Definition of polytrauma: Discussion on the objective definition based on quantitative estimation of multiply injured patients during wartime

Synergistic Effects of Forensic Medicine and Traumatology: Comparison of Clinical Diagnosis Autopsy Findings in Trauma-Related Deaths

BACKGROUND

Trauma is the third leading cause of death worldwide after cardiovascular and oncologic diseases. Predominant causes of trauma-related death (TD) are severe traumatic brain injury (sTBI), hemorrhagic shock, and multiple organ failure. An analysis of TD is required in order to review the quality of trauma care and grasp how well the entire trauma network functions, especially for the most severely injured patients. Furthermore, autopsies not only reveal hidden injuries, but also verify clinical assumed causes of death.

MATERIAL

During the study period of 3 years, a total of 517 trauma patients were admitted to our supraregional University Centre of Orthopaedics and Traumatology in Dresden. 13.7% (71/517) of the patients died after trauma, and in 25 cases (35.2%), a forensic autopsy was instructed by the federal prosecutor. The medical records, death certificates, and autopsy reports were retrospectively evaluated and the clinical findings matched to autopsy results.

RESULTS

The observed mortality rates (13.7%) were 4.2% less than expected by the calculated RISC II probability of survival (mortality rate of 17.9%). The most frequent trauma victims were due to falls >3 m (n = 29), followed by traffic accidents (n = 28). The median ISS was 34, IQR 25, and the median New ISS (NISS) was 50, IQR 32. Locations of death were in emergency department (23.9%), ICU (73.2%), OR and ward (1.4%, respectively). Clinicians classified 47.9% of deaths due to sTBI (n = 34), followed by 9.9% thoracic trauma and multiple organ failure (n = 7), 8.4% multiple trauma (n = 6), and 2.8% hypoxia and exsanguination (n = 2). In 18.3%, cases were unspecific or other causes of death recorded on the death certificates. Evident differences with evident clinical consequences were ascertained in 4% (n = 1) and marginal clinical consequences in 24% (6/25). In 16% (4/25), marginal differences with minor forensic consequences were revealed.

CONCLUSIONS

Even in a supraregional trauma center, specialized in multiple trauma management (4.2% survival benefit), room for improvement exists in more than a quarter of all casualties. This underlines the need for higher autopsy rates to uncover missed injuries and to understand the pathomechanism in each trauma fatality. This would also help to uncover potential insufficiencies in clinical routines with regard to diagnostics. The interdisciplinary cooperation of trauma surgeons and forensic pathologists can increase the quality of trauma patient care.

Complex knee injury scenario in tertiary level care in North India: An epidemiological study

Floating knee injury has been considered as one of the severe orthopedic injury, and is often associated with major systemic trauma involving other organs.

OBJECTIVE

To identify the incidence of floating knee injury, severity of injury and associated orthopaedic and non-orthopaedic injury.

METHODS

Epidemiologic study conducted from 1 Jan 2014 to 31 Dec 2014.

RESULTS

A total of 136 cases with floating knee injury were registered. Modified Fraser classification showed 58 patients had type 1, 74 had type 2 and 4 had type 3 floating knees. 119(87.5%) patients had open fractures and Gustilo-Anderson type IIIA(29.4%) being the commonest. No Mortality was found. 16 (11.76%) of floating knees had to undergo amputation of afflicted limb.

CONCLUSION

Statics of such data would be helpful in planning and preparing ourselves as healthcare professionals to prevent high mortality and morbidity/disability in floating knee injury.

STUDY DESIGN

Retrospective Epidemiological.

LEVEL OF EVIDENCE

Level 4 (Case Study).