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PubMed1992

[Multiple trauma: preclinical needs, transportation, time sequences].

Compared to the magnitude of the trauma problem few precise data exist on prehospital care of trauma patients. The aim of the study was the collection and careful evaluation of prehospital data on trauma patients concerning time sequences, patients' status and prehospital interventions. From 1. 1. 1987 to 31. 12. 1990 all 49,045 prehospital emergencies in Cologne were prospectively registered. 8792 trauma patients were treated by an emergency physician in the field. 9.5% were severely injured, defined by a trauma score less than or equal to 12. 9.9% of the trauma patients were intubated, 54.9% received an i.v. line, and 20.6% were triaged to a trauma center. Our data form a valid base for analysis of the effectiveness of prehospital trauma care.

Adult↗
PubMed2001

[Thromboembolism complication in multiple trauma patients: an underestimated problem? Results of a clinical observational study of 50 patients].

INTRODUCTION: The incidence of thromboembolic complications in patients with severe polytrauma in the ICU is not well known. Only a few publications deal with this problem. Systematic investigations in this high-risk patient group are not routinely used. METHOD: From January 1996 to January 1998, 50 polytrauma patients with a mean ISS > 15 were included in a clinical study to evaluate the incidence of thromboembolism in this patient group. Further inclusion criteria were a minimum stay of 72 h in the ICU and mechanical ventilation for a minimum time of 72 h. All patients were examined with color-coded duplex sonography according to a standardized protocol. The duplex sonography was performed before the patients were first mobilized in the ICU (15 +/- 12.8 days). RESULTS: If not otherwise indicated all values are given as mean +/- SD. The age of the patients was 38 years (range 17-77 years), the severity of trauma was characterized by an ISS of 40 (range 16-70). Eight of the included patients died during their stay in the ICU after developing a multiple organ failure. According to autopsy data none of them had a deep venous thrombosis or pulmonary embolus. Eight patients (19%) developed deep venous thrombosis, and 4 patients with thrombosis developed pulmonary embolism. CONCLUSION: The incidence of deep venous thrombosis in polytrauma patients seems to be much higher than expected reviewing the results of other publications. The low detection rate of other authors results from using only clinical signs. The routine use of color-coded duplex sonography is effective in detecting unsuspected deep vein thrombosis.

Adolescent↗
PubMed1997

[The epidemiology of multiple trauma].

Trauma is the leading cause of death for people up to 40 years of age in Germany. Most of the patients were injured in traffic accidents where special injury patterns could be detected: head injuries in bicycle and pedestrian accidents, lower extremity injuries in motorcycle accidents, and chest and pelvis injuries in car accidents. After falls from a height, the most common injuries were fractures of the thoracic and lumbar spine. The treatment of polytrauma patients requires high health care resources and demands sophisticated medical support. It is estimated that every trauma patient costs daily approximately DM 4,700. It is not only the acute medical care that burdens our social system, but also the long period of rehabilitation and reintegration. The number of preventable trauma deaths can be significantly reduced in special trauma centers, and the high costs could be damaging for smaller hospitals. A plea is made for more preventive measures and legislative changes to reduce the number of traffic accidents. The medical care of trauma patients should be in special trauma centers.

Accidental Falls↗
PubMed2002

Multiple trauma in children: predicting outcome and long-term results.

OBJECTIVE: To analyze the management of pediatric trauma and the efficacy of the Pediatric Trauma Score (PTS) in classifying injury severity and predicting prognosis. DESIGN: A retrospective case series. SETTING: The Children's Hospital of Eastern Ontario, a major pediatric trauma centre. PATIENTS: One hundred and forty-nine traumatized children with 2 or more injuries to 1 body system or a single injury to 2 or more body systems. INTERVENTIONS: Use of the PTS and Glasgow Coma Scale score in trauma management. MAIN OUTCOME MEASURES: Types of injuries sustained, complications, missed injuries, psychosocial effects and residual deficiencies. RESULTS: The average PTS was 8.5 (range from -3 to 11). The total number of injuries sustained was 494, most commonly closed head injury (86). Forty-two percent of children with an average trauma score of 8.5 were treated surgically. There were 13 missed injuries, and complications were encountered in 57 children, the most common being secondary to fractures. Forty-eight (32%) children had residual long-term deficiency, most commonly neurologic deficiency secondary to head injury. CONCLUSIONS: Fractures should be stabilized early to decrease long-term complications. A deficiency of the PTS is the weighting of open fractures of a minor bone. For example, metacarpal fracture is given the same weight as an open fracture of the femur. Neuropsychologic difficulties secondary to trauma are a major sequela of trauma in children.

Adolescent↗
PubMed1992

External fixation of fractures with a new frame in managing patients with multiple trauma.

The use of a new modular frame with the AO tubular fixator in managing the cases of severely injured patients is reported. The simplicity in design, the versatility, and the ease of insertion make this frame very useful in managing a patient with multiple injuries in the emergency department when stable fixation of a variety of fractures is needed. Our clinical experience with 23 patients, all with an ISS of 16 or greater, is reported and four representative cases are described.

Adolescent↗