Analysis on care outcome of patients with polytrauma and coma.

ABSTRACT

OBJECTIVE: To make further improvement of outcome of patients with polytrauma and coma. METHODS: The data of 3361 patients (2378 males and 983 females, aged from 5-95 years, 38.2 years on average) with severe polytrauma and coma admitted to Chongqing Emergency Medical Center (Level I Trauma Center), Chongqing, China, from November 1978 to December 2004 were analyzed retrospectively in this study. RESULTS: The overall survival rate and mortality were 93.2% (3133/3361) and 6.8% (228/3361), respectively. The mortalities in patients with coma duration less than 1 hour and combined with neural dysfunction and in patients with coma duration larger than or equal to 1 hour and combined with or without neural dysfunction were significantly higher than that of those with coma duration less than 1 hour but without neural dysfunction [39.5% (136/344) vs 3.0% (92/3017), P less than 0.01]. There existed significant differences in GCS, ISS, and revised trauma score (RTS) between the death group and the survival group (P less than 0.01). RTS was in good correspondence with patient's pathophysiological status and outcome in patients with multiple trauma and coma for different groups of systolic blood pressure (SBP). The mortality in patients with SBP less than 90 mm Hg was significantly higher than that of those with SBP larger than or equal to 90 mm Hg [33.3% (68/204) vs 5.1% (160/3157), P less than 0.01]. The mortality in polytrauma patients combined with serious head injury (AIS larger than or equal to 3) was 8.2%, among which, 76.5% died from lung complications. The morbidity rate of lung complications and mortality rate increased in patients with head injury complicated with chest or abdomen injury (23.9%, 61.1% vs 27.3%, 50.0%). The mortality reached up to 61.9% in patients complicated with severe head, chest and abdomen injuries simultaneously. CONCLUSIONS: It plays a key role to establish a fast and effective trauma care system and prompt and definite surgical procedures and to strengthen the management of complications for improving the survival rate of patients with severe polytrauma and coma.