Trends in intubation rates and durations in ventilated severely injured trauma patients: an analysis from the TraumaRegister DGU®.

Background: Endotracheal intubation in severely injured patients is known to be a risk factor for systemic complications. We aimed to examine the changes in intubation rates and durations in severely injured trauma patients, and rates of the systemic complications associated with ventilation changes by using a large trauma registry over the period of 13 years.

Methods: Patient demographics, Injury Severity Score (ISS), ventilation days, ventilation free days (VFD), and prevalence of systemic complications (sepsis and multiple organ failure (MOF)) were obtained from the TraumaRegister DGU® and were compared over the study period.

Association of an In-House Blood Bank with Therapy and Outcome in Severely Injured Patients: An Analysis of 18,573 Patients from the TraumaRegister DGU®.

Introduction: Hemorrhagic shock remains one of the most common causes of death in severely injured patients. It is unknown to what extent the presence of a blood bank in a trauma center influences therapy and outcome in such patients.

Material And Methods: We retrospectively analyzed prospectively recorded data from the TraumaRegister DGU® and the TraumaNetzwerk DGU®.

Which score should be used for posttraumatic multiple organ failure? - Comparison of the MODS, Denver- and SOFA- Scores.

Background: Multiple organ dysfunction and multiple organ failure (MOF) is still a major complication and challenge in the treatment of severely injured patients. The incidence varies decisively in current studies, which complicates the comparability regarding risk factors, treatment recommendations and patients' outcome. Therefore, we analysed how the currently used scoring systems, the MODS, Denver- and SOFA Score, influence the definition and compared the scores' predictive ability.

Which factors influence the need for inpatient rehabilitation after severe trauma?

Introduction: Despite the importance of rehabilitation in the treatment of patients with severe trauma or even of severely injured patients, the cooperation between acute and rehabilitation hospitals is often inadequate. The present study aims to identify factors that make it probable that a severely injured patient requires inpatient rehabilitation following the acute treatment.

Material And Methods: A retrospective analysis of 75.

Epidemiology of accidental hypothermia in polytrauma patients: An analysis of 15,230 patients of the TraumaRegister DGU.

Background: Accidental hypothermia (AH) endangers the patient after polytrauma. Past studies have emphasized this entity as a major risk factor. The aim of this study was to describe the epidemiology of AH in major trauma considering the preclinical and clinical course.

Classification of soft-tissue injuries in open femur fractures: Relevant for systemic complications?

Background: A broad range of systemic complications has been described to occur in patients with open major fractures. Various causes have been claimed to play a role. We therefore surveyed a nationwide trauma registry to assess risk factors associated with closed and various types of open femur fractures.

Direct Oral Anticoagulants in Emergency Trauma Admissions.

Background: Direct (non-vitamin-K-dependent) oral anticoagulants (DOAC) are given as an alternative to vitamin K antagonists (VKA) to prevent stroke and embolic disease in patients with atrial fibrillation that is not due to pathology of the heart valves. Fatal hemorrhage is rarer when DOACs are given (nonvalvular atrial fibrillation: odds ratio [OR] 0.68; 95% confidence interval [95% CI: 0.

Challenges in Cost-Effectiveness Analysis Modelling of HPV Vaccines in Low- and Middle-Income Countries: A Systematic Review and Practice Recommendations.

Background: Low- and middle-income countries (LMICs) face a number of challenges in implementing cervical cancer prevention programmes that do not apply in high-income countries.

Objective: This review assessed how context-specific challenges of implementing cervical cancer prevention strategies in LMICs were accounted for in existing cost-effectiveness analysis (CEA) models of human papillomavirus (HPV) vaccination.

Methods: The databases of MEDLINE, EMBASE, NHS Economic Evaluation Database, EconLit, Web of Science, and the Center for the Evaluation of Value and Risk in Health (CEA) Registry were searched for studies published from 2006 to 2015.

Outcome and predictors for successful resuscitation in the emergency room of adult patients in traumatic cardiorespiratory arrest.

Background: Data of the TraumaRegister DGU® were analyzed to derive survival rates, neurological outcome and prognostic factors of patients who had suffered traumatic cardiac arrest in the early treatment phase.

Methods: The database of the TraumaRegister DGU® from 2002 to 2013 was analyzed. The main focus of this survey was on different time points of performed resuscitation.

Does the presence of an emergency physician influence pre-hospital time, pre-hospital interventions and the mortality of severely injured patients? A matched-pair analysis based on the trauma registry of the German Trauma Society (TraumaRegister DGU).

Purpose: The role of emergency physicians in the pre-hospital management of severely injured patients remains controversial. In Germany and Austria, an emergency physician is present at the scene of an emergency situation or is called to such a scene in order to provide pre-hospital care to severely injured patients in approximately 95% of all cases. By contrast, in the United States and the United Kingdom, paramedics, i.

The Reliability of the Pre-hospital Physical Examination of the Pelvis: A Retrospective, Multicenter Study.

Introduction: This study assesses the incidence of missed pelvic injuries in the pre-hospital setting.

Methods: All blunt trauma patients (ISS ≥ 9) with pre-hospital suspicion of and/or radiologically proven pelvic fracture documented in the TraumaRegister DGU (TR-DGU) of the German Trauma Society DGU (2002-2011) were identified and retrospectively analyzed. Patients with a missed pelvic injury in the pre-hospital period were compared with those who were correctly identified.

Prehospital administration of tranexamic acid in trauma patients.

Background: Evidence on prehospital administration of the antifibrinolytic tranexamic acid (TXA) in civilian trauma populations is scarce. The aim was to study whether prehospital TXA use in trauma patients was associated with improved outcomes.

Methods: The prehospital database of the ADAC (General German Automobile Club) Air Rescue Service was linked with the TraumaRegister of the German Trauma Society to reidentify patients documented in both registries.

Most overviews of Cochrane reviews neglected potential biases from dual authorship.

Objective: Some authors of Cochrane overviews have also (co-)authored one or more of the underlying reviews. We examined the extent of dual (co-)authorship in Cochrane overviews, how it is dealt with, and whether the issue is raised in protocols.

Study Design: The Cochrane Library was searched for overviews and protocols for overviews in September 2015.

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

Background: Clinical 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).

Coagulation factor concentrate-based therapy for remote damage control resuscitation (RDCR): a reasonable alternative?

The concept of remote damage control resuscitation (RDCR) is still in its infancy and there is significant work to be done to improve outcomes for patients with life-threatening bleeding secondary to injury. The prehospital phase of resuscitation is critical and if shock and coagulopathy can be rapidly minimized before hospital admission this will very likely reduce morbidity and mortality. The optimum transfusion strategy for these patients is still highly debated and the potential implications of the recently published pragmatic, randomize, optimal platelet, and plasma ratios trial (PROPPR) for RDCR have been reviewed.

O2C Laser Doppler and Digital Photo Analysis for Treatment Evaluation of Beta-Glucan versus Provitamin Pantothenic Acid of Facial Burns.

Various creams are available for superficial second-degree burns (SSDB) of the face. We evaluated provitamin pantothenic acid versus β-glucan for SSDB of the face using the O2C laser Doppler system and digital photo analysis. Out of 20 patients (January to December 2012) with facial burns, 7 with SSDB of both cheeks were included to our study.

Fibrinogen levels in trauma patients during the first seven days after fibrinogen concentrate therapy: a retrospective study.

Background: Fibrinogen concentrate (FC) is increasingly used as first line therapy in bleeding trauma patients. It remains unproven whether FC application increases post-traumatic plasma fibrinogen concentration (FIB) in injured patients, possibly constituting a prothrombotic risk. Thus, we investigated the evolution of FIB following trauma in patients with or without FC therapy.

The Impact of Prehospital Intubation With and Without Sedation on Outcome in Trauma Patients With a GCS of 8 or Less.

Background: Although unconsciousness (Glasgow Coma Scale [GCS] 3 to 8) necessitates intubation according national guidelines, there is a notable lack of evidence to support this approach. This study evaluates the impact on outcome of prehospital intubation with and without sedation in trauma patients with a GCS of ≤8.

Methods: A retrospective cohort analysis of severely injured trauma patients registered in the TraumaRegister DGU of the German Trauma Society (DGU) from 2002 to 2013 was conducted.

Impact of Helicopter Emergency Medical Service in Traumatized Patients: Which Patient Benefits Most?

Introduction: The Helicopter Emergency Medical Service (HEMS) was established for the prehospital trauma care of patients. Improved rescue times and increased coverage areas are discussed as specific advantages of HEMS. We recently found evidence that HEMS exerts beneficial effects on outcomes for severely injured patients.

Numbers of Severely Injured Patients in Germany. A Retrospective Analysis From the DGU (German Society for Trauma Surgery) Trauma Registry.

Background: Persons who sustain severe traumatic injury, i.e., those with an Injury Severity Score (ISS) of 16 or above, go on to suffer major physical, emotional, and socio-economic consequences.

Comparison of hemostatic dressings for superficial wounds using a new spectrophotometric coagulation assay.

Background: Due to demographical changes the number of elderly patients depending on oral anticoagulation is expected to rise. Prolonged bleeding times in case of traumatic injuries represent the drawback of these medications, not only in major trauma, but also in superficial wounds. Therefore, dressings capable of accelerating coagulation onset and shortening bleeding times are desirable for these patients.

Practice management of acute trauma haemorrhage and haemostatic disorders across German trauma centres.

Purpose: Early detection and management of trauma haemorrhage and coagulopathy have been associated with improved outcomes. We assessed infrastructure, logistics and management practice of trauma-associated haemorrhage and coagulopathy across German trauma centres.

Methods: A web-based survey of 20 questions was developed using the open source survey application LimeSurvey.

Development of a scoring system based on conventional parameters to assess polytrauma patients: PolyTrauma Grading Score (PTGS).

Background: The impact of conventional laboratory data to identify polytrauma patients at risk of complications is established. However, it has not been assessed in terms of prognostic accuracy for systemic complications (ARDS, organ failure). We therefore assessed the most predictive parameters for systemic complications and developed a scoring system for early grading of polytrauma patients.