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Evidenzbasiertes diagnostisches Vorgehen bei Verdacht auf stumpfes HWS-Trauma

Entwicklung eines Algorithmus

Patient management guidelines for blunt cervical spine injuries

Development of an algorithm

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Zusammenfassung

Hintergrund

Ziel dieser Arbeit war einerseits die Darstellung der bisher publizierten, unterschiedlichen diagnostischen Vorgehensweisen bei Verdacht auf stumpfe HWS-Verletzung, sowie andererseits deren evidenzbasierte Berücksichtigung bei der Entwicklung einer Empfehlung zum adäquaten diagnostischen Vorgehen.

Material und Methoden

Mittels systematischer Literaturrecherche in Medline, Embase, National Guideline Clearinghouse, Cochrane Library sowie manueller Referenzrecherche sichteten wir relevante Veröffentlichungen zwischen 1966 und Juli 2004. Suchbegriffe waren: Cervical Spine, Cervical Vertebrae, Spinal, Spinal Cord, Injury, Trauma, Fracture, Dislocation, Imaging, Radiography, Flexion, Extension, Fluoroscopy, Computed Tomography, Computed Scanning und Magnetic Resonance Imaging. Evidenzbasiert selektierten wir die Suchergebnisse und klassifizierten sie entsprechend ihrem Evidenzgrad.

Ergebnisse

Aus insgesamt >10.000 Veröffentlichungen sichteten wir mit stringenten Kriterien 137 relevante Artikel. Der Evidenzgrad ist aufgrund mangelnder Datenlage insgesamt eingeschränkt. Wegen fehlender Klasse-I-Daten sind nur Stufe-II- bis -III-Empfehlungen möglich. Wir entwickelten einen Algorithmus für das diagnostische Vorgehen bei Verdacht auf HWS-Trauma. Dieser klinische Algorithmus setzt die komplexe Diagnostik potentieller HWS-Verletzungen in einen übersichtlichen, logisch aufgebauten und systematischen Prozess um.

Schlussfolgerungen

Der nach reproduzierbaren, evidenzbasierten Kriterien entwickelte diagnostische Algorithmus erfüllt aktuelle geforderte Standards, um die Behandlungsqualität frisch Verletzter zu maximieren. Auch durch seine nachvollziehbare Transparenz bietet er eine wesentliche Entscheidungshilfe in der Auswahl des adäquaten diagnostischen Vorgehens.

Abstract

Background

The aim of this study was to present existing publications, describing various diagnostic procedures as well as considering the evidence supporting them, to develop a recommendation for diagnosis.

Material and methods

We reviewed relevant publications between 1966 and 2004 by a systemic literature search in MEDLINE, EMBASE, National Guideline Clearinghouse, Cochrane Library as well as a manual reference search. Keywords were cervical spine, cervical vertebrae, spinal, spinal cord, injury, trauma, fracture, dislocation, imaging, radiography, flexion, extension, fluoroscopy, computed tomography, computed scanning, and magnetic resonance imaging. The selected search results were then classified into levels of evidence.

Results

From among a total of 10,000 publications, 137 relevant publications were stringently reviewed. The level of evidence is on the whole limited due to deficit data; therefore, only class II-III recommendations are possible. We developed an algorithm for the diagnostic approach to suspected trauma of the cervical spine. This clinical algorithm displays the complex diagnosis of cervical spine injury in a clear and logically structured process.

Conclusions

The diagnostic algorithm for cervical spine injury meets the presently required standards and maximizes care for the newly injured. The development, which can be followed using evidence-based medicine, is transparent and therefore aids the decision process when choosing an adequate diagnostic procedure.

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  1. Chirurgische Klinik und Poliklinik Innenstadt, Klinikum der Universität München

    B. A. Leidel, K.-G. Kanz & W. Mutschler

  2. Chirurgische Klinik und Poliklinik Innenstadt, Klinikum der Universität, Nußbaumstraße 20, 80336, München

    B. A. Leidel

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Leidel, B.A., Kanz, KG. & Mutschler, W. Evidenzbasiertes diagnostisches Vorgehen bei Verdacht auf stumpfes HWS-Trauma. Unfallchirurg 108, 905–919 (2005). https://doi.org/10.1007/s00113-005-0968-2

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