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 vary 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 the 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 GPPs 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 developing national guidelines, particularly in regions with evolving trauma systems, and promote alignment toward a uniform standard of care across Europe.

Keywords: Consensus; Guidelines; Injury; Polytrauma; Recommendations.