T. Paffrath

[Are computer assisted total knee replacements more accurately placed? A meta-analysis of comparative studies].

ZusammenfassungDer Einsatz der computerassistierten Chirurgie auf dem Gebiet der Endoprothetik hat sich insbesondere für die navigationsgestützte Knieprothesenimplantation an vielen Kliniken weltweit etabliert. In einer Analyse der verfügbaren Studien wurden 18 vergleichende Studien zur Präzision nach Knieprothesenimplantation im Vergleich der konventionellen zur navigationsgestützten Technik ermittelt.In einer Metaanalyse von 13xa0Studien, die den gleichen Zielbereich der korrekten Implantation mit einer postoperativen Beinachse zwischen 3° Varus und 3° Valgus definierten, wurden insgesamt 1784 Implantationen untersucht. In dem konventionellen Kollektiv konnten 75,6% (654/865) gegenüber 93,9% (863/919) im navigierten Kollektiv innerhalb dieses Bereichs implantiert werden. Die Unterschiede der Behandlungskollektive sind in 11 der 13xa0Studien statistisch signifikant, der Gruppenunterschied für das Gesamtkollektiv ist hoch signifikant.Für die Implantationsgenauigkeit der Einzelkomponenten lassen sich Vorteile der Navigationstechnik nicht ebenso eindeutig nachweisen. Vor allem in Studien mit kleineren Fallzahlen sind z.xa0T. keine statistischen Unterschiede der Kollektive nachweisbar. Klinische Ergebnisse werden in den vorliegenden Vergleichsstudien nur begrenzt erhoben, wobei im kurzfristigen klinischen Verlauf keine wesentlichen Unterscheide der Behandlungsgruppen aufgezeigt werden.AbstractComputer-assisted surgery (CAS) has become established in many hospitals throughout the world, especially in the form of computer navigation for total knee replacement (TKR). Analysis of the studies available revealed 18 comparative studies examining the precision of implantation of knee endoprostheses following CAS and after implantation by the conventional technique.In a meta-analysis of 13 studies in which the same safe zone of ±3 from neutral alignment was defined for the leg axis, a total of 1,784 TKR were performed. In the group of patients in whom the conventional technique was used, 75.6% (654/865) of TKR were implanted within the safe zone. In the CAS group 93.9% (863/919) of the prostheses were implanted within the safe zone (p<0.0001). The differences between the groups were statistically significant in 11 of the 13 studies, and the difference between groups for the entire patient population is highly significant.Only limited clinical results were ascertained in these comparative studies; there were no great differences between the treatment groups in clinical course.

Comparative Update on Documentation of Trauma in Seven National Registries

AbstractIntroduction:The role of trauma documentationnsystems for trauma research has continuously increasednsince the first trauma registries were developed innthe late 1980s. Data acquisition and processing improvednhighly, partly because modern computer and networkntechnologies offer new approaches. Internationalncomparison is important for the learning process andnthe investigation of differences in the mechanisms ofninjury, rescue systems and treatment protocols.nWe demonstrate keypoints of the learning curve thusnsupporting a further spreading of trauma registries.Methods:Seven exemplary trauma registries from thenUnited States, Canada, Victoria (Australia), UnitednKingdom, France, Germany and the new EuropeannTrauma Audit and Research Network registry werenanalyzed according to their development until thencurrent status. Special investigations were conductednfor data acquisition, inclusion criteria and the volumenand characteristics of patient data.Results:We found a clear overall beneficial influencenof the documentation systems on the respectiventrauma system. Data acquisition displayed a widenrange of difference from paper forms being enteredninto a centralized database by hand to direct entry ofnthe data into the database by a local user via an Internetnplatform. Some systems copy computerized patientndata from local hospital systems. Two registries arenavailable in two languages. One has the option to addnfurther languages as demanded. Datasets are comparablenin terms of general data and a compulsory traumandiagnosis. Still, the details of the documented period ofncare and the inclusion criteria differ considerably.Discussion:We describe the important role of severalntrauma registries within a trauma care system. Althoughnthe success is hard to measure, relatednpublications, continuous growth, the official use fornquality control and the demand to participate by otherncountries stress their wide spread acceptancen(secondary internationalization). These advantagesnmake trauma registries a valuable tool in manyncountries.

Injury pattern, outcome and characteristics of severely injured pedestrian

BackgroundPedestrians who are involved in motor vehicle collisions present with a unique trauma situation. The aim of this study was to demonstrate the specific clinical characteristics of this patient population in comparison to injured motor vehicle occupants in the medical emergency setting.MethodsA total of 4435 pedestrian traffic collision victims admitted to hospitals participating at TraumaRegister DGU® between 2002 and 2012 (primary admission, Injury Severity Score, ISSu2009≥u20099; ageu2009≥u20092xa0years) was assessed and compared to 16,042 severely injured motor vehicle occupants. Analyses included features such as demographic distribution, injury patterns, treatment course, subsequent complications and overall clinical outcome.ResultsSeverely injured pedestrians more commonly were female (42xa0% vs. 34xa0% of motor vehicle occupants) and children below 16xa0years (12xa0% vs. 2xa0%) or seniors above 60xa0years of age (39xa0% vs. 17xa0%). Pedestrians were injured more severely (ISS: 26 vs. 25; NISS 32 vs. 30) with higher rates of head injuries (64xa0% vs. 47xa0%), pelvic injuries (32xa0% vs. 23xa0%) and lower extremity injuries (52xa0% vs. 43xa0%). Accordingly, pedestrians more commonly presented with Glasgow Coma Scale <9 (36xa0% vs. 28xa0%) and a systolic blood pressure below 90xa0mmHg (18xa0% vs. 13xa0%) accumulating in a worse prognosis (RISC-Score 24xa0% vs. 15xa0%) despite of a shorter on-scene treatment time (26xa0min vs. 38xa0min) and a shorter period from the collision until hospital admission (61xa0min vs. 78xa0min). Finally, pedestrians showed a higher mortality (22xa0% vs. 12xa0%).ConclusionSeverely injured pedestrians represent a challenging patient population with unique injury patterns and high subsequent mortality. Emergency team members should be sensitized to the trigger term “pedestrian” in order to improve the initial emergency management and thus the overall clinical outcome.

Factors influencing lengths of stay in the intensive care unit for surviving trauma patients: a retrospective analysis of 30,157 cases

IntroductionThere are many potential influencing factors that affect the duration of intensive care treatment for patients who have survived multiple trauma. Yet the respective factors’ relevance to ICU length of stay (LOS) has been rarely studied. Thus, the aim of the present study was to investigate to what extent specific factors influence ICU LOS in surviving trauma patients.MethodsWe retrospectively analyzed a dataset of 30,157 surviving trauma patients from the TraumaRegister DGU® who were older than six years of age and received subsequent intensive care treatment for more than one day, from 2002 to 2011. Univariate analysis and multiple linear regression analysis were used to examine 25 categorical pre- and post-trauma parameters.ResultsUnivariate analysis confirmed the impact of all analyzed factors. In subsequent multiple linear regression analyses, coefficients ranged from -1.3 to +8.2xa0days. The factors that influenced the prolongation of ICU LOS most were renal failure (+8.1xa0days), sepsis (+7.8xa0days) and respiratory failure (+4.9xa0days). Patients spent one additional day in the ICU for every 5 additional points on the Injury Severity Score (regression coefficient +0.2 per point). Furthermore, massive transfusion (+3.3xa0days), invasive ventilation (+3.1xa0days), and an initial Glasgow Coma Scale score ≤8 (+3.0xa0days) had a significant impact on ICU LOS. The coefficient of determination for the model was 44% (R2).ConclusionsTreatment regimens, as well as secondary effects and complications of trauma and intensive care treatment, prolong ICU LOS more than the mechanism of trauma or pre-trauma patient conditions. Successful prevention of complicated courses of illness, such as sepsis and renal and respiratory failure, could significantly abbreviate the ICU stay in trauma patients. Therefore, the staff’s attention should be focused on preventive strategies.

A Consensus-Based Criterion Standard for the Requirement of a Trauma Team

BackgroundTrauma team activation (TTA) represents a considerable expenditure of trauma centre resources. It is mainly triggered by field triage criteria. The overall quality of the criteria may be evaluated based on the rate of over- and undertriage. However, there is no gold standard that defines which adult patients truly require a trauma team. The objective of this study was to develop consensus-based criteria defining the necessity for a trauma team.MethodsA consensus group was formed by trauma specialists experienced in emergency and trauma care with a specific interest in field triage and having previously participated in guideline development. A literature search was conducted to identify criteria that have already been used or suggested. The initial list of criteria was discussed in two Delphi round and two consensus conferences. The entire process of discussion and voting was highly standardized and extensively documented, resulting in a final list of criteria.ResultsInitially 95 criteria were identified. This was subsequently reduced to 20 final criteria to appropriately indicate the requirement for attendance of a trauma team. The criteria address aspects related to injury severity, admission to an intensive care unit, death within 24xa0h, need for specified invasive procedures, need for surgical and/or interventional radiological procedures, and abnormal vital signs within a defined time period.ConclusionsThe selected criteria may be applied as a tool for research and quality control concerning TTA. However, future studies are necessary to further evaluate for possible redundancy in criteria that may allow for further reduction in criteria.

Change of initial and ICU treatment over time in trauma patients. An analysis from the TraumaRegister DGU

BackgroundClinical guidelines have been standardized for pre- and in-hospital trauma management in the last decades. Therefore, it is known that prehospital management has changed significantly. Furthermore, in-hospital course may be altered to reduce complications and length of stay (LOS). However, the development of trauma patient in-hospital management as well as LOS in the intensive care unit (ICU) has not been investigated systematically over a long-term period in Germany. Aim of our study is to examine the changes in in-hospital management and LOS in the ICU in moderately and severely injured patients.MethodsPatients documented in the TraumaRegister DGU® (TR-DGU) of the German Trauma Society from 2000 to 2011 and admitted to ICU were included in this study. Demographic data, the pattern of injury, injury severity, duration of mechanical ventilation, LOS in the ICU, hospital LOS, and discharge destination were evaluated. The mean values and the standard deviations are shown. The constant variables were calculated with changes over time analyzed by linear regression analysis, and categorical variables were calculated with the chi-square test.ResultsA total of 18,048 patients were analyzed. The rate of patients being intubated at the time of ICU admission decreased from 86.8xa0% in 2000 to 60.0xa0% in 2011 (pu2009<u20090.001). The time of mechanical ventilation decreased from 7.5u2009±u200910.5 to 4.7u2009±u20098.7xa0days. The intensive care unit LOS was reduced from 11.7u2009±u200912.8 to 9.0u2009±u200911.3xa0days and the length of hospital stay from 27.9u2009±u200928.7 to 21.1u2009±u200920.4xa0days (both pu2009<u20090.01). The ICU LOS remained stable in the subgroup of mechanically ventilated patients (12.7u2009±u200913.2xa0day in 2000, 12,6u2009±u200912.9 in 2011, pu2009=u20090.6), whereas it was reduced in non-mechanically ventilated patients (5.5u2009±u20096.8xa0days in 2000, 3.6u2009±u20094.5xa0days in 2011; pu2009<u20090.001).ConclusionsThe reduction LOS in the analyzed dataset is mainly explained by the relevantly reduced rate of patients being intubated at the time of ICU admission. Our data demonstrate that trauma patients’ in-hospital course is influenced by reduced intubation rate at the time of ICU admission.

Advanced Trauma Life Support (ATLS) in the emergency room. Is it suitable as an SOP

There is clinical evidence that a standardized management of trauma patients in the emergency room improves outcome. ATLS is a training course that teaches a systematic approach to the trauma patient in the emergency room. The aims are a rapid and accurate assessment of the patients physiologic status, treatment according to priorities, and making decisions on whether the local resources are sufficient for adequate definitive treatment of the patient or if transfer to a trauma center is necessary. Above all it is important to prevent secondary injury, to realize timing as a relevant factor in the initial treatment, and to assure a high standard of care. A standard operating procedure (SOP) exactly regulates the approach to trauma patients and determines the responsibilities of the involved faculties. An SOP moreover incorporates the organizational structure in the treatment of trauma patients as well as the necessary technical equipment and staff requirements. To optimize process and result quality, priorities are in the fields of medical fundamentals of trauma care, education, and fault management. SOPs and training courses increase the process and result quality in the treatment of the trauma patient in the emergency room. These programs should be based on the special demands of the physiology of the trauma as well as the structural specifics of the hospital. ATLS does not equal an SOP but it qualifies as a standardized concept for management of trauma patients in the emergency room.ZusammenfassungEs ist aus klinischen Untersuchungen bekannt, dass ein standardisiertes Schockraummanagement die Behandlungsergebnisse von Schwerverletzten verbessert. „Advanced Trauma Live Support“ (ATLS®) stellt ein Ausbildungskonzept dar, das ein standardisiertes Schockraummanagement lehrt. Ziele sind die schnelle und genaue Einschätzung des Zustands des Traumapatienten, aus der sich eine prioritätenorientierte Behandlung ableitet. Über allem stehen die Gedanken, Sekundärschäden zu vermeiden, die Zeit nicht aus den Augen zu verlieren und eine gleichbleibende Qualität der Versorgung zu sichern.Eine „Standard Operating Procedure“ (SOP) regelt den genauen Behandlungsablauf der Schwerverletztenversorgung und legt die Aufgabenverantwortung der verschiedenen an der Schwerverletztenversorgung teilnehmenden Fachbereiche fest. Eine SOP berücksichtigt darüber hinaus die Grundlagen der Organisationsstruktur der Schwerverletztenversorgung, die erforderlichen räumlichen/apparativen und personellen Anforderungen sowie medizinische Grundlagen der Schwerverletztenversorgung, die Ausbildung und ein Fehlermanagement, um eine Verbesserung der Prozess- und Ergebnisqualität erzielen zu können.Unabhängig von der Versorgungsstufe einer Klinik verbessern SOP und Ausbildungsprogramme die Prozess- und Ergebnisqualität der Behandlung Schwerverletzter. SOP und Ausbildungsprogramme müssen an den Bedürfnissen der Traumaphysiologie und den strukturellen Gegebenheiten orientiert sein. ATLS® stellt keine SOP dar, eignet sich aber als Konzept, standardisierte Behandlungsabläufe für die Schwerverletztenversorgung entsprechend einer SOP zu entwickeln.AbstractThere is clinical evidence that a standardized management of trauma patients in the emergency room improves outcome. ATLS® is a training course that teaches a systematic approach to the trauma patient in the emergency room. The aims are a rapid and accurate assessment of the patient’s physiologic status, treatment according to priorities, and making decisions on whether the local resources are sufficient for adequate definitive treatment of the patient or if transfer to a trauma center is necessary. Above all it is important to prevent secondary injury, to realize timing as a relevant factor in the initial treatment, and to assure a high standard of care. A standard operating procedure (SOP) exactly regulates the approach to trauma patients and determines the responsibilities of the involved faculties. An SOP moreover incorporates the organizational structure in the treatment of trauma patients as well as the necessary technical equipment and staff requirements. To optimize process and result quality, priorities are in the fields of medical fundamentals of trauma care, education, and fault management.SOPs and training courses increase the process and result quality in the treatment of the trauma patient in the emergency room. These programs should be based on the special demands of the physiology of the trauma as well as the structural specifics of the hospital. ATLS® does not equal an SOP but it qualifies as a standardized concept for management of trauma patients in the emergency room.

Schockraummanagement von Schwerverletzten

There is clinical evidence that a standardized management of trauma patients in the emergency room improves outcome. ATLS is a training course that teaches a systematic approach to the trauma patient in the emergency room. The aims are a rapid and accurate assessment of the patients physiologic status, treatment according to priorities, and making decisions on whether the local resources are sufficient for adequate definitive treatment of the patient or if transfer to a trauma center is necessary. Above all it is important to prevent secondary injury, to realize timing as a relevant factor in the initial treatment, and to assure a high standard of care. A standard operating procedure (SOP) exactly regulates the approach to trauma patients and determines the responsibilities of the involved faculties. An SOP moreover incorporates the organizational structure in the treatment of trauma patients as well as the necessary technical equipment and staff requirements. To optimize process and result quality, priorities are in the fields of medical fundamentals of trauma care, education, and fault management. SOPs and training courses increase the process and result quality in the treatment of the trauma patient in the emergency room. These programs should be based on the special demands of the physiology of the trauma as well as the structural specifics of the hospital. ATLS does not equal an SOP but it qualifies as a standardized concept for management of trauma patients in the emergency room.ZusammenfassungEs ist aus klinischen Untersuchungen bekannt, dass ein standardisiertes Schockraummanagement die Behandlungsergebnisse von Schwerverletzten verbessert. „Advanced Trauma Live Support“ (ATLS®) stellt ein Ausbildungskonzept dar, das ein standardisiertes Schockraummanagement lehrt. Ziele sind die schnelle und genaue Einschätzung des Zustands des Traumapatienten, aus der sich eine prioritätenorientierte Behandlung ableitet. Über allem stehen die Gedanken, Sekundärschäden zu vermeiden, die Zeit nicht aus den Augen zu verlieren und eine gleichbleibende Qualität der Versorgung zu sichern.Eine „Standard Operating Procedure“ (SOP) regelt den genauen Behandlungsablauf der Schwerverletztenversorgung und legt die Aufgabenverantwortung der verschiedenen an der Schwerverletztenversorgung teilnehmenden Fachbereiche fest. Eine SOP berücksichtigt darüber hinaus die Grundlagen der Organisationsstruktur der Schwerverletztenversorgung, die erforderlichen räumlichen/apparativen und personellen Anforderungen sowie medizinische Grundlagen der Schwerverletztenversorgung, die Ausbildung und ein Fehlermanagement, um eine Verbesserung der Prozess- und Ergebnisqualität erzielen zu können.Unabhängig von der Versorgungsstufe einer Klinik verbessern SOP und Ausbildungsprogramme die Prozess- und Ergebnisqualität der Behandlung Schwerverletzter. SOP und Ausbildungsprogramme müssen an den Bedürfnissen der Traumaphysiologie und den strukturellen Gegebenheiten orientiert sein. ATLS® stellt keine SOP dar, eignet sich aber als Konzept, standardisierte Behandlungsabläufe für die Schwerverletztenversorgung entsprechend einer SOP zu entwickeln.AbstractThere is clinical evidence that a standardized management of trauma patients in the emergency room improves outcome. ATLS® is a training course that teaches a systematic approach to the trauma patient in the emergency room. The aims are a rapid and accurate assessment of the patient’s physiologic status, treatment according to priorities, and making decisions on whether the local resources are sufficient for adequate definitive treatment of the patient or if transfer to a trauma center is necessary. Above all it is important to prevent secondary injury, to realize timing as a relevant factor in the initial treatment, and to assure a high standard of care. A standard operating procedure (SOP) exactly regulates the approach to trauma patients and determines the responsibilities of the involved faculties. An SOP moreover incorporates the organizational structure in the treatment of trauma patients as well as the necessary technical equipment and staff requirements. To optimize process and result quality, priorities are in the fields of medical fundamentals of trauma care, education, and fault management.SOPs and training courses increase the process and result quality in the treatment of the trauma patient in the emergency room. These programs should be based on the special demands of the physiology of the trauma as well as the structural specifics of the hospital. ATLS® does not equal an SOP but it qualifies as a standardized concept for management of trauma patients in the emergency room.

Das TraumaRegister DGU® als Datenquelle für das Monitoring schwerer Unfallverletzungen

ZusammenfassungHintergrundSeit 1993 sammelt das TraumaRegister DGU® der Deutschen Gesellschaft für Unfallchirurgie (TR-DGU) Daten zur Versorgung schwer verletzter Unfallopfer in Deutschland. Aufgrund der aktuellen Zahl von mehr als 600 teilnehmenden Kliniken, die regelmäßig vergleichende Qualitätsberichte erhalten, werden diese Registerdaten eine zunehmend wertvolle Quelle für die Versorgungsforschung.ZielDarstellung des Potenzials des TR-DGU zur Bearbeitung epidemiologischer Fragestellungen sowie zur Beschreibung der Prozess- und Ergebnisqualität der Versorgung schwer verletzter Patienten.Material und MethodenDas TR-DGU erfasst pro Patient etwa 100xa0Angaben zur Person, zum Unfallgeschehen, zum Verletzungsmuster, zur präklinischen und innerklinischen Versorgung, zum Zustand der Patienten sowie zum Outcome. Bei vergleichenden Analysen wird die beobachtete Sterblichkeit durch Berücksichtigung prognostisch relevanter Befunde adjustiert. Einige Eckdaten des Registers werden für Patienten, die in deutschen Kliniken zwischen 2002 und 2012 behandelt wurden, mit einem Injury Severity Score vonu2009³u20099xa0Punkten berichtet.ErgebnisseSeit 1993 konnten mehr als 122.000xa0Patienten im Register erfasst werden. Die Mehrzahl sind Verkehrsunfallopfer (57u2009%), gefolgt von Patienten mit Stürzen aus niedriger (<u20093xa0m; 17u2009%) oder aus großer Höhe (>u20093xa0m; 16u2009%). Unter den Verkehrsunfallopfern ist etwa jeder Zweite ein Autofahrer oder Beifahrer (46u2009%), ein Viertel sind Motorradfahrer (25u2009%), der Rest Fahrradfahrer (14u2009%) und Fußgänger (13u2009%). Die Sterblichkeit bei Patienten mit einem Injury Severity Score von ³u20099 liegt bei 12,8u2009%. Dieser Wert liegt etwa 1–2u2009% unterhalb der erwarteten Prognose, die auf Daten aus den 1990er-Jahren beruht.DiskussionDas TraumaRegister DGU® ist nicht nur ein erfolgreiches Instrument zur externen Qualitätssicherung der Versorgung schwer verletzter Patienten, sondern stellt auch eine zunehmend wertvollere Quelle für wissenschaftliche Auswertungen im Rahmen der Versorgungsforschung dar. Die Einführung regionaler Traumanetzwerke durch die DGU hat einen ganz wesentlichen Beitrag zur flächendeckenden Erfassung Schwerverletzter geleistet und ermöglicht zunehmend vollständigere Angaben zur Epidemiologie schwerer Verletzungen in Deutschland.AbstractBackgroundThe TraumaRegister DGU® of the German Society for Trauma Surgery (TR-DGU) has collected data on the treatment of severely injured accident victims in Germany since 1993. Due to the current number of more than 600 participating clinics which regularly receive quality comparison reports, these register data are becoming an increasingly more valuable source for healthcare research.ObjectivesThe aims of this article are to describe the potential of the TR-DGU for dealing with epidemiological questions and for describing the quality of the process and results for treatment of severely injured patients.Material and methodsThe TR-DGU includes approximately 100 details per patient on the person, the circumstances of the accident, the injury pattern, the preclinical and hospital treatment, the condition of the patient and the outcome. Using comparative analyses the observed mortality is adjusted by considering prognostically relevant findings. Some key features of the register are reported for patients who were treated in German hospitals between 2002 and 2012 with an injury severity score (ISS) of u2009³u20099 points.ResultsSince 1993 more than 122,000 patients have been included in the register. The majority are traffic accident victims (57xa0%), followed by patients with falls from low heights (<u20093xa0m, 17u2009%) or greater heights (>u20093xa0m, 16u2009%). Among the traffic accident victims approximately one half are car drivers or passengers (46xa0%), one quarter are motorbike drivers (25xa0%) and the rest are cyclists (14xa0%) and pedestrians (13xa0%). The mortality of patients with an ISS ³u20099 is 12.8u2009%. This value is approximately 1–2u2009% below the expected prognosis based on data from the 1990s.DiscussionThe TR-DGU is not only a successful instrument for external quality assurance of the treatment of severely injured patients but also an increasingly more valuable source for scientific evaluation within the framework of healthcare research. The introduction of regional trauma networks by the DGU has made a substantial contribution to the comprehensive compilation of severely injured patients and allows increasingly more detailed information on the epidemiology of severe injuries in Germany to be compiled.BACKGROUNDnThe TraumaRegister DGU® of the German Society for Trauma Surgery (TR-DGU) has collected data on the treatment of severely injured accident victims in Germany since 1993. Due to the current number of more than 600 participating clinics which regularly receive quality comparison reports, these register data are becoming an increasingly more valuable source for healthcare research.nnnOBJECTIVESnThe aims of this article are to describe the potential of the TR-DGU for dealing with epidemiological questions and for describing the quality of the process and results for treatment of severely injured patients.nnnMATERIAL AND METHODSnThe TR-DGU includes approximately 100 details per patient on the person, the circumstances of the accident, the injury pattern, the preclinical and hospital treatment, the condition of the patient and the outcome. Using comparative analyses the observed mortality is adjusted by considering prognostically relevant findings. Some key features of the register are reported for patients who were treated in German hospitals between 2002 and 2012 with an injury severity score (ISS) of u2009≥9 points.nnnRESULTSnSince 1993 more than 122,000 patients have been included in the register. The majority are traffic accident victims (57 %), followed by patients with falls from low heights (<u20093 m, 17u2009%) or greater heights (>u20093 m, 16u2009%). Among the traffic accident victims approximately one half are car drivers or passengers (46 %), one quarter are motorbike drivers (25 %) and the rest are cyclists (14 %) and pedestrians (13 %). The mortality of patients with an ISS ³u20099 is 12.8u2009%. This value is approximately 1-2u2009% below the expected prognosis based on data from the 1990s.nnnDISCUSSIONnThe TR-DGU is not only a successful instrument for external quality assurance of the treatment of severely injured patients but also an increasingly more valuable source for scientific evaluation within the framework of healthcare research. The introduction of regional trauma networks by the DGU has made a substantial contribution to the comprehensive compilation of severely injured patients and allows increasingly more detailed information on the epidemiology of severe injuries in Germany to be compiled.

The TraumaRegister DGU(®) as data source for monitoring severe injuries

ZusammenfassungHintergrundSeit 1993 sammelt das TraumaRegister DGU® der Deutschen Gesellschaft für Unfallchirurgie (TR-DGU) Daten zur Versorgung schwer verletzter Unfallopfer in Deutschland. Aufgrund der aktuellen Zahl von mehr als 600 teilnehmenden Kliniken, die regelmäßig vergleichende Qualitätsberichte erhalten, werden diese Registerdaten eine zunehmend wertvolle Quelle für die Versorgungsforschung.ZielDarstellung des Potenzials des TR-DGU zur Bearbeitung epidemiologischer Fragestellungen sowie zur Beschreibung der Prozess- und Ergebnisqualität der Versorgung schwer verletzter Patienten.Material und MethodenDas TR-DGU erfasst pro Patient etwa 100xa0Angaben zur Person, zum Unfallgeschehen, zum Verletzungsmuster, zur präklinischen und innerklinischen Versorgung, zum Zustand der Patienten sowie zum Outcome. Bei vergleichenden Analysen wird die beobachtete Sterblichkeit durch Berücksichtigung prognostisch relevanter Befunde adjustiert. Einige Eckdaten des Registers werden für Patienten, die in deutschen Kliniken zwischen 2002 und 2012 behandelt wurden, mit einem Injury Severity Score vonu2009³u20099xa0Punkten berichtet.ErgebnisseSeit 1993 konnten mehr als 122.000xa0Patienten im Register erfasst werden. Die Mehrzahl sind Verkehrsunfallopfer (57u2009%), gefolgt von Patienten mit Stürzen aus niedriger (<u20093xa0m; 17u2009%) oder aus großer Höhe (>u20093xa0m; 16u2009%). Unter den Verkehrsunfallopfern ist etwa jeder Zweite ein Autofahrer oder Beifahrer (46u2009%), ein Viertel sind Motorradfahrer (25u2009%), der Rest Fahrradfahrer (14u2009%) und Fußgänger (13u2009%). Die Sterblichkeit bei Patienten mit einem Injury Severity Score von ³u20099 liegt bei 12,8u2009%. Dieser Wert liegt etwa 1–2u2009% unterhalb der erwarteten Prognose, die auf Daten aus den 1990er-Jahren beruht.DiskussionDas TraumaRegister DGU® ist nicht nur ein erfolgreiches Instrument zur externen Qualitätssicherung der Versorgung schwer verletzter Patienten, sondern stellt auch eine zunehmend wertvollere Quelle für wissenschaftliche Auswertungen im Rahmen der Versorgungsforschung dar. Die Einführung regionaler Traumanetzwerke durch die DGU hat einen ganz wesentlichen Beitrag zur flächendeckenden Erfassung Schwerverletzter geleistet und ermöglicht zunehmend vollständigere Angaben zur Epidemiologie schwerer Verletzungen in Deutschland.AbstractBackgroundThe TraumaRegister DGU® of the German Society for Trauma Surgery (TR-DGU) has collected data on the treatment of severely injured accident victims in Germany since 1993. Due to the current number of more than 600 participating clinics which regularly receive quality comparison reports, these register data are becoming an increasingly more valuable source for healthcare research.ObjectivesThe aims of this article are to describe the potential of the TR-DGU for dealing with epidemiological questions and for describing the quality of the process and results for treatment of severely injured patients.Material and methodsThe TR-DGU includes approximately 100 details per patient on the person, the circumstances of the accident, the injury pattern, the preclinical and hospital treatment, the condition of the patient and the outcome. Using comparative analyses the observed mortality is adjusted by considering prognostically relevant findings. Some key features of the register are reported for patients who were treated in German hospitals between 2002 and 2012 with an injury severity score (ISS) of u2009³u20099 points.ResultsSince 1993 more than 122,000 patients have been included in the register. The majority are traffic accident victims (57xa0%), followed by patients with falls from low heights (<u20093xa0m, 17u2009%) or greater heights (>u20093xa0m, 16u2009%). Among the traffic accident victims approximately one half are car drivers or passengers (46xa0%), one quarter are motorbike drivers (25xa0%) and the rest are cyclists (14xa0%) and pedestrians (13xa0%). The mortality of patients with an ISS ³u20099 is 12.8u2009%. This value is approximately 1–2u2009% below the expected prognosis based on data from the 1990s.DiscussionThe TR-DGU is not only a successful instrument for external quality assurance of the treatment of severely injured patients but also an increasingly more valuable source for scientific evaluation within the framework of healthcare research. The introduction of regional trauma networks by the DGU has made a substantial contribution to the comprehensive compilation of severely injured patients and allows increasingly more detailed information on the epidemiology of severe injuries in Germany to be compiled.BACKGROUNDnThe TraumaRegister DGU® of the German Society for Trauma Surgery (TR-DGU) has collected data on the treatment of severely injured accident victims in Germany since 1993. Due to the current number of more than 600 participating clinics which regularly receive quality comparison reports, these register data are becoming an increasingly more valuable source for healthcare research.nnnOBJECTIVESnThe aims of this article are to describe the potential of the TR-DGU for dealing with epidemiological questions and for describing the quality of the process and results for treatment of severely injured patients.nnnMATERIAL AND METHODSnThe TR-DGU includes approximately 100 details per patient on the person, the circumstances of the accident, the injury pattern, the preclinical and hospital treatment, the condition of the patient and the outcome. Using comparative analyses the observed mortality is adjusted by considering prognostically relevant findings. Some key features of the register are reported for patients who were treated in German hospitals between 2002 and 2012 with an injury severity score (ISS) of u2009≥9 points.nnnRESULTSnSince 1993 more than 122,000 patients have been included in the register. The majority are traffic accident victims (57 %), followed by patients with falls from low heights (<u20093 m, 17u2009%) or greater heights (>u20093 m, 16u2009%). Among the traffic accident victims approximately one half are car drivers or passengers (46 %), one quarter are motorbike drivers (25 %) and the rest are cyclists (14 %) and pedestrians (13 %). The mortality of patients with an ISS ³u20099 is 12.8u2009%. This value is approximately 1-2u2009% below the expected prognosis based on data from the 1990s.nnnDISCUSSIONnThe TR-DGU is not only a successful instrument for external quality assurance of the treatment of severely injured patients but also an increasingly more valuable source for scientific evaluation within the framework of healthcare research. The introduction of regional trauma networks by the DGU has made a substantial contribution to the comprehensive compilation of severely injured patients and allows increasingly more detailed information on the epidemiology of severe injuries in Germany to be compiled.