Management of polytraumatized patients with associated blunt chest trauma: a comparison of two European countries.
BACKGROUND
Blunt chest trauma represents one of the most common injuries in polytrauma patients. Blunt chest injury complicating polytrauma is associated with significant prolongation of intensive care stay. Further, it has a great impact on the timing of fixation of skeletal injuries, possibly contributing to adverse outcome. The purpose of this study is to assess whether there are any differences in the management and outcome of polytrauma patients with blunt chest trauma between trauma units in two different countries. Detailed information about advantages and disadvantages of these two systems might allow optimising the management of blunt chest trauma.


METHODS
This investigation was performed using the polytrauma database of the German Trauma Society and the British Trauma Audit Research Network. After the definition of the inclusion abbreviated injury scale (AIS(chest) > or = 3) and injury severity score (ISS > 16) and exclusion (AIS(head/neck) > or = 2, referral from outside institutions) criteria, patients were recruited solely from these databases.


RESULTS
188 patients from the German database and 181 patients from the British database were enrolled in this study. Demographic data and injury pattern of the two patient populations did not significantly differ. The volume of initial red blood cell transfusion and length of the intensive care stay were significantly higher in Germany (p < 0.05). Mortality in the UK was 9% higher than in Germany (p = 0.057). Time to death in non-survivors was also significantly longer in Germany (p < 0.05).


CONCLUSIONS
The reasons for the differences regarding survival times and survival rates seem to be multiple. German patients received more red blood cells, had a longer hospital stay in intensive care and a better survival rate. The use of kinetic therapy in Germany, not standard in the UK, may contribute to a more favourable outcome.
Hildebrand
Frank
F
Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. Hildebrand.Frank@mh-hannover.de
Giannoudis
Peter V
PV
Griensven
Martijn van
Mv
Zelle
Boris
B
Ulmer
Bastian
B
Krettek
Christian
C
Bellamy
Mark C
MC
Pape
Hans-Christoph
HC
D015998:Abbreviated Injury Scale; D000063:Accidents, Traffic; D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods; D019992:Databases as Topic; D005260:Female; D005858:Germany; D006302:Health Services Research; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D009104:Multiple Trauma / Q000150:complications / Q000209:etiology / Q000628:therapy*; D011379:Prognosis; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology; D013898:Thoracic Injuries / Q000150:complications / Q000209:etiology / Q000628:therapy*; D014193:Trauma Centers; D006113:United Kingdom; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000209:etiology / Q000628:therapy*