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Unterschiedliche Letalitätsraten an deutschen Traumazentren

Kritische Analyse

Different case fatality rates at German trauma centres

Critical analysis

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Zusammenfassung

Hintergrund

Die Traumaversorgung in Deutschland zählt zu den weltweit besten, jedoch haben frühere Studien einen signifikanten Unterschied in der Letalitätsrate einzelner deutscher Traumazentren gezeigt. Es war daher das Ziel dieser Arbeit, mögliche Gründe hierfür mithilfe des TraumaRegisters (TR) der Deutschen Gesellschaft für Unfallchirurgie (DGU) zu erörtern.

Methode

In einer retrospektiven Multizenterstudie auf Basis des TR wurde anhand der mithilfe der Revised Injury Severity Classification (RISC) ermittelten Überlebenswahrscheinlichkeiten, der beobachteten Letalitätsraten und der hieraus ermittelten standardisierten Mortalitätsraten (SMR) ein „ranking“ der teilnehmenden Kliniken vorgenommen. Unterschiede im Traumamanagement der 10 Top- [niedrige „standardised mortality ratio“ (SMR)], der 10 mittleren (mittlere SMR) und den 10 letzten Kliniken (hohe SMR) des Ranking sollten aufgedeckt werden.

Ergebnisse

Es wurden die Daten von 6522 Patienten ausgewertet. Es zeigten sich Zeitunterschiede in der prähospitalen und in der Schockraumversorgung sowie der CT-Diagnostik. Computertomographien und besonders die Ganzkörper-CT wurden in den Top-Kliniken eher und häufiger eingesetzt. Die Volumentherapie bis zur Verlegung auf die Intensivstation erfolgte in den Top-Kliniken deutlich liberaler.

Abstract

Objective

The level of trauma care in Germany belongs to one of the best worldwide. Nevertheless, previous studies have shown significant differences in the case fatality rates of multiple trauma patients in German trauma centres. The objective of this study was to indentify the reasons for the different outcomes based on data of the trauma registry of the German Society of Orthopaedic Surgery and Traumatology.

Methods

Due to the inadequacy of comparing only the case fataltiy rates in the different trauma centres, the data recorded in the trauma registry were analyzed in a retrospective, multicentre study to calculate the probability of survival, revised injury severity classification (RISC) and, additionally, the standardized mortality ratio (SMR) for ranking of the participating trauma centres. As a criterion for inclusion in the study, a minimum of 100 trauma patients admitted directly from the scene within a 4 year period was set. The ranking was carried out using the SMR (observed mortality divided by probability of survival). With the help of data from the trauma registry an attempt was made to find the differences in trauma management between the top 10 centres (lowest SMR), the 10 middle and the last 10 centres (highest SMR) in the ranking.

Results

The data of 6,522 patients were included in the study. There were significant differences in the pre-hospital time, the time spent in the emergency room (ER) and time until a CT scan had been performed. Pre-hospital time was longer in patients admitted to the top centres, whereas time in the ER was longer in the last centres of the ranking. Comparing the sum of pre-hospital time and time in the ER, there were no differences between the top and the last centres. At the scene of accident overall intubation rate and intubation rate in patients with traumatic brain injury were higher in patients admitted to the top centres. Regarding the transport modality, significantly more patients were transported by helicopter in the group of the top centres. In top centres CT scans, in particular whole-body CTs, were initiated sooner and used much more frequently so that the rate of missed injuries was much lower. The amount of fluid given at the scene of accident did not differ between the centres but the amount of fluid given in ER and the operating room until admission to the intensive care unit was significantly higher in the top centres.

Conclusion

There are significant differences in the pre-hospital and clinical care of patients admitted to German trauma centres. Under clinical conditions a tight time management, an immediate and complete diagnostic approach, particularly by means of whole-body CT and a liberal fluid resuscitation seem to be favorable factors.

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Literatur

  1. Bogner V, Mutschler W, Biberthaler P (2009) The factor „time“: its impact in pathophysiology and therapy of multiple trauma. Unfallchirurg 112:838–845

    Article  CAS  PubMed  Google Scholar 

  2. Boldt J (2004) Fluid choice for resuscitation of the trauma patient: a review of the physiological, pharmacological and clinical evidence. Can J Anaesth 51(5):500–513

    Article  PubMed  Google Scholar 

  3. Chiara O, Bucci L, Sara A et al (2008) Quality and quantity of volume replacement in trauma patients. Minerva Anestesiol 74(6):303–306

    CAS  PubMed  Google Scholar 

  4. Cowley RA (1976) The resuscitation and stabilization of major multiple trauma patients in a trauma center environment. Clin Med 83(1):16–22

    Google Scholar 

  5. Exadaktylos AK, Benneker LM, Jeger V et al (2008) Total-body digital X-ray in trauma. An experience report on the first operational full body scanner in Europe and its possible role in ATLS. Injury 39(5):525–529

    Article  CAS  PubMed  Google Scholar 

  6. Hilbert P, Hoeller J, Wawro W et al (2005) Emergency room management of multiple injured patients. A multislice computed tomography orientated treatment algorithm. Anasthesiol Intensivmed Notfallmed Schmerzther 40(12):720–725

    Article  CAS  PubMed  Google Scholar 

  7. Hilbert P, Zur NK, Hofmann GO et al (2007) New aspects in the emergency room management of critically injured patients: a multi-slice CT-oriented care algorithm. Injury 38(5):552–558

    Article  CAS  PubMed  Google Scholar 

  8. Hoffstetter P, Herold T, Daneschnejad M et al (2008) Non-trauma-associated additional findings in whole-body CT examinations in patients with multiple trauma. Rofo 180(2):120–126

    CAS  PubMed  Google Scholar 

  9. Huber-Wagner S, Lefering R, Qvick LM et al (2009) Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 373(9673):1455–1461

    Article  PubMed  Google Scholar 

  10. Kanz KG, Korner M, Linsenmaier U et al (2004) Priority-oriented shock trauma room management with the integration of multiple-view spiral computed tomography. Unfallchirurg 107(10):937–944

    Article  PubMed  Google Scholar 

  11. Mauritz W, Weninger P (2007) Multislice computed tomography in blunt abdominal trauma. Trauma 9:195–212

    Article  Google Scholar 

  12. Nast-Kolb D, Krettek C, Mutschler W (2005a) Operative Versorgungsstrategien beim Polytrauma. Unfallchirurg 108(10):792

    Article  Google Scholar 

  13. Nast-Kolb D, Ruchholtz S, Waydhas C et al (2005b) Damage control orthopedics. Unfallchirurg 108(10):804, 806–804, 811

    Article  CAS  PubMed  Google Scholar 

  14. Osterwalder JJ (2002) Can the „golden hour of shock“ safely be extended in blunt polytrauma patients? Prospective cohort study at a level I hospital in eastern Switzerland. Prehosp Disaster Med 17(2):75–80

    PubMed  Google Scholar 

  15. Probst C, Hildebrand F, Frink M et al (2007) Prehospital treatment of severely injured patients in the field: an update. Chirurg 78(10):875–884

    Article  CAS  PubMed  Google Scholar 

  16. Revell M, Porter K, Greaves I (2002) Fluid resuscitation in prehospital trauma care: a consensus view. Emerg Med J 19(6):494–498

    Article  CAS  PubMed  Google Scholar 

  17. Roberts I, Alderson P, Bunn F et al (2004) Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev (4):CD000567

    Google Scholar 

  18. Ruchholtz S (2000) The Trauma Registry of the German Society of Trauma Surgery as a basis for interclinical quality management. A multicenter study of the German Society of Trauma Surgery. Unfallchirurg 103(1):30–37

    Article  CAS  PubMed  Google Scholar 

  19. Ruchholtz S, Lefering R, Paffrath T, Oestern HJ (2008) Rückgang der Traumaletalität. Ergebnisse des Traumaregisters der deutschen Gesellschaft für Unfallchirurgie. Dtsch Arztbl 105(13):225–231

    Google Scholar 

  20. Ruchholtz S, Waydhas C, Ose C et al (2002) Prehospital intubation in severe thoracic trauma without respiratory insufficiency: a matched-pair analysis based on the Trauma Registry of the German Trauma Society. J Trauma 52(5):879–886

    Article  PubMed  Google Scholar 

  21. Salim A, Sangthong B, Martin M et al (2006) Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study. Arch Surg 141(5):468–473

    Article  PubMed  Google Scholar 

  22. Trupka A, Waydhas C, Nast-Kolb D, Schweiberer L (1994) Early intubation in severely injured patients. Eur J Emerg Med 1(1):1–8

    Article  CAS  PubMed  Google Scholar 

  23. Trupka A, Waydhas C, Nast-Kolb D, Schweiberer L (1995) Effect of early intubation on the reduction of post-traumatic organ failure. Unfallchirurg 98(3):111–117

    CAS  PubMed  Google Scholar 

  24. Vollmar B, Menger MD (2004) Volume replacement and microhemodynamic changes in polytrauma. Langenbecks Arch Surg 389(6):485–491

    Article  PubMed  Google Scholar 

  25. Weninger P, Mauritz W, Fridrich P et al (2007) Emergency room management of patients with blunt major trauma: evaluation of the multislice computed tomography protocol exemplified by an urban trauma center. J Trauma 62(3):584–591

    Article  PubMed  Google Scholar 

  26. Westhoff J, Kalicke T, Muhr G, Kutscha-Lissberg F (2002) The reality of preclinical treatment in thoracic trauma – a prospective study. Anasthesiol Intensivmed Notfallmed Schmerzther 37(7):395–402

    Article  CAS  PubMed  Google Scholar 

  27. Wurmb T, Balling H, Fruhwald P et al (2009a) Polytrauma management in a period of change: time analysis of new strategies for emergency room treatment. Unfallchirurg 112(4):390–399

    Article  CAS  PubMed  Google Scholar 

  28. Wurmb TE, Fruhwald P, Hopfner W et al (2009b) Whole-body multislice computed tomography as the first line diagnostic tool in patients with multiple injuries: the focus on time. J Trauma 66(3):658–665

    Article  PubMed  Google Scholar 

  29. Wurmb TE, Fruhwald P, Knuepffer J et al (2008) Application of standard operating procedures accelerates the process of trauma care in patients with multiple injuries. Eur J Emerg Med 15(6):311–317

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Anaesthesiologie, Intensiv- und Notfallmedizin, BG-Kliniken Bergmannstrost, Merseburgerstr. 165, 06112, Halle (Saale), Deutschland

    P. Hilbert & R. Stuttmann

  2. IFOM – Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke, Köln, Deutschland

    R. Lefering

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  1. P. Hilbert
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  2. R. Lefering
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  3. R. Stuttmann
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Correspondence to P. Hilbert.

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Hilbert, P., Lefering, R. & Stuttmann, R. Unterschiedliche Letalitätsraten an deutschen Traumazentren. Anaesthesist 59, 700–708 (2010). https://doi.org/10.1007/s00101-010-1742-6

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  • DOI: https://doi.org/10.1007/s00101-010-1742-6

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