Background The temporal distribution of trauma mortality has been classically described as a trimodal pattern with an immediate, early and late peak. In modern health care systems this time distribution has changed. Methods Data from the TraumaRegister DGU was analysed retrospectively. Between 2002 and 2015, all registered in-hospital deaths with an Injury Severity Score (ISS) ≥ 16 were evaluated considering time of death, trauma mechanism, injured body area, age distribution, rates of sepsis and multiple organ failure. Pre-hospital and post-discharge trauma deaths were not considered. Results 78 310 severely injured patients were registered, non-survivors constituted 14 816, representing an in-hospital mortality rate of 18.9%. Mean ISS of non-survivors was 36.0±16.0, 66.7% were male, mean age was 59.5±23.5. Within the first hour after admission to hospital, 10.8% of deaths occurred, after 6 hours the percentage increased to 25.5%, after 12 hours 40.0%, after 24 hours 53.2% and within the first 48 hours 61.9%. Mortality showed a constant temporal decrease. Severe head injury (defined by Abbreviated Injury Scale, AIS-Head≥3) was found in 76.4% of non-survivors. Patients with an isolated head injury showed a more distinct decrease in survival rate, which was accentuated in the first days after admission. The correlation of age and time of death showed a proportional increase with age (55-74a). The rate of sepsis and multiple organ failure among non-survivors was 11.5% and 70.1%, respectively. Conclusion In a modern trauma care system, the mortality distribution of severely injured patients has changed its pattern, where especially the third peak is no longer detectable.
Introduction The current treatment concepts of fracture-related infection (FRI) [Consensus Conference (Anti-Infection Task Force (AITF)) on the definition of acute or chronic osteomyelitis (cOM)] are associated with unsolved challenges and problems, underlining the need for ongoing medical research. Method Literature review of treatments for FRI and description of own cases. Results We could include eight papers with 394 patients reporting treatments and outcome in FRI. The infection was resolved in 92.9% (mean) of all treatments. The mean follow-up was 25 months with a persistent non-union in 7% of the patients. We diagnosed 35 (19f/16m; 56.4 ± 18.6 years) patients with bone infections anatomically allocated to the proximal and distal femur (12×), the pelvis (2×), distal tibia (3×), tibial diaphysis (11×), the ankle joint (4×) and calcaneus (3×). These 35 patients were treated (1) with surgical debridement; (2) with antibiotic-eluting ceramic bone substitutes; (3) bone stabilization (including nail fixation, arthrodesis nails, plates, or external ring fixation), (4) optionally negative pressure wound therapy (NPWT) and (5) optionally soft tissue closure with local or free flaps. The mean follow-up time was 14.9 ± 10.6 months (min/max: 2/40 month). The overall recurrence rate is low (8.5%, 3/35). Prolonged wound secretion was observed in six cases (17.1%, 6/35). The overall number of surgeries was a median of 2.5. Conclusion The results in the literature and in our case series are explicitly promising regarding the treatment of posttraumatic fracture-related infection.
Zusammenfassung Hintergrund Seit ihrer Zulassung in Deutschland im Juli 2019 erfreuen sich E‑Scooter zunehmender Popularität. Diese steigende Beliebtheit und die einfache Zugänglichkeit der E‑Scooter für jedermann haben jedoch auch zu teils schweren Unfällen geführt. Ziel der Arbeit Das Ziel dieser Studie war es, die Art und Schwere der Verletzungen, die in direktem Zusammenhang mit der Nutzung von E‑Scootern in einer deutschen Millionenstadt stehen, zu analysieren und hieraus Schlüsse für zukünftige Sicherheitskonzepte und Verhaltensregeln zu ziehen. Methodik Alle Patienten, die sich aufgrund eines Unfalls mit einem E‑Scooter in der interdisziplinären Notaufnahme des Klinikums rechts der Isar, Universitätsklinikum der Technischen Universität München, zwischen dem 01.07.2019 und dem 01.04.2020 vorstellten, wurden erfasst und sowohl demografische Daten als auch Informationen zu Traumamechanismus und den entstandenen Verletzungen dokumentiert. Ergebnisse Im oben genannten Zeitraum wurden prospektiv 60 Patienten erfasst, wovon 34 (56,7 %) Männer waren. Durchschnittlich waren die Patienten 34,7 Jahre (18 bis 73 Jahre) alt. Unter Alkoholeinfluss fuhren 22 Patienten (36,7 %); ein Helm wurde lediglich von einer Person getragen. Verletzungen des Kopfes waren mit Abstand am häufigsten, gefolgt von Verletzungen der oberen und der unteren Extremität (Radiusköpfchenfraktur n = 5, Riss-Quetsch-Wunden an Fuß/Sprunggelenk n = 8). 2 Patienten (3,3 %) waren schwer verletzt (ISS ≥16) Diskussion Mit zunehmender Beliebtheit der E‑Scooter steigt auch die Anzahl an Verletzungen. Am häufigsten ist die Kopfregion betroffen, weshalb zukünftig eine Helmpflicht sinnvoll erscheint. Zudem sollten eine breitere Informationskampagne und strengere polizeiliche Kontrollen im Hinblick auf die Vielzahl an alkoholisierten Unfallopfern erfolgen.
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