Abbreviated Injury Scale; Acute Kidney Injury; Acute Lung Injury; Biomarkers, Pharmacological; Fracture Fixation; Glasgow Coma Scale; Injury Severity Score; Multiple Trauma; Survival; Time-to-Treatment; Treatment Outcome
In polytrauma care the timing of definitive surgical treatment of major fractures is crucial for morbidity and mortality. Whereas early total care involves immediate definitive surgical fracture fixation, damage control orthopedics temporarily stabilizes the fracture with an external fixator and performs definitive osteosynthesis after optimizing the patient’s condition on the ICU. Polytrauma victims with concomitant severe chest trauma are at high risk of developing ARDS and pneumonia. As these patients are considered especially vulnerable to a sustained inflammatory response from immediate surgical intervention, damage control orthopedics seems to be their treatment of choice. However, pulmonary complications may develop while waiting for secondary surgery, impeding definitive osteosynthesis and thus the best possible outcome. In consequence, the choice of fracture treatment poses a serious challenge to trauma surgeons. Providing decision making tools concerning this matter was the impetus of our biomarker research. Meanwhile, we also search for diagnostic biomarkers to quantify the extent of an injury, for prognostic biomarkers to indicate the patient’s probable outcome, and for predictive biomarkers to forecast the likelihood of complications and syndromes in polytrauma victims. Furthermore, we focus on the time course of biomarker levels to elucidate pathophysiological changes that might contribute to an improved polytrauma regimen.
- Negrin, L.L. et al., 2019. The impact of polytrauma on sRAGE levels: evidence and statistical analysis of temporal variations. World Journal of Emergency Surgery, 14(1). Available at: http://dx.doi.org/10.1186/s13017-019-0233-6.
- Negrin, L.L. et al., 2017. Club cell protein 16 and cytokeratin fragment 21-1 as early predictors of pulmonary complications in polytraumatized patients with severe chest trauma S. Brakenridge, ed. PLOS ONE, 12(4), p.e0175303. Available at: http://dx.doi.org/10.1371/journal.pone.0175303.
- Negrin, L.L., Jahn, A. & van Griensven, M., 2017. Leptin Protects Against Mortality and Organ Dysfunction in A Two-Hit Trauma/Sepsis Model and is IL-6-Dependent. SHOCK, 48(1), pp.130-137. Available at: http://dx.doi.org/10.1097/SHK.0000000000000837.
- Negrin, L.L. et al., 2017. The clinical benefit of a follow-up thoracic computed tomography scan regarding parenchymal lung injury and acute respiratory distress syndrome in polytraumatized patients. Journal of Critical Care, 37, pp.211-218. Available at: http://dx.doi.org/10.1016/j.jcrc.2016.10.003.
- Negrin, L.L. et al., 2017. Soluble Receptor for Advanced Glycation End Products Quantifies Lung Injury in Polytraumatized Patients. The Annals of Thoracic Surgery, 103(5), pp.1587-1593. Available at: http://dx.doi.org/10.1016/j.athoracsur.2016.09.021.