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

Summary

ESTES used a three-round RAND/UCLA modified Delphi process to adapt Grade A and Good Practice Point elements of the German S3 severe-injury guideline for European trauma systems. Of 139 recommendations initially considered, four were removed and seven GPPs rephrased; 135 remained, with 128 judged appropriate and necessary and seven uncertain. The framework spans prehospital care through the first operative phase and leaves some contested practices, including broad REBOA use, uncertain.

Why it matters

For major trauma, this provides a broad systems-level framework supporting structured hemorrhage resuscitation, airway management, imaging, and early operative decision-making while highlighting areas where blanket recommendations are inappropriate. It is useful context for ED trauma pathways but should not replace local ACS/TQIP or institution-specific protocols.

Key recommendations

• The panel reviewed 82 Grade A and 57 Good Practice Point recommendations in the first round.
• Four recommendations were removed and seven Good Practice Points were rephrased, leaving 135 final recommendations.
• 128 recommendations (77 Grade A and 51 GPP) were considered appropriate and necessary; seven remained uncertain.
• The full text notes uncertainty around generic REBOA recommendations after newer trial evidence and emphasizes context-specific hemorrhage resuscitation.

Limitations

European consensus adapting a prior German S3 guideline rather than a new evidence synthesis for every recommendation; implementation depends on trauma-system resources and may differ from US practice. Several recommendations remained uncertain, and later evidence or guidance may supersede individual elements.

Recommendation strength

Consensus adapted 82 Grade-of-Recommendation A items and 53 final Good Practice Points; 128 of 135 final recommendations were judged appropriate and necessary, while seven remained uncertain.