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Diagnostik und sofortige Therapiemaßnahmen bei Verletzungen des Thorax

Eine systematische Literaturübersicht

Diagnosis and emergency room management of chest trauma: a systematic review of the literature

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Zusammenfassung

Fragestellung.

Thoraxverletzungen tragen wesentlich zur Morbidität und Mortalität von Schwerstverletzten bei. Diese Übersicht untersucht die im Rahmen der Schockraumversorgung notwendige klinische Diagnostik und erforderliche Sofortmaßnahmen.

Methodik.

Klinische Studien wurden über systematische Literatursuchen (Medline, Cochrane und Handsuchen) und Klassifikation nach Evidenzgüte (Level 1–5 nach Oxford-Schema) zusammengetragen.

Ergebnisse.

Einige wenige Studien belegen die Bedeutung des Unfallmechanismus und die der körperlichen Untersuchung. So deuten insbesondere Hochrasanztraumen und Verkehrsunfälle mit Lateralaufprall auf ein Thoraxtrauma. Die Auskultation hat einen hohen Stellenwert zum Nachweis eines Pneumothorax. Eine zentrale Rolle in der Diagnostik nimmt das Spiral-CT des Thorax ein, insbesondere bei der Aortenruptur. Ob eine Entlastung CT-diagnostizierter ventraler Pneumothoraces in jedem Falle notwendig ist, ist derzeit noch nicht hinreichend geklärt. Der Stellenwert von Intubation und Beatmung im Schockraum ist nur unzureichend untersucht und beruht großteils auf Expertenmeinungen.

Schlussfolgerungen.

Zur Schockraumdiagnostik und Therapie des Thoraxtraumas liegen eine Vielzahl vergleichender (EL 2) Untersuchungen vor, randomisierte Studien existieren jedoch wenige. Anhand der Datenlage ist eine wissenschaftlich begründete Behandlung dieser Patienten in weiten Bereichen möglich.

Abstract

Objective.

Injuries to the chest contribute significantly to the morbidity and mortality in multiple injured patients. This systematic review focuses on evidence based initial diagnostics and emergency room management of chest trauma.

Methods.

Clinical trials was systematically collected (Medline, Cochrane and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system).

Results.

There are only a few studies that document the impact of injury mechanism and clinical examination of the patient. There is a positive correlation between crash severity or lateral impact with injury severity. Auscultation was found to be very sensitive in the detection of pneumothorax. Helical CT of the chest is most important in the initial work-up. Aortography is only indicated in selected cases. Whether tube thoracostomy is necessary in patients with occult pneumotharaces is still a matter of discussion. Indications for endotracheal intubation are poorly investigated and predominantly based on expert opinion.

Conclusion.

Numerous comparative studies (LE 2) dealing with emergency diagnostics and therapy of chest trauma are available, however only a few randomized studies do exist. Based on the available data a rational therapy of chest trauma is possible.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie, Universitätsklinikum Mannheim gGmbH

    G. Voggenreiter, C. Eisold & U. Obertacke

  2. Biochemische & Experimentelle Abteilung, Medizinische Fakultät der Universität zu Köln

    S. Sauerland

  3. Klinik für Unfallchirurgie, Universitätsklinikum, 65135, Mannheim

    G. Voggenreiter

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  1. G. Voggenreiter
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  2. C. Eisold
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  3. S. Sauerland
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  4. U. Obertacke
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Correspondence to G. Voggenreiter.

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Voggenreiter, G., Eisold, C., Sauerland, S. et al. Diagnostik und sofortige Therapiemaßnahmen bei Verletzungen des Thorax. Unfallchirurg 107, 881–891 (2004). https://doi.org/10.1007/s00113-004-0837-4

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