Der Unfallchirurg
-
Are the costs required for a polytraumatised patient sufficiently paid by the health care companies?The study population consisted of 71 polytrauma patients. The treatment-costs were calculated and compared with the reimbursements. The mean patient age was 38.0 years with a mean injury severity score (ISS) of 23.0 points. ⋯ It is necessary to consider the implementation of an additional polytrauma-reimbursement based on the injury severity and duration of hospitalisation. The concentration of the patients in trauma centres, where the optimum of therapy is guarantied, leads in these hospitals to a continuously increasing deficit. The latter may be deleterious for the concept of "trauma centers" in the future.
-
To what extent does the scientific literature have an impact on current clinical practice guidelines (CPGs) in trauma surgery? ⋯ Information flow between clinical research and CPG development remains difficult. Thoroughly performed literature searches have an important role in CPG development.
-
Case Reports Comparative Study
[Optimized management of polytraumatized patients by prehospital ultrasound].
The purpose of the study was to evaluate the practicability and the benefit of focused abdominal sonography for trauma (FAST) on scene. ⋯ In the present study the data have shown that the prehospital ultrasound is a useful and reliable tool for diagnostic procedure on the scene. The data are the basis for a multicenter study in the helicopter rescue service. This study will try to answer the question whether prehospital ultrasound may be generally recommended in trauma patients suspicious for abdominal trauma.
-
Comparative Study
[Pediatric prehospital trauma care. A retrospective comparison of air and ground transportation].
In contrast to prehospital care of adult trauma victims, prehospital care providers have only limited clinical experience of pediatric trauma cases as these are relatively infrequent. Literature reports on prehospital pediatric trauma care given by paramedics are frequently found in the literature, but there are few publications analyzing the quality of prehospital trauma care provided by emergency physicians in the care of injured children. It was the goal of this study to analyze the prehospital care of the pediatric trauma victims transported to a trauma center by physician-staffed ambulances and helicopters. ⋯ Prehospital pediatric trauma care delivered by physician-staffed ambulances or rescue helicopters is associated with a high rate of i.v. line placement (92%) and high intubation rates (90%) in patients with an altered level of consciousness (GCS<9). The prehospital care provided by helicopter or ground ambulance personnel was not different and was not associated with longer stays in the intensive care unit or longer overall stays in hospital. Scene times became longer with increasing number of i.v. line placements and with endotracheal intubation, but was not prolonged by a greater severity of injury as determined by the ISS. Preventable deaths were not observed in the patient population. In summary, owing to the the local infrastructure, pediatric trauma patients are more frequently transported to the trauma center by air (87 by air vs. 17 by road per 5-year time period). However, despite being less frequently involved in the case of pediatric trauma, the quality of care provided by road ambulance staff is similar to that in air ambulances.