Early biochemical characterization of soft-tissue trauma and fracture trauma

Objective: The long-term outcome of trauma patients basically depends on th e relation between the clearance capacity of the organism, e.g., the lungs, and the antigenic (inflammatory) load in relation to the amount of damaged and perfused tissue, It is necessary to determine quality and quantity of fracture and soft-tissue damage by clinical means as early as possible. It is unknown whether biochemical markers and the impact of soft-tissue trauma correlate and whether there is a predictive value on clinical outcome. Methods: A total of 107 trauma patients were prospectively enrolled in the study. Blood samples were collected immediately at the site of accident, at hospital admission, and every 2 hours for an interval of 25 hours, then da ily. In addition to the biochemical analysis of 20 different substances, th e following data were collected and correlated to the laboratory results: I njury Severity Score, polytrauma score of Hannover, modified fracture index , and soft-tissue index. These primary clinical findings as well as the lab oratory data were correlated to criteria of clinical outcome such as length of stay in the intensive care unit, length of hospital stay, infections, s ystemic inflammatory response syndrome, sepsis, multiple organ failure scor e according to Goris, and finally to primary (< 72 hours), secondary (> 72 hours), and overall lethality. The determination of individual extent and s everity of soft-tissue trauma is based on standard partial body volumes der ived from healthy volunteers. In addition, clinical estimation of the degre e of soft-tissue damage according to the usual classifications was performe d. Results: Significant (p > 0.05) correlations were found between fracture as well as soft-tissue trauma and intensive care unit stay, hospital stay, in fections, systemic inflammatory response syndrome, multiple organ failure s core, serum concentrations/activities of serum interleukin-6 and -8 and cre atine kinase during the first 24 hours after trauma, Severe soft-tissue tra uma was related to secondary lethality, however, without statistical signif icance, Conclusion: The amount of fracture and soft-tissue damage can be estimated early by analysis of serum interleukin-6 and creatine kinase and is of grea t importance with regard to longterm outcome after trauma.