What is multisystem trauma and which organ systems can be involved?

From the Guidelines

Multisystem trauma refers to injuries affecting multiple organ systems simultaneously, typically resulting from severe physical trauma such as car accidents, falls from heights, or explosions. This condition occurs when the force of impact is significant enough to damage several body regions at once, creating a complex medical emergency that requires rapid assessment and intervention. The systems commonly involved include:

• Neurological system (brain, spinal cord injuries)
• Respiratory system (pneumothorax, pulmonary contusions)
• Cardiovascular system (cardiac contusions, major vessel tears, hemorrhage)
• Musculoskeletal system (fractures, dislocations, crush injuries)
• Abdominal system (liver, spleen, kidney lacerations, bowel perforations)
• Genitourinary system (bladder rupture, urethral injuries)
• Integumentary system (extensive lacerations, burns, degloving injuries) Management requires a systematic approach following ATLS (Advanced Trauma Life Support) protocols, beginning with primary survey (ABCDE: Airway, Breathing, Circulation, Disability, Exposure) followed by resuscitation and secondary survey, as outlined in recent guidelines 1. Treatment priorities focus on stabilizing life-threatening conditions first, with interventions often occurring simultaneously by a multidisciplinary trauma team. The severity of multisystem trauma correlates with higher mortality rates due to complications like hemorrhagic shock, respiratory failure, and multiple organ dysfunction syndrome, making rapid transport to a trauma center and coordinated care essential for improving patient outcomes 1. In the context of trauma care, regionalization of trauma management and timely intervention are crucial for minimizing mortality and improving outcomes, as emphasized in the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1.

From the Research

Definition of Multisystem Trauma

Multisystem trauma refers to injuries that affect multiple organ systems in the body. This type of trauma can lead to multi-system organ failure (MSOF), which is a major cause of mortality in critically ill patients 2.

Systems Involved in Multisystem Trauma

The following systems can be involved in multisystem trauma:

• Cardiovascular system: shock, hypotension, and cardiac dysfunction can occur due to blood loss, trauma, or other factors 3, 4
• Respiratory system: injuries to the lungs, airways, or chest wall can lead to respiratory failure 5
• Neurological system: traumatic brain injury (TBI) can cause extracranial organ dysfunction and impact clinical care and outcomes 6
• Renal system: acute kidney injury can occur due to trauma, shock, or other factors 4
• Hepatic system: liver dysfunction can occur due to trauma, shock, or other factors 2
• Hematological system: coagulopathy, bleeding disorders, or other hematological abnormalities can occur due to trauma or other factors 5

Clinical Management of Multisystem Trauma

The clinical management of multisystem trauma involves a structured approach, including:

• Initial assessment and stabilization of the patient using the A-B-C-D-E scheme (airway, breathing, circulation, neurologic deficits, and whole-body examination) 5
• Recognition and prompt treatment of acutely life-threatening injuries in the order of their priority 5
• Use of diagnostic procedures such as computerized tomography with contrast medium, ultrasonography, and laboratory tests to assess the severity of trauma and individual injuries 5
• Therapeutic decision-making based on the patient's physiological parameters, overall severity of trauma, and complexity of individual injuries 5
• Consideration of damage control surgery, which focuses on hemostasis, avoidance of secondary damage, and temporary treatment of fractures with external fixation 5