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Head Injury and Outcome—What Influence do Concomitant Injuries Have?

Lefering, Rolf PhD; Paffrath, Thomas MD; Linker, Ralph MD; Bouillon, Bertil MD; Neugebauer, Edmund A. M. PhD; Deutsche Gesellschaft für Unfallchirurgie/German Society for Trauma Surgery

Journal of Trauma-Injury Infection & Critical Care: November 2008 - Volume 65 - Issue 5 - pp 1036-1044
doi: 10.1097/TA.0b013e318184ee48
Original Articles

Background: Severe head injury (HI) is known to be a major determinant of mortality in patients with multiple injuries but additional injuries also contribute to the clinical outcome. The Trauma Registry of the German Society for Trauma Surgery offers sufficient data for comparative outcome analysis in relation to the injury pattern.

Methods: A total of 21,356 cases from Trauma Registry of the German Society for Trauma Surgery with complete data for pattern of injury (Abbreviated Injury Scale [AIS], Injury Severity Score), the incidence of hospital mortality, organ failure, sepsis, duration of hospital stay, and intubation-free days. Maximum AIS severity of HI, including brain, skull, face, and cervical spine, and injuries to the torso and/or extremities (TEI) were used for comparative subgroup analysis.

Results: Overall mortality rate was 13.7% (mean age, 41.3 years; 72.6% men; mean Injury Severity Score, 24.4). Patients with relevant HI (AISHI ≥3) were found to have a higher mortality rate (22.1%) than patients with relevant TEI (12.9%). In all HI severity subgroups mortality increased consistently by about 5% with TEI of grade 4, and by 15% with TEI of grade 5, but no increase is observed for lower severity grades. The incidence of organ failure (overall 31.4%), multiple organ failure (15.0%), and sepsis (9.9%) are mainly influenced by the severity of TEI. Intubation-free days are equally influenced by both types of injuries of grade 3 or higher.

Conclusions: Mortality in patients with severe trauma is mainly determined by the severity of HI, while TEI contribute consistently only from AIS grade 4 or higher.

From Institute for Research in Operative Medicine (IFOM) (R. Lefering, E.A.M.N.), University of Witten/Herdecke, Cologne, Germany; Department of Trauma and Orthopedic Surgery (T.P., B.B.), Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany; and Orthopedic Medical Practice Center (R. Linker), Zell/Mosel, Germany.

Submitted for publication April 9, 2008.

Accepted for publication June 4, 2008.

The Trauma Registry of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU) was partly funded by the Deutsche Forschungsgemeinschaft (DFG) Ne 385/5 and by a grant of Novo Nordisk A/S, Bagsvaerd, Denmark.

Presented at the Annual Trauma Registry Meeting 2006 in Munich.

Address for reprints: Rolf Lefering, PhD, IFOM—Institute for Research in Operative Medicine, University of Witten/Herdecke, Campus Cologne Merheim; Building 38, Ostmerheimer Street 200, 51109 Cologne, Germany; email:

© 2008 Lippincott Williams & Wilkins, Inc.