title: The definition of polytrauma revisited: An international consensus process and proposal of the new 'Berlin definition'
abstract: BACKGROUND
  The nomenclature for patients with multiple injuries with high mortality rates is highly variable, and there is a lack of a uniform definition of the term polytrauma. A consensus process was therefore initiated by a panel of international experts with the goal of assessing an improved, database-supported definition for the polytraumatized patient.
  
  
  METHODS
  The consensus process involved the following: RESULTS: A total of 28,211 patients in the trauma registry met the inclusion criteria. The mean (SD) age of the study cohort was 42.9 (20.2) years (72% males, 28% females). The mean (SD) ISS was 30.5 (12.2), with an overall mortality rate of 18.7% (n = 5,277) and an incidence of 3% of penetrating injuries (n = 886). Five independent physiologic variables were identified, and their individual cutoff values were calculated based on a set mortality rate of 30%: hypotension (systolic blood pressure ≤ 90 mm Hg), level of consciousness (Glasgow Coma Scale [GCS] score ≤ 8), acidosis (base excess ≤ -6.0), coagulopathy (international normalized ratio ≥ 1.4/partial thromboplastin time ≥ 40 seconds), and age (≥70 years).
  
  
  CONCLUSIONS
  Based on several consensus meetings and a database analysis, the expert panel proposes the following parameters for a definition of "polytrauma": significant injuries of three or more points in two or more different anatomic AIS regions in conjunction with one or more additional variables from the five physiologic parameters. Further validation of this proposal should occur, favorably by mutivariate analyses of these parameters in a separate data set.
authors.affiliation: From the Department of Orthopedics/Trauma (P.L.), Aachen University Medical Center; and Harald Tscherne Lab for Orthopaedic Trauma (H.-C.P., P.L.), Aachen; Institute for Research in Operative Medicine (IFOM) (R.L., B.B.), University of Witten/Herdecke, Witten; Department of Orthopaedics (R.L., B.B.) at Merheim, Cologne; and Department of Trauma, Hand, and Reconstructive Surgery (I.M.), J. W. von Goethe University, Frankfurt; Department of Orthopaedic Trauma (C.J.), University of Leipzig, Leipzig; and AUC-Academy for Trauma Surgery (U.S.), Munich, Germany; Department of Traumatology (N.B., Z.B.), John Hunter Hospital and University of Newcastle, Newcastle, Australia; Department of Surgery (A.P.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and Department of Orthopaedic Surgery (P.S.), Denver Health Medical Center, Denver, Colorado, Department of Trauma (L.L.), Utrecht University, Utrecht, the Netherlands; and Department of Trauma (P.G.), Academic Unit of the University of Leeds, West Yorkshire, United Kingdom.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Pape
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.forename: Nerida
authors.initials: N
authors.lastname: Butcher
authors.forename: Andrew
authors.initials: A
authors.lastname: Peitzman
authors.forename: Luke
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authors.lastname: Leenen
authors.forename: Ingo
authors.initials: I
authors.lastname: Marzi
authors.forename: Philip
authors.initials: P
authors.lastname: Lichte
authors.forename: Christoph
authors.initials: C
authors.lastname: Josten
authors.forename: Bertil
authors.initials: B
authors.lastname: Bouillon
authors.forename: Uli
authors.initials: U
authors.lastname: Schmucker
authors.forename: Philip
authors.initials: P
authors.lastname: Stahel
authors.forename: Peter
authors.initials: P
authors.lastname: Giannoudis
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Balogh