Article
Soft tissue injuries in multiple trauma patients – a challenge we can meet? A matched-pair analysis from the TraumaRegister DGU
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Authors
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Nora Kirsten
- Medizinische Hochschule Hannover, Klinik für Unfallchirurgie, Hannover, Germany
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Georg Maximilian Franke
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Orthopädie und Unfallchirurgie, Kiel, Germany
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Rolf Lefering
- Universität Witten/Herdecke, Institut für Forschung in der Operativen Medizin (IFOM), Köln, Germany
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Andreas Seekamp
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Orthopädie und Unfallchirurgie, Kiel, Germany
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Tim Klüter
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Orthopädie und Unfallchirurgie, Kiel, Germany
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Stefanie Fitschen-Oestern
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Orthopädie und Unfallchirurgie, Kiel, Germany
| Published: | October 21, 2024 |
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Outline
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Objectives: Despite tremendous clinical efforts over the past few decades, the treatment of severely injured patients remains still challenging. Concomitant soft tissue injuries represent a particular challenge, as they can lead to complications at any time of trauma care, hold a high risk of infection and often require multiple surgical interventions and interdisciplinary collaboration.
Methods: This retrospective, multicentric study used the TraumaRegister DGU® to examine the effect of open fractures and severe soft tissue injuries on outcome of multiple trauma patients. Primary admitted multiple trauma patients at the age of 16 to 70 years, treated from 2010 to 2021, were included. A Matched pair analysis was performed for better comparability of trauma patients with and without open fractures and/or severe soft tissue injuries.
TR-DGU project ID: 2021-018
Data provision was carried out by TraumaRegister DGU®.
Evaluation and interpretation are in the author's responsibility and haven't yet accomplished the review process of TraumaRegister DGU®.
Results and conclusion: After applying the matching criteria, 5,795 pairs were created and analyzed. The group with sustained soft tissue injuries was found to have a higher ISS ([mean ± SD] 22.1 ± 10.4 vs. 20.6 ± 10.2, p < 0.001). Endotracheal tube insertion (27.7 % vs. 30.4 %, p = 0.003), catecholamine administration (6.0 % vs. 8.4 %, p < 0.001) and cardio-pulmonary resuscitation (1.6 % vs. 2.1 %, p = 0.027) were more frequent in the group with sustained soft tissue injury. Both groups were equally frequent admitted to the intensive care unit (ICU) and length of stay (LOS) at the ICU ([d] 7.1 ± 12.5 vs. 7.2 ± 11.4, p = 0.584) did not differ significantly. However, total LOS at the hospital was longer for the group with sustained soft tissue injury ([d] 21.6 ± 19.1 vs. 23.6 ± 21.5, p < 0.001). Sepsis occurred more often in patients with soft tissue injury (4.3% vs. 5.2%, p = 0.034). There was no significant difference in prevalence of multi organ failure, 24h-mortality (2.1% vs. 2.5%, p = 0.151) and overall-mortality (3.6% vs. 3.9%, p = 0.329) between both groups.
Due to database analysis and revision of guidelines, the treatment of severely injured patients has steadily improved in recent years. Patients with severe soft tissue injuries required more medical interventions and length of stay at the hospital was longer.
In this study, we were able to show that although concomitant severe soft tissue injuries required more ICU interventions and led to a longer length of stay, 24-hour and all-cause mortality were not significantly increased.
