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Prognostischer Wert von Routineparametern und -laborparametern nach schwerem Trauma

Eine prospektive präklinische-klinische Studie mit Patienten des RTH Christoph 1

Prognostic value of routine parameters and laboratory parameters after major trauma

A prospective preclinical-clinical study of air rescue patients

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Zusammenfassung

In diese Studie wurden 273 Patienten nach schwerem stumpfem Trauma eingeschlossen, die im Rahmen eines Primäreinsatzes des Rettungshubschraubers (RTH) „Christoph 1“ aus München-Harlaching versorgt wurden. Bei diesen Patienten wurden zu einem präklinischen und drei klinischen Zeitpunkten definierte Parameter erhoben; dazu wurden an der Einsatzstelle und im Schockraum Blutabnahmen vorgenommen. Mit den Daten wurde erstmals ein Prognosemodell mit präklinischen und frühklinischen Routineparametern und Routinelaborparametern getestet. Für die Überlebenswahrscheinlichkeit der Patienten zeigten sich der Quick-, Base-Excess-, Glasgow-Coma-Scale- (GCS-)Wert sowie das Alter am Unfalltag und die Verletzungsschwere als relevante Einflussgrößen.

Die Wahrscheinlichkeit des Überlebens nach schwerem stumpfem Trauma sinkt mit zunehmendem Alter und Verletzungsschwere und mit abnehmendem GCS-, Base-Excess- und Quick-Wert.

Die vorliegenden Daten zeigen, dass es möglich ist, mit leicht zugänglichen, reliablen und validen Parametern aus der Einsatzpraxis unter Hinzunahme von Laborwerten, die frühklinisch bzw. bereits präklinisch zu erheben sind, mit einer großen Zuverlässigkeit von 82% die Überlebenswahrscheinlichkeit des Patienten zu prognostizieren. Dies würde die ersten, prognostisch wichtigen 60 min des schweren Traumas als „golden hour disease“ positiv beeinflussen und die Gefahr einsatztaktischer Fehlentscheidungen minimieren.

Abstract

In this prospective study, 273 air rescue patients with major blunt trauma were followed throughout their prehospital and clinical management. A blood sample was taken upon arrival and data acquired at three defined time points.

With these data, for the first time a prognosis prediction model with prehospital and early clinical routine parameters and routine lab parameters was tested for predictive power.

Coagulation test, value of base excess, Glasgow Coma Scale (GCS) value, severity of injury, and age appeared to be relevant parameters. The probability of survival after major blunt trauma decreases with increasing age and severity of injury and decreasing values in GCS, base excess, and coagulation test.

These data showed that it is possible with the help of easily accessible routine parameters and routine lab parameters to predict individual survival with a high degree of accuracy of 82%.

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Author notes

  1. C.K. Lackner & E. Stolpe

    Present address: Luftrettungsstation RTH Christoph 1, Städt. Krankenhaus , München-Harlaching, Deutschland

  2. T. Schlechtriemen

    Present address: Klinik für Anästhesiologie, Klinikum, Saarbrücken, Deutschland

Authors and Affiliations

  1. Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Schillerstr. 53, 80336, München, Deutschland

    C.K. Lackner, K. Burghofer, E. Stolpe, T. Schlechtriemen & W.E. Mutschler

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  1. C.K. Lackner
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  2. K. Burghofer
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  3. E. Stolpe
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  4. T. Schlechtriemen
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  5. W.E. Mutschler
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Correspondence to C.K. Lackner.

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Lackner, C., Burghofer, K., Stolpe, E. et al. Prognostischer Wert von Routineparametern und -laborparametern nach schwerem Trauma. Unfallchirurg 110, 307–319 (2007). https://doi.org/10.1007/s00113-006-1216-0

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