ESTES recommendations for the treatment of polytrauma—a European consensus based on the German S3 guidelines for the treatment of patients with severe/multiple injuries
Cristina Rey Valcárcel, Dan Bieler, Gary Alan Bass, Christine Gaarder, Frank Hildebrand, the ESTES Polytrauma Consensus Group, Ana María González, Klemens Horst, Enrico Marrano, Christoph Nau, Roman Pfeifer, Agron Dogjani, Michiel Herteleer, Femke De Haes, Vincent Duibusson, Gerhard Achatz, Diego Mariani, Henrique Alexandrino, Jorge Pereira, Luís Vale, Liliana Duarte, Luís Ferreira, Filipa Taré, Filipa Madeira, Maria João Koch, Rui Escaleira, Sérgio Baptista, Marin Valeriu Surlin, Krstina Doklestic Vasiljev, Zlatibor Lončar, Dušan Micić, Vladimir Resanović, Marija Milenković, Lukas Rasulić, Slađana Matić, Dejan Stevanović, Matevz Tomazevic, Christian Michetitsch
Abstract
INTRODUCTION: Considerable heterogeneity exists in the configuration and implementation maturity of trauma systems across European healthcare settings, and the opportunities for guideline-informed high-quality care varies considerably. Therefore, the European Society of Trauma and Emergency Surgery (ESTES), with its constituent national societies, has developed comprehensive consensus recommendations for care-context appropriate treatment of polytrauma patients in Europe, from the pre-hospital setting to the first surgical phase. METHODS: Adhering to the RAND/UCLA Appropriateness Method (RAM), ESTES conducted a three-round modified Delphi consensus. National society expert delegates assessed Grade of Recommendation (GoR) A and Good Clinical Practice Points (GPP) elements of the German Society of Trauma Surgery (DGU) "S3 guidelines for polytrauma/severe injury management" for appropriateness and implementability within their respective healthcare systems. RESULTS: In the first consensus round, 82 GoR A and 57 GPP recommendations were analysed. Of these, seven GPP were rephrased for clarity and four were removed due to redundancy or conflicting content. Consequently, 135 recommendations (82 GoR A and 53 GPP) remained, with 128 (77 GoR A and 51 GPP) deemed appropriate and necessary, and seven as uncertain due to expert disagreement. CONCLUSION: These ESTES recommendations constitute the first cohesive Europe-wide framework for managing the polytrauma patient from the prehospital setting to the end of the first surgical phase. They serve as a foundational tool for the development of national guidelines, particularly in regions with evolving trauma systems, and promote alignment towards a uniform standard-of-care across Europe.