and maximal volume [r = 0.39, p = 0.03]). Severity of constipation also correlated with diminished rectal mucosal blood flow in both patient groups (r = -0.51, p = 0.006). In both groups, constipation correlated with diminished relaxation of the sphincters in the RAIR whilst fecal incontinence correlated with a prolonged duration of RAIR (r = 0.33, p = 0.009) and recovery phase (r = 0.37, p = 0.05). Bowel symptoms in patients with MS and SCI correlate with specific alterations of anorectal physiology. This provides objective assessment of bowel symptoms and may allow tailored treatment to individual patients.

Early diagnosis and treatment of combined thoracoabdominal injury

Objective To summarize the experience in early diagnosis and emergency treatment for combined thoracoabdominal injury (CTI). Methods Clinical data of 58 cases of CTI admitted to our hospital from June 2001 to August 2009 were analyzed retrospectively.All the patients were treated by closed drainage of thoracic cavity,of which 12 cases were treated with thoracotomy,31 with laparotomy,seven with thoracic and abdominal incisions and three with combined thoracoabdominal incision.Internal fixation for long limb bones was performed in 27 cases,spinal laminectomy and pedicle screw fixation in five and amputation in one. Results After operation,six cases were found to have adult respiratory distress syndrome (ARDS) and 12 cases were complicated with multiple organ dysfunction syndrome (MODS).Fifty-three cases were cured and five died. Conclusions CTI based multiple injuries are severe and complicated.CT scan in the early stage plays a significant role in the diagnosis of CTI and closed drainage of thoracic cavity is an important assurance of the security of abdominal operation.Early diagnosis,correct choice of operation procedures and reasonable handling order of injured organs can improve the successful rescue rate for multiple injury patients. Key words: Multiple trauma; First aid; Combined thoracoabdominal injury