Introduction: Treating severely injured patients requires numerous critical decisions within short intervals in a highly complex situation. The coordination of a trauma team in this setting has been shown to be associated with multiple procedural errors, even of experienced care teams. Machine learning (ML) is an approach that estimates outcomes based on past experiences and data patterns using a computer-generated algorithm. This systematic review aimed to summarize the existing literature on the value of ML for the initial management of severely injured patients. Methods: We conducted a systematic review of the literature with the goal of finding all articles describing the use of ML systems in the context of acute management of severely injured patients. MESH search of Pubmed/Medline and Web of Science was conducted. Studies including fewer than 10 patients were excluded. Studies were divided into the following main prediction groups: (1) injury pattern, (2) hemorrhage/need for transfusion, (3) emergency intervention, (4) ICU/length of hospital stay, and (5) mortality. Results: Thirty-six articles met the inclusion criteria; among these were two prospective and thirty-four retrospective case series. Publication dates ranged from 2000 to 2020 and included 32 different first authors. A total of 18,586,929 patients were included in the prediction models. Mortality was the most represented main prediction group (n = 19). ML models used were artificial neural network ( n = 15), singular vector machine (n = 3), Bayesian network (n = 7), random forest (n = 6), natural language processing (n = 2), stacked ensemble classifier [SuperLearner (SL), n = 3], k-nearest neighbor (n = 1), belief system (n = 1), and sequential minimal optimization (n = 2) models. Thirty articles assessed results as positive, five showed moderate results, and one article described negative results to their implementation of the respective prediction model. Conclusions: While the majority of articles show a generally positive result with high accuracy and precision, there are several requirements that need to be met to make the implementation of such models in daily clinical work possible. Furthermore, experience in dealing with on-site implementation and more clinical trials are necessary before the implementation of ML techniques in clinical care can become a reality.

La atención inicial de pacientes politraumatizados en los servicios de emergencia representan un notable problema de salud por su alto índice de mortalidad y secuelas asociadas al inadecuado manejo inicial debido al limitado conocimiento del personal de salud; por ello que se realizó el trabajo titulado: Criterios de enfermería a considerar para la atención inicial de pacientes politraumatizados en un servicio de emergencia, con el objetivo de identificar los criterios que los enfermeros deben poseer durante la atención inicial a pacientes politraumatizados en los servicios de emergencia. La Enfermería Basada en Evidencia (EBE) fue la metodología empleada en este estudio secundario, optando por 08 investigaciones científicas relacionadas al tema, utilizado bases de datos como Scielo, Cochrane, PubMed, Google Académico, aplicándoles minuciosamente la guía de utilidad y validez aparente de Gálvez Toro; seleccionando para el comentario crítico un estudio titulado “Guía de práctica clínica: Atención en emergencia del paciente politraumatizado”, determinándose un nivel de evidencia 3 y un grado de recomendación A según GRADE; calificando así su beneficio en toma de decisiones. La revisión da respuesta finalmente al planteamiento de la pregunta clínica ¿Cuáles son los criterios de enfermería a considerar para la atención inicial de pacientes poli traumatizados en un servicio de emergencia? Refiriendo que la atención inicial protocolizada de forma secuencial desde el reconocimiento oportuno de signos y síntomas dentro del examen físico exhaustivo utilizando ABCDE ayudaría a minimizar las complicaciones y sus secuelas, mejorando enormemente la evolución clínica y acortando la estancia hospitalaria. / The initial care provided to polytrauma patients in emergency services poses a significant health issue due to the high mortality rate and adverse effects resulting from inadequate initial management caused by the limited knowledge of healthcare staff. Consequently, a study titled "Nursing Criteria to Consider for Initial Care of Polytrauma Patients in an Emergency Service" was undertaken to pinpoint the essential criteria that nurses should possess while attending to polytrauma patients in emergency services. Evidence-Based Nursing (EBN) was the methodology employed in this secondary study, involving the selection of 8 scientific research studies related to the subject and using databases such as Scielo, Cochrane, PubMed, Google Scholar, with rigorous application of the utility and apparent validity guide by Gálvez Toro. A study called "Clinical Practice Guidelines: Emergency Care for Polytrauma Patients" was chosen for critical evaluation, indicating an evidence level of 3 and a recommendation grade A according to GRADE, thereby validating its utility in decision-making. The review ultimately addresses the clinical query: What nursing criteria should be taken into account for the initial care of polytrauma patients in an emergency service? It proposes that a standardized initial care process, commencing with prompt identification of signs and symptoms during a comprehensive physical examination utilizing the ABCDE approach, could reduce complications and their repercussions, notably enhancing clinical outcomes and shortening hospital stays.

Polytrauma is a severe multiple injury posing an imminent threat to human life. Such trauma will then significantly affect the quality of client's life and, consequently, also the constituent parts of his or her personality. The research has shown that, the therapy succes, which is realised in the system of comprehensive rehabilitation, depends on an effective medical care delivered by a multidisciplinary team of specialists and also on an active involvement in the treatment by the clients themselves.The quality of clients' life that the polytraumas entaile is influenced by their age, sex, education, profession, classification of multiple injury and also by harmonious family relationships and support offered by the clients' partners.

Die Behandlung polytraumatisierter Patienten stellt in ihrer Komplexität hohe Anforderungen an die aparativen und personellen Voraussetzungen einer Klinik. Dies bedingt einen erheblichen Kostenaufwand sowohl für die primäre Diagnostik und Therapie als auch für die Rehabilitation. Im Unfallkrankenhaus Berlin sieht der Algorithmus der Polytraumaversorgung nach klinischer Erstversorgung und sonographischer Untersuchung von Abdomen und Thorax die weitere primäre radiologische Diagnostik von Schädel, Halswirbelsäule, Thorax, Abdomen und Becken mittels Spiral-Computertomographie nach einem standardisiertem Untersuchungsprotokoll vor. Im Zeitraum von September 1997 bis Juli 1999 wurden 334 aufeinander folgende Patienten erfasst, bei denen unter dem Verdacht auf ein Polytrauma eine CT-Untersuchung im Rahmen des klinikinternen Algorithmus durchgeführt wurde. Unter Kenntnis aller Untersuchungsbefunde erfolgte die retrospektive Gruppenbildung mit Unterscheidung in polytraumatisierte (n=116) und nicht polytraumatisierte (n=220) Patienten. Der durchschnittliche ISS lag bei 32 (+/- 10) in der Gruppe der tatsächlich polytraumatisierten Patienten und bei 15 (+/- 9,4) in der Gruppe der nicht polytraumatisierten Patienten. In der weiteren Auswertung wurden die in der primären CT-Untersuchung erhobenen Diagnosen anhand des klinischen Verlaufs, operativer und anderer therapeutischer Maßnahmen sowie der weiteren Bildgebung überprüft. In der vorliegenden Untersuchung konnte gezeigt werden, dass die Spiral-Computertomographie in der Lage ist, das Verletzungsmuster eines polytraumatisierten Patienten, abgesehen von Extremitätenverletzungen, nahezu vollständig und mit großer Sicherheit zeiteffizient zu erfassen. Dabei konnte auf Grund der Verkürzung der Untersuchungszeit die Indikationsstellung auf Patienten mit kritischen Kreislaufsituationen ausgedehnt werden. Als strukturelle Voraussetzung muss jedoch die unmittelbare Nachbarschaft von Schockraum und CT-Untersuchungsraum sowie ein routiniertes Team gewährleistet sein. Insgesamt profitierten insbesondere die tatsächlich polytraumatisierten Patienten von der Durchführung des standardisierten Untersuchungsprotokolls bei der Aufdeckung von Verletzungen. Der große Anteil der nicht polytraumatisierten Patienten profitierte vorwiegend vom Verletzungsausschluss. Hier muss die Indikationsstellung überaus kritisch erfolgen. / The complex treatment of patients with multiple traumas requires a high standard of staff and equipment causing considerable expense at the point of primary diagnosis and treatment as well as at the rehabilitation stage. Conforming to a standardised examination routine, the algorithm of treating patients with multiple traumas at the Unfallkrankenhaus Berlin includes, after primary clinical treatment and ultrasound examination of abdomen and thorax , the further primary radiological diagnosis of the skull, the cervical spine, the thorax, the abdomen and the pelvis via spiral CT. Between September 1997 and July 1999 we registered 334 successive patients with suspected multiple traumas who underwent a CT examination according to our clinical algorithm. In the knowledge of all diagnoses the patients were subdevided into two groups: patients suffering from multiple traumas (n=116) and patients without multiple traumas (n=220). The average ISS was 32(+/- 10) for the group of patients actually suffering from multiple traumas and 15 (+/- 10) for the group of patients without multiple traumas. The diagnoses based on the primary CT examination were analysed in the light of the clinical course, surgical and other therapeutic measures as well as compared with other imaging methods (modalities). This study shows that, apart from injuries of the extremities, the spiral CT can reveal the injuries of a patient suffering from multiple traumas efficiently and quickly. Because of the shorter time needed for examination the diagnosis can be extended to patients with critical haemodynamical conditions. Yet it is important that the emergency romm and CT examination rooms are in close vicinity and that the team of examiners is well trained. Especially patients with multiple traumas benefit from this standardised routine of examinations. The majority of patients without multiple traumas benefit from the exclusion of injuries. Here the medical indication has to be carefully considered.

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