The following is a summary of “Heterogeneity in defining multiple trauma: a systematic review of randomized controlled trials,” published in the September 2023 issue of Critical Care by Jeanmougin et al.
Trauma randomized controlled trials (RCTs) often yield negative results, possibly due to inconsistent definitions of multiple trauma. Researchers performed a retrospective study to identify how multiple trauma patients are defined and characterized in RCTs.
They systematically reviewed the literature in MEDLINE, EMBASE, and clinicaltrials.gov (January 1, 2002, to July 31, 2022). Eligible studies included RCTs or RTCs protocols involving multiple trauma patients. Terms defining patient populations were identified, extracted, and then documented with impact on recruited populations to reveal clinical heterogeneity.
The results showed 50 RCTs, identifying 12 different terms. The most frequently used terms were “multiple trauma” (n = 21, 42%), “severe trauma” (n = 8, 16%), “major trauma” (n = 4, 8%), and “trauma with hemorrhagic shock” (n = 4, 8%). Only 62% of RCTs (n = 31) provided term definitions, totaling 21 different definitions. These definitions mostly relied on the injury severity score (ISS) (n = 15, 30%), revealing significant heterogeneity. Term choice impacted the study population, affecting ISS and in-hospital mortality. Eleven protocols were included, featuring five different terms, with “severe trauma” occurring six times (55%).
They concluded that trauma RCTs use various definitions for multiple trauma, highlighting the need for a single, consistent definition.