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Rettungszeit und Überleben von Schwerverletzten in Deutschland

Rescue time and survival of severely injured patients in Germany

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Zusammenfassung

Hintergrund

Die Einhaltung einer Rettungszeit <60 min („golden hour“) wird unabhängig vom Rettungssystem gefordert. Ziel dieser Studie war es, den Einfluss der Rettungszeit auf das Überleben bei Schwerverletzten in Deutschland zu untersuchen.

Methode

Anhand des Traumaregisters der DGU wurde eine retrospektive Studie an 20.078 Patienten durchgeführt. In Klein- und Millionenstädten lag eine niedrigere Letalität vor, wobei Patienten in Millionen- und mittelgroßen Städten schwerer verletzt waren.

Ergebnisse

Anhand einer multivarianten Regressionsanalyse konnte kein Effekt für die Letalität in Abhängigkeit von der Dauer der Rettungszeit gezeigt werden. Bei längeren Rettungszeiten wurden signifikant mehr medizinische Maßnahmen durchgeführt und die Patienten waren schwerer verletzt.

Schlussfolgerung

Das Überleben schwerverletzter Patienten in Deutschland scheint nicht relevant von der Dauer der Rettungszeit beeinflusst zu werden, wobei bei längeren Rettungszeiten ein Selektionseffekt vorliegen kann. Präklinisch notwendige Maßnahmen zur Stabilisierung der Patienten sollten somit nicht zu Gunsten des Faktors Zeit unterlassen werden.

Abstract

Background

Independent of the rescue system type, a rescue time of less than 60 min for trauma patients is usually required and considered to be crucial for the outcome. The goal of this study was to investigate the impact of the rescue time on hospital survival in severely injured patients.

Methods

With the help of the German Trauma Registry of the DGU, the population and rescue time were systematically analyzed with regard to the survival rate. A lower mortality rate was observed with a higher injury severity in metropolitan cities compared to small towns.

Results

A multivariate regression analysis revealed no clinically relevant impact of the rescue time length in the German rescue system on survival. This can be explained by a higher amount of preclinical medical procedures during longer rescue times.

Conclusions

Within the German rescue system, the length of rescue time has no relevant impact on the survival of trauma patients admitted to a clinic. This could be explained by the higher numbers of preclinical measures and due to the limitations of a register study with selection bias. Therefore, we advocate that the necessary and suitable preclinical medical procedures be performed to stabilize the patient, even in cases that have exceeded the 60-min gold standard time window. In conclusion the “golden hour” concept today might better be interpreted as an individual and appropriate “golden period” of trauma.

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Correspondence to C. Kleber MD.

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Kleber, C., Lefering, R., Kleber, A. et al. Rettungszeit und Überleben von Schwerverletzten in Deutschland. Unfallchirurg 116, 345–350 (2013). https://doi.org/10.1007/s00113-011-2132-5

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