Early Total Care versus Damage Control: Current Concepts in the Orthopedic Care of Polytrauma Patients

Table 1

The assessment of the four clinical grades with the corresponding range of clinical parameters (data from [26]).

	Parameter	Stable (grade I)	Borderline (grade II)	Unstable (grade III)	In extremis (grade IV)
Shock	BP (mmHg)	≥100	80–100	60–90	<50–60
	Blood units (2 h)	0–2	2–8	5–15	>15
	Lactate levels	Normal range	Approx 2.5	>2.5	Severe acidosis
	Base deficit (mmol/L)	Normal range	No data	No data	>6–18
	ATLS classification	I	II-III	III-IV	IV
	UO (mL/h)	>150	50–150	<100	<50
Coagulation	Platelet count (μg/mL)	>110000	90000–110000	<70000–90000	<70000
	Factor II and V (%)	90–100	70–80	50–70	<50
	Fibrinogen (g/dL)	>1	Approx 1	<1	DIC
	D-Dimer	Normal range	Abnormal	Abnormal	DIC
Temperature		>35°C	33–35°C	30–32°C	30°C or less
Soft tissue injuries	Lung function, PaO2/FiO2	>350	300	200–300	<200
	Chest trauma scores, AIS	AIS I or II	AIS ≥ 2	AIS ≥ 2	AIS ≥ 3
	TSS	O	I-II	II-III	IV
	Abdominal trauma (moore)	≤II	≤III	III	≥III
	Pelvic trauma (AO classification)	A	B or C	C	C (crush, rollover with abd trauma)
	Extremities	AIS I or II	AIS II-III	AIS III-IV	Crush, rollover, extremities

Abbreviations: BP: blood pressure, ATLS: advanced trauma life support, UO: urine output, TTS: thoracic trauma score, AIS: abbreviated injury scale, DIC: disseminated intravascular coagulation.