[Does initial management of polytrauma patients have an effect on the development of multiple organ failure? Evaluation of preclinical and clinical data of 1,112 polytrauma patients].

The aim of this study was to investigate criteria in the preclinical and early clinical treatment which contribute to the development of posttraumatic multiple organ failure (MOV). In a retrospective study, 1112 primarily treated patients with multiple trauma and an injury severity > 20 on the Hanover Polytrauma Score (PTS) were investigated. The patients were classified according to Goris into groups with MOV (+MOV; 16.8%) and without MOV (-MOV). Patients with MOV had a significantly higher injury severity score (39.1 vs 33.7). A significantly higher proportion of +MOV patients had severe trunk injuries: thorax (85.2% vs 68.9%), abdomen (37.0% vs 26.1%) and pelvis (49.4% vs 35.6%). -MOV patients had significantly more injuries of the extremities (83.6% vs 72.8%). Differences in preclinical management were seen. The proportion of helicopter transports was significantly higher in the -MOV group (67.9% vs 57.8%). A positive effect was seen for early preclinical intubation. Patients who were intubated before arrival at the hospital had the same rate of MOV incidence as late intubated patients, but they had significantly higher (trunk) injury severity. +MOV patients received a significantly higher quantity of fluid replacement. In particular, more blood units and fresh frozen plasma were given in the first 24 h after trauma, possibly in association with the trunk injuries and the consequently increased hemorrhage. The mortality for all patients was 27.2%, in the +MOV group 60.4%. Posttraumatic MOV was the most frequent cause of death (37.5%), and the mean time of death after MOV was 16.7 days.