Negative and positive prognostic factors in polytrauma, especially referring to “golden hour”

Abstract

BACKGROUND AND OBJECTIVES: Polytrauma, or the condition of victim affected by two or more lesions compromising vital parameters, is the third cause of death (0.6/1000/year), and the first one of mortality for subjects 44 year-younger, responsible of 26000 annual deaths, (60% for car accidents).

MATERIALS AND METHODS: A personal experience concerning four car crash victims contemporary accepted in our Surgical Emergency of a peripheric hospital and an overview of clinical and therapeutical aspects of polytrauma are reported.

RESULTS: Topographic distribution of deaths shows this patterns: during the transport to hospital: 4%; peripheric hospital: 10%; Emergency Departments: 13%; during hospitalization: 25%; Intensive Care Units: 46%. The outcome is strictly depending on the quality of the first approach, confirming the importance of golden hour.

CONCLUSIONS: The complexity of polytrauma is related to the various pathologies affecting the victims, either neurological ones, or thoracic, abdominal, vascular and orthopedic ones, emphasizing the role of diagnostic and therapeutic timely approach.