From Trauma Scoring System to Early Appropriate Care

Trauma is still the main cause of mortality in Western countries. Patients die as a direct consequence of major trauma or by additional damage due to the immune reaction. Mortality is due to a first hit (trauma load) or second hit (interventional load) related to the immune response and medical treatment. In this chapter, we focus on the pathophysiology of the reaction of the human body to trauma, the primary scoring systems used in medical practice and how to use them in the effort to improve mortality and morbidity in trauma patients. After trauma, a pro-inflammatory systemic reaction (SIRS) is induced by pro-inflammatory cytokines. To restore the equilibrium of an excessive pro-inflammatory reaction, an anti-inflammatory response is induced, and in favourable cases, the homeostasis can be achieved. An overreaction of the anti-inflammatory response can lead to either a compensatory anti-inflammatory response (CARS) or a mixed antagonist response (MARS). The amount of the injury to the host can be expressed in scoring systems, and these have become important prognostic tools to calculate the risk based on clinical signs and symptoms in combination with inflammatory parameters when a threshold has been reached before clinical symptoms become evident. Medical trauma team has to deal with the decision to choose the right strategy and right timing to improve mortality and morbidity.