Multiply injured patients with lung contusion, high PPT levels at risk for complications following major surgery

DENVER — The results of a European study suggest that using a combination of conventional scores and physiologic parameters is useful for judging the clinical condition of a patient with multiple injuries before clearing him or her for surgery.

Using data from eight Level I trauma centers, Hans-Christoph Pape, MD, and colleagues prospectively studied 162 adult polytrauma patients who had a moderate New Injury Severity Score. They excluded patients who were unstable or in critical condition.

The investigators tested more than 40 parameters to determine whether a patient is cleared for surgery, including prothrombin time (PTT), volume replacement, unilateral and bilateral lung contusion and the Abbreviated Injury Scale (AIS) for all body regions. Clinical complications such as sepsis, multiple organ failure and pneumonia served as the study endpoints.

The study revealed that fluid requirements, a lung contusion, AIS chest score and elevated PPT levels at hospital admittance were the most sensitive individual parameters for developing a complication, according to Pape, who presented the findings at the 24th Annual Meeting of the Orthopaedic Trauma Association, here. The investigators also found that combining three of the factors increased the sensitivity for identifying patients who would develop a complication.

“We feel that predication of the complication is possible by just using conventional parameters, which are easily accessible,” Pape said. “It would be helpful to have one score that clears patients, but of course, further studies are required.”

For more information:
Pape HC, McClinsy M, Tarkin IS, et al. Paper #11. Clearing polytrauma patients for major surgery: Which parameters are the best? Presented at the 24th Annual Meeting of the Orthopaedic Trauma Association. Oct. 16-18, 2008. Denver