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The most critically injured polytrauma patient mortality: should it be a measurement of trauma system performance?
Benjamin Maurice Hardy1,2, Natalie Enninghorst2, Kate Louise King1,2
1Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia.
Insights
Trauma mortality has decreased, but not for critical polytrauma patients (ISS 50-75). This high-risk group requires further study to improve survival rates in severe injury cases.
Area of Science:
- Trauma surgery
- Public health
- Injury epidemiology
Background:
- Developed trauma systems have achieved record low mortality rates for major trauma (Injury Severity Score [ISS] > 15).
- However, critical polytrauma patients (ISS 50-75) represent a subgroup with persistently high mortality risks.
- This study investigates whether overall trauma mortality improvements are driven by reduced moderate injuries, while critical polytrauma outcomes remain unchanged.
Purpose of the Study:
- To test the hypothesis that reductions in trauma mortality are primarily due to improvements in moderate injury severity.
- To determine if mortality rates for critical polytrauma patients (ISS 50-75) have remained persistently high despite overall system improvements.
- To analyze trends in trauma mortality over a 20-year period in a Level-1 trauma center.
Main Methods:
- A 20-year retrospective analysis (ending December 2021) of a Level-1 trauma center registry.
- Inclusion criteria: all trauma patients with an Injury Severity Score (ISS) > 15.
- Multivariate logistic regression analysis was used to examine mortality trends for the entire cohort and the critical polytrauma subset (ISS 50-75).
Main Results:
- A total of 8462 severely injured patients (ISS > 15) were analyzed.
- Critical polytrauma patients (ISS 50-75) constituted 2.8% (n=238) of the severely injured cohort.
- Overall mortality for ISS > 15 decreased from 11.3% to 9.4% (Adjusted OR 0.98).
- Mortality for critical polytrauma patients (ISS 50-75) showed no significant change, remaining between 46.2% and 60.0% (Adjusted OR 0.96).
Conclusions:
- Improvements in trauma mortality over the past two decades have not benefited all patient groups equally.
- Mortality rates for critical polytrauma patients (ISS 50-75) remain high and have not significantly improved.
- The critical polytrauma group (ISS 50-75) is a well-defined cohort suitable for targeted research and reporting to drive improvements in care and outcomes.
Purpose:
The risk of death after traumatic injury in developed trauma systems is at an all-time low. Among 'major trauma' patients (injury severity score, ISS > 15), the risk of dying is less than 10%. This group contains critical polytrauma patients (ISS 50-75), with high risks of death. We hypothesized that the reduction in trauma mortality was driven by reduction in moderate injury severity and that death from critical polytrauma remained persistently high.
Methods:
A 20-year retrospective analysis ending December 2021 of a Level-1 trauma center's registry was performed on all trauma patients admitted with ISS > 15. Patients' demographics, injury severity and outcomes were collected. Multivariate logistic regression analysis was performed. Mortality was examined for the entire study group and separately for the subset of critical polytrauma patients (ISS 50-75).
Results:
A total of 8462 severely injured (ISS > 15) trauma patients were identified during the 20-year period. Of these 238 (2.8%) were critical polytrauma patients (ISS 50-75). ISS > 15 mortality decreased from 11.3 to 9.4% over the study period (Adjusted OR 0.98, 0.97-0.99). ISS 50-75 mortality did not change significantly (46.2-60.0%), adjusted OR 0.96, 0.92-1.00).
Conclusion:
The improvement in trauma mortality over the past 20 years has not been experienced equally. The ISS50-75 critical polytrauma mortality is a practical group to capture. It could be a group for deeper study and reporting to drive improvement.
