Session V - Polytrauma

Application of a Standardized Polytrauma Rehabilitation Score for Patients with Injuries below the Knee

Christian Probst, MD; Frank Muller, MD; Boris A. Zelle, MD; Martin Panzica, MD; Hans-Christoph Pape, MD; Christian Krettek, MD, FRACS; Medizinische Hochschule Hannover, Hannover, Germany

Purpose: An increasing number of patients survive the acute phase after severe polytrauma. Thus, the outcome of rehabilitation gains in importance. Until now, few scoring systems were available to perform accurate grading of objective outcomes for several body regions, especially in multiply injured patients. We evaluated the efficacy of a previously described new scoring system in patients reexamined 2 years after recovery from polytrauma.

Methods: A total of 169 patients injured between January 1, 1995 and December 31, 1998 were reexamined and evaluated with the Hannover Score for polytrauma outcome (HASPOC) 2 years after treatment for polytrauma at one of three German level IV trauma centers (Cologne, Munich, and Hannover). The inclusion criteria were participation in the German Trauma Registry, age at injury between 14 and 75 years, and follow-up between 1.5 and 3 years. The patients were later divided into two similar subgroups with and without injury below the knee for further statistical analysis.

Results: Demographic data are shown in Table 1. In comparison with established parameters for outcome measurement, we found significant correlations between the HASPOC and the Short Form-12 (R = -0.754, physical scale; R = -0.475, psychical scale, P < 0.01). In addition, we compared correlations of the HASPOC and the SF-12 with the ISS, the PTS, days of ventilation, duration of hospital stay, duration of unemployment, and time of in-patient and out-patient rehabilitation (see Table 2). Finally, we found a significant difference in outcome after polytrauma with and without injury below the knee (see Table 3).

Conclusion: HASPOC correlated more closely with the outcome of multiply injured patients than did other established tests. Moreover, significant correlations of this score with further outcome-related parameters (such as ISS and days of ventilation) were more accurate than determined with other commonly used tests. Therefore, we found that the HASPOC is a valid instrument for evaluating the rehabilitation results of multiply injured patients.

Table 1: Demographic data for 169 multiply injured patients

Age at injury (years)	35.9 ± 14.46
ISS	24.2 ± 12.6
PTS	25.7 ± 13.4
Male/female (N)	121/48
HASPOC (total)	84.2 ± 54.4

Table 2: Correlations between the HASPOC and the SF-12

Parameter	Correlation HASPOC (R)	Significance HASPOC (P)	Correlation  SF-12 (R)	Significance SF-12 (P)
ISS	0.229	< 0.01	-0.037	0.643
PTS1	0.344	< 0.01	-0.173	< 0.05
Hospital stay (days)	0.276	< 0.01	-0.334	< 0.01
Ventilation (days)	0.357	< 0.01	-0.212	< 0.05
Inability to work (days)	0.337	< 0.01	-0.286	< 0.05
In-patient rehab (days)	0.424	< 0.01	-0.115	0.147
Out-patient rehab (days)	0.323	< 0.01	-0.250	< 0.01

1, Hannover Polytrauma Score

Table 3: Analysis of the subgroups with (group A) and

without (group B) injury below the knee

	Group A	Group B
N	103	66
HASPOC mean	75.5 ± 51.6*	97.8 ± 35.3*
SF-12	42.9 ± 11.5*	38.5 ± 10.7*

*P < 0.01 between groups