DOES THE INITIAL TREATMENT OF MULTIPLE TR AUMA PATIENTS INFLUENCE THEDEVELOPMENT OF MULTIPLE ORGAN FAILURE - EVALUATION OF THE PRECLINICALAND CLINICAL-DATA OF 1112 PATIENTS WITH MULTIPLE INJURIES

The aim of this study was to investigate criteria in the preclinical a nd early clinical treatment which contribute to the development of pos ttraumatic multiple organ failure (MOV). In a retrospective study, 111 2 primarily treated patients with multiple trauma and an injury severi ty >20 on the Hanover Polytrauma Score (PTS) were investigated. The pa tients were classified according to Goris into groups with MOV (+MOV; 16.8%) and without MOV (-MOV). Patients with MOV had a significantly h igher injury severity score (39.1 vs 33.7). A significantly higher pro portion of +MOV patients had severe trunk injuries: thorax (85.2% vs 6 8.9%), abdomen (37.0% vs 26.1%) and pelvis (49.4% vs 35.6%). -MOV pati ents had significantly more injuries of the extremities (83.6% vs 72.8 %). Differences in preclinical management were seen. The proportion of helicopter transports was significantly higher in the -MOV group (67. 9% vs 57.8%). A positive effect was seen for early preclinical intubat ion. Patients who were intubated before arrival at the hospital had th e same rate of MOV incidence as late intubated patients, but they had significantly higher (trunk) injury severity. +MOV patients received a significantly higher quantity of fluid replacement. In particular, mo re blood units and fresh frozen plasma were given in the first 24 h af ter trauma, possibly in association with the trunk injuries and the co nsequently increased hemorrhage. The mortality for all patients was 27 .2%, in the +MOV group 60.4%. Posttraumatic MOV was the most frequent cause of death (37.5%), and the mean time of death after MOV was 16.7 days.