1,721,220 research outputs found
Lung failure after polytrauma with concomitant thoracic trauma in the elderly: an analysis from the TraumaRegister DGU®
No full textBackground: In developed countries worldwide, the number of older patients is increasing. Pulmonary complications are common in multiple injured patients with chest injuries. We assessed whether geriatric patients develop lung failure following multiple trauma with concomitant thoracic trauma more often than younger patients.
Methods: A retrospective analysis of severely injured patients with concomitant blunt thoracic trauma registered in the TraumaRegister DGU® (TR-DGU) between 2009 and 2018 was performed. Patients were categorized into four age groups: 55–64 y, 65–74 y, 75–84 y, and ≥ 85 y. Adult patients aged 18–54 years served as a reference group. Lung failure was defined as PaO2/FIO2 ≤ 200 mm Hg, if mechanical ventilation was performed.
Results: A total of 43,289 patients were included, of whom 9238 (21.3%) developed lung failure during their clinical stay. The rate of posttraumatic lung failure was seen to increase with age. While lung failure markedly increased the length of hospital stay, duration of mechanical ventilation, and length of ICU stay independent of the patient’s age, differences between younger and older patients with lung failure in regard to these parameters were clinically comparable. In addition, the development of respiratory failure showed a distinct increase in mortality with higher age, from 16.9% (18–54 y) to 67.2% (≥ 85 y).
Conclusion: Development of lung failure in severely injured patients with thoracic trauma markedly increases hospital length of stay, length of ICU stay, and duration of mechanical ventilation in patients, regardless of age. The development of respiratory failure appears to be related to the severity of the chest trauma rather than to increasing patient age. However, the greatest effects of lung failure, particularly in terms of mortality, were observed in the oldest patients
Changes in transfusion and fluid therapy practices in severely injured children: an analysis of 5118 children from the TraumaRegister DGU®
No full textPurpose: Trauma is the leading cause of death in children. In adults, blood transfusion and fluid resuscitation protocols changed resulting in a decrease of morbidity and mortality over the past 2 decades. Here, transfusion and fluid resuscitation practices were analysed in severe injured children in Germany.
Methods: Severely injured children (maximum Abbreviated Injury Scale (AIS) ≥ 3) admitted to a certified trauma-centre (TraumaZentrum DGU®) between 2002 and 2017 and registered at the TraumaRegister DGU® were included and assessed regarding blood transfusion rates and fluid therapy.
Results: 5,118 children (aged 1–15 years) with a mean ISS 22 were analysed. Blood transfusion rates administered until ICU admission decreased from 18% (2002–2005) to 7% (2014–2017). Children who are transfused are increasingly seriously injured. ISS has increased for transfused children aged 1–15 years (2002–2005: mean 27.7–34.4 in 2014–2017). ISS in non-transfused children has decreased in children aged 1–15 years (2002–2005: mean 19.6 to mean 17.6 in 2014–2017). Mean prehospital fluid administration decreased from 980 to 549 ml without affecting hemodynamic instability.
Conclusion: Blood transfusion rates and amount of fluid resuscitation decreased in severe injured children over a 16-year period in Germany. Restrictive blood transfusion and fluid management has become common practice in severe injured children. A prehospital restrictive fluid management strategy in severely injured children is not associated with a worsened hemodynamic state, abnormal coagulation or base excess but leads to higher hemoglobin levels
Trauma registry record linkage: methodological approach to benefit from complementary data using the example of the German Pelvic Injury Register and the TraumaRegister DGU(®)
Get PDFIn Germany, hospitals can deliver data from patients with pelvic fractures selectively or twofold to two different trauma registries, i.e. the German Pelvic Injury Register (PIR) and the TraumaRegister DGU(®) (TR). Both registers are anonymous and differ in composition and content. We describe the methodological approach of linking these registries and reidentifying twofold documented patients. The aim of the approach is to create an intersection set that benefit from complementary data of each registry, respectively. Furthermore, the concordance of data entry of some clinical variables entered in both registries was evaluated
An Additional Certification as a Centre for Geriatric Trauma Had No Benefit on Mortality Among Seriously Injured Elderly Patients—An Analysis of the TraumaRegister DGU® with Data of the Registry for Geriatric Trauma (ATR-DGU)
No full textBackground/Objectives: The number of seriously injured elderly patients is continuously rising. Several studies have underlined the benefit of orthogeriatric co-management in treating older patients with a proximal femur fracture. The basis of this orthogeriatric co-management is a certification as a Centre for Geriatric Trauma (ATZ). Data of seriously injured patients are collected in the TraumaRegister DGU® (TR-DGU) from participating trauma centres. We hypothesise that if a certified trauma centre is also a certified Centre for Geriatric Trauma, a benefit can be measured. Methods: Retrospective cohort analysis was conducted from 1 January 2016 to 31 December 2021. The TraumaRegister DGU® collected the data prospectively. This retrospective multicentre registry study included patients 70 years or older with an abbreviated injury scale of ≥3 and intensive care unit treatment from 700 certified Trauma Centres and 110 Centres for Geriatric Trauma in Germany, Austria and Switzerland. The primary outcome was mortality in in-hospital stays. Other outcome parameters were days of intubation, the length of stay in ICU, and in-hospital stays. Furthermore, the discharge target and the Glasgow Outcome Scale (GOS) were analysed. Results: The inclusion criteria were met by 27,531 patients. The majority of seriously injured patients (n = 23,007) were transported to certified trauma centres without certification as ATZ. A total of 4524 patients were transported to a trauma centre with additional ATZ certifications. Mortality and the Revised Injury Severity Classification II (RISC-II) model for prediction of mortality after trauma were higher in ATZ hospitals. Logistic regression analysis showed no effect on mortality by a certification as a centre for geriatric trauma in treating seriously injured elderly patients. Conclusions: We assume that the additional ATZ certification does not positively influence the treatment of seriously injured elderly patients. A potential side effect could not be measured
Nerve injury in severe trauma with upper extremity involvement: evaluation of 49,382 patients from the TraumaRegister DGU® between 2002 and 2015
No full textAbstract Background Peripheral nerve injury (PNI) as an adjunct lesion in patients with upper extremity trauma has not been investigated in a Central European setting so far, despite of its devastating long-term consequences. This study evaluates a large multinational trauma registry for prevalence, mechanisms, injury severity and outcome characteristics of upper limb nerve lesions. Methods After formal approval the TraumaRegister DGU® (TR-DGU) was searched for severely injured cases with upper extremity involvement between 2002 and 2015. Patients were separated into two cohorts with regard to presence of an accompanying nerve injury. For all cases demographic data, trauma mechanism, concomitant lesions, severity of injury and outcome characteristics were obtained and group comparisons performed. Results About 3,3% of all trauma patients with upper limb affection (n = 49,382) revealed additional nerve injuries. PNI cases were more likely of male gender (78,6% vs.73,2%) and tended to be significantly younger than their counterparts without nerve lesions (mean age 40,6 y vs. 47,2 y). Motorcycle accidents were the most frequently encountered single cause of injury in PNI patients (32,5%), whereas control cases primarily sustained their trauma from high or low falls (32,2%). Typical lesions recognized in PNI patients were fractures of the humerus (37,2%) or ulna (20,3%), vascular lacerations (arterial 10,9%; venous 2,4%) and extensive soft tissue damage (21,3%). Despite of similar average trauma severity in both groups patients with nerve affection had a longer primary hospital stay (30,6 d vs. 24,2 d) and required more subsequent inpatient rehabilitation (36,0% vs. 29,2%). Conclusion PNI complicating upper extremity trauma might be more commonly encountered in Central Europe than suggested by previous foreign studies. PNI typically affect males of young age who show significantly increased length of hospitalization and subsequent need for inpatient rehabilitation. Hence these lesions induce extraordinary high financial expenses besides their impact on health related quality of life for the individual patient. Further research is necessary to develop specific prevention strategies for this kind of trauma
Trauma-induced disturbances in ionized calcium levels correlate parabolically with coagulopathy, transfusion, and mortality: a multicentre cohort analysis from the TraumaRegister DGU®
No full textAbstract Background To which extent trauma- induced disturbances in ionized calcium (iCa2+) levels have a linear relationship with adverse outcomes remains controversial. The goal of this study was to determine the association between the distribution and accompanying characteristics of transfusion-independent iCa2+ levels versus outcome in a large cohort of major trauma patients upon arrival at the emergency department. Methods A retrospective observational analysis of the TraumaRegister DGU® (2015–2019) was performed. Adult major trauma patients with direct admission to a European trauma centre were selected as the study cohort. Mortality at 6 h and 24 h, in-hospital mortality, coagulopathy, and need for transfusion were considered as relevant outcome parameters. The distribution of iCa2+ levels upon arrival at the emergency department was calculated in relation to these outcome parameters. Multivariable logistic regression analysis was performed to determine independent associations. Results In the TraumaRegister DGU® 30 183 adult major trauma patients were found eligible for inclusion. iCa2+ disturbances affected 16.4% of patients, with hypocalcemia (< 1.10 mmol/l) being more frequent (13.2%) compared to hypercalcemia (≥ 1.30 mmol/l, 3.2%). Patients with hypo- and hypercalcemia were both more likely (P < .001) to have severe injury, shock, acidosis, coagulopathy, transfusion requirement, and haemorrhage as cause of death. Moreover, both groups had significant lower survival rates. All these findings were most distinct in hypercalcemic patients. When adjusting for potential confounders, mortality at 6 h was independently associated with iCa2+ < 0.90 mmol/L (OR 2.69, 95% CI 1.67–4.34; P < .001), iCa2+ 1.30–1.39 mmol/L (OR 1.56, 95% CI 1.04–2.32, P = 0.030), and iCa2+ ≥ 1.40 mmol/L (OR 2.87, 95% CI 1.57–5.26; P < .001). Moreover, an independent relationship was determined for iCa2+ 1.00–1.09 mmol/L with mortality at 24 h (OR 1.25, 95% CI 1.05–1.48; P = .0011), and with in-hospital mortality (OR 1.29, 95% CI 1.13–1.47; P < .001). Both hypocalcemia < 1.10 mmol/L and hypercalcemia ≥ 1.30 mmol/L had an independent association with coagulopathy and transfusion. Conclusions Transfusion-independent iCa2+ levels in major trauma patients upon arrival at the emergency department have a parabolic relationship with coagulopathy, need for transfusion, and mortality. Further research is needed to confirm whether iCa2+ levels change dynamically and are more a reflection of severity of injury and accompanying physiological derangements, rather than an individual parameter that needs to be corrected as such. Graphical Abstrac
Calcium supplementation during trauma resuscitation: a propensity score-matched analysis from the TraumaRegister DGU®
No full text<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>In major trauma patients, hypocalcemia is associated with increased mortality. Despite the absence of strong evidence on causality, early calcium supplementation has been recommended. This study investigates whether calcium supplementation during trauma resuscitation provides a survival benefit.</jats:p>
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<jats:title>Methods</jats:title>
<jats:p>We conducted a retrospective analysis using data from the TraumaRegister DGU<jats:sup>®</jats:sup> (2015–2019), applying propensity score matching to balance demographics, injury severity, and management between major trauma patients with and without calcium supplementation. 6 h mortality, 24 h mortality, and in-hospital mortality were considered as primary outcome parameters.</jats:p>
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<jats:title>Results</jats:title>
<jats:p>Within a cohort of 28,323 directly admitted adult major trauma patients at a European trauma center, 1593 (5.6%) received calcium supplementation. Using multivariable logistic regression to generate propensity scores, two comparable groups of 1447 patients could be matched. No significant difference in early mortality (6 h and 24 h) was observed, while in-hospital mortality appeared higher in those with calcium supplementation (28.3% vs. 24.5%, <jats:italic>P</jats:italic> = 0.020), although this was not significant when adjusted for predicted mortality (<jats:italic>P</jats:italic> = 0.244).</jats:p>
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<jats:title>Conclusion</jats:title>
<jats:p>In this matched cohort, no evidence was found for or against a survival benefit from calcium supplementation during trauma resuscitation. Further research should focus on understanding the dynamics and kinetics of ionized calcium levels in major trauma patients and identify if specific conditions or subgroups could benefit from calcium supplementation.</jats:p>
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TraumaRegister DGU-® as basis for a global network of data on severe injuries
Get PDFTo date, the Trauma Registry (TraumaRegister DGU-® contains data of approximately 100.000 severely injured patients, 65% of which suffered from a road traffic crash. Thus, it is the world's largest data base for severely injured patients. The article describes the development of the registry and explains how it was rolled out over Germany using the established structure of the German Trauma Network (TraumaNetzwerk DGU-®). In addition, this article presents three typical use cases from the fields of quality management, policy making and system-wide interventions, clinical research and injury prevention. In conclusion, the TraumaRegister DGU-® is a well-established tool for various purposes related to the control and reduction of the burden of road injury. Its ongoing expansion to other countries will support the goal of international benchmarking of hospitals and trauma systems
Additional file 1 of Trauma-induced disturbances in ionized calcium levels correlate parabolically with coagulopathy, transfusion, and mortality: a multicentre cohort analysis from the TraumaRegister DGU®
No full textAdditional file 1. Description of the TraumaRegister DGU®
Der schwer verletzte ältere Fahrradfahrer – Auswertung des TraumaRegister DGU®
Get PDFHintergrund:
Entgegen dem Trend sinkender Verkehrstoter nimmt die Zahl der getöteten Fahrradfahrer in Deutschland in den letzten Jahren kontinuierlich zu. Mit zunehmender Popularität des Fahrradfahrens in allen Altersklassen erhöht sich die Anzahl an Unfällen mit z. T. schweren Verletzungen. Im Zuge dessen stellt sich die Frage, welchen Einfluss das Alter auf die Art und Schwere der Verletzungen, die Überlebenswahrscheinlichkeit und die Krankenhausverweildauer bei schwer verletzten Fahrradfahrern hat.
Methoden:
Es wurde eine retrospektive Auswertung der Daten des TraumaRegister DGU® (TR-DGU) der Jahre 2010–2019 durchgeführt. Alle schwer verletzten Fahrradfahrer mit einem maximalem MAIS von 3 (Abbreviated Injury Scale) von 3+ (n = 14.651) im TR-DGU wurden in diese Studie eingeschlossen und die vorliegenden Parameter ausgewertet. Es erfolgte eine Unterteilung in 3 Altersgruppen (60 bis 69, 70 bis 79 und ≥ 80 Jahre) und eine Kontrollgruppe (20 bis 59 Jahre).
Ergebnisse:
Verletzungen des Schädels traten mit 64,2 % mit Abstand am häufigsten auf. Es zeigte sich eine deutliche Zunahme der schweren Kopfverletzungen in der Gruppe der über 60-Jährigen. Mit steigendem Alter nahmen des Weiteren die Wahrscheinlichkeit einer präklinischen Intubation, die Katecholaminpflichtigkeit, die Intensiv- und Krankenhausverweildauer sowie die Sterblichkeit zu.
Schlussfolgerung:
Kopfverletzungen stellen die häufigste schwere Verletzung, insbesondere bei älteren Fahrradfahrern, dar. Da das Helmtragen im TraumaRegister DGU® im Auswertungszeitraum nicht erfasst wurde, kann auf dessen Effekt kein Rückschluss gezogen werden. Ein höheres Alter korreliert des Weiteren mit einer längeren Krankenhausverweildauer und einer höheren Sterblichkeit, stellt jedoch keinen unabhängigen Risikofaktor zum Versterben bei einem schwer verletzten Patienten dar
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