Sepsis in Polytrauma Patients: A Comparative Analysis of Damage Control versus Early Total Care regarding the Injury Severity Score using IBM Watson Pathway Explorer®

Author(s): Jan Hambrecht, Philipp Vetter, Cedric Niggli, Hans-Christoph Pape, Ladislav Mica

Sepsis presents a challenge in polytrauma patients care, where timing of procedures is crucial. The University Hospital of Zurich and IBM developed IBM Watson Trauma Pathway Explorer for predicting polytrauma complications such as SIRS, Sepsis, and early death within 72 hours. We intended to investigate the association of surgical treatment (Damage Control, DCS and Early Total Care, ETC) and injury severity (Injury Severity Score, ISS) with the development of sepsis. Data from 3653 patients was included. Patients were divided into two groups based on the type of surgical management (DCS, ETC) and injury severity (ISS ≤ 30, ISS > 30). The groups were assessed for the development of sepsis. Totally, 1242 patients had an ISS > 30 (34.6%), while 2374 had an ISS ≤ 30 (65.4%). DCS was conducted in 66.3% of cases versus 33.7% for ETC. DCS was performed in 73.5% of patients with an ISS > 30 and in 62.5% of patients with an ISS ≤ 30. ETC was performed in 26.5% for ISS > 30 and 37.5% for ISS ≤ 30. Sepsis was detected in 15% of the patients. 50.8% of sepsis cases had an initial ISS > 30. Regarding ETC, sepsis occurred in 9.6% of cases with ISS ≤ 30 and in 18.5% of cases with an ISS > 30. Regarding DCS, sepsis was detected in 12.3% with ISS ≤ 30 and in 23.4% with ISS > 30. Development of sepsis was associated with ISS > 30 (OR 2.21, p < 0.001) and DCS treatment (OR 1.45, p< 0.001). The findings confirm the association of sepsis development in polytrauma patients with a higher injury severity (ISS < 30). On the other hand, DCS does not generally imply a lower risk for this complication.