Incidences and characteristics of multifactorial shock in polytrauma patients in the early phase after trauma
Objective To assess the incidences and clinical characteristics of multifactorial shock in the early phase after polytrauma.Methods Totally 1 493 patients with polytrauma admitted to our 3 multiple trauma centers from Jun.2020 to Mar.2023 were enrolled.Inclusion criteria were age≥18 years and meeting the new Berlin definition of polytrauma.Patients'medical records,clinical manifestations,laboratory tests,imaging exams,and complications were collected.According to the diagnostic criteria for each type of shock,the incidences and clinical characteristics of multifactorial shock in the early phase after polytrauma were analyzed.The differences be-tween the groups were compared by Student's t-test,or chi-square test.Results The ISS of the enrolled polytrau-ma patients was 24.52±7.28.Among the 1 493 polytrauma patients,1 043(69.86％,95％CI:67.5％-72.2％)were accompanied by shock,with single-factor shock accounting for 90.89％(948/1043,95％CI:89.1％-92.6％)and multifactorial shock accounting for 9.11％(95/1043,95％CI:7.4％-10.9％).In total,six combinations of multifac-torial shock were observed,respectively hypovolemic shock(HS)+distributed shock(DS),HS+obstructive shock(OS),HS+cardiogenic shock(CS),OS+CS,HS+DS+OS,and HS+DS+CS,accouting for 41.05％,23.16％,14.74％,3.16％,11.58％,6.32％,respectively.Compared to patients with single-factor shock,patients with multi-factorial shock had significantly higher rates of mechanical ventilation(77.89％vs.34.60％),more use of vasoac-tive agents(87.37％vs.58.86％),longer ICU length of stay(d,15.7±6.5 vs.7.2±3.1),and higher mortality(37.89％vs.9.60％,all P＜0.01).Conclusion Multifactorial shock is not uncommon in polytrauma patients in the early phase after trauma.These patients are critically injured and have a relatively poor outcome and high mor-tality.
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