Acute phase protein levels as an index of severity of physical injury

Inflammation resulting from any form of tissue injury causes an increase in plasma concentration of a number of liver-derived proteins (the acute phase reactant proteins), the measurement of which provides an indication of the magnitude of the inflammatory response. C reactive protein (CRP) is an example of an acute phase protein. Although concentrations increase particularly dramatically in response to inflammation and reflect the degree of ongoing tissue damage, this method has yet to be used to assess severity of injury in traumatology and forensic medicine. The rate at which the acute phase protein response occurred after injury was therefore explored in a series of 16 patients with maxillofacial skeletal injuries and in a series of 22 age- and sex-matched control patients. Increases in the plasma concentration of CRP were not detected until 6-12 h after injury and peaked at 48-72 h. Concentration of CRP was less than 10 mgm/l in all control patients. There was significant relation between peak levels and Abbreviated Injury Scale and Injury Severity scores. Results suggest that this method of assessing the severity of traumatic injury deserves further investigation and may be of use clinically, medico-legally and in relation to compensation awards.