The Road to Sepsis in Polytrauma Patients: Waypoints between Damage Control Surgery and Early Total Care to Avoid Sepsis

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

Prompt and effective sepsis treatment is crucial for reducing multiorgan failure and improving patient outcomes following polytrauma. The management of severe trauma involves two strategies: damage control surgery (DCS) and early total care (ETC), each with distinct timing and objectives to prevent sepsis development. This study aimed to examine different clinical and laboratory parameters in the DCS and ETC groups regarding the development of sepsis. A retrospective cohort study was conducted at the University Hospital. Participants included trauma patients aged ≥16 years with an Injury Severity Score (ISS) ≥16, investigating sepsis within 21 days of admission. DCS and ETC groups were compared in relation to sepsis development. Statistical methods encompassed group comparisons with Welch’s t-test, binary logistic regression, and conditional augmented inverse probability weighting (CAIPW). 2881 patients were included in the final study. The analysis showed that ISS had a significant impact on sepsis risk in both groups. Other factors like GCS, temperature, and ATLS shock class influenced sepsis risk in the ETC group, while leucocytosis, low pH, and high Quick values impacted sepsis risk in the DCS group. The study's key results indicate that sepsis is more common in the DCS group due to the higher frequency of DCS procedures in patients with high ISS scores, making them more susceptible to infection. The study highlights the complexity of choosing between DCS and ETC strategies, with both having advantages and challenges concerning sepsis development in polytrauma patients.