{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:12:54Z","timestamp":1791231174587,"version":"4.1.0"},"reference-count":58,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2022,11,18]],"date-time":"2022-11-18T00:00:00Z","timestamp":1668729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81873870"],"award-info":[{"award-number":["81873870"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Shock after traumatic injury is likely to be hypovolemic, but different types of shock (distributive shock, obstructive shock, or cardiogenic shock) can occur in combination, known as multifactorial shock. Multifactorial shock is a neglected area of study, and is only reported sporadically. Little is known about the incidence, characteristics, and outcomes of multifactorial shock after polytrauma. Methods: A retrospective, observational, multicenter study was conducted in four Level I trauma centers involving 1051 polytrauma patients from June 2020 to April 2022. Results: The mean Injury Severity Score (ISS) was 31.1, indicating a severely injured population. The most common type of shock in the early phase after polytrauma (\u226448 h) is hypovolemic shock (83.2%), followed by distributive shock (14.4%), obstructive shock (8.7%), and cardiogenic shock (3.8%). In the middle phase after polytrauma (&gt;48 h or \u226414 days), the most common type of shock is distributive shock (70.7%), followed by hypovolemic shock (27.2%), obstructive shock (9.9%), and cardiogenic shock (7.2%). Multifactorial shock accounted for 9.7% of the entire shock population in the early phase and 15.2% in the middle phase. In total, seven combinations of multifactorial shock were described. Patients with multifactorial shock have a significantly higher complication rate and mortality than those with single-factor shock. Conclusions: This study characterizes the incidence of various types of shock in different phases after polytrauma and emphasizes that different types of shock can occur simultaneously or sequentially in polytrauma patients. Multifactorial shock has a relatively high incidence and mortality in polytrauma patients, and trauma specialists should be alert to the possibility of their occurrence.<\/jats:p>","DOI":"10.3390\/jcm11226829","type":"journal-article","created":{"date-parts":[[2022,11,21]],"date-time":"2022-11-21T04:33:32Z","timestamp":1669005212000},"page":"6829","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Multifactorial Shock: A Neglected Situation in Polytrauma Patients"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8179-5236","authenticated-orcid":false,"given":"Jialiu","family":"Luo","sequence":"first","affiliation":[{"name":"Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liangsheng","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2337-5222","authenticated-orcid":false,"given":"Hai","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunyao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teding","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liming","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenguo","family":"Wang","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Trauma Center, Suizhou Central Hospital, Hubei University of Medicine, Suizhou 441300, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaqiang","family":"Xu","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Trauma Center, Suizhou Central Hospital, Hubei University of Medicine, Suizhou 441300, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miaobo","family":"He","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Trauma Center, Suizhou Central Hospital, Hubei University of Medicine, Suizhou 441300, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongli","family":"Wan","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Trauma Center, Suizhou Central Hospital, Hubei University of Medicine, Suizhou 441300, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Trauma Center, Tianmen First People\u2019s Hospital, Hubei University of Science and Technology, Tianmen 417300, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengfan","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Trauma Center, Tianmen First People\u2019s Hospital, Hubei University of Science and Technology, Tianmen 417300, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengsheng","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Emergency and Intensive Care, Trauma Center, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Emergency and Intensive Care, Trauma Center, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441021, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhao-Hui","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1136\/injuryprev-2015-041616","article-title":"The global burden of injury: Incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013","volume":"22","author":"Haagsma","year":"2016","journal-title":"Inj. 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