Der Unfallchirurg
-
Numerous scoring systems are available for various particular situations. Some clinicians consider scores as mandatory for daily clinical decision making, while others see them only as additional work with no proven benefit except for scientific aspects. Although scoring systems have their limitations, they can also be of value. ⋯ The specific aims of different scoring systems are discussed and evaluated for the areas of disease classification, monitoring of individual patients and applications to individual decisions, quality assurance (comparison of patient groups and therapies), economic evaluation and global triage decisions. Despite the additional workload it is concluded that scoring systems are of proven benefit for classification of the degree of severity of a disease process, quality assurance, and better assessment of costs containment. These instruments will become increasingly important in our current discussion on changes in health care systems.
-
A variety of different scoring systems are in current use, with an increasing impact on intensive care treatment. Originally these scoring systems were applied to evaluate objective grading and to estimate survival and mortality. More recently, other potential applications have been investigated. ⋯ Although desirable, individual patient prediction is therefore not allowed, and therapeutic strategies and therapy evaluation based on scoring systems cannot be implemented, or only in a limited way. For daily use in individual patient evaluation--monitoring, therapy response, prognosis--biochemical monitoring is still of primary importance. Scoring systems have now found a useful application as a supplement, rather than a rival, to clinical patient evaluation.
-
In January 1992 the German Society of Trauma Surgery founded the working group "Scoring" with the aim of developing guidelines for a standardized use of scoring systems in severely injured patients. The study group developed the "Trauma Register" for prospective data collection in severely injured patients, from the scene of the accident up to discharge from hospital. The register contains routinely available anatomical and physiological variables, diagnostic and therapeutic interventions, and any complications. ⋯ Trauma centres can compare their own performance against given standards (quality control). If there are deviations from the norms the reasons have to be identified and necessary countermeasures should be implemented (quality assurance). The register has been tested in a feasibility phase in six German trauma centres and will hopefully have an impact comparable to that of the Major Trauma Outcome Study (MTOS) in the USA.
-
Fractures of the distal humeral diaphysis are rare and have not been reported very often in the literature, although therapeutic management is more difficult than that of midshaft humeral fractures. As they are so near to the elbow, these fractures are not suitable for bracing, because pro/supination movements cannot be eliminated. Muscular forces, especially of the pronator teres muscle, force the fracture into a varus position with every supination movement. ⋯ The advantage of the method is that the nails are inserted far distant from the fracture site. Anatomical reduction is not necessary, which means there is no danger of devitalizing fragments; the technique is also quick. In the "fixator" group, we saw 1 case of non-union and 1 of refracture, both following compound fractures.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Intestinal injury is increasing in frequency among persons sustaining blunt abdominal trauma, and the consequences of delayed recognition of intestinal injuries are serious. This critical retrospective analysis evaluates the role for CT in the diagnosis of blunt abdominal trauma, including hollow visceral injury. ⋯ Intestinal wall thickening with low-density fluid in the abdominal cavity strongly suggests rupture. Until further experience is gained with CT, free intraperitoneal fluid in the absence of solid organ injury should be regarded as an indication for exploratory laparotomy.