Monitoring the response to injury

• Published in: Injury Vol. 22; no. 5; pp. 377 - 382
• Main Authors: Schöffel, U., Bonnaire, F., van Specht, B.U., Kuner, E.H.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.09.1991; Elsevier
• Subjects: Adolescent; Adult; alpha 1-Antitrypsin; Biological and medical sciences; Complement C3a - analysis; Female; Femoral Fractures - blood; Femoral Fractures - surgery; Fibrinopeptide A - analysis; Fracture Fixation; Humans; Injury Severity Score; Male; Medical sciences; Middle Aged; Monitoring, Physiologic - methods; Multienzyme Complexes - blood; Multiple trauma; Multiple Trauma - blood; Multiple Trauma - surgery; Pancreatic Elastase - blood; Sepsis - blood; Time Factors; Traumas. Diseases due to physical agents; Human; Blood coagulation; Femur; Diseases of the osteoarticular system; Lower limb; Exploration; Fracture; Multiple injury
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/0020-1383(91)90099-Z

Tissue trauma leads to a severity-dependent activation of plasma and cellular systems. This response can be recorded by determining parameters which represent the activation state of these systems. In severely injured patients with multiple trauma three out of 14 parameters measured at the time of admission proved to be indicators of subsequent septic complications with a high degree of accuracy: Fibrinopeptide A (FPA — the first split product of fibrinogen), the C3 split product C3a, and the elastase- α 1 proteinase inhibitor-complex (E α 1 PI). In a second series of multiply-injured patients with femoral fractures who did not develop clinical sepsis (N = 25) these parameters were measured continuously to evaluate the influence of injury severity and of therapeutic strategy on the further course. We found a strong correlation between injury severity (ISS) and the degree of activation. The signs of activation decreased rapidly following immediate operative fixation, and remained elevated or even increased after primary femoral traction and secondary stabilization. The operative procedure did not cause any additional activation. Complications such as infection or the formation of haematomas were reflected by raised parameter levels