Zentralblatt für Chirurgie
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Review Comparative Study
[Value of clinical scoring systems for evaluation of injury severity and as an instrument for quality management of severely injured patients].
Trauma Score Systems attempt to summarize the severity of injury in a single value. They provide a better classification of trauma patients and translate different severities of injury in a common language. They enable thereby comparisons between hospitals or trauma systems. ⋯ Glasgow Coma Scale, Revised Trauma Score, Injury Severity Score and TRISS are the most often used international scores for severely injured patients. Their sensitivity and specificity, validity, reliability and practicability have been studied and proved in many trials. The role of these scoring systems for quality management purposes in the treatment of severe trauma is actually studied with the Trauma Registry of the German Society for Trauma Surgery.
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Sequential organ failure after multiple trauma emerges from a whole-body inflammatory process which develops as a complex host defense response to hypovolemic shock/resuscitation and traumatic tissue injury. Successful prevention and treatment involves exact assessment of inflicted damage and profound knowledge of the different stages of posttraumatic immune alterations. Local release of potent inflammatory mediators (cytokines, complement, arachidonic acid derivatives, reactive oxygen metabolites) primarily induces a repair process. ⋯ Diffuse capillary leakage and microcirculatory disorder prepare cellular dysfunction. Secondary severe immune defects support septic complications which maintain an autodestructive process. Therapeutical advances depend on the analysis of local and time-dependent expression of relevant inflammatory mediators and cellular signalling systems.
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Over the last 30 years intensive care medicine has undergone drastic changes not only because of changes in patient population but also because of the progress in medical technology. Given that resources are finite and limited medical and socio-ethical principles should be applied for the distribution and withdrawal of these resources. ⋯ Whilst in intensive care patients should be scored every day to identify as early as possible those patients who are going to die and those who are going to survive in order to use intensive care resources efficiently. After discharge from intensive care quality of life should be an important factor to assess intensive care performance.
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Patient data management in anaesthesia and intensive care should include besides medical data of individual patients economically important parameters, e.g. working time or cost of material. Integration of this data management system in the hospital information network enables case-oriented analyses for costs in relation to outcome. Standards of therapy including cost-benefit estimates may be an approach to improve the quality of care and to control the cost of medical care, in particular in the setting of teaching hospitals, avoiding erratic and costly orders by staff in training.