How To Clear Polytrauma Patients For Fracture Fixation

Injury 54 (2023) 292–317
Contents lists available at ScienceDirect
Injury
journal homepage: www.elsevier.com/locate/injury
Review
How to Clear Polytrauma Patients for Fracture Fixation: Results of a

systematic review of the literature
Roman Pfeifer a,∗,#, Felix Karl-Ludwig Klingebiel a,∗, Sascha Halvachizadeh a, Yannik Kalbas a,
Hans-Christoph Pape a
a
Department of Traumatology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
a r t i c l e i n f o a b s t r a c t
Article history: Introduction: Early patient assessment is relevant for surgical decision making in severely injured patients
Accepted 6 November 2022 and early definitive surgery is known to be beneficial in stable patients. The aim of this systematic review
is to extract parameters indicative of risk factors for adverse outcome. Moreover, we aim to improve
Keywords: decision making and separate patients who would benefit from early versus staged definitive surgical
Polytrauma fixation.
Surgical treatment strategy Methods: Following the PRISMA guidelines, a systematic review of peer-reviewed articles in English or
Safe definitive surgery German language published between (20 0 0 and 2022) was performed. The primary outcome was the
Damage control pathophysiological response to polytrauma including coagulopathy, shock/haemorrhage, hypothermia and
Timing of Fracture Fixation
soft tissue injury (trauma, brain injury, thoracic and abdominal trauma, and musculoskeletal injury) to
determine the treatment strategy associated with the least amount of complications. Articles that had
used quantitative parameters to distinguish between stable and unstable patients were summarized. Two
authors screened articles and discrepancies were resolved by consensus. Quantitative values for relevant
parameters indicative of an unstable polytrauma patient were obtained.
Results: The initial systematic search using MeSH criteria yielded 1550 publications deemed relevant
to the following topics (coagulopathy (n = 37), haemorrhage/shock (n = 7), hypothermia (n = 11), soft
tissue injury (n = 24)). Thresholds for stable, borderline, unstable and in extremis conditions were defined
according to the existing literature as follows: Coagulopathy; International Normalized Ratio (INR) and
viscoelastic methods (VEM)/Blood/shock; lactate, systolic blood pressure and haemoglobin, hypothermia;
thresholds in degrees Celsius/Soft tissue trauma: traumatic brain injury, thoracic and abdominal trauma
and musculoskeletal trauma.
Conclusion: In this systematic literature review, we summarize publications by focusing on different path-
ways that stimulate pathophysiological cascades and remote organ damage. We propose that these pa-
rameters can be used for clinical decision making within the concept of safe definitive surgery (SDS) in
the treatment of severely injured patients.
© 2022 The Authors. Published by Elsevier Ltd.
This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
Abbreviations: acots, acute coagulopathy of trauma shock; Ais, abbreviated in-

Background
jury scale; Ards, acute respiratory distress syndrome; Atls, advanced trauma life
support; C°, degree celsius; Cpp, cerebral perfusion pressure; Dc, damage control; Fracture fixation has been known to represent an essential part
Dcs, damage control surgery; Dco, damage control orthopedics; Etc, early total of the treatment in patients with multiple trauma [1]. Early defini-
care; Fpr, false positive rate; Hb, haemoglobin; Icp, intracerebral pressure; Iss, in-
tive surgery is known to be beneficial in stable patients [2], how-
jury severity score; Inr, international normalized ratio; Map, mean arterial pressure;
Mof, multiple organ failure; Mods, multiple organ dysfunction syndrome; Mtp, mas- ever, in patients with physiological derangements early fracture
sive transfusion protocol; NpPV, Negative predictive value. fixation is associated with severe complications during the clini-
#
Corresponding author. Roman Pfeifer, Department of Traumatology, University cal course [3]. Abbreviated surgery concepts reduced mortality and
Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland morbidity in selective polytrauma population [4]. However, there
E-mail addresses: [email protected] (R. Pfeifer), FelixKarl-
are no recommendations showing how to identify polytrauma pa-
[email protected] (F.K.-L. Klingebiel), [email protected] (S.
Halvachizadeh), [email protected] (Y. Kalbas), [email protected] (H.-C. tients with fractures that benefit from early surgical stabilization.
Pape). Numerous parameters can be used for the initial assessment of
∗
The authors contributed equally to this manuscript. polytrauma patients. Some of the parameters can alrealy be as-
https://doi.org/10.1016/j.injury.2022.11.008
0020-1383/© 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
R. Pfeifer, F.K.-L. Klingebiel, S. Halvachizadeh et al. Injury 54 (2023) 292–317
Fig. 1. Parameters required for initial assessment of a severely injured patient (following Pape et al.)
Pape HC, Giannoudis PV, Krettek C, Trentz O. Timing of fixation of major fractures in blunt polytrauma: role of conventional indicators in clinical decision making. J Orthop
Trauma. 2005 Sep;19(8):551–62. doi: 10.1097/01.bot.0 0 0 0161712.87129.80. PMID: 16,118,563.
sessed in the trauma bay (Fig. 1), while others are time-consuming Eligibility criteria
and only available during the clinical course, which limits the ini-
tial assessment of the patient. The assessment of injury severity Inclusion criteria were original studies published from 20 0 0 un-
in AIS/ISS is still very subjective and therefore not always optimal til 2022, reported in English or German language. Further inclu-
for surgical decision making [5]. Moreover, several clinical scores sion criteria were the assessment of the following selected quan-
or protocols have been proposed in order to classify severely in- titative parameters in polytrauma as defined by an injury sever-
jured patients [6]. Some of them focus mainly on one system (acid- ity score (ISS) of 16 points and higher. In this analysis, parame-
base system) and are therefore unsuitable for the complete assess- ters were sought to represent the four pathophysiologic cascades
ment of a multiply injured patient [7]. Others are very detailed and in the trauma bay [11]. These include: the triad of death (acido-
therefore difficult to use in daily practice [8]. However, the identifi- sis, coagulopathy and hypothermia) and the assessment of soft tis-
cation of patients at risk at the initial stage of treatment is crucial. sue damage and severity: Coagulopathy (including measures of ei-
The exhaustion of physiological reserves results in the develop- ther INR, or r-TEG/ROTEM-values), haemorrhage (blood pressure,
ment of profound acidosis, hypothermia and coagulopathy [9]. The haemoglobin count (Hb)), hypothermia (degrees Celsius ( °C)), soft
"Triad of Death” is widely accepted and parameters such as lac- tissue injuries including Thorax Trauma Severity Score (TTSS), ab-
tate, coagulation and temperature are routinely used as indicators dominal trauma and traumatic brain injuries (TBI), and severity of
of risk [10]. In blunt trauma patients’ tissue trauma and related cell extremity and pelvic injuries.
damage has been described as another component in the assess- Exclusion criteria were letters, commentaries, books, correspon-
ment of trauma patients [11]. Studies analysing the metabolome dence, conference abstracts, expert opinions, case studies, editori-
after trauma indicate that optimized resuscitative interventions in als, reviews and in vitro/vivo experiments. Further exclusion cri-
critically ill patients are possible after identifying the severity of teria included articles that assessed combat trauma, paediatric
tissue injury and haemorrhage [12]. trauma, and isolated traumatic brain injuries (TBI).
In the available literature, the majority of existing studies de-
pend on the availability of parameters included in large databases.
While, new parameters have recently become available, such as Information sources and search strategy
ROTEM/TEG, their possible value has not been fully evaluated [13].
The assessment of numerous systems and parameters, such as acid The primary information sources were MEDLINE, the reference
base, coagulation, temperature and tissue damage, has been shown lists of articles that met the inclusion criteria, and relevant studies
to be a safe measure allowing the early prediction of complications recommended by experts in the field of trauma surgery. The search
[14]. Taking into account the known four pathophysiological cas- was conducted between Jan 5 and April 5, 2022. A combination
cades, the aim of this systematic review is to identify parameters of controlled vocabulary and regular search terms was used. The
and thresholds that indicate risk factors for an unfavourable out- search terms were adjusted for each topic individually to detect
come (early complications), allowing the earliest possible manage- the most relevant sources.
ment of fractures. In addition, we aim to improve decision making
and distinguish patients who would benefit from early or staged References of included articles
definitive surgical fixation by identifying quantitative values that
are useful in daily practice. To provide a more profound data collection, all reviews that
were obtained by our search terms, were individually screened for
Methods referred relevant original articles focusing our regions of interest.
Those were included if fulfilling our inclusion criteria and anal-
The reporting of this systematic review adheres to the Pre- ysed separately. Next to papers identified via search terms, alterna-
ferred Reporting Items for Systematic Reviews and Meta-Analyses tive sources have been used to optimize the dataset. This includes
(PRISMA) guidelines (http://www.prisma-statement.org/). sources used by reviews, identified via our search terms, that fulfil
293
the inclusion criteria as well as relevant studies recommended by typical complications in the immediate post-traumatic course af-
experts in the field of trauma. ter polytrauma and the studies were inserted into the tables in
The search for the articles was performed for predefined areas a structured manner. General adverse outcomes after polytrauma
of interest as follows. were defined as mortality, mass transfusion, sepsis, MOF, SIRS, and
ARDS. More specific complications were included depending on the
Coagulopathy topic assessed. These included the presence of shock, MTP (Mas-
sive Transfusion Protocol) activation, and the diagnosis of trauma
(polytrauma∗ OR "multiple traum∗ " OR "major traum∗ " OR induced coagulopathy in the field of haemorrhage and coagulopa-
"severely injured") AND (INR OR "international normalized ratio" thy, and respiratory decompensation in the thoracic injury topic.
OR "ROTEM" OR "Extem" OR "FIBTEM" OR "TEG" OR “Viscoelastic Each pathophysiological cascade was considered in this review.
haemostatic assay” OR “VHA”) AND (complication∗ OR outcome∗ The parameters and their cutoff values were listed in a table
OR "DOC" OR "Damage control surgery∗ ") (Table 2) and the studies were compared. If the published val-
ues were associated with the lowest complication in the respec-
Haemorrhage and shock tive studies, then this parameter could indicate a "stable" state
of the patient as a threshold value. On the other hand, values
(polytrauma∗ OR "multiple traum∗ " OR "major traum∗ " demonstrating increasing destabilization of the patient and asso-
OR "severely injured") AND (anaemia∗ OR transfusion∗ AND ciated with increasing complication rates were determined as a
(haemoglobin OR HB OR Hb OR haematocrit OR HcT OR HCT)) cutoff value for an "unstable" state. Values between the "stable"
AND (complication∗ OR outcome∗ ) and "unstable" states were defined as "borderline." Patients "in ex-
tremis" were defined as being in an extreme situation, represent-
ing a life-threatening situation requiring immediate intensive care
Hypothermia
and resuscitation (Fig. 3).
(polytrauma∗ OR "multiple traum∗ " OR "major traum∗ " OR
Study risk of bias assessment
"severely injured") AND (hypotherm∗ OR "accidental hypotherm∗ ")
AND (" °C" OR ° OR "°F" OR degree∗ ) AND (complication∗ OR
Yet study methodology was not a limiting factor for inclusion in
outcome∗ )
this systematic review, a formal risk assessment using the Quality
in Prognosis Studies (QUIPS) tool was used for evaluation [15]. Two
Soft tissue injury
authors (FK, RP) rated those studies independently; in case of dis-
crepancy the higher risk evaluation was chosen (Table 3). Further
Thorax
aspects taken into consideration by the expert panel were study
"Thoracic trauma severity score"; “Thorax trauma severity
type, study size, clinical applicability and overall transferability of
score”; TraumaRegister AND thorax∗
the data for qualitative synthesis.
Traumatic brain iinjury Synthesis methods

(polytrauma∗ OR "multiple traum∗ " OR "major traum∗ " OR
"severely injured") AND ("TBI" OR "traumatic∗ brain∗ injur∗ " OR Data was collected manually by one of the first authors and
“severe head∗ ” OR "cerebral∗ injur∗ ") AND (("ICP" OR "Intracra- transferred onto a spreadsheet. In addition to general information
nial pressure∗ " OR “intracranial hypertension∗ ”) OR (TBI OR “se- and year of publication, items of interest were number of patients,
vere head injur∗ ” AND “mmHg”) OR ("craniecto∗ OR hemicran∗ OR type of study, outcome and quantitative parameters and their oc-
craniotomy∗ )) AND (complication∗ OR outcome∗ ); Polytrauma AND currence in the patient group. Synthesis was performed by adding
TBI AND Outcome; ("polytrauma∗ " OR "major injur∗ " OR "mul- data to a flow diagram and a summarizing overview that assessed
tiple trauma∗ ") AND "TBI" AND "ICP"; ("polytrauma∗ " OR "ma- the stability of polytrauma patients according to the pathophysio-
jor injur∗ " OR "multiple trauma∗ ") AND "TBI" AND "Damage con- logical pathways.
trol"; ("polytrauma∗ " OR "major injur∗ " OR "multiple trauma∗ ")
AND "TBI" AND "unstable"
Results
Pelvis Systematic review

"Polytrauma" AND "Pelvis" AND "damage control"; TraumaReg-
ister AND pelvi∗ The initial systematic search using MeSH criteria yielded 1550
publications deemed relevant to the above topics (coagulopathy
Selection process (n = 37), haemorrhage/shock (n = 7), hypothermia (n = 11), soft
tissue injury (n = 24)). Fig. 2 shows the flowchart of all included
The two first authors received the same list of articles and in- and excluded publications. After the exclusion of duplicates or
dependently screened the titles and abstracts for eligibility crite- studies that did not include the parameters of this systematic re-
ria. Any discrepancies were either resolved by consensus or, if nec- view, 68 remained; a further 8 papers included data to different
essary, by a third party (senior author). Following the screening topics. The results are presented in Table 1. Publications included
process full text analyses were performed. Data were extracted for each topic are summarized in Table 2.
and stored, and qualitative and quantitative synthesis was per-
formed. Articles were screened, analysed and stored as PDF files Coagulopathy
in EndNoteTM version 20 by CarivateTM .
INR
Data item A total of 23 publications on INR and trauma were included
(Table 2). Most publications mainly examined the association be-
Articles were stratified according to the aforementioned patho- tween INR or VEM and mortality or the need for massive trans-
physiological pathways. The included studies were searched for fusions. Studies indicate that an INR of 1.5 defines the presence
294
Fig. 2. Flowchart of the systematic review.
of coagulopathy. Our analysis found that in most studies (n = 11) quantitative value was established for patients defined as "in ex-
with an INR < 1.2 were less likely to be associated with higher tremis," but they must be associated with severe trauma-related
mortality and the need for massive transfusion (MTP) protocols. coagulopathy.
Other publications (Table 2) reported selected higher INR values
from 1.4 to >2. . Therefore, INR values below 1.2 were defined Rotational thromboelastometry (ROTEM)
as the criteria for a "stable" patient. The presence of coagulopa- Numerous parameters can be read from thromboelastography,
thy (INR >1.5) defined an "unstable" patient. The interval between and not all correlate closely with the presence of coagulopathy.
1.2 and 1.5 was defined as the "borderline" range. An INR > 1.2 Studies found that EXTEM CT, EXTEM MCF and FIBTEM MCF can
and < 1.5 is associated with an increased risk of complications. No be used for screening and repeated values are associated with the
295
Table 1
Quantitative values of the vicious cycle classified to stability of the patient.
PATHOGENETIC
PATHWAYS PARAMETER STABLE BORDERLINE UNSTABLE IN EXTREMIS REFERENCES
Haemorrhage Systolic Blood Pressure >100mmHg ≤100 mmHg / Uncontrollable haemorrhage or [16]
≥90mmHg <90 mmHg/Need hypotension non-responsible to
for therapy
vasopressors
Lactate <2 mmol/l ≥2 mmol/l / >4 mmol/l [17]
≤4 mmol/l
Haemoglobin >9 g/dl ≤9 g/dl/ ≥7 <7 g/dl [18,19–24]
g/dl
Coagulopathy INR <1.2 ≥1.2 / <1.5 >1.5 Not measurable or severe trauma [24–32, 21,33–35,
induced coagulopathy 36,37–42, 8,43]
ROTEM
EXTEM CT <60s ≥60 s / ≤80s >80s [25,26,44–48,
EXTEM MCF >60mm ≤60 mm / <45mm 43,49]
≥45mm
FIBTEM MCF >12mm ≤12 mm / <5mm
≥5mm
TEG
ACT <110s ≥110 s / ≤128s >128s [25,40,36,37,50,51]
MA >60mm ≤60 mm / <55mm
≥55mm
LY30 <3% ≥3% / ≤5% >5%
Hypothermia Body Temperature (°C) >35 °C ≤35 °C / ≥ <33 °C Persistent hypothermia or difficult [52–54, 55,56–60,
33 °C rewarming 24,21]
Soft tissue Traumatic Brain
injuries Injury
ICP <15mmHg ≥15 mmHg / >20mmHg Herniation [61–69]
≤20mmHg
CCP >70mmHg ≤70 mmHg / <60mmHg
≥60mmHg
Midline shift No <5mm ≥5mm
Thoracic and
abdominal trauma
TTSS
Points ≤5 >5 / <8 ≥8 Deformation of the thoracic wall [70–81]
Grade 0 I-II ≥III and respiratory decompensation
Soft tissue DC Surgery criteria A diffucult access major vanous injury [82]
injuries according to Roberts Major liver or combined pancreaticoduodenal injury with haemodynamic
et al. ∗ [21] instability
Devascularisation or massive disruption of intra-abdominal organs, such
as duodenum, pancreas, pancreatic-duodenal complex
Uncontrollable haemorrhage
Need for surgical abdominal or thoracic reconstruction (open abdomen
treatment, abdominal or thoracic compartment syndrome, reassessment
of the bowel function)
Musculoskeletal
trauma
Pelvic trauma
AO/Tile classification A-B B-C∗ Complex pelvic (Hemi)pelvectomy [83,84,85]
injury∗
Temporary fixation Associated vascular injuries [86]
according to MUST Severe contaminated wounds
criteria∗ [64] Severe bone defects
Complex articular fractures
∗
Classification in combination with patient’s physiology.
presence of complications or the need for mass transfusions [87]. <60 mm; >12 mm) were measured. When EXTEM CT >80 s,
In total 9 publications were included describing ROTEM measure- EXTEM MCF <45 mm and FIBTEM MCF <5 mm was observed,
ments in patients with trauma (Table 2). Four studies described patients were at risk for trauma-induced coagulopathy (TIC)
safe EXTEM CT values of approximately 60 s. Others (n = 3) re- and therefore defined as "unstable" in our classification system,
ported values between 80 and 100 s. Publications reported the whereas values between "stable" and "unstable" were defined as
presence of trauma-related coagulopathy or the need for mass "borderline." Patients defined as “in extremis” did not receive a
transfusion at EXTEM MCF values below approximately 60 mm. defined quantitative value but needs to be associated with severe
Mortality rates and transfusion protocol activation continued to in- trauma-induced coagulopathy in existence and/or values exceeding
crease after EXTEM-MCF values fell further below 40–50 mm. Fi- the measurement range of the ROTEM.
nally, FEBTEM-MCF values were associated with fewer complica-
tions if they were measured above 10–12 mm. Further decline in Thromboelastography (r-TEG)
these parameters proved the presence of trauma-induced coagu- Similarly, only a few studies have reported thresholds associ-
lopathy <5 mm. ated with adverse outcome in severely injured patients and TEG.
In summary, no trauma-induced coagulopathy (TIC) was con- In particular, parameters such as ACT/MA/Ly30 have been used to
firmed when EXTEM CT, EXTEM MCF and FIBTEM MCF (<60 s; predict the need for a mass transfusion protocol in trauma pa-
296
R. Pfeifer, F.K.-L. Klingebiel, S. Halvachizadeh et al.
Table 2
List of publications considered to define values.
Hypothermia
Authors Title Journal Year Type Study n Outcome Parameter Statistic
Ireland et al. The incidence and significance of accidental hypothermia in Resuscitation 2011 Prospective 732 Mortality >35 °C vs. <35 °C 5.98% vs. 29.90%
major trauma–a prospective observational study (Monocenter)
Weuster et al. Epidemiology of accidental hypothermia in polytrauma J Trauma Acute 2016 Retrospective 15,230 Sepsis 36 °C 6.40%
patients: An analysis of 15,230 patients of the Care Surg (Database) 35 °C 11%
TraumaRegister DGU 34 °C 12.10%
33 °C 15.50%
MOF 36 °C 20.50%
35 °C 34.60%
34 °C 44.50%
33 °C 56.20%
Mortality 36 °C 9.00%
(overall) 35 °C 14.30%
34 °C 20.60%
33 °C 32.40%
Mortality 36 °C 4.40%
(24 h) 35 °C 6.60%
34 °C 10.30%
33 °C 18.80%
Aitken et al. Hypothermia and associated outcomes in seriously injured Resuscitation 2009 Retrospective 2182 Mortality >35 °C vs. <35 °C 11% vs. 40%
297
trauma patients in a predominantly sub-tropical climate (Database)

Wang et al. Admission hypothermia and outcome after major trauma Crit Care Med 2005 Retrospective 38,520 Mortality >35 °C vs. ≤35 °C 4.4% vs. 26.6%
(Database)
Beilmann et al. Early Hypothermia in Severely Injured Trauma Patients Is a Ann Surg. 2009 Prospective 359 MOF >35 °C vs. <35 °C 9% vs. 21%
significant Risk Factor for Multiple Organ Dysfunction (Multicenter) Mortality >35 °C vs. <35 °C 12% vs. 16%
Syndrome but Not Mortality
Martin et al. Injury-associated hypothermia: an analysis of the 2004 Shock 2005 Retrospective 7,01,491 Mortality >35 °C vs. ≤35 °C 3% vs 25.5%
National Trauma Data Bank (Database)
Mommsen Effects of accidental hypothermia on posttraumatic Injury 2013 Retrospective 310 SIRS ≥35 °C vs. <35 °C 73.5% vs. 84.2%
et al. complications and outcome in multiple trauma patients (Monocenter) Sepsis ≥35 °C vs. <35 °C 39.3% vs. 49.1%
MOF ≥35 °C vs. <35 °C 6.6% vs. 9.6%
Mortality ≥35 °C vs. <35 °C 19.9% vs. 28.0%
Shafi et al. Is hypothermia simply a marker of shock and injury severity J Trauma 2005 Retrospective 38,550 Any ≥35 °C vs. <35 °C 11% vs. 25%
or an independent risk factor for mortality in trauma (Database) Complication
patients? Analysis of a large national trauma registry
Trentzsch et al. Hypothermia for prediction of death in severely injured blunt Shock 2012 Retrospective 5197 MTP ≥35 °C vs. <35 °C 6.3% vs. 17.0%
trauma patients (Database) Sepsis ≥35 °C vs. <35 °C 10.6% vs. 17.5%
MOF ≥35 °C vs. <35 °C 28.8% vs. 53.5%
(24 h)
(overall)
Frischknecht Damage control in severely injured trauma patients – A J Emerg 2011 Retrospective 319 Mortality Survivor vs. 35.06 ± 0.10 vs.
Injury 54 (2023) 292–317

et al. ten-year experience Trauma Shock (Monocenter) (72 h) Non-Survivor ( °C) 33.81 ± 0.22
(continued on next page)
Table 2 (continued)
Hypothermia
Mitra et al. Trauma patients with the ’triad of death’ Emerg Med J. 2012 Retrospective 90 Mortality Survivors ( °C) 33.2 ± 1.5
(Monocenter) Non-Survivors ( °C) 32.8 ± 1.4
Haemoglobin
Tanner et al. Influence of anaemia in severely injured patients on Eur J Trauma 2022 Retrospective 67,595 Sepsis Hb ≥9 2.68%
mortality, transfusion and length of stay: an analysis of the Emerg Surg. (Database) Hb 7–8 5.65%
TraumaRegister DGU® Hb < 7 7.29%
Shock Hb ≥9 6.75%
Hb 7–8 27,24%
Hb < 7 36.72%
MOF Hb ≥9 8.46%
Hb 7–8 20.86%
Hb < 7 24.69%
MTP Hb ≥9 0.59%
Hb 7–8 7.18%
Hb < 7 13.49%
Dead in ER Hb ≥9 0.73%
Hb 7–8 7.18%
Hb < 7 16.91%
Mortality Hb ≥9 4.97%
(24 h) Hb 7–8 23.00%
Hb < 7
298
40.77%
Mortality Hb ≥9 11.19%
Hb 7–8 39.14%
Hb < 7 55.29%
Kenji et al. The impact of uncross-matched blood transfusion on the J Trauma 2008 Retrospective 25,599 MTP Hb ≥8 9.00%
need for massive transfusion and mortality: analysis of 5166 (Multicenter) HB <8 21.40%
uncross-matched units
Doklestic et al. Severe Blunt Hepatic Trauma in Polytrauma Patient - Serbian 2015 Retrospective 70 Mortality Survivor vs. 9.86 ± 1.28 vs.
Management and Outcome archives of (Monocenter) Non-Survivor (Hb) 8.1.3 ± 1.56
entire
medicine Mortality (30d) Hb <10 12.30%
Hb 9–10 34.60%
Hb 8–9 25.30%
Hb 7–8 33.30%
Hb ≤7 26.10%
Haemoglobin drop
(first 2 h)
MTP ≤2 Hb 1.80%
>2 - ≤3.9 Hb 5.60%
≥4 Hb 20.60%
Mortality (30d) ≤2 Hb 12.30%
>2 - ≤3.9 Hb 13.60%
≥4 Hb 30.80%
Injury 54 (2023) 292–317

Mitra et al. Trauma patients with the ‘triad of death’ Emerg Med J. 2012 Retrospective 90 Mortality Survivors vs.
(Monocenter) Non-Survivors
Hb 98.3 ± 22.1 vs. 83.5 ± 22.4
Table 2 (continued)
Hypothermia
Hilbert et al. Trauma bay haemoglobin level. Predictor of coagulation Unfallchirurg 2015 Retrospective 425 MTP Receiving MTP
disorder in major trauma (Monocenter) Hb 7.98 (SD 3.8)
Hirschmann Quality management of interdisciplinary treatment of Anaesthesist 2007 Retrospective 172 Mortality Survivor (Hb) 11 ± 2.8
et al. polytrauma. Possibilities and limits of retrospective routine (Monocenter) Non-Survivor (Hb) 8.8 ± 3.5
data collection
Frischknecht Damage control in severely injured trauma patients – A J Trauma 2011 Retrospective 319 Mortality Survivor vs. Non-Survivor
et al. ten-year experience (Monocenter) (72 h) (°C)
Hb 9.16 ± 0.13 vs. 9.06 ± 0.47
Independent for
early Mortality
Hb < 0.7 g/dl p = 0.045
INR
Frischknecht Damage control in severely injured trauma patients - A J Emerg 2011 Retrospective 319 Mortality All patients (INR) 1.25 ± 0.02
et al. ten-year experience Trauma Shock (Monocenter) (72 h) Early survivors 1.23 ± 0.02
(INR)
Early deaths (INR) 1.42 ± 0.06
Stettler et al. Rotational thromboelastometry thresholds for patients at risk J Surg Res 2018 Prospective 222 Indication for No MTP 1.1 (1.04–1.23)
for massive transfusion (Monocenter) MTP MTP 1.72 (1.33–2.07)
David et al. Is it possible to improve prediction of outcome and blood Eur J Trauma 2022 Retrospective 1076 TIC defined by INR
299
requirements in the severely injured patients by defining Emerg Surg. (Monocenter) Rotem CT (s)
categories of coagulopathy? 10.0–90.9 No TIC 1.1
91–130 Moderate TIC 1.5
131–200 Severe TIC 1.9
>200 Major TIC 3.4
Bilgic et al. Evaluation of liver injury in a tertiary hospital: a Turkish journal 2014 Retrospective 82 Mortality Survivors (INR) 1.1 (0.95–1.68)
retrospective study of trauma & (Moonocenter) Non-Survivors 1.56 (1.02–3.75)
emergency
surgery
Kautza et al. Changes in Massive Transfusion Over Time: An Early Shift In J Trauma Acute 2012 Prospective 526 Receiving MTP Early (INR) 1.68 ± 1
The Right Direction? Care Surge (Multicenter) Recent (INR) 1.74 ± 1
Torabi et al. Blood sugar changes and hospital mortality in multiple Am J Emerg 2018 Retrospective 280 Mortality Survivors 1.09 ± 0.2
trauma Med. (Monocenter) Non-Survivors 1.81 ± 1.55
Stettler et al. Citrated kaolin thrombelastography (TEG) thresholds for J Trauma Acute 2018 Prospective 825 Indication for No MTP 1.1 (1–1.2)
goal-directed therapy in injured patients receiving massive Care Surg. (Multicenter) MTP/
transfusion Threshold for MTP 1.4 (1.3–1.8)
MTP
INR >1.3
Sensitivity 66.67%
Specificity 88.20%
PPV 46.15%
NPV 94.58%
Injury 54 (2023) 292–317

Table 2 (continued)
Hypothermia
Holcomb et al. Increased platelet:RBC ratios are associated with improved J Trauma 2011 Retrospective 2312 Receiving MTP MTP 1.6 ± 0.9
survival after massive transfusion (Multicenter)
Kutcher et al. A paradigm shift in trauma resuscitation: evaluation of JAMA Surg. 2013 Prospective 174 Receiving MTP MTP 1.3 (1.2–1.6)
evolving massive transfusion practices (Monocenter)
Mitra et al. Trauma patients with the ’triad of death’ Emerg Med J. 2012 Retrospective 90 Mortality Survivors 2.1 ± 0.4
(Monocenter) Non-Survivors 4.0 ± 2.8
Coccolini et al. Aortic balloon occlusion (REBOA) in pelvic ring injuries: Updates Surg. 2020 Retrospective (DGU 72 Early mortality Survivor 1.46
preliminary results of the ABO Trauma Registry Database) (24 h) Non-Survivor 2.42
Johansson Disseminated intravascular coagulation or acute coagulopathy Crit Care 2011 Observational 80 ACoTS Normal 1.1 (1.1–1.1)
et al. of trauma shock early after trauma? An observational study Cohort (acute ACoTS 1.3 (1.3–1.5)
(Monocenter) coagulopathy
of trauma
shock)
Hilbert-Carius „Hämoglobinorientierter und gerinnungsfaktorbasierter Anaesthesist 2015 Retrospective 86 Receiving MTP Early 1.72
et al. Algorithmus“ (Monocenter) Recent 1.77
Holcomb et al. Admission rapid thrombelastography can replace Ann Surg. 2012 Retrospective 1974 Prediction MTP MTP >1.5
conventional coagulation tests in the emergency department: (Monocenter)
experience with 1974 consecutive trauma patients
Kashuk et al. Primary fibrinolysis is integral in the pathogenesis of the Ann surg. 2010 Retrospective 61 Receiving <5 RBC‘s / 6h 1.17
acute coagulopathy of trauma (Monocenter) Transfusion 5–9 RBC‘s / 6h 1.46
MTP / 6h 2.24
Hilbert-Carius Clinical presentation and blood gas analysis of multiple Anaesthesist 2016 Retrospective (DGU 40.129 MTP MTP 1.81
et al. trauma patients for prediction of standard coagulation Database)
parameters at emergency department arrival
300
Connor et al. Damage-control thoracic surgery: Management and outcomes J Trauma Acute 2014 Retrospective 44 Undergoing INR, mean (SD) 1.7 (0.7)
Care Surg. (Database) DOC INR >= 2 (%) 39%
Cotton et al. Rapid thrombelastography delivers real-time results that J Trauma 2011 Retrospective 272 MTP No MTP 1.16
predict transfusion within 1 h of admission (Database) MTP 1.65
Peltan et al. An International Normalized Ratio-Based Definition of Acute Crit Care Med. 2015 Prospective 1031 Mortality/MTP Complication INR ≤1.2
Traumatic Coagulopathy Is Associated With Mortality, Venous observational In-hospital 11.10%
Thromboembolism, and Multiple Organ Failure After Injury (Multicenter) mortality
Overall Mortality 2.70%
MTP 17%
INR >1.2
In-hospital 18.50%
mortality
Overall 6.00%
Massive 32.20%
transfusion
INR ≤1.5
In-hospital 11.70%
mortality
Overall 2.80%
Massive 19.10%
transfusion
INR >1.5
Injury 54 (2023) 292–317

In-hospital 26.50%
mortality
Overall 10.10%
Massive 45.20%
transfusion
Table 2 (continued)
Hypothermia
Lui et al. Predictive model integrating dynamic parameters for massive AM J Emerg 2018 Retrospective 4991 Mortality / INR Mortality
blood transfusion in major trauma patients: The Dynamic Med (Database) MTP ≤1.1 10.30%
MBT score 1.1 22.80%
1.2 33.30%
1.3 48.30%
1.4 59.10%
≥1.5 55.20%
INR MTP
≤1.1 2%
1.1 7.30%
1.2 11.60%
1.3 18.30%
1.4 22.70%
≥1.5 19%
Hildebrand Development of a scoring system based on conventional Injury 2015 Retrospective 11,436 Mortality INR Mortality
et al. parameters to assess polytrauma patients: PolyTrauma (Database) <1.4 5.10%
301
Grading Score (PTGS) 1.4–2.0 17.90%

Leemann et al. The role of rotation thromboelastometry in early prediction J Trauma 2010 Retrospective 53 MTP INR
of massive transfusion (Monocenter) No-MTP 1.22
MTP 1.46
ROTEM
Stettler et al. Rotational thromboelastometry thresholds for patients at risk J Surg Res. 2018 Prospective 222 Indication for EXTEM CT (s)
for massive transfusion (Monocenter) MTP No MTP 64 (56–75)
MTP 87 (67.25–118.3)
EXTEM MCF (mm)
No MTP 59 (54–64)
MTP 42 (24.75–52.75)
FIBTEM MCF (mm)
No MTP 13 (10–16)
MTP 5 (3–9)
EXTEM CT >78.5s
Sensitivity 58.33%
Specificity 81.62%
PPV 42.98%
NPV 57.74%
Injury 54 (2023) 292–317

Table 2 (continued)
Hypothermia
David et al. Is it possible to improve prediction of outcome and blood Eur J Trauma 2022 Retrospective 1076 TIC defined by
requirements in the severely injured patients by defining merg Surg. (Monocenter) a) ROTEM CT
categories of coagulopathy? (s) b) INR
a) CT (s) EXTEM MCF (mm)
10.0–90.9 No TIC 60
91–130 Moderate TIC 51
131–200 Severe TIC 42
>200 Major TIC 21
FIBTEM MCF (mm)

No TIC 12
Moderate TIC 5
Severe TIC 3
Major TIC 0
Mortality 24 h (OR)
No TIC
Moderate TIC 3.2
Severe TIC 11.8
Major TIC 86.5
302
b) INR EXTEM MCF (mm)

0.80–1.20 No TIC 61
Moderate TIC 55
1.91–3.00 Severe TIC 40
>3.00 Major TIC 18
CT (s)
No TIC 61
Moderate TIC 76
Severe TIC 169
Major TIC 271
FIBTEM MCF (mm)

No TIC 12
Moderate TIC 8
Severe TIC 0
Major TIC 0
Mortality 24 h (OR)
No TIC
Moderate TIC 2.7
Severe TIC 20.1
Injury 54 (2023) 292–317

Major TIC 49.7
Table 2 (continued)
Hypothermia
Tauber et al. Prevalence and impact of abnormal ROTEM assays in severe BR J Anaesth. 2011 Prospective 403 Mortality ROTEM Mortality threshold
blunt trauma: results of the ‘Diagnosis and Treatment of (Monocenter) (thresholds) EXTEM MCF 45 mm (25.4% vs. 9.4%)
Trauma-Induced Coagulopathy (DIA-TRE-TIC) study’ EXTEM CT 100 s (45.5% vs. 8.4%)
EXTEM CFT 200 s (27% vs. 8.7%)
FIBTEM MCF 7 mm (21% vs. 9%)
Maximum sum EXTEM
of sensitivity & EXTEM MCF 46mm
specificity EXTEM CT 91s
(AUC 0.8) EXTEM CFT 218s
Hagemo et al. Detection of acute traumatic coagulopathy and massive Crit Care 2015 Prospective 808 Coagulopathy EXTEM CT >94s
transfusion requirements by means of rotational (Multicenter) MTP Detection rate 28.9
thromboelastometry: an international prospective validation Thresholds
study FPR 8.8
PPV 16.5
NPV 95.5
Davenport Functional definition and characterization of acute traumatic Crit Care Med 2011 Prospective 325 MTP CA5≤35mm
et al. coagulopathy (Monocenter) Detection rate 71.40%
FPR 15.30%
PPV 10.20%
NPV 99.20%
CT >94s
Detection rate 28.60%
FPR 12.20%
PPV 5.40%
303
NPV 98.10%
a-angle <65°
Detection rate 42.90%
FPR 10.10%
PPV 9.40%
NPV 98.50%
Schöchl et al. Goal-directed coagulation management of major trauma Crit Care 2010 Retrospective 131 Mortality FIBTEM MCF <10 mm
patients using thromboelastometry (ROTEM)-guided (Monocenter) (threshold) EXTEM CT >1.5x normal
administration of fibrinogen concentrate and prothrombin
complex concentrate
Schöchl et al. Thromboelastometric (ROTEM) findings in patients suffering J Neurotrauma 2011 Retrospective 67 Mortality EXTEM CT>80s
from isolated severe traumatic brain injury (Monocenter) Survivors 0.2
Non-Survivors 0.591
EXTEM MCF<50mm
Survivors 0.116
Non-Survivors 0.409
FIBTEM MCF <9mm
Survivors 0.136
Non-Survivors 0.591
Independent risc FIBTEM MCF <9mm
factor
Leemann et al. The role of rotation thromboelastometry in early prediction J Trauma 2010 Retrospective 53 MTP EXTEM MCF
Injury 54 (2023) 292–317

of massive transfusion (Monocenter) No-MTP 45.5 ± 2.6
MTP 39.3 ± 2.7
EXTEM CT
No-MTP 120 ± 16.2
MTP 107.9 ± 10.1
Table 2 (continued)
Hypothermia
Schöchl et al. FIBTEM provides early prediction of massive transfusion in Crit Care 2011 Retrospective 323 MTP EXTEM CT
trauma No-MTP 67 (56–90)
MTP 91 (73–129)
EXTEM MCF
No-MTP 57 (53–62)
MTP 48 (41–56)
FIBTEM MCF
No-MTP 11 (7–14)
MTP 5 (0–7)
MTP threshold AUC
EXTEM CT ≤72s 0.71
EXTEM MCF 0.76
≤52mm
FIBTEM MCF 0.84
≤7mm
MTP
MTP EXTEM CT 91 (73–129)
EXTEM MCF 48 (41–55)
FIBTEM MCF 5 (0–7)
Non-MTP
EXTEM CT 67 (56–90)
EXTEM MCF 57 (51–62)
FIBTEM MCF 11 (7–14)
304
r-TEG
Stettler et al. Rotational thromboelastometry thresholds for patients at risk J Surg Res. 2018 Prospective 222 MTP thresholds r-TEG ACT >128s
for massive transfusion (Monocenter) Sensitivity 0.5833
Specificity 0.7432
PPV 0.3088
NPV 0.9007
MA <55mm
Sensitivity 0.7222
Specificity 0.8661
PPV 0.4643
NPV 0.9387
LY30 >5%
Sensitivity 0.4167
Specificity 0.9399
PPV 0.58
NPV 0.8912
Cotton et al. Rapid thrombelastography delivers real-time results that J Trauma 2011 Prospective 272 MTP r-TEG ACT (s)
predict transfusion within 1 h of admission (Database) No MTP 113
MTP 121
MA (mm)
No MTP 65
MTP 61
Injury 54 (2023) 292–317

LY30 (%)
No MTP 0.6
MTP 0.3
OR / MTP
ACT >128s 5.15
Table 2 (continued)
Hypothermia
Holcomb et al. Admission rapid thrombelastography can replace Ann Surg. 2012 Retrospective 1974 MTP thresholds r-TEG OR
conventional coagulation tests in the emergency department: (Monocenter) ACT >128 s 1.63
experience with 1974 consecutive trauma patients MA <55 mm 3.1
LY30 >3% 1.48
No Transfusion OR
ACT <105 s 1.59
MA >68 mm 1.69
LY30 (%) <3%
Kashuk et al. Primary fibrinolysis is integral in the pathogenesis of the Ann Surg. 2010 Prospective 61 MTP 1 h (r-TEG) Minimal Transfusion
acute coagulopathy of trauma (Monocenter) (<5RBC/6 h)
ACT (s) 110.75
MA (mm) 57.71
1h Moderate Transfusion 5–9
RBC/6 h)
ACT (s) 124.5
MA (mm) 51.27
1h MTP
ACT (s) 192.23
MA (mm) 37.63
Einersen et al. Rapid thrombelastography thresholds for goal-directed J Trauma Acute 2017 Prospective 190 MTP r-TEG >4 RBC/h in 6h
resuscitation of patients at risk for massive transfusion Care Surg (Monocenter) Mortality ACT (s) 139
thresholds
305
LY30 (%) 4
MA (mm) 55
MTP/Death 6h
ACT (s) 128
LY30 (%) 5
MA (mm) 55
Death 24h
ACT (s) 133
LY30 (%) 5
MA (mm) 54
MTP ACT >128s
Sensitivity 64
Specificity 67
PPV 66
NPV 65
LY30% >5%
Sensitivity 54
Specificity 91
PPV 86
NPV 66
MA <55mm
Sensitivity 70
Injury 54 (2023) 292–317

Specificity 82
PPV 79
NPV 73
Table 2 (continued)
Hypothermia
Cotton et al. Hyperfibrinolysis at admission is an uncommon but highly J Trauma Acute 2012 Prospective 1996 Mortality (30d) r-TEG Mortality
lethal event associated with shock and prehospital fluid Care Surg (Monocenter) LY30 ≤3% 9%
administration LY30 >3% 20%
LY30 >4% 35%
LY30 >5% 58%
LY30 >15% 81%
TBI
Clifton et al. Fluid thresholds and outcome from severe brain injury Crit Care Med 2002 Clinical trial 392 Outcome poor Independent
variable
ICP >25 mmHg p = 0.0448
Jiang et al. Early indicators of prognosis in 846 cases of severe traumatic J Neurotrauma 2002 Retrospective 846 Mortality ICP Mortality
brain injury (Monocenter) ICP <20 mmHg 13.76%
20 < ICP <40 29.50%
mmHg
>40 mmHg 40.43%
Juul et al. Intracranial hypertension and cerebral perfusion pressure: J Neurosurg 2000 Prospective 427 Mortality (predetoriation) Mortality
influence on neurological deterioration and outcome in (Multicenter ICP <20 & CPP ≥60 52%
severe head injury. The Executive Committee of the randomized, ICP <20 & CPP ≥70 51%
International Selfotel Trial double-blind) ICP ≥20 & CPP ≥ 74%
60
ICP ≥20 & CPP ≥ 73%
70
CPP <70 & ICP ≥20 87%
Marmarou Contribution of raised ICP and hypotension to CPP reduction Acta Neurochir 2005 Retrospective 139 Mortality Mortality
306
et al. in severe brain injury: correlation to outcome Suppl. (Database) ICP >20 mmHg 38.20%
MAP <80 mmHg 11.60%
ICP >20mmHg+ 34.90%
MAP <80 mmHg
Total 25.10%
Ratanalert ICP Threshold in CPP Management of Severe Head Injury Surg Neurol. 2004 Prospective 197 Outcome poor Outcome poor
et al. Patients (Monocenter) ICP <20 mmHg 17.10%
ICP ≥20mmHg 33.30%
Lannoo et al. Early predictors of mortality and morbidity after severe J Neurotrauma 2000 Retrospective 190 Mortality ICP
closed head injury (Monocenter) Survivors 18 mmHg
Nonsurvivors 44 mmHg
CPP
Survivors 61 mmHg
Non-Survivors 44 mmHg
Midline shift
Survivors 2.3 mm
Non-Survivors 5.5 mm
Chambers et al. Determination of threshold levels of cerebral perfusion J Neurosurg. 2001 Clinical trial 291 Treshold Predicting threshold
pressure and intracranial pressure in severe head injury by ICPmax 35 mmHg
using receiver-operating characteristic curves: an CPPmin 55 mmHg
observational study in 291 patients
Injury 54 (2023) 292–317

Balestreri et al. Intracranial hypertension: what additional information can be Acta Neurochir 2004 Retrospective 96 Outcome Outcome ICP (Median)
derived from ICP waveform after head injury? (Monocenter) Favourable 21 mmHg
Fatal 28 mmHg
CPP (Median)
Favourable 75 mmHg
Fatal 68 mmHg
Table 2 (continued)
Hypothermia
Schreiber et al. Determinants of mortality in patients with severe blunt head Arch Surg. 2002 Prospective 213 Mortality OR (95% CI)
injury (Monocenter) ICP ≥ 15 mmHg 4.4 (2.1–9.0)
Midline shift 4.3 (1.8–10.3)
≥5mm
Thorax
Casas et al. Thorax Trauma Severity Score: Is it reliable for Patient’s Bull Emerg 2016 Retrospective 238 Complications Complications TTSS ≥8
Evaluation in a Secondary Level Hospital? Trauma (Monocenter) Mortality Sensibility 0.66
Specificity 0.94
PPV 0.22
NPV 0.99
Mortality TTSS ≥8
Sensibility 0.8
Specificity 0.94
PPV 0.22
NPV 0.99
Daurat et al. Thoracic Trauma Severity score on admission allows to Injury 2016 Retrospective 329 ARDS TTSS (admission)
determine the risk of delayed ARDS in trauma patients with (Monocenter) ARDS 12 (10–14)
pulmonary contusion No ARDS 8 (6–10)
TTS OR
0–7 Reference
8–12. 3.0 (1.3–6.7)
13–25 67.1 (21.7)
Aukema et al. Validation of the Thorax Trauma Severity Score for mortality Open Access 2011 Retrospective 712 Mortality Higher mortality
307
and its value for the development of acute respiratory Emerg Med. (Monocenter) TTSS 6–9.
Kumari et al. Changes in extracellular cytokines in predicting disease
distress syndrome Immunobiology 2021 Prospective 65 Fatal outcome TTSS
severity and final clinical outcome of patients with blunt (Monocenter) Fatal 6.86 ± 2.27
chest trauma Discharged 4.72 ± 1.94
Mommsen Comparison of different thoracic trauma scoring systems in J Surg Res. 2012 Retrospective 278 ARDS TTSS ARDS
et al. regards to prediction of post-traumatic complications and (Monocenter) SIRS ≤9 14.50%
outcome in blunt chest trauma Sepsis >9 49.20%
MODS TTSS SIRS (Cut-off >8)
Mortality ≤9 47.50%
>9 58.80%
TTSS Sepsis (Cut-off >8)
≤9 37.00%
>9 44.30%
TTSS MODS (%)
≤9 5.70%
>9 35.30%
TTSS Mortality
≤9 3.80%
>9 20.60%
Okabe et al Risk factors for prolonged mechanical ventilation in patients Acute Med 2018 Retrospective 133 Prolonged OR
with severe multiple injuries and blunt chest trauma: a Surg. (Monocenter) mechanical TTSS 11 1.2
single centre retrospective case-control study ventilation
Seok et al. Chest Trauma Scoring Systems for Predicting Respiratory J Surg Res. 2019 Retrospective 177 Complication TTSS
Injury 54 (2023) 292–317

Complications in Isolated Rib Fracture (Monocenter) Pneumonia Noncomplication 8
Respiratory Complication 11
failure
Empyema AUC
TTSS >9 0.723
Table 2 (continued)
Hypothermia
Subhani et al. Comparison of outcome between low and high thoracic J Ayub Med 2014 Prospective 264 Outcome Outcome Low TTS
trauma severity score in blunt trauma chest patients Coll (Multicenter)
Abbottabad Low TTS
(0°, 1°, 2°)
Normal 6.10%
High TTS Good 45.40%
(3°, 4°) Fair 19.30%
Poor 0.00%
Fatal 0.00%
Outcome High TTS
Normal 0.00%
Good 3.10%
Fair 3.40%
Poor 12.90%
Fatal 9.80%
Zahran et al. Evaluation of the predictive value of thorax trauma severity CTS 2020 Prospective 300 Outcome TTSS Mortality
score (TTSS) in thoracic-traumatized patients (Multicenter) Mortality 0–5 0%
6.0–10.0 0%
308
11–15.0 0%
16–20 16.70%
21–25 100%
Thresholds
TTSS ≥7 ARDS/
need for ventilation
Fair/Poor/fatal AUC
prognosis
TTSS ≥7 0.998
Sharma et al. A study to validate thoracic trauma severity score in chest Int Surg J. 2020 Prospective 110 Mortality TTSS Mortality
trauma patients (Monocenter) 0–5 0%
6.–10. 0%
11–15.0 3.22%
16–20.0 30.76%
21–25.0 n=0
Elbaih et al. Evaluation of Thoracic Trauma Severity Score in Predicting Int. J Surg Med 2016 Retrospective 30 Outcome Poor Outcome TTSS ≥7
the Outcome of Isolated Blunt Chest Trauma Patients (Monocenter) Sensitivity 100%
Specificity 100%
Rezk et al. Assessment of Isolated Blunt Chest Trauma Patients in Benha AJCTS 2020 Prospective 160 Poor Outcome TTSS ≥8
University Hospital According to Thoracic Trauma Severity (Monocenter) /Mortality Sensitivity 92.30%
Score Specificity 100%
Injury 54 (2023) 292–317

Table 2 (continued)
Hypothermia
Pelvis
Burkhardt Acute management and outcome of multiple trauma patients Crit Care 2012 Retrospective 402 MODS AO-Type A vs. B vs. C
et al. with pelvic disruptions (Database) Sepsis MODS (%) 22.1% vs. 19.6% vs. 32.9%
Mortality Sepsis (%) 3.9% vs. 2.7% vs. 8.1%
Pelvic Ring Mortality (%)

fractures
AO-Type A 5.10%
AO-Type B 6.80%
AO-Type C 10.90%
Complex 15.80%
309
Non-complex 5.50%
Burkhardt Complex pelvic traumas: data linkage of the German Pelvic Unfallchirurg 2015 Retrospective 344 MODS Pelvic ring Complex vs. Non-complex
et al. Injury Register and the TraumaRegister DGU® (Database) Sepsis fractures
Mortality MODS 40% vs. 22%
Sepsis 4% vs. 5%
Mortality (overall) 16.7% vs. 5.9%
Burckhardt Proper coding of the Abbreviated Injury Scale: can clinical Eur J Trauma 2014 Retrospective 11,574 Mortality AO Type B – Mortality (24 h) /
et al. parameters help as surrogates in estimating blood loss? merg Surg. (Database) Pelvic ring fracture Mortality in hospital
AIS 3 5.5% / 9.9%
AIS 4 16.4% / 22.6%
AIS 5 25.8% / 34.8%
AO Type C – Mortality (24 h) /
Pelvic ring fracture Mortality in hospital
AIS 4 8.5% / 13.7%
AIS 5 36.6% / 43.4%
Injury 54 (2023) 292–317

tients. Although different kinds of thromboelastography have been ACT <110 s, MA >60 mm, and Ly30 of 3% have been reported
used (Native, Kaolin and Rapid [88]), we focused on rapid-TEG in the literature as safe thresholds. Thresholds for high mortality
(r-TEG) since it is the mostly commonly mentioned method in and MTP were defined as ACT 128 s, MA 55 mm, and Ly30
the literature. A total of six publications addressed the issues of 5%. All values in between were considered “borderline” in our
r-TEG and trauma (Table 2). In three studies, ACT values above study.
128 s were associated with the indication of mass transfusion.
Complications were found less frequently in patients with values Haemorrhage/shock
around 105 or 110 s. Similar results were found for MA mea-
surements. According to the published studies, MA values below To identify shock patients and determine the value of tissue
55 mm were associated with an adverse outcome. The lowest com- oxygenation disturbance, we focused on the following parameters:
plication rates were found at values around 65 mm. In summary: Lactate, blood pressure, and Hb level on admission.
Table 3
Risk of bias according to the QUIPS-tool.
310
Table 3 (continued)
311
"borderline". Patients should be considered as “in extremis” if an

uncontrollable haemorrhage or hypotension nonresponsive to ther-
apy is seen.
Hypothermia
Eleven publications have addressed the role of hypothermia in

severely injured patients. In most studies (n = 9) (Table 2), a value
below 35 °C body temperature was chosen as the threshold, and
a significant increase in mortality was documented in hypother-
mic patients [55]. Mortality rates are increased when body tem-
perature is below 33 °C, leading to coagulation problems, cardiac
dysfunction, and tissue oxygenation disorders. Therefore, "stable"
patients have body temperatures above 35 °C, "unstable" patients
have values below 33 °C, and "borderline" patients have values in
between. The patient can be considered as “in extremis” if persis-
tent hypothermia occurs or difficult/prolonged rewarming appears
under treatment.
Fig. 3. Identification of thresholds in this review process.
Soft tissue injury

Lactate
Traumatic brain injury
Clinical and radiological signs of increased intracranial pressure
Numerous studies have suggested the use of lactate for decision
in particular may require an abbreviated surgical strategy in order
making in multiply injured patients. A systematic review of stud-
to reduce the risk of secondary brain damage. In total we could
ies published between 20 0 0 and 2020 identified a wide range of
identify 9 publications with the focus on traumatic brain injury, re-
lactate thresholds that can be used for surgical decision making in
quired parameters and outcome. In the majority of studies (n = 5)
orthopaedic trauma [17]. The lowest safe threshold was 2 mmol/l,
(Table 2) an increase in intracranial pressure (ICP) >20 mmHg,
and others suggested values of 4 mmol/l as a threshold. Because
was associated with high mortality rates (up 80%) [63]. Intracra-
fracture fixation has been reported to be safe in patients with val-
nial pressure (ICP) below <15 mmHg [69] and cranial perfusion
ues below 2 mmol/l, "stable" patients should have values below
pressure (CPP) above >70 mmHg [63,68] were associated with
2 mmol/l and "unstable" patients should have lactate values above
a favourable outcome. Reduced cranial perfusion pressure (CPP)
4 mmol/l. Values between 2 and 4 mmol/l were defined as "bor-
<60 mmHg [66] and the presence of a midline shift above 5 mm
derline." Patients should be considered "in extremis" if uncontrol-
[69,66] in a CT scan indicate an unstable status. Patients with a
lable bleeding or hypotension unresponsive to therapy is noted.
traumatic brain injury with clinical/radiological signs of a hernia-
tion may be considered as “in extremis”.
Systolic blood pressure
In a large registry study of more than 3411 polytrauma pa- Thoracic and abdominal trauma
tients, Mutschler et al. critically reviewed the ATLS classification of In an extensive systematic review including 127 publications,
hypovolemic shock [16]. In particular, systolic blood pressure be- Roberts et al. defined the indication for use of damage control
low 90 mmHg on admission was associated with a high compli- surgery in civilian trauma patients. Beside the physiological param-
cation rate (up to 45%). For systolic blood pressure values above eters that have been described previously the authors summarized
100 mmHg on admission, mortality decreased to 9%. According to organ-related injuries that provide the highest rated indications for
the above comprehensive study, all patients with systolic blood damage control surgery. The following list includes a short version
pressure above 100 mmHg were classified as "stable" and values of the indications described by Roberts et al. [90].
below 90 mmHg were classified as "unstable". Patients should be
- A difficult-access major venous injury
considered as “in extremis” if an uncontrollable haemorrhage or
- Major liver or combined pancreaticoduodenal injury with
hypotension nonresponsive to therapy is seen.
haemodynamic instability
- Devascularization or massive disruption of intra-abdominal or-
Haemoglobin level gans, such as duodenum, pancreas, pancreatic-duodenal com-
plex
Hb at admission correlates very closely with the presence of - Uncontrollable haemorrhage
shock and is a marker of tissue oxygenation. A total of 7 publi- - Need for surgical abdominal or thoracic reconstruction (open
cations (Table 2) on Hb and haemorrhagic shock were included. abdomen treatment, abdominal or thoracic compartment syn-
In general, all included studies described cutoff values between drome, reassessment of bowel function)
7 g/dl and 10 g/dl. The largest study was conducted by Tanner et al.
[89], which included more than 60,0 0 0 trauma patients from a na- Assessment of the Thoracic Trauma Severity Score (TTS) also
tionwide trauma registry. This study clearly describes a safe cutoff allows the identification of patients at risk after sustained blunt
value associated with mortality, transfusion, and length of stay. Pa- thoracic trauma [91]. Our review identified 12 publications sum-
tients presenting with an Hb value < 7 g/dl on admission, up to mizing the evaluation and associated outcome with the thoracic
36% were in shock and the mortality rate within 24 h was over trauma severity score Table 2. Five publications reported a TTS of
40% [18]. A higher survival rate in the first 24 h was observed for 8 points as threshold for early complications. Others reported val-
Hb values above 9 g/dl (up to 95%). Therefore, patients were de- ues of 9 points (n = 1) and 7 points (n = 2). According to publi-
fined as "unstable" with Hb values below 7 g/dL and "stable" with cations describing the thresholds of the score, patients with a TTS
values above 9 g/dL. Values that fell in between were classified as of ≥ 8 points were defined as “unstable” due to their associated
312
high mortality and complications, such as Acute Respiratory Dis- the aforementioned abnormal parameters in the "lethal triad" (hy-
tress Syndrome (ARDS). A favourable outcome has been reported pothermia, coagulopathy, and acidosis). Up to 35% of patients with
with values below 5 points [72]. This threshold was used to de- severe injuries present with trauma-induced coagulopathy on ad-
fine “stable” patients. Patients “in extremis” can be identified if a mission [36]. Abnormal coagulation is associated with higher mor-
deformation of the thoracic wall with respiratory decompensation tality even in mildly injured patients. The most recent guide-
occurs. lines for the management of major bleeding (grade 1C) recom-
mend early and repeated assessment of the coagulation system via
Musculoskeletal trauma the International Normalized Ratio (INR) or viscoelastic methods
Beside the degree of the physiological insult, local tissue injury (VEM) [13]. Identification of patients with existing coagulopathy
of the musculoskeletal system may also be an indication for ab- in trauma surgery requires early and rapid diagnosis. Rapid INR
breviated surgery and a staged procedure. It is well known that and VEM are measures that can be monitored while the patient
the severity of pelvic injury has an impact on patient outcome and is present in the trauma bay. Goodmann et al. [96] showed that
complications [85]. The included studies show an increased mor- rapid INR is faster and less expensive than thromboelastography
tality rate associated with classification (AO type A vs. B vs. C) [83]. [96]. However, existing guidelines mainly use thromboelastography
Higher rates of sepsis and multiple organ failure (MOF) were also for initial decision making [13]. TEG and ROTEM provide some con-
reported in patients with unstable pelvic ring injuries (type C) and sistency in their ability to derive fibrinolysis phenotypes to stratify
complex pelvic ring fractures [84]. However, the highest mortal- patients into different risk groups.
ity was reported in complex pelvic ring injuries. Complex pelvic
injuries and hemi-pelvectomies in particular are described as an Haemorrhage/shock
indication for external fixation. In a systematic review and expert
opinion survey, the following list of indications for a staged proce- Acid-base parameters are routinely used to assess severely in-
dure was presented [86]: jured patients. Specifically, lactate has been suggested for screen-
ing patients for definitive long bone or axial fracture reconstruction
- Associated vascular injuries
[92]. There are several factors that may affect lactate levels after
- Severe contaminated wounds
trauma, such as alcohol consumption and liver disease. Other au-
- Severe bone defects
thors have suggested focusing on lactate clearance within the first
- Complex articular fractures
24 h [97], while others suggest that screening multiple systems,
Of high importance is the discrimination between the indica- such as acid-base, coagulation, temperature, and tissue damage,
tion for a temporary fixation due to the patient’s physiology and is safer and predicts the development of complications [14]. Sys-
local tissue trauma. Staged procedures in the musculoskeletal systolic blood pressure was also included in this review since blood
tem performed mainly due to local factors (contaminated wounds, pressure is an important parameter for the assessment of patient
complex fractures, bone defects, etc.) should be called Muscu- haemodynamic stability. The American College of Surgeons shock
loskeletal Temporary Surgery (MUST) and not Damage Control Or- classification was adopted in this systematic review because this
thopaedics (DCO) [86]. In the second type of procedure, secondary scheme is widely established in clinical practice and is also used in
fixation is mainly needed due to the physiological impairment of ATLS guidelines. In addition, it should be noted that systolic blood
the patient. pressure during resuscitation is also a target parameter and there-
fore is always corrected during treatment. Thus, we used validated
Discussion data from large databases as a guide [16].
The current literature confirms that early definitive stabilization Temperature

is beneficial in physiologically stable polytraumatized patients with
major fractures [92,93]. The challenge in the decision-making pro- Most of the included studies that examined the role of hy-
cess is the identification of patients at risk for systemic complica- pothermia in polytrauma care were more or less consistent and
tions. Moreover, recent discussion has shown that decision making described more complications in patients with low temperature.
in the initial phase after trauma should not be dichotomous, but However, we found no publications describing the exact effects of
rather should be dynamic and focus on patient physiology [93]. In hypothermia on the coagulation system and related measurements,
this systematic review, we aimed to increase the level of evidence even though thromboelastography is temperature dependant. Fur-
describing parameters and thresholds associated with a negative ther studies are needed to describe the effects of hypothermia on
outcome. Putting all these parameters together, we can stratify the ROTEM/TEG
polytrauma patient into a known classification system [11] and
identify patients that may profit from early or late fixation strate- Soft tissue injury
gies. Repeated re-evaluation of the abovementioned parameters is
advisable until the full reconstruction of the patient. Our review Experimental and clinical studies suggest that not only haem-
revealed the following parameters to be of value for critical deci- orrhagic shock but also tissue damage during resuscitation must
sion making. be initially assessed and targeted [98]. However, assessing tissue
damage in the brain, trunk, and musculoskeletal system is a ma-
Coagulopathy jor challenge. Identification and stratification of tissue damage af-
ter trauma is critical for the initial assessment of a severely in-
Recently published studies demonstrated that the majority of jured patient and subsequent decision making. Tissue damage re-
trauma surgeons identify physiologically unstable patients as those sulting from direct physical trauma stimulates immune system ac-
with impaired hemodynamics who do not respond to resuscitation, tivation and impacts the endothelial system, coagulation, local and
with coagulopathy and acidosis [94]. This is consistent with sev- systemic blood flow, and tissue oxygenation [99]. However, an ob-
eral previous studies using multiple parameters [95,90,82]. How- jective and reliable marker of tissue injury has not yet been de-
ever, besides the physiological parameters, the severity of injury, scribed. In particular, the injury severity score (ISS) correlates with
determined by the initial ISS score, seems to play only a less rel- mortality, inflammation, and surgical decision making [17]. Very
evant role. Moreover, to assess the patient, trauma surgeons use low interobserver variability and incomplete assessment of the
313
Fig. 4. Treatment algorithm in polytraumatized patients according to the Safe Definitive Surgery concept (SDS). Repeated assessment of numerous pathophysiologic cascades
allows the identification of patients at risk [93].
overall ISS in the trauma bay are major limitations of the score in ods, either due to their high cost or insufficient evidence of their
the initial phase of treatment [5]. The use of immunological mark- benefits.
ers such as interleukin (IL-6, 8, etc.), which indicate the inflam-
matory status of the body [100], have also been suggested. These Limitations
markers are not measured in the primary care laboratory and have Most included studies did not examine the target parameters
not yet been introduced into broad clinical practice. and thresholds for damage control in orthopaedics and thus cutoff
Traumatic brain injury is one of the most important factors values from the included datasets were used. Therefore, there is
influencing initial decision making after polytrauma. Giannoudis some selection bias in these studies.
et al. review 13 papers focusing on the timing of fixation of ma-
jor fractures in patients with concomitant brain injuries [101]. Conclusion
In this study, outcomes were found to be better when frac-
tures were fixed early. However, disadvantages of early fixation In this systematic literature review including 68 publications,
include stimulation of the systemic inflammatory response and we have summarized relevant publications that focus on param-
the possibility of secondary brain injury from hypoxia or hy- eters that stimulate pathophysiological cascades and remote organ
potension. Therefore, perfusion of the brain must be maintained damage. The physiologic parameters included are clinically relevant
by monitoring ICP and CPP, which was also worked up in our and available in the trauma bay and emergency room. We have
study. also developed thresholds using a known classification system (sta-
If a Damage Control indication is made in one injured body re- ble, borderline, unstable, in extremis). Repeated re-evaluation and
gion, then this indication is normally transferred to the other body assessment of patients in terms of their physiology allows dynamic
regions as well. Roberts et al. identified a comprehensive list of classification and adaptation of the treatment strategy. We propose
candidate indications for use of DC surgery in trunk (thorax, ab- that these parameters can be used for clinical decision making
domen, and pelvis) [82]. This work demonstrates an elaborated list within the concept of safe definitive surgery (SDS) in the treatment
of clear indications, which has also been included in our table. of severely injured patients (Fig. 4). In future studies parameters
These indications provide a practical foundation to guide surgical and thresholds should be reassessed and evaluated in a separate
practice while studies are conducted to evaluate their impact on database.
patient care and outcomes.
Other factors such as injury pattern, trauma system and organi- CRediT authorship contribution statement
zation, education and experience of the responsible trauma team
are also relevant in the initial decision making, however, these Roman Pfeifer: Conceptualization, Data curation, Formal analy-
topics were not covered in this systematic review. Moreover, the sis, Investigation, Methodology, Project administration, Supervision,
included studies usually mentioned the treatment strategy used Writing – review & editing. Felix Karl-Ludwig Klingebiel: Concep-
but did not address the complexity of the initial decision mak- tualization, Data curation, Formal analysis, Investigation, Method-
ing in the treatment of polytraumatized patients. Our purpose was ology, Writing – original draft, Writing – review & editing. Sascha
to include parameters that are widely accepted and can be as- Halvachizadeh: Methodology, Writing – original draft, Writing –
sessed in every trauma centre. As an example, recent recommen- review & editing. Yannik Kalbas: Methodology, Writing – original
dations for the treatment of bleeding patients mainly suggest us- draft, Writing – review & editing. Hans-Christoph Pape: Concep-
ing thromboelastometry to guide the treatment of trauma patients. tualization, Data curation, Investigation, Project administration, Su-
However, not all trauma centers have access to viscoelastic meth- pervision, Writing – review & editing.
314
References [21] Mitra B, Tullio F, Cameron PA, Fitzgerald M. Trauma patients with the ’triad
of death’. Emerg Med J 2012;29(8):622–5 Epub 2011 Jul 23. PMID: 21785151.
[1] Nauth A, Hildebrand F, Vallier H, Moore T, Leenen L, Mckinley T, Pape HC. doi:10.1136/emj.2011.113167.
Polytrauma: update on basic science and clinical evidence. OTA Int 2021 [22] Hilbert P, Hofmann GO, Lefering R, Struck MF. Schockraumhämoglobin.
Feb 23;4(1):e116 PMID: 33937720; PMCID: PMC8016602. doi:10.1097/OI9. Prädiktor für eine Gerinnungsstörung beim Traumapatienten [Trauma
0 0 0 0 0 0 0 0 0 0 0 0 0116. bay haemoglobin level. Predictor of coagulation disorder in major
[2] Nahm NJ, Como JJ, Wilber JH, Vallier HA. Early appropriate care: definitive trauma]. Unfallchirurg 2015;118(7):601–6 GermanPMID: 24445308.
stabilization of femoral fractures within 24 h of injury is safe in most patients doi:10.10 07/s0 0113-013- 2522- y.
with multiple injuries. J Trauma 2011;71(1):175–85 PMID: 21336198. doi:10. [23] Hirschmann MT, Uike KN, Kaufmann M, Huegli R, Regazzoni P, Gross T. Qual-
1097/TA.0b013e3181fc93a2. itätssicherung interdisziplinärer Polytraumaversorgung. Möglichkeiten und
[3] Lichte P, Kobbe P, Dombroski D, Pape HC. Damage control orthopedics: Grenzen retrospektiver Standarderfassung [Quality management of interdisci-
current evidence. Curr Opin Crit Care 2012;18(6):647–50 PMID: 23037876. plinary treatment of polytrauma. Possibilities and limits of retrospective rou-
doi:10.1097/MCC.0b013e328359fd57. tine data collection]. Anaesthesist 2007;56(7):673–8 GermanPMID: 17483913.
[4] Shapiro MB, Jenkins DH, Schwab CW, Rotondo MF. Damage control: collective doi:10.10 07/s0 0101- 007- 1192- y.
review. J Trauma 20 0 0;49(5):969–78. [24] Frischknecht A, Lustenberger T, Bukur M, Turina M, Billeter A, Mica L, Keel M.
[5] Bolierakis E, Schick S, Sprengel K, Jensen KO, Hildebrand F, Pape HC, Pfeifer R. Damage control in severely injured trauma patients - A ten-year expe-
Interobserver variability of injury severity assessment in polytrauma patients: rience. J Emerg Trauma Shock 2011;4(4):450–4 PMID: 22090736; PMCID:
does the anatomical region play a role? Eur J Med Res 2021;26(1):35 PMID: PMC3214499. doi:10.4103/0974-2700.86627.
33858510; PMCID: PMC8051093. doi:10.1186/s40 0 01- 021- 00506- w. [25] Stettler GR, Moore EE, Nunns GR, Chandler J, Peltz E, Silliman CC, Baner-
[6] Halvachizadeh S, Pape HC. Determining the patient at risk - are scoring sys- jee A, Sauaia A. Rotational thromboelastometry thresholds for patients at risk
tems helpful to develop individualized concepts for safe definitive fracture for massive transfusion. J Surg Res 2018;228:154–9 Epub 2018 Apr 11. PMID:
fixation and damage control techniques? Injury 2019;50(7):1269–71 Erratum 29907206; PMCID: PMC6039387. doi:10.1016/j.jss.2018.03.027.
in: Injury. 2019 Nov;50(11):2147-2148. PMID: 31280866. doi:10.1016/j.injury. [26] David JS, Friggeri A, Vacheron CH, Bouzat P, Fraticelli L, Claustre C,
2019.06.031. Maegele M, Inaba K. Is it possible to improve prediction of outcome and
[7] Vallier HA, Moore TA, Como JJ, Wilczewski PA, Steinmetz MP, Wagner KG, blood requirements in the severely injured patients by defining categories of
Smith CE, Wang XF, Dolenc AJ. Complications are reduced with a protocol coagulopathy? Eur J Trauma Emerg Surg 2022 Feb 3 Epub ahead of print.
to standardize timing of fixation based on response to resuscitation. J Or- PMID: 35118557. doi:10.10 07/s0 0 068- 022- 01882- 6.
thop Surg Res 2015;10:155 PMID: 26429572; PMCID: PMC4590279. doi:10. [27] Bilgiç İ, Gelecek S, Akgün AE, Özmen MM. Evaluation of liver injury in
1186/s13018- 015- 0298- 1. a tertiary hospital: a retrospective study. Ulus Travma Acil Cerrahi Derg
[8] Hildebrand F, Lefering R, Andruszkow H, Zelle BA, Barkatali BM, Pape HC. De- 2014;20(5):359–65 PMID: 25541848. doi:10.5505/tjtes.2014.22074.
velopment of a scoring system based on conventional parameters to assess [28] Kautza BC, Cohen MJ, Cuschieri J, Minei JP, Brackenridge SC, Maier RV, Har-
polytrauma patients: polyTrauma Grading Score (PTGS). Injury 2015;46(Suppl brecht BG, Moore EE, Billiar TR, Peitzman AB, Sperry JL. Inflammation and
4):S93–8 PMID: 26542873. doi:10.1016/S0020-1383(15)30025-5. the Host Response to Injury Investigators. Changes in massive transfusion
[9] Moore E. Staged laparotomy for the hypothermia, acidosis, and coagulopathy over time: an early shift in the right direction? J Trauma Acute Care Surg
syndrome. Am J Surg 1996;172:405–10. 2012;72(1):106–11 PMID: 22310123; PMCID: PMC3276234. doi:10.1097/TA.
[10] Rotondo MF, Schwab CW, McGonigal MD, et al. Damage control: an ap- 0b013e3182410a3c.
proach for improved survival in exsanguinating penetrating abdominal injury. [29] Torabi M, Mazidi Sharaf Abadi F, Baneshi MR. Blood sugar changes and hos-
J Trauma 1993;35:375–82. pital mortality in multiple trauma. Am J Emerg Med 2018;36(5):816–19 Epub
[11] Pape HC, Giannoudis PV, Krettek C, Trentz O. Timing of fixation of ma- 2017 Oct 13. PMID: 29056393. doi:10.1016/j.ajem.2017.10.029.
jor fractures in blunt polytrauma: role of conventional indicators in clini- [30] Stettler GR, Sumislawski JJ, Moore EE, Nunns GR, Kornblith LZ, Con-
cal decision making. J Orthop Trauma 2005;19(8):551–62 PMID: 16118563. roy AS, Callcut RA, Silliman CC, Banerjee A, Cohen MJ, Sauaia A. Citrated
doi:10.1097/01.bot.0 0 0 0161712.87129.80. kaolin thrombelastography (TEG) thresholds for goal-directed therapy in
[12] Clendenen N, Nunns GR, Moore EE, Reisz JA, Gonzalez E, Peltz E, Sil- injured patients receiving massive transfusion. J Trauma Acute Care Surg
liman CC, Fragoso M, Nemkov T, Wither MJ, Hansen K, Banerjee A, 2018;85(4):734–40 PMID: 30059456; PMCID: PMC6158094. doi:10.1097/TA.
Moore HB, DʼAlessandro A. Hemorrhagic shock and tissue injury drive dis- 0 0 0 0 0 0 0 0 0 0 0 02037.
tinct plasma metabolome derangements in swine. J Trauma Acute Care Surg [31] Holcomb JB, Zarzabal LA, Michalek JE, Kozar RA, Spinella PC, Perkins JG,
2017;83(4):635–42 PMID: 28463938; PMCID: PMC5608631. doi:10.1097/TA. Matijevic N, Dong JF, Pati S, Wade CE, Group Trauma Outcomes, Hol-
0 0 0 0 0 0 0 0 0 0 0 01504. comb JB, Wade CE, Cotton BA, Kozar RA, Brasel KJ, Vercruysse GA,
[13] Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, Ko- MacLeod JB, Dutton RP, Hess JR, Duchesne JC, McSwain NE, Muskat PC, Jo-
madina R, Maegele M, Nardi G, Riddez L, Samama CM, Vincent JL, Ros- hannigamn JA, Cryer HM, Tillou A, Cohen MJ, Pittet JF, Knudson P, De-
saint R. The European guideline on management of major bleeding and Moya MA, Schreiber MA, Tieu BH, Brundage SI, Napolitano LM, Brunsvold ME,
coagulopathy following trauma: fifth edition. Crit Care 2019;23(1):98 Sihler KC, Beilman GJ, Peitzman AB, Zenati MS, Sperry JL, Alarcon LH,
PMID: 30917843; PMCID: PMC6436241. doi:10.1186/s13054-019- Croce MA, Minei JP, Steward RM, Cohn SM, Michalek JE, Bulger EM,
2347-3. Nunez TC, Ivatury RR, Meredith JW, Miller PR, Pomper GJ, Marin B. Increased
[14] Halvachizadeh S, Baradaran L, Cinelli P, Pfeifer R, Sprengel K, Pape HC. How platelet:RBC ratios are associated with improved survival after massive trans-
to detect a polytrauma patient at risk of complications: a validation and fusion. J Trauma 2011;71(2 Suppl 3):S318–28 PMID: 21814099. doi:10.1097/
database analysis of four published scales. PLoS ONE 2020;15(1):e0228082 TA.0b013e318227edbb.
PMID: 31978109; PMCID: PMC6980592. doi:10.1371/journal.pone. [32] Kutcher ME, Kornblith LZ, Narayan R, Curd V, Daley AT, Redick BJ, Nelson MF,
0228082. Fiebig EW, Cohen MJ. A paradigm shift in trauma resuscitation: evaluation of
[15] Hayden JA, van der Windt DA, Cartwright JL, Côté P, Bombardier C. Assess- evolving massive transfusion practices. JAMA Surg 2013;148(9):834–40 PMID:
ing bias in studies of prognostic factors. Ann Intern Med 2013;158(4):280–6 23864019. doi:10.1001/jamasurg.2013.2911.
PMID: 23420236. doi:10.7326/0 0 03- 4819- 158- 4- 201302190- 0 0 0 09. [33] Coccolini F, Ceresoli M, McGreevy DT, Sadeghi M, Pirouzram A, Toivola A,
[16] Mutschler M, Nienaber U, Brockamp T, Wafaisade A, Wyen H, Peiniger S, Paf- Skoog P, Idoguchi K, Kon Y, Ishida T, Matsumura Y, Matsumoto J, Reva V,
frath T, Bouillon B, Maegele M, TraumaRegister DGU. A critical reappraisal of Maszkowski M, Fugazzola P, Tomasoni M, Cicuttin E, Ansaloni L, Zaghi C,
the ATLS classification of hypovolaemic shock: does it really reflect clinical Sibilla MG, Cremonini C, Bersztel A, Caragounis EC, Falkenberg M, Handolin L,
reality? Resuscitation 2013;84(3):309–13 Epub 2012 Jul 24. PMID: 22835498. Oosthuizen G, Szarka E, Manchev V, Wannatoop T, Chang SW, Kessel B, He-
doi:10.1016/j.resuscitation.2012.07.012. bron D, Shaked G, Bala M, Ordoñez CA, Hibert-Carius P, Chiarugi M, Nils-
[17] Pape HC, Halvachizadeh S, Leenen L, Velmahos GD, Buckley R, Giannoudis PV. son KF, Larzon T, Gamberini E, Agnoletti V, Catena F, Hörer TM. Aortic bal-
Timing of major fracture care in polytrauma patients - An update on princi- loon occlusion (REBOA) in pelvic ring injuries: preliminary results of the ABO
ples, parameters and strategies for 2020. Injury 2019;50(10):1656–70 Epub Trauma Registry. Updates Surg 2020;72(2):527–36 Epub 2020 Mar 4. PMID:
2019 Sep 13. PMID: 31558277. doi:10.1016/j.injury.2019.09.021. 32130669. doi:10.1007/s13304- 020- 00735- 4.
[18] Tanner L, Neef V, Raimann FJ, Störmann P, Marzi I, Lefering R, Zacharowski K, [34] Johansson PI, Sørensen AM, Perner A, Welling KL, Wanscher M, Larsen CF,
Piekarski F. Committee on Emergency Medicine, Intensive Care and Trauma Ostrowski SR. Disseminated intravascular coagulation or acute coagulopa-
Management (Sektion NIS) of the German Trauma Society (DGU). Influence of thy of trauma shock early after trauma? An observational study. Crit Care
anaemia in severely injured patients on mortality, transfusion and length of 2011;15(6):R272 Epub 2011 Nov 17. PMID: 22087841; PMCID: PMC3388658.
stay: an analysis of the TraumaRegister DGU®. Eur J Trauma Emerg Surg 2022 doi:10.1186/cc10553.
Epub ahead of print. PMID: 35059750. doi:10.10 07/s0 0 068- 021- 01869- 9. [35] Hilbert-Carius P, Hofmann G, Stuttmann R. Hämoglobinorientierter und gerin-
[19] Inaba K, Teixeira PG, Shulman I, Nelson J, Lee J, Salim A, Brown C, Deme- nungsfaktorbasierter Algorithmus": effekt auf Transfusionsbedarf und stan-
triades D, Rhee P. The impact of uncross-matched blood transfusion on dardisierte Mortalitätsrate bei massivtransfusionspflichtigen Traumapatien-
the need for massive transfusion and mortality: analysis of 5,166 uncross- ten [Hemoglobin-oriented and coagulation factor-based algorithm : effect on
matched units. J Trauma 2008;65(6):1222–6 PMID: 19077605. doi:10.1097/TA. transfusion needs and standardized mortality rate in massively transfused
0b013e31818e8ff3. trauma patients]. Anaesthesist 2015;64(11):828–38 GermanEpub 2015 Oct 9.
[20] Doklestić K, Djukić V, Ivančević N, Gregorić P, Lončar Z, Stefanović B, Jo- PMID: 26453580. doi:10.10 07/s0 0101-015- 0093- 8.
vanović D, Karamarković A. Severe Blunt Hepatic Trauma in Polytrauma Pa- [36] Holcomb JB, Minei KM, Scerbo ML, Radwan ZA, Wade CE, Kozar RA, Gill BS,
tient - Management and Outcome. Srp Arh Celok Lek 2015;143(7–8):416–22 Albarado R, McNutt MK, Khan S, Adams PR, McCarthy JJ, Cotton BA. Ad-
PMID: 26506751. doi:10.2298/sarh1508416d. mission rapid thrombelastography can replace conventional coagulation tests
315
in the emergency department: experience with 1974 consecutive trauma [55] Wang HE, Callaway CW, Peitzman AB, Tisherman SA. Admission hypothermia
patients. Ann Surg 2012;256(3):476–86 PMID: 22868371. doi:10.1097/SLA. and outcome after major trauma. Crit Care Med 2005;33(6):1296–301 PMID:
0b013e3182658180. 15942347. doi:10.1097/01.ccm.0 0 0 0165965.31895.80.
[37] Kashuk JL, Moore EE, Sawyer M, Wohlauer M, Pezold M, Barnett C, Biffl WL, [56] Beilman GJ, Blondet JJ, Nelson TR, Nathens AB, Moore FA, Rhee P, Puyana JC,
Burlew CC, Johnson JL, Sauaia A. Primary fibrinolysis is integral in the patho- Moore EE, Cohn SM. Early hypothermia in severely injured trauma patients
genesis of the acute coagulopathy of trauma. Ann Surg 2010;252(3):434–42 is a significant risk factor for multiple organ dysfunction syndrome but
discussion 443-4PMID: 20739843. doi:10.1097/SLA.0b013e3181f09191. not mortality. Ann Surg 2009;249(5):845–50 Erratum in: Ann Surg. 2009
[38] Hilbert-Carius P, Hofmann GO, Lefering R, Stuttmann R, Struck MF. Clini- Oct;250(4):661. PMID: 19387315. doi:10.1097/SLA.0b013e3181a41f6f.
cal presentation and blood gas analysis of multiple trauma patients for pre- [57] Martin RS, Kilgo PD, Miller PR, Hoth JJ, Meredith JW, Chang MC. Injury-
diction of standard coagulation parameters at emergency department ar- associated hypothermia: an analysis of the 2004 National Trauma Data Bank.
rival. Anaesthesist 2016;65(4):274–80 Epub 2016 Apr 8. PMID: 27059795. Shock 2005;24(2):114–18 PMID: 16044080. doi:10.1097/01.shk.0 0 0 0169726.
doi:10.10 07/s0 0101-016-0150-y. 25189.b1.
[39] O’Connor JV, DuBose JJ, Scalea TM. Damage-control thoracic surgery: man- [58] Mommsen P, Andruszkow H, Frömke C, Zeckey C, Wagner U, van
agement and outcomes. J Trauma Acute Care Surg 2014;77(5):660–5 PMID: Griensven M, Frink M, Krettek C, Hildebrand F. Effects of accidental hypother-
25494414. doi:10.1097/TA.0 0 0 0 0 0 0 0 0 0 0 0 0451. mia on posttraumatic complications and outcome in multiple trauma pa-
[40] Cotton BA, Faz G, Hatch QM, Radwan ZA, Podbielski J, Wade C, Kozar RA, tients. Injury 2013;44(1):86–90 Epub 2011 Oct 30. PMID: 22040695. doi:10.
Holcomb JB. Rapid thrombelastography delivers real-time results that predict 1016/j.injury.2011.10.013.
transfusion within 1 h of admission. J Trauma 2011;71(2):407–14 discussion [59] Shafi S, Elliott AC, Gentilello L. Is hypothermia simply a marker of
414-7PMID: 21825945. doi:10.1097/TA.0b013e31821e1bf0. shock and injury severity or an independent risk factor for mortality in
[41] Peltan ID, Vande Vusse LK, Maier RV, Watkins TR. An International Nor- trauma patients?. Analysis of a large national trauma registry J Trauma
malized Ratio-Based Definition of Acute Traumatic Coagulopathy Is Associ- 2005;59(5):1081–5 PMID: 16385283. doi:10.1097/01.ta.0 0 0 0188647.03665.fd.
ated With Mortality, Venous Thromboembolism, and Multiple Organ Fail- [60] Trentzsch H, Huber-Wagner S, Hildebrand F, Kanz KG, Faist E, Piltz S, Lefer-
ure After Injury. Crit Care Med 2015;43(7):1429–38 PMID: 25816119; PMCID: ing R, TraumaRegistry DGU. Hypothermia for prediction of death in severely
PMC4512212. doi:10.1097/CCM.0 0 0 0 0 0 0 0 0 0 0 0 0981. injured blunt trauma patients. Shock 2012;37(2):131–9 PMID: 22249218.
[42] Lui CT, Wong OF, Tsui KL, Kam CW, Li SM, Cheng M, Leung KKG. Predictive doi:10.1097/SHK.0b013e318245f6b2.
model integrating dynamic parameters for massive blood transfusion in major [61] Clifton GL, Miller ER, Choi SC, Levin HS. Fluid thresholds and outcome
trauma patients: the Dynamic MBT score. Am J Emerg Med 2018;36(8):1444– from severe brain injury. Crit Care Med 2002;30(4):739–45 PMID: 11940738.
50 Epub 2018 Jan 4. PMID: 29307764. doi:10.1016/j.ajem.2018.01.009. doi:10.1097/0 0 0 03246-20 02040 0 0-0 0 0 03.
[43] Leemann H, Lustenberger T, Talving P, Kobayashi L, Bukur M, Brenni M, [62] Jiang JY, Gao GY, Li WP, Yu MK, Zhu C. Early indicators of prognosis in
Brüesch M, Spahn DR, Keel MJ. The role of rotation thromboelastometry in 846 cases of severe traumatic brain injury. J Neurotrauma 2002;19(7):869–
early prediction of massive transfusion. J Trauma 2010;69(6):1403–8 discus- 74 PMID: 12184856. doi:10.1089/08977150260190456.
sion 1408-9PMID: 21150521. doi:10.1097/TA.0b013e3181faaa25. [63] Juul N, Morris GF, Marshall SB, Marshall LF. Intracranial hypertension and
[44] Tauber H, Innerhofer P, Breitkopf R, Westermann I, Beer R, El Attal R, cerebral perfusion pressure: influence on neurological deterioration and out-
Strasak A, Mittermayr M. Prevalence and impact of abnormal ROTEM(R) come in severe head injury. The Executive Committee of the International
assays in severe blunt trauma: results of the ’Diagnosis and Treat- Selfotel Trial. J Neurosurg 20 0 0;92(1):1–6 PMID: 10616075. doi:10.3171/jns.
ment of Trauma-Induced Coagulopathy (DIA-TRE-TIC) study’. Br J Anaesth 20 0 0.92.1.0 0 01.
2011;107(3):378–87 Epub 2011 Jun 23. PMID: 21705350. doi:10.1093/bja/ [64] Marmarou A, Saad A, Aygok G, Rigsbee M. Contribution of raised ICP and
aer158. hypotension to CPP reduction in severe brain injury: correlation to out-
[45] Hagemo JS, Christiaans SC, Stanworth SJ, Brohi K, Johansson PI, Goslings JC, come. Acta Neurochir Suppl 2005;95:277–80 PMID: 16463865. doi:10.1007/
Naess PA, Gaarder C. Detection of acute traumatic coagulopathy and mas- 3- 211- 32318- x_57.
sive transfusion requirements by means of rotational thromboelastometry: [65] Ratanalert S, Phuenpathom N, Saeheng S, Oearsakul T, Sripairojkul B, Hirun-
an international prospective validation study. Crit Care 2015;19(1):97 PMID: pat S. ICP threshold in CPP management of severe head injury patients.
25888032; PMCID: PMC4374411. doi:10.1186/s13054-015-0823-y. Surg Neurol 2004;61(5):429–34 discussion 434-5PMID: 15120212. doi:10.
[46] Davenport R, Manson J, De’Ath H, Platton S, Coates A, Allard S, Hart D, 1016/S0090-3019(03)00579-2.
Pearse R, Pasi KJ, MacCallum P, Stanworth S, Brohi K. Functional defini- [66] Lannoo E, Van Rietvelde F, Colardyn F, Lemmerling M, Vandekerckhove T,
tion and characterization of acute traumatic coagulopathy. Crit Care Med Jannes C, De Soete G. Early predictors of mortality and morbidity after se-
2011;39(12):2652–8 PMID: 21765358; PMCID: PMC3223409. doi:10.1097/ vere closed head injury. J Neurotrauma 20 0 0;17(5):403–14 PMID: 10833059.
CCM.0b013e3182281af5. doi:10.1089/neu.20 0 0.17.403.
[47] Schöchl H, Nienaber U, Hofer G, Voelckel W, Jambor C, Scharbert G, Kozek- [67] Chambers IR, Treadwell L, Mendelow AD. Determination of threshold levels
Langenecker S, Solomon C. Goal-directed coagulation management of ma- of cerebral perfusion pressure and intracranial pressure in severe head injury
jor trauma patients using thromboelastometry (ROTEM)-guided administra- by using receiver-operating characteristic curves: an observational study in
tion of fibrinogen concentrate and prothrombin complex concentrate. Crit 291 patients. J Neurosurg 2001;94(3):412–16 PMID: 11235944. doi:10.3171/
Care 2010;14(2):R55 Epub 2010 Apr 7. PMID: 20374650; PMCID: PMC2887173. jns.2001.94.3.0412.
doi:10.1186/cc8948. [68] Balestreri M, Czosnyka M, Steiner LA, Schmidt E, Smielewski P, Matta B,
[48] Schöchl H, Solomon C, Traintinger S, Nienaber U, Tacacs-Tolnai A, Wind- Pickard JD. Intracranial hypertension: what additional information can be
hofer C, Bahrami S, Voelckel W. Thromboelastometric (ROTEM) findings in derived from ICP waveform after head injury? Acta Neurochir (Wien)
patients suffering from isolated severe traumatic brain injury. J Neurotrauma 2004;146(2):131–41 Epub 2004 Feb 2. PMID: 14963745. doi:10.1007/
2011;28(10):2033–41 Epub 2011 Sep 23. PMID: 21942848. doi:10.1089/neu. s0 0701-0 03-0187-y.
2010.1744. [69] Schreiber MA, Aoki N, Scott BG, Beck JR. Determinants of mortality in pa-
[49] Schöchl H, Cotton B, Inaba K, Nienaber U, Fischer H, Voelckel W, Solomon C. tients with severe blunt head injury. Arch Surg 2002;137(3):285–90 PMID:
FIBTEM provides early prediction of massive transfusion in trauma. Crit Care 11888450. doi:10.1001/archsurg.137.3.285.
2011;15(6):R265 Epub 2011 Nov 11. PMID: 22078266; PMCID: PMC3388656. [70] Martínez Casas I, Amador Marchante MA, Paduraru M, Fabregues Olea AI,
doi:10.1186/cc10539. Nolasco A, Medina JC. Thorax Trauma Severity Score: is it reliable for
[50] Einersen PM, Moore EE, Chapman MP, Moore HB, Gonzalez E, Silliman CC, Patient’s Evaluation in a Secondary Level Hospital? Bull Emerg Trauma
Banerjee A, Sauaia A. Rapid thrombelastography thresholds for goal-directed 2016;4(3):150–5 PMID: 27540549; PMCID: PMC4989041.
resuscitation of patients at risk for massive transfusion. J Trauma Acute Care [71] Daurat A, Millet I, Roustan JP, Maury C, Taourel P, Jaber S, Capdevila X, Char-
Surg 2017;82(1):114–19 PMID: 27805995; PMCID: PMC5177474. doi:10.1097/ bit J. Thoracic Trauma Severity score on admission allows to determine the
TA.0 0 0 0 0 0 0 0 0 0 0 01270. risk of delayed ARDS in trauma patients with pulmonary contusion. Injury
[51] Cotton BA, Harvin JA, Kostousouv V, Minei KM, Radwan ZA, Schöchl H, 2016;47(1):147–53 Epub 2015 Aug 29. PMID: 26358517. doi:10.1016/j.injury.
Wade CE, Holcomb JB, Matijevic N. Hyperfibrinolysis at admission is an 2015.08.031.
uncommon but highly lethal event associated with shock and prehospital [72] Aukema TS, Beenen LF, Hietbrink F, Leenen LP. Validation of the Thorax
fluid administration. J Trauma Acute Care Surg 2012;73(2):365–70 discussion Trauma Severity Score for mortality and its value for the development of
370PMID: 22846941. doi:10.1097/TA.0b013e31825c1234. acute respiratory distress syndrome. Open Access Emerg Med 2011;3:49–53
[52] Ireland S, Endacott R, Cameron P, Fitzgerald M, Paul E. The incidence and PMID: 27147852; PMCID: PMC4753967. doi:10.2147/OAEM.S22802.
significance of accidental hypothermia in major trauma–a prospective ob- [73] Kumari M, Mathur P, Aggarwal R, Madan K, Sagar S, Gupta A, Khurana S,
servational study. Resuscitation 2011;82(3):300–6 Epub 2010 Nov 12. PMID: Sreenivas V, Kumar S. Changes in extracellular cytokines in predicting dis-
21074927. doi:10.1016/j.resuscitation.2010.10.016. ease severity and final clinical outcome of patients with blunt chest trauma.
[53] Weuster M, Brück A, Lippross S, Menzdorf L, Fitschen-Oestern S, Behrendt P, Immunobiology 2021;226(3):152087 Epub 2021 Mar 27. PMID: 33857690.
Iden T, Höcker J, Lefering R, Seekamp A, Klüter T, TraumaRegister DGU. Epi- doi:10.1016/j.imbio.2021.152087.
demiology of accidental hypothermia in polytrauma patients: an analysis [74] Mommsen P, Zeckey C, Andruszkow H, Weidemann J, Frömke C, Puljic P, van
of 15,230 patients of the TraumaRegister DGU. J Trauma Acute Care Surg Griensven M, Frink M, Krettek C, Hildebrand F. Comparison of different tho-
2016;81(5):905–12 PMID: 27533910. doi:10.1097/TA.0 0 0 0 0 0 0 0 0 0 0 01220. racic trauma scoring systems in regards to prediction of post-traumatic com-
[54] Aitken LM, Hendrikz JK, Dulhunty JM, Rudd MJ. Hypothermia and associ- plications and outcome in blunt chest trauma. J Surg Res 2012;176(1):239–47
ated outcomes in seriously injured trauma patients in a predominantly sub- Epub 2011 Oct 5. PMID: 22099585. doi:10.1016/j.jss.2011.09.018.
tropical climate. Resuscitation 2009;80(2):217–23 Epub 2008 Dec 6. PMID: [75] Okabe Y. Risk factors for prolonged mechanical ventilation in patients with
19059696. doi:10.1016/j.resuscitation.2008.10.021. severe multiple injuries and blunt chest trauma: a single center retrospec-
316
tive case-control study. Acute Med Surg 2018;5(2):166–72 PMID: 29657729; [88] Coleman JR, Moore EE, Chapman MP, Banerjee A, Silliman CC, Ghasabyan A,
PMCID: PMC5891117. doi:10.1002/ams2.331. Chandler J, Samuels JM, Sauaia A. Rapid TEG efficiently guides hemostatic re-
[76] Seok J, Cho HM, Kim HH, Kim JH, Huh U, Kim HB, Leem JH, Wang IJ. Chest suscitation in trauma patients. Surgery 2018;164(3):489–93 Epub 2018 Jun 12.
Trauma Scoring Systems for Predicting Respiratory Complications in Isolated PMID: 29903508; PMCID: PMC6108915. doi:10.1016/j.surg.2018.04.029.
Rib Fracture. J Surg Res 2019;244:84–90 Epub 2019 Jul 4. PMID: 31279998. [89] Tanner L, Neef V, Raimann FJ, Störmann P, Marzi I, Lefering R, Zacharowski K,
doi:10.1016/j.jss.2019.06.009. Piekarski F. Committee on Emergency Medicine, Intensive Care and Trauma
[77] Subhani SS, Muzaffar MS, Khan MI. Comparison of outcome between low and Management (Sektion NIS) of the German Trauma Society (DGU). Influence
high thoracic trauma severity score in blunt trauma chest patients. J Ayub of anaemia in severely injured patients on mortality, transfusion and length
Med Coll Abbottabad 2014;26(4):474–7 PMID: 25672168. of stay: an analysis of the TraumaRegister DGU®. Eur J Trauma Emerg Surg
[78] Zahran MR, Elwahab AAEMA, El Nasr MMA, et al. Evaluation of the predictive 2022;48(4):2741–9 Epub 2022 Jan 20. PMID: 35059750; PMCID: PMC9360071.
value of thorax trauma severity score (TTSS) in thoracic-traumatized patients. doi:10.10 07/s0 0 068- 021- 01869- 9.
Cardiothorac Surg 2020;28:3. doi:10.1186/s43057- 020- 0015- 7. [90] Roberts DJ, Bobrovitz N, Zygun DA, Ball CG, Kirkpatrick AW, Faris PD,
[79] Sharma Amit, Rathore Shaitan, Verma Vijay, Yadav Parul. A study to validate Parry N, Nicol AJ, Navsaria PH, Moore EE, Leppäniemi AK, Inaba K,
thoracic trauma severity score in chest trauma patients. International Surgery Fabian TC, D’Amours S, Brohi K, Stelfox HT. Indications for use of tho-
Journal 2020;7:1526. doi:10.18203/2349-2902.isj20201863. racic, abdominal, pelvic, and vascular damage control interventions in trauma
[80] Elbaih Hamed, Adel, Elshapowry Islam, Kalil Nancy. Evaluation of Thoracic patients: a content analysis and expert appropriateness rating study. J
Trauma Severity Score in Predicting the Outcome of Isolated Blunt Chest Trauma Acute Care Surg 2015;79(4):568–79 PMID: 26402530. doi:10.1097/TA.
Trauma Patients. International Journal of Surgery and Medicine 2016;2:100–6. 0 0 0 0 0 0 0 0 0 0 0 0 0821.
doi:10.5455/ijsm.chesttrauma. [91] Pape HC, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H. Appraisal of
[81] E’Rezk, Moataz et al. “Assessment of Isolated Blunt Chest Trauma Patients early evaluation of blunt chest trauma: development of a standardized scor-
in Benha University Hospital According to Thoracic Trauma Severity Score.” ing system for initial clinical decision making. J Trauma 20 0 0;49(3):496–504
American Journal of Cardiovascular and Thoracic Surgery (2020): n. pag. PMID: 11003329. doi:10.1097/0 0 0 05373-20 0 0 090 0 0-0 0 018.
[82] Roberts DJ, Bobrovitz N, Zygun DA, Ball CG, Kirkpatrick AW, Faris PD, [92] Vallier HA, Super DM, Moore TA, Wilber JH. Do patients with multiple
Stelfox HT. Indications for use of damage control surgery and dam- system injury benefit from early fixation of unstable axial fractures? The
age control interventions in civilian trauma patients: a scoping review. J effects of timing of surgery on initial hospital course. J Orthop Trauma
Trauma Acute Care Surg 2015;78(6):1187–96 PMID: 26151522. doi:10.1097/TA. 2013;27(7):405–12.
0 0 0 0 0 0 0 0 0 0 0 0 0647. [93] Volpin G, Pfeifer R, Saveski J, Hasani I, Cohen M, Pape HC. Damage con-
[83] Burkhardt M, Nienaber U, Pizanis A, Maegele M, Culemann U, Bouillon B, trol orthopaedics in polytraumatized patients- current concepts. J Clin Or-
Flohé S, Pohlemann T, Paffrath T, TraumaRegister DGU. German Pelvic Injury thop Trauma 2021;12(1):72–82 Epub 2020 Nov 6. PMID: 33716431; PMCID:
Register of the Deutsche Gesellschaft für Unfallchirurgie. Acute management PMC7920204. doi:10.1016/j.jcot.2020.10.018.
and outcome of multiple trauma patients with pelvic disruptions. Crit Care [94] Scherer J, Coimbra R, Mariani D, Leenen L, Komadina R, Peralta R, Fattori L,
2012;16(4):R163 PMID: 22913820; PMCID: PMC3580753. doi:10.1186/cc11487. Marzi I, Wendt K, Gaarder C, Pape HC, Pfeifer R. Standards of fracture care in
[84] Burkhardt M, Nienaber U, Krause J, Pizanis A, Moersdorf P, Culemann U, polytrauma: results of a Europe-wide survey by the ESTES polytrauma sec-
Aghayev E, Paffrath T, Pohlemann T, Holstein JH, Beckenregister DGU. Trau- tion. Eur J Trauma Emerg Surg 2022 Epub ahead of print. PMID: 36227354.
maRegister DGU®. Das komplexe Beckentrauma : matching des Becken- doi:10.10 07/s0 0 068- 022- 02126- 3.
registers DGU mit dem TraumaRegister DGU® [Complex pelvic traumas : [95] Roberts DJ, Bobrovitz N, Zygun DA, Ball CG, Kirkpatrick AW, Faris PD, Brohi K,
data linkage of the German Pelvic Injury Register and the TraumaRegister D’Amours S, Fabian TC, Inaba K, Leppäniemi AK, Moore EE, Navsaria PH,
DGU®]. Unfallchirurg 2015;118(11):957–62 GermanPMID: 24695812. doi:10. Nicol AJ, Parry N, Stelfox HT. Indications for Use of Damage Control Surgery
10 07/s0 0113-014-2565-8. in Civilian Trauma Patients: a Content Analysis and Expert Appropriateness
[85] Burkhardt M, Holstein JH, Moersdorf P, Kristen A, Lefering R, Pohlemann T, Rating Study. Ann Surg 2016;263(5):1018–27 PMID: 26445471. doi:10.1097/
Pizanis A, TraumaRegister DGU. Proper coding of the Abbreviated Injury SLA.0 0 0 0 0 0 0 0 0 0 0 01347.
Scale: can clinical parameters help as surrogates in estimating blood loss? Eur [96] Goodman MD, Makley AT, Hanseman DJ, Pritts TA, Robinson BR. All the bang
J Trauma Emerg Surg 2014;40(4):473–9 Epub 2013 Oct 5. PMID: 26816243. without the bucks: defining essential point-of-care testing for traumatic co-
doi:10.10 07/s0 0 068- 013- 0335-x. agulopathy. J Trauma Acute Care Surg 2015;79(1):117–24 discussion 124PMID:
[86] Pfeifer R, Kalbas Y, Coimbra R, Leenen L, Komadina R, Hildebrand F, Hal- 26091324; PMCID: PMC5558264. doi:10.1097/TA.0 0 0 0 0 0 0 0 0 0 0 0 0691.
vachizadeh S, Akhtar M, Peralta R, Fattori L, Mariani D, Hasler RM, Lefer- [97] Davis JW, Kaups KL, Parks SN. Base deficit is superior to pH in evaluat-
ing R, Marzi I, Pitance F, Osterhoff G, Volpin G, Weil Y, Wendt K, Pape HC. ing clearance of acidosis after traumatic shock. J Trauma 1998;44(1):114–18
Indications and interventions of damage control orthopedic surgeries: an ex- PMID: 9464758. doi:10.1097/0 0 0 05373-1998010 0 0-0 0 014.
pert opinion survey. Eur J Trauma Emerg Surg 2021;47(6):2081–92 Epub 2020 [98] Pape HC, Moore EE, McKinley T, Sauaia A. Pathophysiology in patients with
May 26. PMID: 32458046. doi:10.10 07/s0 0 068- 020- 01386- 1. polytrauma. Injury 2022;53(7):2400–12 Epub 2022 May 14. PMID: 35577600.
[87] Maegele M, Inaba K, Rizoli S, Veigas P, Callum J, Davenport R, Fröh- doi:10.1016/j.injury.2022.04.009.
lich M, Hess J. Konsensusgruppe zur Erarbeitung einer viskoelastizitäts- [99] Keel M, Trentz O. Pathophysiology of polytrauma. Injury 2005;36(6):691–709
basierten Leitlinie zur frühen Gerinnungstherapie bei blutenden Schw- PMID: 15910820. doi:10.1016/j.injury.2004.12.037.
erverletzten. Frühe viskoelastizitätsbasierte Gerinnungstherapie bei bluten- [100] Volpin G, Cohen M, Assaf M, Meir T, Katz R, Pollack S. Cytokine levels (IL-4,
den Schwerverletzten: bericht der Konsensusgruppe über die Konsensuskon- IL-6, IL-8 and TGFβ ) as potential biomarkers of systemic inflammatory re-
ferenz 2014 zur Erarbeitung einer S2k-Leitlinie [Early viscoelasticity-based sponse in trauma patients. Int Orthop 2014;38(6):1303–9 Epub 2014 Jan 9.
coagulation therapy for severely injured bleeding patients: report of the PMID: 24402554; PMCID: PMC4037528. doi:10.10 07/s0 0264- 013- 2261- 2.
consensus group on the consensus conference 2014 for formulation of [101] Giannoudis PV, Veysi VT, Pape HC, Krettek C, Smith MR. When should we
S2k guidelines]. Anaesthesist 2015;64(10):778–94 GermanPMID: 26136120. operate on major fractures in patients with severe head injuries? Am J Surg
doi:10.10 07/s0 0101-015- 0040- 8. 2002;183(3):261–7 PMID: 11943123. doi:10.1016/s0002-9610(02)00783-3.
317

How To Clear Polytrauma Patients For Fracture Fixation

Uploaded by

Copyright:

Available Formats

How To Clear Polytrauma Patients For Fracture Fixation

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

How To Clear Polytrauma Patients For Fracture Fixation

Uploaded by

Copyright:

Available Formats

Injury 54 (2023) 292–317

Contents lists available at ScienceDirect