title: Definition of polytrauma: Discussion on the objective definition based on quantitative estimation of multiply injured patients during wartime.
abstract: OBJECTIVE
  There is a clear lack of consensus on a validated definition of the term "polytrauma". This study presents and classifies the extent of injuries during wartime in Croatia using the Revised Trauma Score and Injury Severity Score (TRISS) and compares the scores with a clinical estimation based on subjective assessments of polytraumatised and non-polytraumatised patients.
  
  
  METHODS
  We analysed the data from 426 war victims who sustained multiple injuries and were managed at Osijek University Hospital from September 1st 1991 to December 31st 1991. The victims were divided into polytraumatised (n=149) and multitraumatised (n=277) patients according to the initial clinical estimation of the extent of injury. Patients classified as monotraumatised were excluded from this study. The assessment was based on the following definition of polytrauma: simultaneous injury of two or more body regions or anatomical systems with at least one injury being life-threatening. All data were scored retrospectively using TRISS methodology.
  
  
  RESULTS
  Two patients classified as polytraumatised had an ISS of less than 16, and one patient classified as multitraumatised had an ISS of more than 16. The difference between the actual (29.5%) and expected (40.44%) postoperative mortality in the polytraumatised group was statistically significant (p=0.0016), whereas in the multitraumatised group, the difference between the actual (3.2%) and expected (3.04%) postoperative mortality was not significant (p=0.6103).
  
  
  CONCLUSIONS
  The data show that clinical and subjective assessment of polytraumatised patients can be useful in the management of such cases and can be tested retrospectively using TRISS methodology.
authors.affiliation: Department for Traumatology and Orthopaedics, University Hospital Dubrava, Zagreb, Av. Gojka Suska 6, HR-10040 Zagreb, Croatia. Electronic address: zlovric@kbd.hr.
authors.forename: Zvonimir
authors.initials: Z
authors.lastname: Lovrić
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D003210:Concept Formation; D032921:Consensus; D017523:Croatia / Q000453:epidemiology; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D009626:Terminology as Topic; D015599:Trauma Severity Indices; D000067398:War-Related Injuries / Q000175:diagnosis*
keywords: Assessment; Definition of polytrauma; Management; Multiple injuries; Surgery; War injury