Polytrauma: Definition, Scoring, Glasgow Coma Scale & Damage Control Orthopaedics
DNB Orthopaedics • October 2024 • Paper III • 10 Marks
Introduction
Polytrauma refers to major trauma involving more than one body region, where the combined injuries produce a significant physiological threat to life. Orthopaedic injuries are common in such patients and must be managed as part of the overall resuscitation strategy rather than in isolation.
Core principle
In polytrauma, the priority is: life before limb, physiology before definitive fixation.
A. Definition of Polytrauma
Traditionally, polytrauma was described as injuries involving two or more anatomical regions or organ systems, with at least one injury, or the combination of injuries, being potentially life-threatening.
A more objective contemporary definition is the Berlin definition of polytrauma.
Berlin Definition
Polytrauma is present when a patient has:
AIS ≥ 3 in at least TWO different body regions
AND
at least one additional physiological risk factor.
Physiological Criteria in the Berlin Definition
| Parameter | Criterion |
|---|---|
| Hypotension | Systolic BP ≤ 90 mmHg |
| Reduced consciousness | GCS ≤ 8 |
| Acidosis | Base excess ≤ −6 mmol/L |
| Coagulopathy | PTT ≥ 40 s or INR ≥ 1.4 |
| Age | ≥ 70 years |
Exam memory line:
2 regions with AIS ≥3 + 1…