This consensus paper established the Berlin Definition of polytrauma — the first standardized, database-validated criteria for this diagnosis. An international expert panel combined four years of meetings with analysis of 28,211 patients in the German Trauma Registry to replace decades of vague, subjective terminology. The definition answers a single clinical question: which multiply injured patients have a mortality high enough to warrant full polytrauma-level resource activation?
Before this definition, 'polytrauma' meant something different in every trauma center — some used ISS >15 alone, others used subjective clinical judgment, and comparison across institutions was nearly impossible.
When you receive a multiply injured patient, run the Berlin checklist: confirm AIS ≥3 in two or more body regions, then screen for any one physiologic red flag. If present, this patient meets formal polytrauma criteria with an expected mortality near 30–48%, justifying immediate ICU-level resource allocation and a damage-control surgical strategy.
Pay particular attention to coagulopathy. It carries the highest odds ratio for death (OR 5.81) of any single parameter. An INR ≥1.4 or PTT ≥40s on admission is not a lab footnote; it is your strongest independent mortality signal.
The timing rule matters operationally: do not label a patient as polytrauma based on scene assessment alone. Physiologic parameters shift with resuscitation, so the formal diagnosis belongs to the first hospital day after workup. This keeps the definition reproducible across institutions and registries.
This consensus paper established the Berlin Definition of polytrauma — the first standardized, database-validated criteria for this diagnosis. An international expert panel combined four years of meetings with analysis of 28,211 patients in the German Trauma Registry to replace decades of vague, subjective terminology. The definition answers a single clinical question: which multiply injured patients have a mortality high enough to warrant full polytrauma-level resource activation?
Before this definition, 'polytrauma' meant something different in every trauma center — some used ISS >15 alone, others used subjective clinical judgment, and comparison across institutions was nearly impossible.
When you receive a multiply injured patient, run the Berlin checklist: confirm AIS ≥3 in two or more body regions, then screen for any one physiologic red flag. If present, this patient meets formal polytrauma criteria with an expected mortality near 30–48%, justifying immediate ICU-level resource allocation and a damage-control surgical strategy.
Pay particular attention to coagulopathy. It carries the highest odds ratio for death (OR 5.81) of any single parameter. An INR ≥1.4 or PTT ≥40s on admission is not a lab footnote; it is your strongest independent mortality signal.
The timing rule matters operationally: do not label a patient as polytrauma based on scene assessment alone. Physiologic parameters shift with resuscitation, so the formal diagnosis belongs to the first hospital day after workup. This keeps the definition reproducible across institutions and registries.