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Verletzungsschwere und -muster am Unfallort

Welchen Einfluss hat der Unfallmechanismus?

Injury severity and pattern at the scene

What is the influence of the mechanism of injury?

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Zusammenfassung

Hintergrund

Der Verletzungsmechanismus ist der häufigste Grund für die Aktivierung der Traumateams und einer Behandlung im Schockraum. Es ist jedoch unklar, in wieweit der Unfallmechanismus das Verletzungsmuster und die -schwere beeinflusst.

Material und Methoden

Es wurde eine umfassende Literaturrecherche bzgl. der Fragestellung durchgeführt. Ergänzt wurde die Suche durch eine Handrecherche nichtindizierter Quellen.

Ergebnisse

Insgesamt finden sich nur wenige Untersuchungen, die sich mit dem Einfluss des Unfallmechanismus auf Verletzungsmuster und -schwere beschäftigen. Anhand der identifizierten Studien lassen sich für Verletzungen des Schädels und der Wirbelsäule keine bestimmten Mechanismen erkennen. Thorakale und abdominelle Verletzungen im Rahmen von Verkehrsunfällen treten am häufigsten bei Insassen auf, die auf der Seite des Aufpralls sitzen. Dabei korreliert die Verformung des Lenkrads mit der Verletzungsschwere. Auch Beckenfrakturen treten mit der höchsten Inzidenz nach Verkehrsunfällen auf, wobei die Schwere der Verletzung mit der Kollisionsgeschwindigkeit steigt. Die Aufprallrichtung hat dabei Einfluss auf den Frakturtyp. Die höchste Mortalität besteht für von einem Fahrzeug angefahrene Fußgänger und bei Tod eines Mitinsassen.

Schlussfolgerung

Die Ergebnisse der Literaturrecherche erbringen widersprüchliche Resultate, in wieweit sich der Verletzungsmechanismus auf Verletzungsmuster und -schwere auswirkt. Dementsprechend sollte ein vom Unfallmechanismus unabhängiger Algorithmus bei der Versorgung schwerstverletzter Patienten genutzt werden. Dies wird in verschiedenen Ausbildungssystemen, wie z. B. ATLS® und PHTLS®, bereits propagiert. Trotzdem kann der Unfallmechanismus die Aufmerksamkeit des behandelnden Teams für die Verletzungsschwere und das Verletzungsmuster beeinflussen.

Abstract

Background

The mechanism of injury is the major cause for trauma team activation and emergency room resuscitation of trauma victims. To date, it remains unclear to what extent the injury mechanism influences injury pattern and severity.

Methods

A comprehensive systematic literature search based on Medline was carried out.

Results

Only a limited number of studies are available which investigated the influence of injury mechanisms on injury patterns and severity. There are no specific mechanisms for traumatic brain and spine injuries. Injuries to the chest and abdomen most frequently resulted from motor vehicle accidents involving passengers sitting on the side of the impact. Steering wheel deformity correlated with the injury severity. Pelvic fractures occurred most frequently due to motor vehicle accidents. The highest mortality resulted from pedestrians being struck by a vehicle and additional loss of life in the same vehicle compartment.

Conclusions

The systematic literature research showed inconsistent results regarding the influence of trauma mechanisms on the resulting injury. Therefore, a treatment algorithm for trauma patients should be independent of the mechanism which is represented in several training programs (e.g. ATLS® and PHTLS®). However, the mechanism of injury may increase the alertness of the trauma team with respect to injury distribution and severity.

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Correspondence to M. Frink.

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Teile dieses Projekts wurden auf dem Jahreskongress der Österreichischen Gesellschaft für Notfall- und Katastrophenmedizin am 4./5.12.2009 in Linz vorgestellt und sind beim Jahreskongress der Deutschen Gesellschaft für Unfallchirurgie 2010 eingereicht. Dieses Projekt wurde unter Mitarbeit der AG „Prävention von Verletzungen“ der Deutschen Gesellschaft für Unfallchirurgie e.V. realisiert.

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Frink, M., Zeckey, C., Haasper, C. et al. Verletzungsschwere und -muster am Unfallort. Unfallchirurg 113, 360–365 (2010). https://doi.org/10.1007/s00113-010-1776-x

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