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European Journal of Trauma and Emergency Surgery

Open Access 18-12-2023 | Polytrauma | Review Article

The outcomes of the most severe polytrauma patients: a systematic review of the use of high ISS cutoffs for performance measurement

Authors: Benjamin M. Hardy, Adrian Varghese, Megan J. Adams, Natalie Enninghorst, Zsolt J. Balogh

Published in: European Journal of Trauma and Emergency Surgery

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Abstract

Background

This systematic review aimed to describe the outcomes of the most severely injured polytrauma patients and identify the consistent Injury Severity Score based definition of utilised for their definition. This could provide a global standard for trauma system benchmarking.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was applied to this review. We searched Medline, Embase, Cochrane Reviews, CINAHL, CENTRAL from inception until July 2022. Case reports were excluded. Studies in all languages that reported the outcomes of adult and paediatric patients with an ISS 40 and above were included. Abstracts were screened by two authors and ties adjudicated by the senior author.

Results

7500 abstracts were screened after excluding 13 duplicates. 56 Full texts were reviewed and 37 were excluded. Reported ISS groups varied widely between the years 1986 and 2022. ISS groups reported ranged from 40–75 up to 51–75. Mortality varied between 27 and 100%. The numbers of patients in the highest ISS group ranged between 15 and 1451.

Conclusions

There are very few critically injured patients reported during the last 48 years. The most critically injured polytrauma patients still have at least a 50% risk of death. There is no consistent inclusion and exclusion criteria for this high-risk cohort. The current approach to reporting is not suitable for monitoring the epidemiology and outcomes of the critically injured polytrauma patients.

Level of evidence

Level 4—systematic review of level 4 studies.
Appendix
Available only for authorised users
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Metadata
Title
The outcomes of the most severe polytrauma patients: a systematic review of the use of high ISS cutoffs for performance measurement
Authors
Benjamin M. Hardy
Adrian Varghese
Megan J. Adams
Natalie Enninghorst
Zsolt J. Balogh
Publication date
18-12-2023
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-023-02409-3