30 years of polytrauma care: An analysis of the change in strategies and results of 4849 cases treated at a single institution

Injury. 2009 Jan;40(1):77-83. doi: 10.1016/j.injury.2008.10.004. Epub 2008 Dec 30.


The quality and progress of treatment of 4849 multiple trauma patients treated at one institution was reviewed retrospectively. Three periods, 1975-1984 (decade I; n=1469) and 1985-1994 (decade II; n=1937) and 1995-2004 (decade III; n=1443) were compared. 65% of multiple trauma patients had cerebral injuries, 58% thoracic trauma and 81% extremity fractures (37% open injuries). Injury combinations decreased during all decades with head/extremity injuries being the most common combination. Throughout the three decades pre-hospital care became more aggressive with an increase of intravenous fluid resuscitation (I: 80%, II: 97%, III: 98%). Chest tube insertion decreased after an initial increase (I: 41%, II: 83%, III: 27%) as well as intubation (I: 82%, II: 94%, III: 59%). Rescue times were progressively shortened. For initial clinical diagnosis of massive abdominal haemorrhage ultrasound (I: 17%, II: 92%, III: 97%) replaced peritoneal lavage (I: 44%, II: 28%, III: 0%). CT-scans were used more frequently for the initial diagnosis of head injuries and other injuries to the trunk throughout the observation time. With regard to complications, acute renal failure decreased by half (I: 8.4%; II: 3.7%; III: 3.9%), ARDS initially decreased but increased again in the last decade (I: 18.1%, II: 13.4%, III: 15.3%), whereas the rate of multiple organ dysfunction syndrome (MODS) increased continuously (I: 14.2%, II: 18.9%, III: 19.8%) probably due to a decline of the mortality rate from 37% in the first to 22% in the second and 18% in the third decade and parallel increase of the time of death. These treatment results summarise the enormous clinical effort as well as medical progress in polytrauma management over the past 30 years. Further reduction of mortality is desirable, but probably only possible when immediate causal therapy of later posttraumatic organ failure can be established.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Clinical Protocols / standards*
  • Emergencies
  • Emergency Medical Services / trends*
  • Female
  • Fluid Therapy / methods
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Multiple Organ Failure / mortality
  • Multiple Organ Failure / therapy
  • Multiple Trauma / mortality
  • Multiple Trauma / surgery
  • Multiple Trauma / therapy*
  • Resuscitation
  • Retrospective Studies
  • Treatment Outcome
  • Wounds, Nonpenetrating / mortality
  • Wounds, Nonpenetrating / surgery
  • Wounds, Nonpenetrating / therapy*