T. Vogel

Versorgungswirklichkeit bei osteoporosebedingten Frakturen in der deutschen Unfallchirurgie

The implementation of clinical pathways has a proven positive effect on the diagnostic workup and initiation of therapy in osteoporotic fracture patients. Unlike in most countries, fracture care in Germany is provided by so-called trauma surgeons. Therefore, it is essential to focus on the trauma surgeon for correct diagnostic workup and therapy initiation after a fragility fracture. A questionnaire was mailed to 409 departments of traumatology inquiring about the existence of a standardized clinical pathway for diagnosis and treatment of patients with fragility fractures. One of the central issues of the survey was whether those pathways comply with national guidelines. Only institutions that stated that they followed a clinical pathway were analyzed. 80% of institutions took part in our survey, 35% of which reported following a defined clinical pathway. Diagnostic workup is in concordance with the national guidelines in 30%, and therapy is guideline-based in 51%, with 12% basing both diagnostic workup and therapy on the guidelines. Thus, the vast majority of German traumatology departments do not follow national guidelines regarding osteoporosis diagnostics and therapy in patients with fragility fractures, leading to a great opportunity to improve fragility fracture care by means of both education and interdisciplinary cooperation.

Größenprogrediente intrakranielle Blutungen nach Schädel-Hirn-Trauma

BACKGROUND The aim of the study was to quantify the occurrence of progressive intracranial bleeding (PIB) and to identify concomitant parameters in patients suffering from traumatic brain injury (TBI). METHODS TBI patients were included if initial and serial cranial computed tomography (CCT) scans were conducted within 24 h after trauma. A progression of > or =25% was considered as PIB. Patients with progression were compared to those with constant bleeding regarding clinical parameters, time lapse and coagulation status. RESULTS A total of 98 patients with TBI and intracranial hemorrhaging were analyzed. PIB was detected in 45 patients showing significantly more intracerebral bleeding as well as fractures to the skull (p<0.05), compared to patients with constant bleeding. No significant differences between the groups regarding demographic and clinical parameters, time interval between trauma and initial CCT, and coagulation status were found. CONCLUSIONS Early progression of intracranial hemorrhaging occurs in nearly every second TBI patient and is recognized frequently in cerebral contusions and after fractures to the skull. Hence, early repeated CT scanning is indicated in all TBI patients suffering from intracranial bleeding.

Loveparade 2010 Duisburg – klinische Erfahrungen in Vorbereitung und Versorgung

ZusammenfassungHintergrundDer tragische Verlauf der Loveparade 2010 hat starke öffentliche Aufmerksamkeit erregt. Bei steigender Frequenz ähnlicher Großveranstaltungen werden zunehmend Kliniken und Praxen mit der Vorbereitung und Reaktion auf unvorhergesehene Ereignisse konfrontiert. Verbindliche ärztliche Leitlinien bestehen nicht, so dass bei jeder Veranstaltung erneut Grundsätzliches diskutiert wird. Ziel dieses Beitrags ist es, die Erfahrungen der an der Loveparade beteiligten Kliniken und Ambulanzen strukturiert auszuwerten, um daraus sinnvolle, für Kliniken und Praxen anwendbare Maßnahmen abzuleiten.MethodeDie strukturierte Analyse der Daten zur Vorbereitung der Patientenströme und der Patientenstatistik aller beteiligten Kliniken ergab ein Profil, aus dem die Notwendigkeit zur Vorhaltung von Personal, Räumlichkeiten und Material resultiert. Zusätzlich erfolgten eine Konsensuskonferenz nach der Veranstaltung und Einzelinterviews mit den Klinikkoordinatoren, um Vorbereitungen und Maßnahmen zu bewerten und sinnvolle von nicht sinnvollen Maßnahmen zu trennen.ErgebnisseEs werden personelle, logistische und räumliche Maßnahmen aus der konkreten Anwendung beschrieben. Sinnvolle Maßnahmen zu Vorbereitung und Bewältigung der aufgetretenen Massenpanik werden analysiert und detailliert dargelegt, sowie konkrete Probleme benannt und Lösungsmöglichkeiten besprochen. Es resultiert ein qualitativer Katalog, der Planung und Vorbereitung zukünftiger Veranstaltungen unterstützen kann.SchlussfolgerungMit konkreten Erfahrungen aus der Loveparade 2010 lassen sich Vorbereitungen zu Großveranstaltungen optimieren und Notfallpläne überprüfen. Eine koordinierte Zusammenarbeit aller Beteiligten ist notwendig.AbstractBackgroundTragic incidents at the 2010 Love Parade attracted significant public attention. As the frequency of similar events increases, more hospitals and practitioners will face the necessities of planning and response to unforeseeable occurrences. Obligatory guidelines for physicians do not exist, so that essential aspects are repeatedly discussed for each new event. This paper summarizes the experience of hospitals and emergency departments and draws conclusions, allowing recommendations for reasonable proposals for hospitals and practitioners.Methods and materialA structured analysis of data concerning planning, patient flow and injury statistics led to a profile determining personnel, rooms and material which have to be provided by the hospitals. In a consensus conference afterwards and personal interviews with clinical coordinators the preparation of hospitals was evaluated to separate reasonable from needless efforts.ResultsWe describe various measures concerning staff, logistics and rooms from the viewpoint of actual application. Reasonable measures for preparation and management of mass panic are analysed and described in detail. Problems are explained and solutions discussed. The result is a qualitative catalogue, which supports the organization of future events.ConclusionKnowledge and reflection on the experience of the 2010 Love Parade optimizes local emergency guidelines and planning for similar events. A coordinated cooperation of all involved is essential.BACKGROUND Tragic incidents at the 2010 Love Parade attracted significant public attention. As the frequency of similar events increases, more hospitals and practitioners will face the necessities of planning and response to unforeseeable occurrences. Obligatory guidelines for physicians do not exist, so that essential aspects are repeatedly discussed for each new event. This paper summarizes the experience of hospitals and emergency departments and draws conclusions, allowing recommendations for reasonable proposals for hospitals and practitioners. METHODS AND MATERIAL A structured analysis of data concerning planning, patient flow and injury statistics led to a profile determining personnel, rooms and material which have to be provided by the hospitals. In a consensus conference afterwards and personal interviews with clinical coordinators the preparation of hospitals was evaluated to separate reasonable from needless efforts. RESULTS We describe various measures concerning staff, logistics and rooms from the viewpoint of actual application. Reasonable measures for preparation and management of mass panic are analysed and described in detail. Problems are explained and solutions discussed. The result is a qualitative catalogue, which supports the organization of future events. CONCLUSION Knowledge and reflection on the experience of the 2010 Love Parade optimizes local emergency guidelines and planning for similar events. A coordinated cooperation of all involved is essential.

Progredient intracranial bleeding after traumatic brain injury. When is a control CCT necessary

BACKGROUND The aim of the study was to quantify the occurrence of progressive intracranial bleeding (PIB) and to identify concomitant parameters in patients suffering from traumatic brain injury (TBI). METHODS TBI patients were included if initial and serial cranial computed tomography (CCT) scans were conducted within 24 h after trauma. A progression of > or =25% was considered as PIB. Patients with progression were compared to those with constant bleeding regarding clinical parameters, time lapse and coagulation status. RESULTS A total of 98 patients with TBI and intracranial hemorrhaging were analyzed. PIB was detected in 45 patients showing significantly more intracerebral bleeding as well as fractures to the skull (p<0.05), compared to patients with constant bleeding. No significant differences between the groups regarding demographic and clinical parameters, time interval between trauma and initial CCT, and coagulation status were found. CONCLUSIONS Early progression of intracranial hemorrhaging occurs in nearly every second TBI patient and is recognized frequently in cerebral contusions and after fractures to the skull. Hence, early repeated CT scanning is indicated in all TBI patients suffering from intracranial bleeding.

Reality of treatment of osteoporotic fractures in German trauma departments. A contribution for outcome research

The implementation of clinical pathways has a proven positive effect on the diagnostic workup and initiation of therapy in osteoporotic fracture patients. Unlike in most countries, fracture care in Germany is provided by so-called trauma surgeons. Therefore, it is essential to focus on the trauma surgeon for correct diagnostic workup and therapy initiation after a fragility fracture. A questionnaire was mailed to 409 departments of traumatology inquiring about the existence of a standardized clinical pathway for diagnosis and treatment of patients with fragility fractures. One of the central issues of the survey was whether those pathways comply with national guidelines. Only institutions that stated that they followed a clinical pathway were analyzed. 80% of institutions took part in our survey, 35% of which reported following a defined clinical pathway. Diagnostic workup is in concordance with the national guidelines in 30%, and therapy is guideline-based in 51%, with 12% basing both diagnostic workup and therapy on the guidelines. Thus, the vast majority of German traumatology departments do not follow national guidelines regarding osteoporosis diagnostics and therapy in patients with fragility fractures, leading to a great opportunity to improve fragility fracture care by means of both education and interdisciplinary cooperation.

[2010 Love Parade in Duisburg: clinical experiences in planning and treatment].

ZusammenfassungHintergrundDer tragische Verlauf der Loveparade 2010 hat starke öffentliche Aufmerksamkeit erregt. Bei steigender Frequenz ähnlicher Großveranstaltungen werden zunehmend Kliniken und Praxen mit der Vorbereitung und Reaktion auf unvorhergesehene Ereignisse konfrontiert. Verbindliche ärztliche Leitlinien bestehen nicht, so dass bei jeder Veranstaltung erneut Grundsätzliches diskutiert wird. Ziel dieses Beitrags ist es, die Erfahrungen der an der Loveparade beteiligten Kliniken und Ambulanzen strukturiert auszuwerten, um daraus sinnvolle, für Kliniken und Praxen anwendbare Maßnahmen abzuleiten.MethodeDie strukturierte Analyse der Daten zur Vorbereitung der Patientenströme und der Patientenstatistik aller beteiligten Kliniken ergab ein Profil, aus dem die Notwendigkeit zur Vorhaltung von Personal, Räumlichkeiten und Material resultiert. Zusätzlich erfolgten eine Konsensuskonferenz nach der Veranstaltung und Einzelinterviews mit den Klinikkoordinatoren, um Vorbereitungen und Maßnahmen zu bewerten und sinnvolle von nicht sinnvollen Maßnahmen zu trennen.ErgebnisseEs werden personelle, logistische und räumliche Maßnahmen aus der konkreten Anwendung beschrieben. Sinnvolle Maßnahmen zu Vorbereitung und Bewältigung der aufgetretenen Massenpanik werden analysiert und detailliert dargelegt, sowie konkrete Probleme benannt und Lösungsmöglichkeiten besprochen. Es resultiert ein qualitativer Katalog, der Planung und Vorbereitung zukünftiger Veranstaltungen unterstützen kann.SchlussfolgerungMit konkreten Erfahrungen aus der Loveparade 2010 lassen sich Vorbereitungen zu Großveranstaltungen optimieren und Notfallpläne überprüfen. Eine koordinierte Zusammenarbeit aller Beteiligten ist notwendig.AbstractBackgroundTragic incidents at the 2010 Love Parade attracted significant public attention. As the frequency of similar events increases, more hospitals and practitioners will face the necessities of planning and response to unforeseeable occurrences. Obligatory guidelines for physicians do not exist, so that essential aspects are repeatedly discussed for each new event. This paper summarizes the experience of hospitals and emergency departments and draws conclusions, allowing recommendations for reasonable proposals for hospitals and practitioners.Methods and materialA structured analysis of data concerning planning, patient flow and injury statistics led to a profile determining personnel, rooms and material which have to be provided by the hospitals. In a consensus conference afterwards and personal interviews with clinical coordinators the preparation of hospitals was evaluated to separate reasonable from needless efforts.ResultsWe describe various measures concerning staff, logistics and rooms from the viewpoint of actual application. Reasonable measures for preparation and management of mass panic are analysed and described in detail. Problems are explained and solutions discussed. The result is a qualitative catalogue, which supports the organization of future events.ConclusionKnowledge and reflection on the experience of the 2010 Love Parade optimizes local emergency guidelines and planning for similar events. A coordinated cooperation of all involved is essential.BACKGROUND Tragic incidents at the 2010 Love Parade attracted significant public attention. As the frequency of similar events increases, more hospitals and practitioners will face the necessities of planning and response to unforeseeable occurrences. Obligatory guidelines for physicians do not exist, so that essential aspects are repeatedly discussed for each new event. This paper summarizes the experience of hospitals and emergency departments and draws conclusions, allowing recommendations for reasonable proposals for hospitals and practitioners. METHODS AND MATERIAL A structured analysis of data concerning planning, patient flow and injury statistics led to a profile determining personnel, rooms and material which have to be provided by the hospitals. In a consensus conference afterwards and personal interviews with clinical coordinators the preparation of hospitals was evaluated to separate reasonable from needless efforts. RESULTS We describe various measures concerning staff, logistics and rooms from the viewpoint of actual application. Reasonable measures for preparation and management of mass panic are analysed and described in detail. Problems are explained and solutions discussed. The result is a qualitative catalogue, which supports the organization of future events. CONCLUSION Knowledge and reflection on the experience of the 2010 Love Parade optimizes local emergency guidelines and planning for similar events. A coordinated cooperation of all involved is essential.

Sonographic diagnostics of proximal humerus fractures in juveniles

AIM OF THE STUDY The exact determination of the extent of deformities in juvenile proximal humerus fractures is difficult with plain x-rays. The aim of this study was to find out whether proximal humerus fractures can be diagnosed and the extent of the deformity can be detected by ultrasonography. PATIENTS AND METHODS In a prospective, multicentre trial children aged 0-12 years with suspected proximal humerus fractures were examined. Initially a standardized sonographic evaluation was performed and the extent and the direction of the deformity were determined. The recommended treatment was noted. Afterwards standard x-rays were taken and the results of both diagnostic procedures were compared. RESULTS A total of 33 children were examined, 14 male and 19 female, with a mean age of 7.6 years. In the ultrasound examination 17 out of 18 proximal humerus fractures were detected. In comparison to x-ray diagnostics ultrasonography proved to have a sensitivity of 94% and a specificity of 100%. In 16 cases ultrasonography gave a better result than x-ray imaging and x-ray was better in 5 cases. CONCLUSION Ultrasonography is suitable for detection and exclusion of fractures and better than x-ray diagnosis for evaluation of the type and direction of deformations of proximal humerus fractures.

Loveparade 2010 Duisburg – klinische Erfahrungen in Vorbereitung und Versorgung@@@2010 Love Parade in Duisburg: clinical experiences in planning and treatment

ZusammenfassungHintergrundDer tragische Verlauf der Loveparade 2010 hat starke öffentliche Aufmerksamkeit erregt. Bei steigender Frequenz ähnlicher Großveranstaltungen werden zunehmend Kliniken und Praxen mit der Vorbereitung und Reaktion auf unvorhergesehene Ereignisse konfrontiert. Verbindliche ärztliche Leitlinien bestehen nicht, so dass bei jeder Veranstaltung erneut Grundsätzliches diskutiert wird. Ziel dieses Beitrags ist es, die Erfahrungen der an der Loveparade beteiligten Kliniken und Ambulanzen strukturiert auszuwerten, um daraus sinnvolle, für Kliniken und Praxen anwendbare Maßnahmen abzuleiten.MethodeDie strukturierte Analyse der Daten zur Vorbereitung der Patientenströme und der Patientenstatistik aller beteiligten Kliniken ergab ein Profil, aus dem die Notwendigkeit zur Vorhaltung von Personal, Räumlichkeiten und Material resultiert. Zusätzlich erfolgten eine Konsensuskonferenz nach der Veranstaltung und Einzelinterviews mit den Klinikkoordinatoren, um Vorbereitungen und Maßnahmen zu bewerten und sinnvolle von nicht sinnvollen Maßnahmen zu trennen.ErgebnisseEs werden personelle, logistische und räumliche Maßnahmen aus der konkreten Anwendung beschrieben. Sinnvolle Maßnahmen zu Vorbereitung und Bewältigung der aufgetretenen Massenpanik werden analysiert und detailliert dargelegt, sowie konkrete Probleme benannt und Lösungsmöglichkeiten besprochen. Es resultiert ein qualitativer Katalog, der Planung und Vorbereitung zukünftiger Veranstaltungen unterstützen kann.SchlussfolgerungMit konkreten Erfahrungen aus der Loveparade 2010 lassen sich Vorbereitungen zu Großveranstaltungen optimieren und Notfallpläne überprüfen. Eine koordinierte Zusammenarbeit aller Beteiligten ist notwendig.AbstractBackgroundTragic incidents at the 2010 Love Parade attracted significant public attention. As the frequency of similar events increases, more hospitals and practitioners will face the necessities of planning and response to unforeseeable occurrences. Obligatory guidelines for physicians do not exist, so that essential aspects are repeatedly discussed for each new event. This paper summarizes the experience of hospitals and emergency departments and draws conclusions, allowing recommendations for reasonable proposals for hospitals and practitioners.Methods and materialA structured analysis of data concerning planning, patient flow and injury statistics led to a profile determining personnel, rooms and material which have to be provided by the hospitals. In a consensus conference afterwards and personal interviews with clinical coordinators the preparation of hospitals was evaluated to separate reasonable from needless efforts.ResultsWe describe various measures concerning staff, logistics and rooms from the viewpoint of actual application. Reasonable measures for preparation and management of mass panic are analysed and described in detail. Problems are explained and solutions discussed. The result is a qualitative catalogue, which supports the organization of future events.ConclusionKnowledge and reflection on the experience of the 2010 Love Parade optimizes local emergency guidelines and planning for similar events. A coordinated cooperation of all involved is essential.BACKGROUND Tragic incidents at the 2010 Love Parade attracted significant public attention. As the frequency of similar events increases, more hospitals and practitioners will face the necessities of planning and response to unforeseeable occurrences. Obligatory guidelines for physicians do not exist, so that essential aspects are repeatedly discussed for each new event. This paper summarizes the experience of hospitals and emergency departments and draws conclusions, allowing recommendations for reasonable proposals for hospitals and practitioners. METHODS AND MATERIAL A structured analysis of data concerning planning, patient flow and injury statistics led to a profile determining personnel, rooms and material which have to be provided by the hospitals. In a consensus conference afterwards and personal interviews with clinical coordinators the preparation of hospitals was evaluated to separate reasonable from needless efforts. RESULTS We describe various measures concerning staff, logistics and rooms from the viewpoint of actual application. Reasonable measures for preparation and management of mass panic are analysed and described in detail. Problems are explained and solutions discussed. The result is a qualitative catalogue, which supports the organization of future events. CONCLUSION Knowledge and reflection on the experience of the 2010 Love Parade optimizes local emergency guidelines and planning for similar events. A coordinated cooperation of all involved is essential.

Erratum zu: Sonographische Diagnostik der subkapitalen Humerusfraktur im Wachstumsalter

M. Roessler6 · C. Rülander1 · T. Vogel7 1 Klinik für Orthopädie und Unfallchirurgie, Klinikum Duisburg 2 Klinik für Kinderchirurgie, Universitäts-Kinderspital beider Basel (UKBB) 3 Abteilung für Kinderchirurgie, St. Elisabethen-Krankenhaus gGmbH, Lörrach 4 Klinik für Kinderchirurgie, Elisabeth-Krankenhaus Essen 5 Klinik und Poliklinik für Kinderchirurgie, Universitätsklinikum Carl Gustav Carus Dresden an der Technischen Universität Dresden 6 Abteilung für Kinderund Jugendchirurgie, Klinikum Mutterhaus der Borromäerinnen, Trier 7 Klinik für Orthopädie und Unfallchirurgie, St. Josefund St. Elisabeth-Hospital, Kliniken der RuhrUniversität Bochum gGmbH

Versorgungswirklichkeit bei osteoporosebedingten Frakturen in der deutschen Unfallchirurgie@@@Reality of treatment of osteoporotic fractures in German trauma departments: Ein Beitrag zur Versorgungsforschung@@@A contribution for outcome research

The implementation of clinical pathways has a proven positive effect on the diagnostic workup and initiation of therapy in osteoporotic fracture patients. Unlike in most countries, fracture care in Germany is provided by so-called trauma surgeons. Therefore, it is essential to focus on the trauma surgeon for correct diagnostic workup and therapy initiation after a fragility fracture. A questionnaire was mailed to 409 departments of traumatology inquiring about the existence of a standardized clinical pathway for diagnosis and treatment of patients with fragility fractures. One of the central issues of the survey was whether those pathways comply with national guidelines. Only institutions that stated that they followed a clinical pathway were analyzed. 80% of institutions took part in our survey, 35% of which reported following a defined clinical pathway. Diagnostic workup is in concordance with the national guidelines in 30%, and therapy is guideline-based in 51%, with 12% basing both diagnostic workup and therapy on the guidelines. Thus, the vast majority of German traumatology departments do not follow national guidelines regarding osteoporosis diagnostics and therapy in patients with fragility fractures, leading to a great opportunity to improve fragility fracture care by means of both education and interdisciplinary cooperation.