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Polytrauma Defined by the New Berlin Definition: A Validation Test Based on Propensity-Score Matching Approach
Cheng-Shyuan Rau1, Shao-Chun Wu2, Pao-Jen Kuo3
1Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City 833, Taiwan. ersh2127@cloud.cgmh.org.tw.
Polytrauma patients, defined by the new Berlin criteria, face significantly higher mortality and intensive care unit (ICU) admission rates compared to non-polytrauma patients. This study validates the Berlin definition for identifying high-risk trauma cases.
Area of Science:
- Trauma Surgery
- Critical Care Medicine
- Injury Epidemiology
Background:
- Polytrauma patients are hypothesized to have a higher mortality risk than the sum of individual injury mortalities.
- The new Berlin definition for polytrauma includes Abbreviated Injury Scale (AIS) ≥ 3 in multiple body regions plus specific physiological parameters.
Purpose of the Study:
- To investigate the outcomes of polytrauma patients using the new Berlin definition.
- To compare mortality, length of stay (LOS), intensive care unit (ICU) utilization, and medical expenses between polytrauma and non-polytrauma patients.
Main Methods:
- Retrospective analysis of 369 polytrauma and 1260 non-polytrauma patients (Injury Severity Score [ISS] ≥ 18) from a level I trauma center registry (2009-2015).
- Exclusion of burn injuries and incomplete data.
- Propensity-score matching (1:1 ratio) was employed to create comparable cohorts for outcome evaluation.
Main Results:
- Polytrauma patients exhibited a significantly higher ISS and a 1.9-fold increased odds of mortality.
- Matched polytrauma patients had a substantially higher mortality rate (OR 17.5), increased ICU admission (84.1%), and longer ICU LOS (10.3 days) compared to non-polytrauma patients.
- Total medical expenses were 35.1% higher for polytrauma patients, though overall hospital LOS showed no significant difference.
Conclusions:
- The new Berlin definition of polytrauma is a feasible and applicable tool for identifying high-risk trauma patients.
- Polytrauma, as defined by the Berlin criteria, is associated with significantly worse patient outcomes and higher healthcare costs.
