Statutory Accident Insurance Research Articles

Fatigue nach einer COVID-19-Erkrankung im Zusammenhang mit Depressivität und Ängstlichkeit bei Versicherten aus Gesundheits- und Sozialberufen

ZusammenfassungHintergrundFatigue bezeichnet einen andauernden Erschöpfungszustand, der auf eine Infektionskrankheit folgen kann. Sie zählt zu den häufigsten Symptomen beim Post-Covid-Syndrom (PCS). Auch bei psychischen Erkrankungen kann Fatigue auftreten, allerdings ist Fatigue, wie andere chronische Erkrankungen, auch selbst ein Risikofaktor für Depressivität und Ängstlichkeit. Ziel der Analyse ist es, zu untersuchen, inwieweit sich Fatigue und Depressivität/Ängstlichkeit gegenseitig bedingen und ob es Unterschiede zwischen PCS-Betroffenen und vollständig Genesenen gibt.MethodikIn einer Längsschnittuntersuchung mit 3 Messzeitpunkten wurden Versicherte der Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege, die im Jahr 2020 mit SARS-CoV‑2 infiziert waren, zu Fatigue, Depressivität/Ängstlichkeit und lang anhaltenden COVID-19-Symptomen befragt. Zur Analyse der längsschnittlichen Effekte der beiden Variablen wurde ein kreuzlagiges Paneldatenmodell angewandt.ErgebnisseDie Stichprobe (n = 860) weist zu den 3 Messzeitpunkten einen Anteil von 68,7–75,1 % an PCS-Betroffenen auf. Das Modell zeigt eine Güte von R2 = 61,49 % und durchgehend signifikante Effekte, jedoch unterscheiden sich die kreuzlagigen Pfade nicht signifikant voneinander. Wird danach stratifiziert, ob eine PCS-Symptomatik vorliegt, schwächen sich in beiden Gruppen die kreuzlagigen Effekte ab, während nur in der Gruppe der PCS-Betroffenen die Effekte von Fatigue auf Depressivität und Ängstlichkeit bestehen bleiben.DiskussionDie vorliegenden Ergebnisse zeigen einen wechselseitigen Zusammenhang von Fatigue- und Depressivitäts‑/Ängstlichkeitssymptomatik. PCS-Betroffene könnten von psychotherapeutischen Behandlungen aufgrund ihrer Fatigue profitieren, da dem Entstehen von Depressionen oder Angststörungen vorgebeugt werden kann.

The Conservative and Operative Treatment of Carpal Fractures.

Carpal fractures (incidence: 30-60 per 100 000 persons per year) are one of the more commonly overlooked fracture types. They can have serious consequences, as the use of the hand is indispensable in everyday life. In the following article, we present the elements of the diagnosis and treatment of fractures of the carpal bones. This review is based on meta-analyses and randomized controlled trials (RCTs) published from 2013 to 2023 that were retrieved by a structured literature search, supplemented by guideline recommendations and expert consensus statements. In addition, data on the administrative prevalence of carpal fractures were obtained from the German Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung, KV) and from the German Statutory Accident Insurance (Deutsche Gesetzliche Unfallversicherung, DGUV). The administrative prevalence of carpal fractures in 2022 was 44 496 outpatient cases (KV, DGUV) in one year. After clinical history-taking, physical examination and x-ray have been performed, thin-slice computed tomography is recommended as part of the diagnostic evaluation. Treatment recommendations are based on evidence of levels II to IV. Multiple RCTs have been carried out on the treatment of scaphoid fractures, and a clinical guideline exists. Proximal, dislocated and unstable scaphoid fractures should be treated surgically. Non-displaced or minimally displaced fractures of the middle third of the scaphoid bone require a shorter period of immobilization with surgical treatment (2-4 weeks) than with conservative treatment (6-8 weeks). The use of plaster casts that do not hinder elbow and thumb mobility yields healing rates similar to those obtained with the immobi - lization of both of these joints. Failure to treat an unrecognized scaphoid fracture can lead to pseudarthrosis, avascular bony necrosis, and misalignment. Other, rarer types of carpal fractures must be managed on an individual basis, as the available ev idence is limited to expert consensus. Early recognition and appropriate treatment of carpal fractures lead to healing in more than 90% of cases. Although the available evidence on their proper treatment is growing, many questions are subject to expert consensus, and decisions about treatment must be made individually.

Four distinct patterns of anterior cruciate ligament injury in women’s professional football (soccer): a systematic video analysis of 37 match injuries

BackgroundTo identify mechanisms and patterns of anterior cruciate ligament (ACL) injury in adult women’s professional football by means of video match analysis.MethodsACL match injuries sustained in Germany’s first women’s league...

Venous disorders as an occupational disease - a systematic review on epidemiology, pathophysiology, and modification strategies.

Forced postures are common in the workplace. Work in the primary economic sector is characterised by a high degree of physical activity and movement; however, activities in the secondary and tertiary sectors commonly require workers to stand or sit. An expansion of the tertiary sector in recent decades has meant that people in industrialised and emerging economies primarily sit or stand at work. The aim of the systematic review was to identify occupational factors relating to the presence of chronic venous disease (CVD), to place these in the context of developments in the workplace, and to determine whether measures are in place to prevent CVD. We performed a systematic literature review to analyse studies assessing work-related risk factors for CVD. We searched for publications in the PubMed database, the clinic library of BG Hospital Bergmannstrost Halle, and the registry of the German Statutory Accident Insurance. Using occupation-specific keyword combinations, we identified 27,522 publications. The publications underwent an automatic and manual filtering process according to the PRISMA guidelines and 81 publications qualified for the review. Ultimately 25 studies were included in the systematic review. All of the subjects of the studies worked in the secondary and tertiary sectors. No studies looked at the relationship between venous disorders and primary sector occupations. Standing at work for more than four hours a day, repeated heavy lifting, and cumulative time working in a sitting or standing position are risk factors for the development of CVD. Sitting is less of a risk factor than standing or walking. Occupational history and the patient's activity profile are important diagnostic tools which can help confirm a diagnosis and justify treatment when findings are inconsistent. Compression therapy is the primary form of secondary and tertiary prevention. There continues to be a lack of primary preventive measures related to workplace design.

The Significance of Chronic Fatigue in the Post-Covid Consultation and its Consequences for Outpatient Rehabilitation in the Context of Statutory Accident Insurance

The post-COVID consultation (PCC) is offered as part of a comprehensive range of treatment services provided by the statutory accident insurance for post-COVID patients to determine individual recommendations for further care. The aim of the study was to record the main symptoms and the associated restrictions on social and occupational participation in order to derive consequences for outpatient rehabilitation. In addition to a medical examination and a psychological consil, numerous assessments were carried out to evaluate the biopsychosocial state of health. 373 female (82.2%) and 81 male patients aged between 40 and 60 years from the professions of health and care services, education and pedagogy participated in the PCC since April 2021. Nearly all patients (98.2%) reported fatigue as a cardinal symptom of their post-COVID complaints, in combination with subjectively experienced limitations in brain functioning in over 73% of cases. The duration of the symptomatology persisted for an average of 14-15 months in both female and male insured persons. Thus, over 85% of the total sample can be classified as cases of chronic fatigue (Fatigue Scale). The severity of fatigue also proportionally affects quality of life (SF-36), feelings of anxiety and depression (HADS), psychological resilience (RS-13), and motor parameters such as maximum grip strength and endurance capacity. 54.3% of the patients also received a suspected mental diagnosis and 38.1% a recommendation for further neuropsychological diagnostics. For further treatment of the leading symptom of chronic fatigue, a multimodal and interdisciplinary outpatient rehabilitation is recommended, which should be oriented towards the treatment of the diagnosis of chronic fatigue syndrome (ME/CFS) and thus in particular towards a psychoeducational and rather than a curative therapeutic approach, and should consider aftercare strategies. Confirmed mental disorders and neuropsychological deficits are to be treated in addition.

Quality of patch testing patient's own material in patients with suspected occupational skin diseases throughout Germany: Interim results of the German Social Accident Insurance (DGUV) research project FB 317b.

Due to limited availability of commercial test preparations, patch testing patient's own material (POM) is of great importance to diagnose occupational allergic contact dermatitis. To assess the quality of performance and documentation of patch testing with POM in patients with suspected occupational skin diseases (OSD) in Germany. Retrospective-prospective analysis of protocols of patch tests with POM was conducted between 2013 and 2021 in patients with suspected OSD and submitted to statutory accident insurance institutions. Assessments were done by predefined criteria. Three thousand and four patch tests with POM from 460 patients were included. A full description of the POM was provided in 73.3% of all tests. The test concentration, test vehicle and pH value were documented in 74.3%, 70.5% and 42.2% of tests, for which the respective parameters were considered relevant. One hundred and sixty-one positive reactions to POM were documented. In 72%, sufficient patch testing with commercial test substances was conducted to investigate the positive reaction. In 30.4%, consecutive patch testing of all ingredients of the POM was done. The results not only show considerable shortcomings mainly in documentation but also to some extent performance of patch tests with POM in patients with suspected OSD in Germany.

The German experience with asbestos-related diseases: a failure of compensation due to the manipulation of science

The world pandemic of asbestos-related diseases results from inadequate prevention and late bans on asbestos use. For years in Germany there has been an annual average of about ten thousand new claims. Many countries deny compensation due to unsound diagnostic applications that have entered into the literature and are used to deny compensation. One such well-established incorrect scientific strategy is the use of quantifying asbestos bodies or fibers in lung tissue and setting restrictive thresholds on the findings in tissues of workers who had been exposed primarily to chrysotile which shows low bio-persistence, movement to the pleura, and rarely forms asbestos bodies. The so called one thousand asbestos body hypothesis for the diagnosis of asbestosis, originating from the German Mesothelioma Register run by the employers’ statutory accident insurance institutions, has been applied in Germany and similarly in several other western countries. As opposed to the well-substantiated hit and run phenomena that has been predominantly applied to chrysotile asbestos, low asbestos body or fiber counts in tissue had been systematically misinterpreted. This, combined with restrictive histopathology definitions, have been used for the manipulation not only of diagnostic criteria but also of science and has had an effect on laws governing compensation. The counting of asbestos bodies or fibers in human lungs should under no circumstances invalidate a qualified occupational history of exposure as the hallmark requisite tool for assessing asbestos exposure and acceptance of asbestos-related diseases in compensation schemes. An outcome suggested by this paper is the need to broaden the WHO beneficial initiative to eliminate ARD worldwide by establishment of an international board of independent scientists on remedial action that would recommend standards for acknowledgement and compensation. Such a board should be supported by national legal branches recognizing possible regional differences and initiating compliance with the recommendations.

Reduction in Earning Capacity (MdE) Statutory Accident Insurance

Changes in the employment market and improvements in the current prosthetic treatment have encouraged German Statutory Health Insurance e. V. (DGUV) to re-examine the standard values for reduced earning capacity after work related accidents. The new standard values for reduced earning capacity came into force on 01.11.2019. The present article summarises the consensus paper of the group of independent experts.

S2k Guideline for Tibial Plateau Fractures - Classification, Diagnosis, and Treatment.

Tibial plateau fractures are mostly complex and surgically demanding joint fractures, which require a comprehensive understanding of the fracture morphology, ligamentous and neurovascular injuries, as well as the diagnostic and therapeutic options for an optimal clinical outcome. Therefore, a standardised and structured approach is required. The success of the treatment of tibial plateau fractures relies on the interdisciplinary cooperation between surgical and conservative physicians in an outpatient and inpatient setting, physical therapists, patients and service providers (health insurance companies, statutory accident insurance, pension providers). On behalf of the German Society for Orthopaedics and Trauma Surgery (DGOU), the German Trauma Society (DGU) and the Society for Arthroscopy and Joint Surgery (AGA), under the leadership of the Fracture Committee of the German Knee Society (DKG), a guideline for tibial plateau fractures was created, which was developed in several voting rounds as part of a Delphi process. Based on the current literature, this guideline is intended to make clear recommendations and outline the most important treatment steps in diagnostics, therapy and follow-up treatment. Additionally, 25 statements were revised by the authors in several survey rounds using the Likert scale in order to reach a final consensus.

Evaluation of long-term and late consequences of mandibular fractures in the context of statutory and private accident insurance

Evaluation of long-term and late consequences of mandibular fractures in the context of statutory and private accident insurance

Die Neustrukturierung der Notaufnahme gemäß dem G-BA-Beschluss zu einem gestuften System von Notfallstrukturen

There is no assessment of the effects regarding the decision of the Federal Joint Committee from April 19th, 2018 which demands a central and interdisciplinary emergency room system under control of a professionally and organizationally independent administration. The aim of this study was to show the current opinion among the leading orthopedic surgeons regarding the above-mentioned decision. An online questionnaire was sent to all 731 members of Verband Leitender Orthopäden und Unfallchirurgen (www.vlou.de) to compare the opinion of these leading physicians on their current and future emergency room system. The majority of the 179 responding surgeons consider emergency room systems with primary treatment of orthopedic patients by original orthopedic surgeons in certain aspects more suitable than systems without such primary treatment. It is also not clarified how work-related accidents should be treated according to the specifications of the German statutory accident insurance (DGUV®). The distribution of education content could become more difficult if the ER rotation of orthopedic surgeons is not any longer part of these new ER concepts. The consequences of the decision of the Federal Joint Committee from April 19th, 2018 have to be reevaluated continuously and if necessary optimized consecutively, taking into account competing requirements, such as training regulations and SGB VII.

COVID-19 as an insurance case of the statutory accident insurance: occupational disease or occupational accident : Relevant knowledge for the (general and abdominal) surgeon

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic resulted in many infections with the virus and sickness due to coronavirus disease 2019 (COVID-19). Therefore, there was adramatic increase in the number of reported and recognized occupational diseases (Berufskrankheit, BK) and occupational accidents (Arbeitsunfall, AU) at the German Social Accident Insurance Institutions (BG) and accident insurance funds (Unfallkassen).The publication aims to show the differences between BK and AU and to review the current data on occupational diseases. It deals with the definitions of BK and AU, the differences in the conditions for recognition as BK or AU. Furthermore, the claims for benefits are presented. Finally, statistical key figures of the BK according to No.3101 and the AU are presented.Results (key points)-According to §7 SGBVII, AU and BK are insured events of the statutory accident insurance.-In surgery, like specifically in the rest of the healthcare system, the relevance of the SARS-CoV‑2 infection with post-COVID in personnel for occupational medical prevention and as acase to be recognized by the statutory accident insurance (BK or AU) becomes clear.-Relevant for the recognition are the duration and the intensity of the contact (local proximity) and the SARS-CoV‑2 occupational health and safety rule of 20 August 2020 essentially recognizes acontact duration of at least 15 min at aspatial distance of less than 1.5-2 m (further aspects: more intensive shorter contacts, number of verifiably infected persons in the closer activity environment or the usual personal contacts, spatial situation, work route, special constellations).-No case numbers can be elicited for the detailed presentation of the surgery setting.-There are still immense problems and challenges in the assessment of COVID-19 consequences or post-COVID as occupational disease, as numerous uncertainty factors, such as insufficiently secured knowledge about the further long-term course over the years or the widely varied symptom spectrum complicates the medical assessment of the consequences of this disease.Conclusion: the SARS-CoV‑2 pandemic is aspecial challenge for surgery with intensive patient contact and for the entire healthcare system. This caused long-lasting changes and the adequate health care as well as insurance law processing of the (case-specific) consequences might still require considerable efforts and resources.

Arbeitsschutz „im Huckepack“ – ein alternatives Konzept zur Ansprache von Unternehmen auf Sicherheit und Gesundheit bei der Arbeit

Occupational safety “piggybacked” – an alternative concept for addressing companies on occupational health and safety. Part I: Theoretical foundation Background: Employers are obliged to implement occupational safety measures. However, implementation rates are rising only very slowly. Reservations about the issues and official requirements are widespread among entrepreneurs. Objective: There is still a great need for statutory accident insurance organisations to successfully address entrepreneurs so that they can ensure the health and safety of their workers. Method: Based on findings from cognitive and learning psychology, an alternative approach, known as the “piggyback” method, was developed. Results: By linking the health and safety topics with positively evaluated contextual stimuli, the reservations can be circumvented and a first positive change in attitude can be achieved. For a sustainable change in behaviour, a deeper dive into the issues is necessary. Conclusions: The “piggyback” method can be used especially to reach entrepreneurs who have shown little motivation for implementation so far. The concept can be applied to different fields of prevention, but still requires further testing and evaluation. Ethical aspects must also be taken into account during implementation. Keywords: occupational health and safety– information processing – entrepreneurs – targeting concept

Hand eczema or psoriasis: update on the FB323 study occupational dermatology cohort

In daily dermatological practice, the distinction between eczema and psoriasis in dermatoses of the hands can be difficult. However, aclear diagnosis is necessary to initiate optimal therapy and management. In recent years, the so-called molecular classifier has been developed for optimized differentiation of eczema and psoriasis. An occupational dermatological cohort has been established at Heidelberg University Hospital since 2020. It is funded by the German Statutory Accident Insurance. The aim is to follow-up patients over 3years where this new diagnostic method is used and to compare the results with aretrospective occupational dermatological cohort. Recruitment ended in December 2022. The current analysis reports participants' occupational activity, insurance status, disease progression, and number of sick days. A total of 287patients were included; mean age was 50.4years and 63.5% (n = 181) were undergoing treatment at the expense of the liable statutory accident insurance at the start of the study. About 50% of the patients worked in health professions, metal industry, or construction. The average duration of occupational dermatosis was 6.5years. In 38.9% of the patients, the clinical diagnosis had been classified as unclear by the treating dermatologist. By using the molecular classifier, the diagnosis could be clarified in 98% of the cases (eczema vs. psoriasis). The first analyses demonstrate that the molecular classifier contributes to improving therapy by optimizing the diagnosis.

Patient education in work-related hand eczema : Importance and challenges in health care practice

Patient education can help patients with work-related hand eczema to cope with their skin disease in an informed and responsible manner and to improve their personal skin protection behavior in everyday working and private life. Skin protection education in centers specialized in occupational dermatology is apivotal component of outpatient and inpatient individual prevention programs for individuals with work-related skin diseases provided by the statutory accident insurance institutions in Germany. Patient education should be patient-oriented and promote learning, e.g., through interactive, activating discussions and design, references to everyday life, and methodically and didactically well-prepared media and materials in clear, understandable language. Challenges may arise in educational practice, e.g., due to subjective illness perceptions, participants with alack of motivation, language barriers, functional illiteracy, or heterogeneous patient groups. In this article, different challenges are presented and educational and health psychological perspectives are discussed to meet these challenges in order to provide an optimal, patient-oriented individual prevention measure.

What are the principles for measurement and estimation of accident sequelae? : Development and function of the reduction in earning capacity (MdE) tables in the statutory accident insurance

The evaluation of permanent dysfunction after injuries to the musculoskeletal system is one of the core activities of a trauma surgeon and orthopedists. Based on the knowledge of the injury and an accurate description of the dysfunction, the medical expert then makes aproposal regarding the amount of the reduction in earning capacity (Minderung der Erwerbsfähigkeit, MdE). The amount is based on the MdE tables, which have been derived from adecade-long harmonization and coordination between administrative authorities, courts and the medical profession. They have been published in the fundamental guidelines for evaluation. Individual recommendations are subject to change; however, the benchmark figures for amputations have not changed significantly since the introduction of the statutory accident insurance in 1884, although the treatment with prostheses has continuously improved. The benchmark for the MdE is the labor market which becomes unavailable to the insured person due to the dysfunction. In the Social Code for Employment Accident Insurance (Sozialgesetzbuch für die Unfallversicherung, SGBVII), the reduction in earning capacity is defined and the amount "…is based on the extent to which job opportunities are available as aresult of the impairment of the physical and mental capacity across the entire area of the working life". The article traces the history of this central instrument for measuring the sequelae of accidents. In this context it is shown that the MdE values did not in fact arise concurrently with the introduction of statutory accident insurance at the end of the nineteenth century but date back to the millennia-old principle of the law of talion (ius talionis). This is the basic form of material civil liability law, according to which the injuring party must compensate the injured party in the case of aculpable impairment of health for the resulting material loss. Here the loss of earnings, the impairment of the capacity to work or, in other words, the reduction in earning capacity is of paramount importance. In the middle of the nineteenth century, private accident insurers developed dismemberment schedules based on the principle of ius talionis. These dismemberment schedules were adopted by the professional organizations after 1884. The highest competent instance for social security matters, which was the Imperial Insurance Office (Reichsversicherungsamt), redefined the dismemberment schedules: the values for the dismemberment schedules then became the benchmark for the reduction of capacity to work (Erwerbsminderung, EM) and subsequently the reduction in earning capacity (MdE). The fact that the MdE values have remained stable over more than 100 years support the view that they not only grant legal certainty but are also regarded as appropriate and fair by both the persons affected and society.

Updated S1guideline on long/post-COVID: relevant aspects for pain medicine

The S1guideline on long/post-COVID of the AWMF [German Association of the Medical Scientific Societies] registration number 020-027) was updated in August2022. Under the coordination of the German Society of Pneumology, the guideline was updated by 21scientific associations, two professional associations and clinical centers each and one institute and statutory accident insurance each. Each scientific association was responsible for its own chapter. The German Pain Society prepared the chapter "Pain". The coordinators of each chapter performed aselective literature search and also received approval for the chapter within their scientific association. During an internal period of comments, all representatives of the participating institutions could comment on all chapters. The AWMF task force commented on the draft of the guideline, which was then finally approved by the boards of all participating institutions. Coronavirus disease 2019 (COVID-19) increases the risk of persistent headache and musculoskeletal pain. Long/Post-COVID pain is frequently associated with fatigue and cognitive problems. Aspecialist assessment might be considered if symptoms with limitations of daily activities persist 3months after the infection. The diagnostic workup of long/post-COVID-associated pain should be performed according to the standards of pain medicine. Management should follow the pain guidelines of the AWMF. The updated S1guideline on long/post-COVID is aclinical manual which offers orientation for diagnostics and treatment despite limited data.

The neuro-urological expert opinion in statutory accident insurance : Consensual recommendations for diagnostics and for the assessment of reduction of earning capacity

Previous assessment guidelines from standard sources for urologic expert opinions show considerable differences in the recommended percentages for the assessment of reduction of earning capacity (MdE) for accident sequelae in the neuro-urological specialty. To develop a"revised and standardized version of the MdE assessments of neuro-urological accident sequelae (in tabular form) as aguideline/manual" for expert opinions in the legal area of the German and Austrian Statutory Accident Insurance ( www.dguv.de , www.auva.at ). Aworking group of neuro-urologists from spinal cord injury centers of different BG ("Berufsgenossenschaft") clinics was formed within the working group Neuro-Urology of DMGP (German-speaking Medical Society for Paraplegiology; www.dmgp.de ). Between January2017 and September2022, atotal of 7working meetings and 2video conferences were held. The consensus of the developed documents was reached by formal consensus finding in anominal group process and in afinal consensus conference. The necessary bases for atargeted, legally sound diagnosis of accident consequences in the neuro-urological field were elaborated and, based on the experience of many years of expert opinion activity, a"matrix" for auniform, graduated assessment of the level of reduction of earning capacity in the (neuro-)urological field in the case of confirmed neuro-urological accident consequences was created. In the interest of equal treatment of all insured persons, it is of great importance to make auniform and comprehensible assessment of the amount of the MdE on the basis of "table values" that reflect the available empirical values.

Severe injury type procedures-Influence of the cipher11 "complications" and the COVID-19 pandemic on acenter for maximum care of severe injuries

Ensuring the best treatment options for injured patients (healing process, Heilverfahren, HV) is the main goal and responsibility of the German statutory accident insurance (DGUV). The injury type catalogue is the tool to guide the HV. The development of the number of cases treated in acenter for severe injury type procedures, the effects of the cipher11 "complications" of the catalogue and the effects of the COVID-19 pandemic are presented. Aretrospective study of all patients treated in the context of the DGUV from January 2019 to December 2021 was carried out. The number of cases before and during the legal lockdown actions were compared. The case mix index, the mean number of operations, the mean time in the operating room and the hospital stay were analyzed. Additionally, the cases under the cipher11 were classified according to the specific anatomical regions. Out of 2007cases 67% were classified as severe injury type procedures (SAV). Of these cases 51% were categorized to the cipher11 of the injury type catalogue. Complications were observed particularly in the anatomical regions of the shoulder girdle, elbow, hand, knee, ankle joint and foot. These complex cases are economically not sufficiently represented. During the governmental COVID-19 lockdown actions, the number of patients treated in the context of the DGUV significantly decreased. The injury type catalogue is used effectively in the catchment area of the present trauma center. Most of the cases treated in the present trauma center are severe injury type procedures; however, more than half of these cases are classified as complications. This development might show the need for astructural change or an adjustment of the HV. The current comments on the injury type catalogue offer important definitions and specifications; however, the conciseness of the entire catalogue should be maintained.

Differences in Work and Commuting Accidents between Employees and Students at Higher Education Institutions in Rhineland-Palatinate, Germany, from December 2014 to December 2019.

Accidents are one of the most important public health concerns because of their high prevalence and considerable health outcomes. Although higher education institutions (HEIs) play an important role in health promotion and disease prevention, accidents are rarely investigated in this setting. Therefore, the aim of the present study was to address this gap by analyzing the frequency and characteristics of employee and student accidents at HEIs in Rhineland-Palatinate, Germany. A dataset of all accidents that happened to employees and students at HEIs in Rhineland-Palatinate from December 2014 to December 2019 and the characteristics of these accidents was provided by the responsible statutory accident insurance (Accident Insurance Fund of Rhineland-Palatinate). Modified thousand-men quotas (the rate of injuries per 1000 people) were calculated to investigate the differences in frequencies and characteristics of accidents between employees and students, as well as between institutions. A total of 3810 accidents (n = 1326; 34.8% work and n = 2484; 65.2% commuting) were reported, of which 426 involved employees and 3384 involved students. The frequency and characteristics of the accidents varied between employees and students, as well as between institutions. Sports programs at HEIs for example imply high risks for unintentional injuries especially for students (as they make up the majority of participants). Other main findings are that medical students, as well as students of subjects including laboratory work, are at a higher risk to experience study-related accidents whereas employees seem to be at a higher risk when working in a technical field. The results call for the development of accident prevention concepts at HEIs and the implementation of interventions in respective institutions and target groups.