Outcome and risk factors in severely traumatised patients

This study presents outcome and risk factors in 228 critically ill adult trauma patients treated in the ICU. Most of the patients had multiple traumas, the most common single trauma among them being brain injury. 23% of all patients died in the ICU and 37% by the end of the first year after intensive care. The mortality rate had not increased by the end of the second year. 9% of the patients remained disabled. The one-year mortality rate was highest (58%) in brain injury patients. On admission, before any treatment was given, disturbances in seven vital functions were classified into three grades according to their severity. An increase in the sum of these severity grades correlated well with eventual mortality. Of many biochemical parameters analysed, only hyperosmolality and hypernatremia were associated with increased mortality. Two logistic models, one for the whole patient material and another for those having no or only minor brain injury, were fitted in order to find risk factors characteristic of non-survivors. The following risk factors were obtained: increasing age, brain injury, deteriorating level of consciousness during intensive care, increasing serum osmolality and creatinine. These logistic models can be used prospectively to estimate the probability of death for an individual patient.