Trauma In Germany Research Articles

Angioembolization in patients with blunt splenic trauma in Germany -guidelines vs. Reality a retrospective registry-based cohort study of the TraumaRegister DGU®.

Nonoperative management (NOM) for blunt splenic injuries (BSIs) is supported by both international and national guidelines in Germany, with high success rates even for severe organ injuries. Angioembolization (ANGIO) has been recommended for stabilizable patients with BSI requiring intervention since the 2016 German National Trauma Guideline. The objectives were to study treatment modalities in the adult BSI population according to different severity parameters including NOM, ANGIO and splenectomy in Germany. Between 2015 and 2020, a retrospective registry-based cohort study was performed on patients with BSIs with an Abbreviated Injury Score ≥ 2 in Germany using registry data from the TraumaRegister DGU® (TR DGU). This registry includes patients which were treated in a resuscitation room and spend more than 24-h in an intensive care unit or died in the resuscitation room. A total of 2,782 patients with BSIs were included in the analysis. ANGIO was used in 28 patients (1.0%). NOM was performed in 57.5% of all patients, predominantly those with less severe organ injuries measured by the American Association for the Surgery of Trauma Organ Injury Scale (AAST) ≤ 2. The splenectomy rate for patients with an AAST ≥ 3 was 58.5%, and the overall mortality associated with BSI was 15%. In this cohort splenic injuries AAST ≥ 3 were predominantly managed surgically and ANGIO was rarely used to augment NOM. Therefore, clinical reality deviates from guideline recommendations regarding the use of ANGIO and NOM. Local interdisciplinary treatment protocols might close that gap in the future.

Use of angioembolization, treatment modalities and mortality in association with blunt liver trauma in Germany — a data analysis of the TraumaRegister DGU®

PurposeAngioembolization (ANGIO) is highly valued in national and international guideline recommendations as a treatment adjunct with blunt liver trauma (BLT). The literature on BLT shows that treatment, regardless of the severity of liver injury, can be accomplished with a high success rate using nonoperative management (NOM). An indication for surgical therapy (SURG) is only seen in hemodynamically instable patients. For Germany, it is unclear how frequently NOM ±\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\pm$$\\end{document} ANGIO is actually used, and what mortality is associated with BLT.MethodsA retrospective systematic data analysis of patients with BLT from the TraumaRegister DGU® was performed. All patients with liver injury AIS ≥ 2 between 2015 and 2020 were included. The focus was to evaluate the use ANGIO as well as treatment selection (NOM vs. SURG) and mortality in relation to liver injury severity. Furthermore, independent risk factors influencing mortality were identified, using multivariate logistic regression.ResultsA total of 2353 patients with BLT were included in the analysis. ANGIO was used in 18 cases (0.8%). NOM was performed in 70.9% of all cases, but mainly in less severe liver trauma (AIS ≤ 2, abbreviated injury scale). Liver injuries AIS ≥ 3 were predominantly treated surgically (64.6%). Overall mortality associated with BLT was 16%. Severity of liver injury ≥ AIS 3, age > 60 years, hemodynamic instability (INSTBL), and mass transfusion (≥ 10 packed red blood cells/pRBC) were identified as independent risk factors contributing to mortality in BLT.ConclusionANGIO is rarely used in BLT, contrary to national and international guideline recommendations. In Germany, liver injuries AIS ≥ 3 are still predominantly treated surgically. BLT is associated with considerable mortality, depending on the presence of specific contributing risk factors.

Paediatric spine injuries in the thoracic and lumbar spine—results of the German multicentre CHILDSPINE study

BackgroundPaediatric thoracolumbar spine injuries are rare, and meaningful epidemiological data are lacking.ObjectivesThe aim of this study was to provide epidemiological data for paediatric patients with thoracolumbar spinal trauma in Germany with a view to enhancing future decision-making in relation to the diagnostics and treatment of these patients.Materials and MethodsA retrospective multicentre study includes patients up to 16 years of age who were suffering from thoracolumbar spine injuries who had been treated in six German spine centres between 01/2010 and 12/2016. The clinical database was analysed for patient-specific data, trauma mechanisms, level of injury, and any accompanying injuries. Diagnostic imaging and subsequent treatment were investigated. Patients were divided into three age groups for further evaluation: age group I (0–6 years), age group II (7–9 years) and age group III (10–16 years).ResultsA total of 153 children with 345 thoracolumbar spine injuries met the inclusion criteria. The mean age at the time of hospitalization due to the injury was 12.9 (± 3.1) years. Boys were likelier to be affected (1:1.3). In all age groups, falls and traffic accidents were the most common causes of thoracolumbar spine injuries. A total of 95 patients (62.1%) were treated conservatively, while 58 (37.9%) of the children underwent surgical treatment. Minimally invasive procedures were the most chosen procedures. Older children and adolescents were likelier to suffer from higher-grade injuries according to the AOSpine classification. The thoracolumbar junction (T11 to L2) was the most affected level along the thoracolumbar spine (n = 90). Neurological deficits were rarely seen in all age groups. Besides extremity injuries (n = 52, 30.2%), head injuries represented the most common accompanying injuries (n = 53, 30.8%). Regarding spinal injuries, most of the patients showed no evidence of complications during their hospital stay (96.7%).ConclusionsThe thoracolumbar junction was more frequently affected in older children and adolescents. The majority of thoracolumbar spinal column injuries were treated conservatively. Nevertheless, 37.9% of hospitalized children had to be treated surgically, and there was an acceptable complication rate for the surgeries that were performed.

Severe trauma in Germany and Israel: are we speaking the same language? A trauma registry comparison.

Trauma registries are a crucial component of trauma systems, as they could be utilized to perform a benchmarking of quality of care and enable research in a critical but important area of health care. The aim of this study is to compare the performance of two national trauma systems: Germany (TraumaRegister DGU®, TR-DGU) and Israel (Israeli National Trauma Registry, INTR). The present study was a retrospective analysis of data from the described above trauma registries in Israel and Germany. Adult patients from both registries treated during 2015-2019 with an Injury Severity Score (ISS) ≥ 16 points were included. Patient demographics, type, distribution, mechanism, and severity of injury, treatment delivered and length of stay (LOS) in the ICU and in the hospital were included in the analysis. Data were available from 12,585 Israeli patients and 55,660 German patients. Age and sex distribution were comparable, and road traffic collisions were the most prevalent cause of injuries. The ISS of German patients was higher (ISS 24 vs. 20), more patients were treated on an intensive care unit (92 vs. 32%), and mortality was higher (19.4 vs. 9.5%) as well. Despite similar inclusion criteria (ISS ≥ 16), remarkable differences between the two national datasets were observed. Most probably, this was caused by different recruitment strategies of both registries, like trauma team activation and need for intensive care in TR-DGU. More detailed analyses are needed to uncover similarities and differences of both trauma systems.

Severe Trauma in Germany and Israel– Are We Speaking the Same Language? A Trauma Registry Comparison

Introduction:Trauma registries are a crucial component of trauma systems, as they could be utilized to perform a benchmarking of quality of care and enable research in a critical but important area of health care. The aim of this study is to compare the performance of two national trauma systems: Germany (TraumaRegister DGU ®,TR-DGU) and Israel (Israeli National Trauma Registry,INTR) in a retrospective analysis.Method:Patients from both registries treated during 2015-2019 with an Injury Severity Score (ISS) ≥ 16 points were included. Patient demographics, pre-hospital care, hospital treatment, and outcome were compared.Results:Data were available from 12,585 Israeli patients and 55,660 German patients. Age and sex distribution were comparable, and road traffic accidents were the most prevalent cause of injuries. The ISS of German patients was higher (ISS 24 versus 20), more patients were treated in an intensive care unit (92% versus 32%), and mortality was higher(19.4% versus 9.5%) as well.Conclusion:Despite similar inclusion criteria (ISS ≥ 16), remarkable differences between the two national datasets were observed. Most likely, this was caused by different recruitment strategies of both registries like trauma team activation and the need for intensive care in TR- DGU. More detailed analyses are needed to uncover similarities and differences between both trauma systems.

Pediatric cervical spine injuries—results of the German multicenter CHILDSPINE study

ObjectivesThe aim of this study was to provide epidemiological data of pediatric patients suffering from cervical spinal trauma in Germany, in order to integrate these data in future decision-making processes concerning diagnosis and therapy.Materials and MethodsRetrospective multicenter study includes all patients up to 16 years suffering from cervical spine injuries who were treated in six German spine centers between 01/2010 and 12/2016. The clinical databases were screened for specific trauma mechanism, level of injury as well as accompanying injuries. Diagnostic imaging and the chosen therapy were analyzed. Patients were divided into three age groups for further evaluation: age group I (0–6 years), age group II (7–9 years), age group III (10–16 years).ResultsA total of 214 children with 265 cervical spine injuries were included during the mentioned period. The mean age at the time of injury was 11.9 (± 3.9) years. In age group I, 24 (11.2%) patients were included, age group II consisted of 22 patients (10.3%), and 168 patients belonged to age group III (78.5%). Girls and boys were equally affected. In all age groups, falls and traffic accidents were the most common causes of cervical spine injuries. A total of 180 patients (84.1%) were treated conservatively, while 34 (15.9%) children underwent surgery. Distorsion/whiplash injury was the most common entity (n = 165; 68.2%). Children aged 0–9 years had significantly (p < 0.001) more frequent injuries of the upper cervical spine (C0-C2) compared to older age groups. Patients of age group III were more likely to suffer from injuries in subaxial localizations. Neurological deficits were rarely seen in all age groups. Head injuries did represent the most common accompanying injuries (39.8%, n = 92).ConclusionsThe upper cervical spine was more frequently affected in young children. Older children more often suffered from subaxial pathologies. The majority of cervical spinal column injuries were treated conservatively. Nevertheless, 15% of the hospitalized children had to be treated surgically.

The Quality of Care of Persons With Severe Trauma In Germany During the COVID-19 Pandemic as Assessed With Data From the TraumaRegister DGU for the Year 2020.

The Quality of Care of Persons With Severe Trauma In Germany During the COVID-19 Pandemic as Assessed With Data From the TraumaRegister DGU for the Year 2020.

COVID-19 and Proximal Femur Fracture in Older Adults-A Lethal Combination? An Analysis of the Registry for Geriatric Trauma (ATR-DGU).

ObjectivesCOVID-19 can be a life-threatening illness, especially for older patients. The COVID-19 outbreak created a dramatic organizational challenge in treating infected patients requiring surgical treatment, like those suffering a proximal femur fracture, in a pandemic setting. We investigate the impact of a COVID-19 infection in patients with a proximal femur fracture not only on mortality but also on quality of life (QoL), length of stay, and discharge target.DesignRetrospective cohort analysis from July 1, 2020, to December 31, 2020. The Registry for Geriatric Trauma collected the data prospectively. Patient groups with and without COVID-19 infection were compared using linear and logistic regression models.Setting and ParticipantsRetrospective multicenter registry study including patients aged ≥70 years with proximal femur fracture requiring surgery from 107 certified Centers for Geriatric Trauma in Germany, Austria, and Switzerland.MeasuresThe occurrence and impact of COVID-19 infection in patients suffering a proximal femur fracture were measured regarding in-house mortality, length of stay, and discharge location. Moreover, QoL was measured by the validated EQ-5D-3L questionnaire.ResultsA total of 3733 patients were included in our study. Of them, 123 patients tested COVID-19 positive at admission. A COVID-19 infection resulted in a 5.95-fold higher mortality risk (odds ratio 5.95, P < .001], a length of stay prolonged by 4.21 days [regression coefficient (β) 4.21, P < .001], a reduced QoL (β −0.13, P = .001), and a change in discharge target, more likely to their home instead of another inpatient facility like a rehabilitation clinic (P = .013).Conclusions and ImplicationsThe impact of a COVID-19 infection in patients suffering a proximal femur fracture is tremendous. The infected patients presented a dramatic rise in mortality rate, were significantly less likely to be discharged to a rehabilitation facility, had a longer in-hospital stay, and a reduced QoL.

Pediatric spine trauma-Results of aGerman national multicenter study including 367 patients

In general, pediatric spinal injuries are rare. No reliable data on the epidemiology of spinal injuries in pediatric patients in Germany are available. Especially in pediatric patients, for whom the medical history, clinical examination and the performance of imaging diagnostics are difficult to obtain, all available information on aspinal injury must be taken into account. The aim of this study was to provide epidemiological data for pediatric patients with spinal trauma in Germany in order to enhance future decision-making for the diagnostics and treatment of these patients. Within the framework of a national multicenter study, data were retrospectively obtained from 6 German spine centers for 7 years between January 2010 and December 2016. In addition to the demographic data, the clinical databases were screened for specific trauma mechanisms, level of injury as well as accompanying injuries. Furthermore, diagnostic imaging and the treatment selected were also analyzed. Atotal of 367 children (female: male = 1:1.2) with a total of 610 spinal injuries were included in this study. The mean age was 12years (±3.5years). The most frequent trauma mechanisms were falls from <3m and traffic accidents. The imaging diagnostics were only rarely carried out with the child under anesthesia. Younger children (0-9 years old) suffered more injuries to the cervical spine, whereas injuries to the thoracic and lumbar spine were more frequently found in older children (>10 years old). The children frequently showed accompanying injuries to the head and the extremities. Accompanying spinal injuries mostly occurred in adjacent regions and only rarely in other regions. Around 75% of the children were treated conservatively. The results were different from the knowledge obtained from adult patients with spinal trauma and describe the special circumstances for pediatric patients with spinal trauma. Despite certain limitations these facts may help to enhance future decision-making for the diagnostics and treatment of these patients.

Early clinical care strategy for severely injured patients with abdominal trauma

The presence of abdominal injuries has amajor impact on the mortality of severely injured patients. For injuries that require surgery, laparotomy is still the gold standard for early surgical care; however, there is increasing evidence that laparoscopy may be an alternative in the early clinical care of polytrauma patients. The present registry-based study analyzed the utilization and the outcome of laparoscopy in severely injured patients with abdominal trauma in Germany. A retrospective analysis of 12,447 patients retrieved from the TraumaRegister DGU® (TR-DGU) was performed. The primary inclusion criteria were an injury severity score (ISS) ≥ 9 and an abbreviated injury scale (AIS) [abdomen] ≥ 1. The included patients were grouped according to early treatment management: (1) laparoscopy, (2) laparotomy and (3) non-operative management (NOM). Finally, group-specific patient characteristics and outcome were analyzed. The majority of patients were treated by NOM (52.4%, n = 6069), followed by laparotomy (50,6%, n = 6295) and laparoscopy (0.7%, n = 83). The majority of laparoscopies were performed in patients with an AIS [abdomen] ≤ 3 (86.7%). The ISS of the laparoscopy group was significantly lower compared to that of the laparotomy and NOM groups (ISS 23.4 vs. 34.5 vs. 28.2, respectively, p ≤ 0.001). The standardized mortality rate (SMR), defined as the ratio between observed and expected mortality, was lowest in the patients receiving laparoscopy followed by laparotomy and NOM (SMR 0.688 vs. 0.931 vs. 0.932, respectively, p-value = 0.2128) without achieving statistical significance. Despite being rarely employed the data indicate the effectiveness of laparoscopy for the early treatment of severely injured, hemodynamically stable patients with an AIS [abdomen] ≤ 3.

Comedy and Trauma in Germany and Austria after 1945: The Inner Side of Mourning by Stephanie Bird

Comedy and Trauma in Germany and Austria after 1945: The Inner Side of Mourning by Stephanie Bird

Bird, Stephanie. Comedy and Trauma in Germany and Austria after 1945. The Inner Side of Mourning

Journal Article Bird, Stephanie. Comedy and Trauma in Germany and Austria after 1945. The Inner Side of Mourning Get access Stephanie Bird. Comedy and Trauma in Germany and Austria after 1945. The Inner Side of Mourning. Cambridge: Legenda, MHRA (Germanic Literatures, 10), 2016. 228 pp. £75.00 / $99.00 / €85.00. ISBN 978–1–909662–95–7. Forum for Modern Language Studies, Volume 54, Issue 4, October 2018, Page 506, https://doi.org/10.1093/fmls/cqy048 Published: 17 October 2018

Firework-Related Eye Trauma in Germany

ABSTRACT Purpose Firework devices cause high numbers of eye trauma cases each year worldwide. These can range from mild conjunctival irritation to devastating loss of all vision or the organ itself. A systematic 10-year retrospective monocentric case analysis was the main aim of this study. Materials and Methods All firework-associated eye trauma patients treated in our clinic from 2007 to 2017 were grouped for trauma severity and analyzed for influencing factors like age, gender, laterality, final visual acuity, and ocular trauma score (OTS). Results Between 2007 and 2017, 165 eyes of 149 patients were treated due to firework-associated eye trauma at our clinic. The mean patient age was 28.5 ± 14.4, 116 patients (78%) were male, 113 (75.8%) were bystanders, 94 right and 71 left eyes were treated, and final visual acuity was 0.26 ± 0.54 logMAR. The causative device were bangers in 98 cases (59%), rockets in 54 cases (33%), and sparklers in 13 cases (8%). Patients were significantly older (p = 0.026), final visual acuity was significantly lower (p < 0.01), and OTS was significantly higher (p < 0.01) in patients suffering from major eye trauma compared to minor trauma cases. Conclusions Patients suffering from firework-associated eye trauma are mostly young, male, and bystanders. However, severe trauma is more frequent in higher age groups, leading to serious consequences. In Germany, more educational efforts and prophylaxis concerning eye trauma caused by firework devices are desirable.

Interdisciplinary treatment in geriatric traumatology from the trauma surgeons' perspective : Results of a survey in Germany

Many patients treated on trauma surgery wards are geriatric trauma patients. To improve treatment of these often multimorbid patients, various interdisciplinary treatment concepts have been established in Germany between trauma surgeons and geriatricians. The aim of this study was to evaluate the dissemination and the impact of the different orthogeriatric treatment concepts for geriatric trauma in Germany. Material and methods In March and April 2014 an electronic questionnaire for assessing the interdisciplinary treatment of geriatric trauma patients was sent to 691 medical directors of trauma surgery departments in Germany. A total of 259 (37 %) fully answered questionnaires could be analyzed. The analysis revealed that 70 % of all responding trauma surgery departments had an orthogeriatric treatment cooperation. Most of themreported having patient discharge agreements to geriatric rehabilitation facilities(59%). Geriatric counseling services were reported by 39 % while 24 % reported having regular interdisciplinary visits and orthogeriatric wards were available in 13 %. The need for orthogeriatric services was considered to be high by 79 % of the participants and benefits especially for the patients were expected. These expectations were largely fulfilled. More than 70 % of respondents planned to intensify the orthogeriatric cooperation. In this context difficulties were seen in the lack of personnel resources, especially in a lack of geriatricians. The results of this survey underline the impact and the positive experiences in orthogeriatric services. Solutions have to be found to address the emerging problem of capacity constraints.

A Psychoanalytic Grave Walk—Scenic Memory of the Shoah. On the Transgenerational Transmission of Extreme Trauma in Germany

In this article we describe a phase of a long-term psychoanalysis of a daughter of Shoah Survivors. The article is part of a research project conducted at the Sigmund Freud-Institute in Frankfurt/Main. The focus of the study is on the transmission of extreme trauma from the First to the Second Generation, with special reference to Germany. "Scenic memory of the Shoah" is presented as a concept that stresses the non-verbal, unconscious communication between the generations. The so-called "concretistic" behavior of the Second Generation, which has been described in the literature, is conceptualized here as scenic memory of the traumatic experiences during Nazi persecution, that is, a highly symbolic and metaphorical expression of the extreme trauma handed down to the patient by the parents.

Shell Shock Cinema: Weimar Culture and the Wounds of War (review)

Reviewed by: Shell Shock Cinema: Weimar Culture and the Wounds of War Barbara Hales Shell Shock Cinema: Weimar Culture and the Wounds of War. By Anton Kaes. Princeton, N.J.: Princeton University Press, 2009. Pp. 326. Cloth $29.95. ISBN 978-0691008509. Anton Kaes’s Shell Shock Cinema presents readings of Weimar film in the context of the ravages of World War I. Kaes argues that Weimar film is best understood as a means of psychologically working through the emotional turmoil of German defeat that included two million dead and four million disabled, as well as the tumultuous social and cultural changes brought on by modernity. Kaes brings his psychoanalytic analysis of trauma and mourning in the Weimar collective unconscious to readings of film protagonists from many of the period’s canonic works (Robert Wiene’s The Cabinet of Dr. Caligari [1920], F. W. Murnau’s Nosferatu, a Symphony of Horror [1922], and Fritz Lang’s Die Nibelungen [1924] and Metropolis [1927]). Rather than directly confronting the soldier’s predicament, Kaes describes the common tension of the battlefield as these characters are struggling with “unspeakable events” through incidents of crime and horror off the battlefield (3). For Kaes, postwar cinema translates “military aggression and defeat” on the battlefield into the betrayal, sacrifice, and injury of the characters in the filmic landscape (3). These character analyses draw on common postwar themes including the returning shell-shocked veteran, the experience of mourning and the burden of the dead on the living, narratives of honor in defeat, and the anxiety resulting from the tumultuous changes brought on by industrialization and modernity. Although Weimar cinema is largely a response to World War I, it depicts these tensions through the psychological landscape that plays out off the battlefield. Kaes provides valuable analyses of Weimar’s early cinema, including lesser known works such as Toward the Light (1918) and Nerves (1919). Building on the work of scholars such as Paul Lerner (Hysterical Men: War, Psychiatry, and the Politics of Trauma in Germany, 1890–1930 [2003]), Kaes investigates the medical literature of the period on neurosis, and posits that these films point to the possible treatment of psychosomatic illness. For example, Kaes argues with regard to Robert Reinert’s Nerves that just as the German population is plagued by a “collective neurasthenia,” so too is it able to empathize with the returning soldier “buffeted” by war (43). The analysis of the war neurotic is further developed in a study of The Cabinet of Dr. Caligari, in which the inmate of an insane asylum captures the medical community’s attempts to treat the war neurotic as he recounts a disjointed story about a sadistic psychiatrist and a hypnotized patient. Kaes nicely brings out the film’s irony of whether it is the asylum director or the shell-shocked patient who is truly insane. In Kaes’s analysis of Nosferatu, the ravages of war and the veteran’s neurosis are transferred to the entire society as the character Hutter, like millions of World War I soldiers, travels to the East and returns home in a neurotic state to find his town decimated by a plague. [End Page 183] Kaes analyzes the myth of heroism and loss as seen through the Nibelungen saga. As the hero Siegfried is laid out for burial like a fallen soldier, Germany is given a filmic memorial for its dead, signifying a national body and fatherland (148–49). In Nibelungen, Kriemhild’s Revenge (part two), the victim becomes the avenger, as a narrative of violence and defeat is staged in the act of total warfare. Here we have infantrymen in the trenches together with death and mourning, signifying important tropes of shell-shock cinema. In an analysis of Metropolis, Kaes focuses on the various reactions to modernity. On the narrative level, the film shows a cynicism toward an older generation that has misused technology for profit. The contrast is thus drawn between the use of technology in war, along with the alienation of industrialization, and the potentially liberating possibilities of modernity presented in the context of America (177, 182). The end of the film suggests a return to more humanistic values and a longing for...

Epidemiology and risk factors of sepsis after multiple trauma: An analysis of 29,829 patients from the Trauma Registry of the German Society for Trauma Surgery*

The objectives of this study were 1) to assess potential changes in the incidence and outcome of sepsis after multiple trauma in Germany between 1993 and 2008 and 2) to evaluate independent risk factors for posttraumatic sepsis. Retrospective analysis of a nationwide, population-based prospective database, the Trauma Registry of the German Society for Trauma Surgery. A total of 166 voluntarily participating trauma centers (levels I-III). Patients registered in the Trauma Registry of the German Society for Trauma Surgery between 1993 and 2008 with complete data sets who presented with a relevant trauma load (Injury Severity Score of ≥ 9) and were admitted to an intensive care unit (n = 29,829). None. Over the 16-yr study period, 10.2% (3,042 of 29,829) of multiply injured patients developed sepsis during their hospital course. Annual data were summarized into four subperiods: 1993-1996, 1997-2000, 2001-2004, and 2005-2008. The incidences of sepsis for the four subperiods were 14.8%, 12.5%, 9.4%, and 9.7% (p < .0001), respectively. In-hospital mortality for all trauma patients decreased for the respective subperiods (16.9%, 16.0%, 13.7%, and 11.9%; p < .0001). For the subgroup of patients with sepsis, the mortality rates were 16.2%, 21.5%, 22.0%, and 18.2% (p = .054), respectively. The following independent risk factors for posttraumatic sepsis were calculated from a multivariate logistic regression analysis: male gender, age, preexisting medical condition, Glasgow Coma Scale score of ≤ 8 at scene, Injury Severity Score, Abbreviated Injury ScaleTHORAX score of ≥ 3, number of injuries, number of red blood cell units transfused, number of operative procedures, and laparotomy. The incidence of sepsis decreased significantly over the study period; however, in this decade the incidence remained unchanged. Although overall mortality from multiple trauma has declined significantly since 1993, there has been no significant decrease of mortality in the subgroup of septic trauma patients. Thus, sepsis has remained a challenging complication after trauma during the past 2 decades. Recognition of the identified risk factors may guide early diagnostic workup and help to reduce septic complications after multiple trauma.

Trauma Care in Germany

Recent years have seen a further decline in the nationwide case fatality rate after major trauma in Germany, but it has not been clear until now whether all centers providing trauma care achieve comparable results. We have attempted to answer this question using data from the trauma registry of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU). The standardized mortality rate of each participating center was calculated on the basis of the RISC prognostic score (Revised Injury Severity Classification) and the observed case fatality rate of the center. Results were compared across centers for the years 2004 to 2007; only the centers that provided the primary treatment of at least 100 patients during this period were included in the analysis. Data from the ten highest-scoring centers, the ten lowest-scoring centers, and the ten centers in the middle of the group were compared, and differences between them were analyzed. The case fatality rate in the top ten centers was 8.7%. The corresponding rate in the bottom ten centers was approXimately twice as high, even though the injuries treated there were of comparable severity. It is evident that the fate of a trauma patient in Germany depends partly on the center in which he or she is treated. These data were drawn from a retrospective evaluation of a case registry and should be assessed in awareness of this fact.

Evaluation of Criteria for Temporary External Fixation in Risk-Adapted Damage Control Orthopedic Surgery of Femur Shaft Fractures in Multiple Trauma Patients: ???Evidence-Based Medicine??? versus ???Reality??? in the Trauma Registry of the German Trauma Society

Femur-shaft fracture treatment (FSFT) follows controversial management concepts after multiple trauma: primary-definitive osteosynthesis, secondary-definitive osteosynthesis after temporary external fixation (EF) in all patients, or individualized primary- or secondary-definitive osteosynthesis ("risk-adapted damage control orthopedics"). This study compares the concepts by analyzing literature evidence and a prospective multicenter database. A systematic literature analysis was performed. The German Trauma Society trauma registry was used to assess variables predictive of treatment concept. Contradictory results in 63 controlled trials failed to support a "generalized management strategy." In all, 1,465 FSFTs in 8,057 trauma registry patients (age 39 +/- 19.5 years; Injury Severity Score [ISS] 23.5 +/- 14.9; 17.3% mortality) were treated initially (<24 hour) by EF, nail, or plate in 47.0%, 41.1%, and 11.9%, respectively. Despite large interhospital variability, EF was more likely with increasing severity of ISS, Glasgow Coma Score, thorax trauma, base excess, coagulation abnormalities, and initial probability of death. Clinical "reality" reflects the controversies of "scientific evidence" for FSFT after multiple trauma in Germany. Although decision making is currently based on unvalidated criteria, anatomic and physiologic injury severity appears to influence the choice of management concept.

Book Review: Hysterical Men: War, Psychiatry and the Politics of Trauma in Germany, 1890-1930

Book Review: Hysterical Men: War, Psychiatry and the Politics of Trauma in Germany, 1890–1930 Get access Lutz D.H. Sauerteig Lutz D.H. Sauerteig Centre for the History of Medicine and Disease, University of Durham Search for other works by this author on: Oxford Academic Google Scholar German History, Volume 23, Issue 4, October 2005, Pages 572–573, https://doi.org/10.1177/026635540502300419 Published: 01 October 2005