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Key post-injury actions improve early outcomes in multiple trauma patients

Issue: November 2011

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SAN ANTONIO, Texas — A number of factors improve outcomes of early total care of multiple trauma patients, including adequate control of acid pH in resuscitation and stability of major skeletal injuries after adequate resuscitation, according to a study presented at the Orthopaedic Trauma Association 2011 Annual Meeting.

“Acidosis is predictive of complications,” Heather Vallier, MD, said in her presentation, here. “Chest injuries, number of fractures and timing of fixation are other significant variables predicted by pulmonary complications.”

She and colleagues studied 1,443 patients who had surgery for pelvis, acetabulum, spine and femur fractures.

“The purposes of this project were to define which injuries and parameters warrant delay of fixation, to determine which time interval for fixation will have the most successful outcome once patients have resuscitated and to develop a model to predict and reduce complications for pelvic, acetabulum, spine and femur fractures,” Vallier said.

The team measured vital signs and laboratory parameters such as pH, base excess, lactate and hematocrit at 8-hour intervals for the first 72 hours postoperatively and evaluated how those parameters over time were associated with complications using univariate and multivariate analyses of variance. The team also used logistic predictive models to calculate odds ratios, F tests and receiver operating characteristic curves.

Of the patients, 12.7% developed pulmonary complications, such as pneumonia. Lactate values were greater in patients with pulmonary complications and correction of pH to 7.25 within the first 8 hours caused fewer pulmonary complications.

Mild to severe chest injury was the largest predictor of pulmonary complications. Fixation of fractures within the first 24 or 48 hours and no chest injury meant fewer complications, according to the results.

Vallier noted that the importance of definitive fixation of major skeletal injury after adequate resuscitation.

Reference:

• Vallier HA, Wang X, Moore TA, Wilber JH. Timing of orthopaedic surgery in multiple trauma patients: Development of a protocol for early appropriate care. Paper #25. Presented at the Orthopaedic Trauma Association 2011 Annual Meeting. Oct. 12-15. San Antonio, Texas.
• Disclosure: Vallier receives institutional support from Synthes, is on the editorial/governing board of the Journal of Orthopaedics and Traumatology and is a board member of the Orthopaedic Trauma Association.

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