Female sex protects from organ failure and sepsis after major trauma haemorrhage.

Introduction: Biological sex is considered a risk factor for adverse outcome after major trauma. We hypothesized that female sex is protective against organ failure, sepsis and mortality in patients with traumatic haemorrhage.

Patients And Methods: We selected patients from TraumaRegister DGU(®) (TR-DGU) with primary admission for blunt trauma with an injury severity score ≥ 16 and an ICU stay ≥ 3 days that presented with relevant bleeding in the years 2007-2012.

Quality of life two years after severe trauma: a single-centre evaluation.

Introduction: Trauma related injuries are a main cause for long-lasting morbidity and disability especially in younger patients with their productive years ahead. On a routine basis, we assessed health related quality of life two years after trauma of severely injured patients at our level-I trauma centre via posted survey.

Patients And Methods: The posted survey included (1) POLO-Chart questionnaire with European Quality of Life (EuroQoL), Short Form Health Survey-36 (SF 36) and the recently developed and validated Trauma Outcome Profile (TOP) combined with (2) single centre data according to TraumaRegister DGU(®) data sets including trauma mechanism, injuries and initial treatment.

Short- and long-term subjective medical treatment outcome of trauma surgery patients: the importance of physician empathy.

Purpose: To investigate accident casualties' long-term subjective evaluation of treatment outcome 6 weeks and 12 months after discharge and its relation to the experienced surgeon's empathy during hospital treatment after trauma in consideration of patient-, injury-, and health-related factors. The long-term results are compared to the 6-week follow-up outcomes.

Patients And Methods: Two hundred and seventeen surgery patients were surveyed at 6 weeks, and 206 patients at 12 months after discharge from the trauma surgical general ward.

Validation of the revised injury severity classification score in patients with moderate-to-severe traumatic brain injury.

Introduction: By analysing risk-adjusted mortality ratios, weaknesses in the process of care might be identified. Traumatic brain injury (TBI) is the main cause of death in trauma, and thus it is crucial that trauma prediction models are valid for TBI patients. Accordingly, we assessed the validity of the RISC score in TBI patients by internal and external validation analyses.

Long-term effects of enriched environment on neurofunctional outcome and CNS lesion volume after traumatic brain injury in rats.

To determine whether the exposure to long term enriched environment (EE) would result in a continuous improvement of neurological recovery and ameliorate the loss of brain tissue after traumatic brain injury (TBI) vs. standard housing (SH). Male Sprague-Dawley rats (300-350 g, n=28) underwent lateral fluid percussion brain injury or SHAM operation.

Negative pressure wound therapy versus standard wound care in chronic diabetic foot wounds: study protocol for a randomized controlled trial.

Background: In August 2010, the Federal Joint Committee (G-BA) decided that negative pressure wound therapy (NPWT) would not be reimbursable in German ambulatory care. This decision was based on reports from the Institute for Quality and Efficiency in Health Care (IQWiG), which concluded that there is no convincing evidence in favor of NPWT. The aim of this diabetic foot study (DiaFu study) is to evaluate whether the clinical, safety and economic results of NPWT are superior to the results of standard wound treatment.

Proper coding of the Abbreviated Injury Scale: can clinical parameters help as surrogates in estimating blood loss?

Purpose: The Abbreviated Injury Scale (AIS) requires the estimation of the lost blood volume for some severity assignments. This study aimed to develop a rule of thumb for facilitating AIS coding by using objective clinical parameters as surrogate markers of blood loss.

Methods: Using the example of pelvic ring fractures, a retrospective analysis of TraumaRegister DGU(®) data from 2002 to 2011 was performed.

The role of biological sex in severely traumatized patients on outcomes: a matched-pair analysis.

Objective: Analyze sex differences in TraumaRegister DGU (TR-DGU).

Background: Sex differences are considered to influence trauma outcomes. However, clinical study results are controversial.

The coagulopathy of trauma.

Trauma is a leading cause of death, with uncontrolled hemorrhage and exsanguination being the primary causes of preventable deaths during the first 24 h following trauma. Death usually occurs quickly, typically within the first 6 h after injury. One out of four patients arriving at the Emergency Department after trauma is already in hemodynamic and hemostatic depletion.

Epidemiology and risk factors of multiple-organ failure after multiple trauma: an analysis of 31,154 patients from the TraumaRegister DGU.

Background: In the severely injured who survive the early posttraumatic phase, multiple-organ failure (MOF) is the main cause of morbidity and mortality. An enhanced prediction of MOF might influence individual monitoring and therapy of severely injured patients.

Methods: We performed a retrospective analysis of a nationwide prospective database, the TraumaRegister DGU of the German Trauma Society.

Systematic review finds overlapping reviews were not mentioned in every other overview.

Objectives: The objective of this study was to determine if the authors mention overlapping reviews in overviews (reviews of reviews). In addition, we aimed to calculate the actual overlap in published overviews using newly introduced, validated measures.

Study Design And Settings: We systematically searched for overviews from 2009 to 2011.

Early or delayed stabilization in severely injured patients with spinal fractures? Current surgical objectivity according to the Trauma Registry of DGU: treatment of spine injuries in polytrauma patients.

Background: Because of a lack of evidence, the appropriate timing of surgical stabilization of thoracic and lumbar spine injuries in severely injured patients is still controversial. Data of a large international trauma register were analyzed to investigate the medical care situation of unstable spinal column fractures in patients with multiple injuries, so as to examine the outcome related to timing of surgical stabilization.

Methods: Data sets of the Trauma Registry of German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie [DGU]) (1993-2010) were analyzed.

Physician empathy and subjective evaluation of medical treatment outcome in trauma surgery patients.

Objective: To analyze whether patients' perception of their medical treatment outcome is higher among patients who experienced a higher empathy by trauma surgeons during their stay in hospital.

Methods: 127 patients were surveyed six weeks after discharge from the trauma surgical general ward. Subjective evaluation of medical treatment outcome was measured with the corresponding scale from the Cologne Patient Questionnaire.

Relative lymphocyte count is a prognostic parameter in cancer patients with catumaxomab immunotherapy.

Background: Catumaxomab (anti-EpCAM × anti-CD3) treatment in peritoneal carcinomatosis (PC) of EpCAM-positive cancers was effective in phase I and II studies. Recently, it was approved in the EU for treatment of peritoneal carcinomatosis and malignant ascites. Aim of this hypothesis-generating study was to identify predictive or prognostic biomarkers with relevance for overall survival.

Appraisal tools for clinical practice guidelines: a systematic review.

Introduction: Clinical practice guidelines can improve healthcare processes and patient outcomes, but are often of low quality. Guideline appraisal tools aim to help potential guideline users in assessing guideline quality. We conducted a systematic review of publications describing guideline appraisal tools in order to identify and compare existing tools.

Is the transnasal access for esophagogastroduodenoscopy in routine use equal to the transoral route? A prospective, randomized trial.

Background And Study Aims: Routine esophagogastroduodenoscopy (EGD) is increasingly performed without sedation. Transoral (TO) and transnasal (TN) EGD offer different patient comfort and complications.

Patients And Methods: For a controlled, randomized, clinical trial comparing TN-EGD with TO-EGD without sedation, patients were assigned to TN-EGD using a thin endoscope (group 1, 93 patients), or TO-EGD using a standard endoscope (group 2, 90 patients).

Partial updating of clinical practice guidelines often makes more sense than full updating: a systematic review on methods and the development of an updating procedure.

Objectives: To conduct a systematic review of the methods used to determine when and how to update clinical practice guidelines (CPGs) and develop a procedure for updating CPGs.

Study Design And Setting: We searched MEDLINE, Embase, and the Cochrane Methodology Register for methodological publications on updating CPGs. Guideline development manuals were obtained from the Web sites of guideline-developing organizations.

Does ATLS trauma training fit into Western countries: evaluation of the first 8 years of ATLS in Germany.

Background: With over 2 million certified physicians worldwide, the Advanced Trauma Life Support (ATLS) program is one of the most successful international medical education programs. Germany joined the ATLS program in 2003. Before implementation of the program, there was a controversial discussion as to whether a country like Germany with a long history of trauma care needed ATLS at all.

Lactic acidosis is associated with multiple organ failure and need for ventilator support in patients with severe hemorrhage from trauma.

Purpose: Lactate is a biomarker for hypoperfusion and subsequent resuscitation in trauma. It is also a predictor of mortality, but few studies have correlated lactate levels with relevant morbidities after trauma.

Methods: A retrospective review was performed of severely injured trauma patients entered into the Trauma Registry of the German Society for Trauma Surgery (TR-DGU) between 2002 and 2008.

Is the ATLS classification of hypovolaemic shock appreciated in daily trauma care? An online-survey among 383 ATLS course directors and instructors.

Objective: For the early recognition and management of hypovolaemic shock, ATLS suggests four shock classes based upon an estimated blood loss in percent. The aim of this study was to assess the confidence and acceptance of the ATLS classification of hypovolaemic shock among ATLS course directors and instructors in daily trauma care.

Methods: During a 2-month period, ATLS course directors and instructors from the ATLS region XV (Europe) were invited to participate in an online survey comprising 15 questions.

Distinguishing between pain intensity and pain resolution: using acute post-surgical pain trajectories to predict chronic post-surgical pain.

Background: High intensity of acute post-surgical pain is one of the strongest predictors for chronic post-surgical pain (CPSP). We investigated the predictive power of acute post-surgical pain trajectories and the interplay of pain trajectories and diverse psychosocial risk factors in the development of CPSP.

Methods: Data from 199 patients were examined using latent growth curve analysis by means of structural equation modelling.

Pain and quality of life 1 year after admission to the emergency department: factors associated with pain.

Objectives: This study describes the prevalence of pain in trauma patients 1 year after hospital admission and investigates separately health-related quality of life (QoL) for patients suffering severe pain and for those without pain. Moreover, psychosocial factors are examined for their impact on pain.

Methods: Patients were contacted 12 months after admission in order to complete the following questionnaires: Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), Trauma Outcome Profile (TOP), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Impact of Event Scale-Revised (IES-R) and additional questions concerning satisfaction, work and financial status.

Adipose-derived stem cells and keratinocytes in a chronic wound cell culture model: the role of hydroxyectoine.

Chronic wounds represent a major socio-economic problem in developed countries today. Wound healing is a complex biological process. It requires a well-orchestrated interaction of mediators, resident cells and infiltrating cells.