Years Of Age In Germany Research Articles

Clinical and economic inpatient burden of respiratory syncytial virus (RSV) infections in children < 2 years of age in Germany, 2014-2019: a retrospective health claims analysis.

Respiratory syncytial virus (RSV) is a common cause for severe lower respiratory tract infections (LRTI) in children < 2 years of age in Germany - though little is known about the clinical and economic burden of RSV in children with and without risk factors per month of life. In a retrospective health claims analysis, we identified RSV inpatient cases between 2014 and 2019. We assessed incidence rates, mortality rate, healthcare resource utilization, associated direct costs per case and excess costs for 30, 90 and 365 days after hospital admission matched to a control group. The outcomes are reported separately for the first and second year of life (i.e., for infants and toddlers) and were stratified by month of life, preterm and risk status (i.e., presence of underlying disease: chronic respiratory or cardiac disease, immunosuppression, neurological diseases, diabetes, conditions originating in the perinatal period). RSV-attributable hospital incidence rate was higher in infants (30.25/1,000) than toddlers (14.52/1,000), highest in the first three months of life (44.21/1,000), in infants born preterm (64.76/1,000) or with any underlying disease (54.85/1,000). Mortality rate was also higher for infants (0.08/1,000) than toddlers (0.04/1,000). Mean 30-day excess costs ranged from 2,953 € for infants born full-term at no risk, hospitalized for 5 days, to 6,694 € for infants born extremely premature, hospitalized for 7 days. In Germany, the clinical and economic burden of RSV is substantial, especially in the most vulnerable population, that is, very young infants, those born premature and/or those with an underlying disease.

Sex differences in symptoms following the administration of BNT162b2 mRNA COVID-19 vaccine in children below 5 years of age in Germany (CoVacU5): a retrospective cohort study

BackgroundSex differences exist not only in the efficacy but also in adverse event rates of many vaccines. Here we compared the safety of BNT162b2 vaccine administered off-label in female and male children younger than 5 years in Germany.MethodsThis is a retrospective cohort study, in which we performed a post-hoc analysis of a dataset collected through an authentication-based survey of individuals having registered children aged 0-<5 years for vaccination against SARS-CoV-2 in six private practices and/or two lay person-initiated vaccination campaigns. We analyzed the safety profiles of the first 3 doses of 3–10 µg BNT162b2. Primary outcome was comparison in frequencies of 4 common post-vaccination symptom categories such as local, general, musculoskeletal symptoms and fever. Data were analyzed according to sex in bivariate analyses and regression models adjusting for age, weight, and dosage. Interaction between sex and BNT162b2 dosage was assessed. An active-comparator analysis was applied to compare post-vaccination symptoms after BNT162b2 versus non-SARS-CoV-2 vaccines.ResultsThe dataset for the present analysis consisted of 7801 participants including 3842 females (49%) and 3977 males (51%) with an age of 3 years (median, interquartile: 2 years). Among individuals receiving 3 µg BNT162b2, no sex differences were noted, but after a first dose of 5–10 µg BNT162b2, local injection-site symptoms were more prevalent in girls compared to boys. In logistic regression, female sex was associated with higher odds of local symptoms, odds ratio (OR) of 1.33 (95% confidence interval [CI]: 1.15–1.55, p < 0.05) and general symptoms with OR 1.21 (95% CI: 1.01–1.44, p < 0.05). Following non-BNT162b2 childhood vaccinations, female sex was associated with a lower odds of post-vaccination musculoskeletal symptoms (OR: 0.29, 95% CI: 0.11–0.82, p < 0.05). An active comparator analysis between BNT162b2 and non-SARS-CoV-2 vaccinations revealed that female sex positively influenced the association between BNT162b2 vaccine type and musculoskeletal symptoms.ConclusionsSex differences exist in post-vaccination symptoms after BNT162b2 administration even in young children. These are of importance for the conception of approval studies, for post-vaccination monitoring and for future vaccination strategies (German Clinical Trials Register ID: DRKS00028759).

EPH84 Burden of Respiratory Syncytial Virus in Children ≤ 2 Years of Age in Germany: Retrospective Analysis of Health Claims Data from 2014-2019

EPH84 Burden of Respiratory Syncytial Virus in Children ≤ 2 Years of Age in Germany: Retrospective Analysis of Health Claims Data from 2014-2019

Inpatient burden of respiratory syncytial virus in children ≤2 years of age in Germany: A retrospective analysis of nationwide hospitalization data, 2019-2022.

Respiratory syncytial virus (RSV) causes respiratory tract disease in seasonal waves, primarily in infants and young children. This study aims to quantify the number of RSV-related hospitalizations in children ≤2 years of age and to determine corresponding resource use and costs in Germany. We retrospectively analyzed population-wide hospital data from the Institute for the Hospital Remuneration System (InEK) from 2019 to 2022. RSV cases were identified using the RSV-specific 10th revision of the International Classification of Diseases (ICD-10) codes J12.1, J20.5, and J21.0. The RSV-associated proportion of all hospitalizations caused by severe acute respiratory infections (SARIs), clinical manifestations, length of stay (LOS), intensive care unit (ICU) admissions, ventilation rates, and hospitalization costs were retrieved. We identified 98,220 hospitalizations (26,052, 15,407, 31,362, and 25,399 in 2019, 2020, 2021, and 2022, respectively) with a principal RSV diagnosis in children aged ≤2 years in Germany. The majority of RSV hospitalizations (73,178) occurred in infants (<1 year), with annual incidence rates ranging from 14.9 to 28.6 per 1000 population. Fifty-eight percent of all SARI hospitalizations in this age group were attributable to RSV. In children aged ≤2 years, mean LOS was 4.5 days, 6.1% of cases were admitted to ICU, and 5.3% of cases were ventilated. Mean hospitalization costs per case ranged from €3001 to €3961 over the study period. RSV causes substantial disease burden and is a leading cause of SARI-related hospital admissions of children ≤2 years of age in Germany. Our results confirm the need to explore and evaluate strategies to prevent RSV in infants and young children.

EPH182 Inpatient Burden of Respiratory Syncytial Virus in Children ≤2 Years of Age in Germany: A Retrospective Analysis of Nationwide Hospitalization Data, 2019-2021

Respiratory syncytial virus (RSV) is a pathogen that causes respiratory tract disease, such as pneumonia, bronchitis, and bronchiolitis in seasonal waves. Infants and young children are primarily affected. However, national epidemiological RSV surveillance and resource use data are limited. This study aims to quantify the number of RSV-associated hospitalizations in children ≤2 years of age and related inpatient resource use in Germany.

Prevalence of type 1 and type 2 diabetes in children and adolescents in Germany from 2002 to 2020: A study based on electronic health record data from the DPV registry.

To provide estimates of the nationwide prevalence of type 1 diabetes (T1D) and type 2 diabetes (T2D) in individuals younger than 20 years of age in Germany from 2002 to 2020 and to identify trends. Data were obtained from the electronic health record "Diabetes Prospective Follow-up Registry (DPV)" specific to diabetes care. Prevalence was estimated based on prevalent cases at the end of each year for the years 2002, 2008, 2014, and 2020 per 100 000 persons assuming a Poisson distribution and directly age- and/or sex-standardized to the population in 2020. Individuals younger than 20 years of age with a clinical diagnosis of T1D or 10-19-year-olds with T2D were eligible for inclusion in the study. The standardized T1D prevalence per 100 000 persons was 138.9 (95% CI: 137.1; 140.6) in 2002 and 245.6 (243.1; 248.0) in 2020. The standardized T2D prevalence per 100 000 persons was 3.4 (3.1; 3.8) in 2002 and 10.8 (10.1; 11.5) in 2020. The annual percent change (APC) in prevalence declined over the three periods 2002-2008/2008-2014/2014-2020 (T1D: 6.3% [3.6%; 9.0%]/3.1% [0.7%; 5.5%]/0.5% [-1.7%; 2.85], T2D: 12.3% [5.3%; 20.8%]/4.7% [-0.6%; 10.3%]/3.0% [-1.8%; 8.0%]). From 2014 to 2020, the highest APCs were observed among 15-19-year-olds (T1D: 2.5% [1.3%; 3.6%], T2D: 3.4% [-0.5%; 7.5%]). The increase in diabetes prevalence has slowed, but medical care should be prepared for an increase in adolescents with diabetes.

POSB196 Epidemiology of Osteoporosis: Risk Factor Distribution, Osteoporosis Prevalence and Treatment Gap in the General Population ≥50 Years of Age in Germany

In Germany, over 7 million adults ≥50 years of age have osteoporosis. New risk factors for fractures were recently added to the Dachverband Osteologie guidelines.1 Recent data regarding the distribution of these risk factors in the German population is lacking. This study estimated the prevalence of these risk factors and the osteoporosis epidemiology and treatment gap in the general population ≥50 years old in Germany.

Perceptions of the Self Versus One's Own Social Group: (Mis)conceptions of Older Women's Interest in and Competence With Technology.

Our analysis investigates how gender, age, and technology stereotypes relate to one another and how this relationship reinforces or questions stereotypes. Based on intersectionality, stereotyping, and sense-making literature, our study explores how older women perceive their own interest in and competence with technology and that of their peers. We conducted qualitative in-depth interviews with women between 65 and 75 years of age in Germany. Our findings indicate that their evaluations of others are age and gender stereotyped. When explaining their own interest in technology, they refer to their individual preferences, and for explaining their own competence of technology, they refer to social categories. Plus, assumptions of technology usage seem to be gendered. On the basis of our findings, we discuss the need for taking social categories into account when evaluating inclusiveness with new technologies.

Mental health care utilization in three-to-six-year-old-children: which behaviours predict parents and daycare teachers’ perceived need for action?

ABSTRACT Unmet mental health needs are common in young children. Recent research on mental health care utilization has focussed mainly on parental perspectives. This study seeks to determine which types of behaviours exhibited by children predict the perceived need for action among both parents and daycare teachers. Parents and daycare teachers reported on problematic behaviours and psychosocial competences among 255 children three to six years of age in Germany. Participants were additionally asked if they perceived a need for action due to the child's behaviour. The results indicate that for parents, Emotional Dysregulation, Speech Problems, and Health and Developmental Problems had predictive power. For daycare teachers, Aggressive Behaviour, Health and Developmental Problems, and the older Age of children predicted the perceived need for action, whereas Social Competence decreased the probability for perceived need. Sensitivity towards the detection of emotional disorders should be increased to improve mental health care utilization.

Hospitalization in Pediatric Diabetes: A Nationwide Analysis of all Admission Causes for Germany in 2015.

Regarding pediatric diabetes, hospital admission for acute complications of type 1 diabetes (T1D) has often been investigated, but little is known about other causes of hospitalization. This study aimed to explore the total burden of hospitalization in individuals with diabetes<20 years of age in Germany. Using the German Diagnosis-Related Groups data for 2015, we examined the frequencies of hospitalization with diabetes (20 251 inpatient cases), stratified by diabetes type [T1D, type 2 diabetes (T2D), other specified diabetes types (T3D), and unclear diabetes], and without diabetes (1 269 631 inpatient cases). Using estimates of the population at risk with T1D, T2D, and without diabetes, we evaluated hospitalization rates (per patient-year) by Poisson regression. For T1D, T2D, and T3D, we investigated the most frequent diagnoses and the median length of stay. Most analyses were stratified by sex, age-group and east/west residence. Children and adolescents with diabetes had a 6 to 9 times higher hospitalization risk than peers without diabetes (hospitalization rate 0.09). The hospitalization rate was higher for T2D compared with T1D (0.84 vs. 0.53, P<0.001). In T2D, two-third of inpatient cases were not directly related to diabetes, and stay was shorter compared with T1D and T3D (3 vs. 4 and 5 days, respectively). In T1D, hospitalization was more frequent among girls than boys (0.58 vs. 0.49, P<0.001), and mostly due to "diabetes without complications" (65.7%). Hospitalization tended to be more frequent and longer in the youngest patients, and in those with east residence. Hospitalization rate in pediatric diabetes in Germany remained high, especially for T2D patients, girls with T1D, and young children.

Effectiveness of Pneumococcal Conjugate Vaccines (PCV7 and PCV13) against Invasive Pneumococcal Disease among Children under Two Years of Age in Germany.

BackgroundIn this study we calculate the effectiveness of pneumococcal conjugate vaccines (PCV) against invasive pneumococcal disease (IPD) among children under the age of two years using the indirect cohort method. We also discuss the timeliness of vaccination and the residual cases of vaccine type IPD.Methods and FindingsFrom July 2006 until June 2015, 921 IPD cases were reported and for 618 children (67.1%), the vaccination status at the time of infection could be accurately determined. Of these, 379 (61.3%) were vaccinated and 239 (38.7%) were not vaccinated. The adjusted vaccine effectiveness (VE) of PCV7 for all included serotypes + 6A was 80% (95% CI: 63–89) for at least one dose, 97% (89–100) after three primary doses (post primary) and 95% (57–100) post booster. The adjusted overall VE of PCV13 was 86% (74–93) for at least one dose, 85% (62–94) post primary and 91% (61–99) post booster. For the additional serotypes included in PCV13, the adjusted VE was 82% (66–91), 80% (46–93) and 90% (54–98) respectively. The serotype specific VE for at least one dose was high for serotypes 1 (83%; 15–97), 3 (74%; 2–93), 7F (84%; 18–98) and 19A (77%; 47–90). Only 39.5% of children with IPD obtained their first dose of PCV7 according to schedule (2nd dose: 32.9%, 3rd dose: 22.0%, booster dose: 63.6%). For children vaccinated with PCV13 values were slightly better: 43.8%, 33.5%, 26.3% and 74.3% respectively. Among 90 residual cases with PCV7 serotypes, 73 (81.1%) were in unvaccinated children, and 15 (16.7%) in children who had not obtained the number of doses recommended for their age, and only two (2.2%) in children vaccinated according to age. Of 82 cases with PCV13 serotypes occurring after the switch from PCV7 to PCV13, 56 (68.3%) were not vaccinated, 22 (26.8%) were incompletely vaccinated, and four (4.9%) were vaccinated according to age.ConclusionsOur data show a high effectiveness of pneumococcal conjugate vaccination in Germany. However, the administration of vaccine doses among children with IPD is often delayed, resulting in many vaccine type cases in non- or incompletely-vaccinated children. Whether the recently-implemented change to a 2+1 schedule will improve the timeliness of vaccination should be subject to careful monitoring.

Rate of deaths due to child abuse and neglect in children 0-3 years of age in Germany.

In recent years, increasing attention has been paid to the issue of (fatal) child abuse and neglect, largely due to the media attention garnered by some headline-grabbing cases. If media statements are to be believed, such cases may be an increasing phenomenon. With these published accounts in mind, publicly available statistics should be analysed with respect to the question of whether reliable statements can be formulated based on these figures. It is hypothesised that certain data, e.g., the Innocenti report published by UNICEF in 2003, may be based on unreliable data sources. For this reason, the generation of such data, and the reliability of the data itself, should also be discussed. Our focus was on publicly available German mortality and police crime statistics (Polizeiliche Kriminalstatistik). These data were classified with respect to child age, data origin, and cause of death (murder, culpable homicide, etc.). In our opinion, the available data could not be considered in formulating reliable scientific statements about fatal child abuse and neglect, given the lack of detail and the flawed nature of the basic data. Increasing the number of autopsies of children 0-3 years of age should be considered as a means to ensure the capture of valid, practical, and reliable data. This could bring about some enlightenment and assist in the development of preemptive strategies to decrease the incidence of (fatal) child abuse and neglect.

Treatment with the SQ-Standardised Grass Allergy Immunotherapy Tablet is well Tolerated in Children, Adolescents and Adults in Real Life Application-A Non-Interventional Observational Study

Background: Efficacy and safety of the SQ-standardised grass allergy immunotherapy tablet (GRAZAX®) has been reported in a large number of randomised, controlled clinical trials in children and adults performed in Europe and the US. GRAZAX® became available for routine treatment in children from 5 years of age in Germany and Austria in 2008.To examine the safety and tolerability of GRAZAX® in patients that were less highly selected as in the controlled trials we performed an open label, uncontrolled, non-interventional study in children and adults who were routinely treated in allergists´ offices. Materials and methods: Patients with allergic rhinoconjunctivitis with or without asthma were treated with GRAZAX® and observed for 3-4 visits every 3 months with the last visit after the first grass pollen season. Adverse seasons before and during therapy. Results: Treatment was documented in 1,761 patients (797 75% in 89.8% of patients, >95% of patients and physicians were satisfied with treatment. Conclusion: The results of our study confirm the safety and tolerability profile observed in controlled clinical trials with GRAZAX®. Treatment satisfaction during routine application was rated high and was combined with a high compliance.

Prediction and prevention of schizophrenia: what has been achieved and where to go next?

In modern medicine, vigorous efforts are being made in the prediction and prevention of diseases. Mental disorders are suitable candidates for the application of this program. The currently known neurobiological and psychosocial risk indicators for schizophrenia do not have a predictive power sufficient for selective prevention in asymptomatic patients at risk. However, once predictive basic and later pre-psychotic high risk symptoms of psychosis develop into the five-year initial prodrome, the impending outbreak of the disease can be predicted with high accuracy. Research findings suggest a differential strategy of indicated prevention with cognitive behavioral therapy in early initial prodromal states and low dosage atypical antipsychotics in late initial prodromal states. The most important future tasks are the improvement of the predictive power by risk enrichment and stratification, as well as the confirmation of the existing and the development of new prevention strategies, with a stronger focus on the etiology of the disorder. In addition, the prediction and prevention approach would benefit from the inclusion of risk symptoms in the DSM-5 criteria.

Varicella vaccination coverage of children under two years of age in Germany

BackgroundSince July 2004, routine varicella vaccination is recommended by the German Standing Vaccination Committee in Germany. Health Insurance Funds started to cover vaccination costs at different time points between 2004 and 2006 in the Federal States. Nationwide representative data on vaccination coverage against varicella of children under two years of age are not available. We aimed to determine varicella vaccination coverage in statutory health insured children under two years of age in twelve German Federal States using data from associations of statutory health insurance physicians (ASHIPs), in order to investigate the acceptance of the recommended routine varicella vaccination programme.MethodsWe analysed data on varicella vaccination from 13 of 17 ASHIPs of the years 2004 to 2007. The study population consisted of all statutory health insured children under two years of age born in 2004 (cohort 2004) or 2005 (cohort 2005) in one of the studied regions. Vaccination coverage was determined by the number of children vaccinated under 2 years of age within the study population.ResultsVaricella vaccination coverage of children under two years of age with either one dose of the monovalent varicella vaccine or two doses of the measles, mumps, rubella, and varicella vaccine increased from 34% (cohort 2004) to 51% (cohort 2005) in the studied regions (p < 0.001). More than half of the vaccinated children of cohort 2004 and two third of cohort 2005 were immunised at the recommended age 11 to 14 months. The level of vaccination coverage of cohort 2004 was significantly associated with the delay in introduction of cost coverage since the recommendation of varicella vaccination (p < 0.001).ConclusionsOur study shows increasing varicella vaccination coverage of young children, indicating a growing acceptance of the routine varicella vaccination programme by the parents and physicians. We recommend further monitoring of vaccination coverage using data from ASHIPs to investigate acceptance of the routine vaccination programmes over time.

Graph Literacy

Visual displays are often used to communicate important medical information to patients. However, even the simplest graphs are not understood by everyone. To develop and test a scale to measure health-related graph literacy and investigate the level of graph literacy in the United States and Germany. Experimental and questionnaire studies. Setting. Computerized studies in the laboratory and on probabilistic national samples in the United States and Germany. Participants. Nationally representative samples of people 25 to 69 years of age in Germany (n = 495) and the United States (n = 492). Laboratory pretest on 60 younger and 60 older people. Measurements. Psychometric properties of the scale (i.e., reliability, validity, discriminability) and level of graph literacy in the two countries. The new graph literacy scale predicted which patients can benefit from visual aids and had promising measurement properties. Participants in both countries completed approximately 9 of 13 items correctly (in Germany, x¯ = 9.4, s = 2.6; in the United States, x¯ = 9.3, s = 2.9). Approximately one third of the population in both countries had both low graph literacy and low numeracy skills. Limitations. The authors focused on basic graph literacy only. They used a computerized scale; comparability with paper-and-pencil versions should be checked. The new graph literacy scale seems to be a suitable tool for assessing whether patients understand common graphical formats and shows that not everyone profits from standard visual displays. Research is needed on communication formats that can overcome the barriers of both low numeracy and graph literacy.

Intussusception-associated hospitalisations in Southern Germany

The primary objective of this epidemiological surveillance study was to estimate the incidence of intussusception (IS) associated with hospitalisation in children <1, <2 and <17 years of age in Germany. We analysed primary and secondary ICD-10 discharge diagnoses for IS (K56.1) and procedure codes for desinvagination from 28 paediatric hospitals in Bavaria, Germany, to identify children hospitalised in 2005 or 2006 due to IS. A total of 518 children with an ICD-10 code for IS were reported: 123 (23.7%) of the children were <1 year of age, 267 (51.5%) were 1-3 years old and 128 (24.8%) older than 3 years of age. IS was the primary ICD-10 diagnosis in 382 (74%) children, including 231 (60%) children with a procedure code for desinvagination. In 136 (26%) children, IS was reported as a secondary ICD-10 diagnosis, including 38 (28%) with a desinvagination procedure code. The yearly incidence of IS in children <1 year of age was estimated as 72/100,000 overall and as 43/100,000 for those with an additional procedural code for desinvagination. Patients solely with an ICD-10 code for IS are often suspected cases, based on clinical presentation. The combination of the ICD-10 code for IS and a procedure code for desinvagination provides a more specific and clinically relevant case definition, thereby offering a useful tool for long-term surveillance of the incidence of IS.

Anaphylactic reactions in children – a questionnaire‐based survey in Germany

Severe anaphylactic reactions are medical emergencies requiring immediate recognition and treatment. Despite this, little is known on their clinical features, especially in infants and children. To evaluate trigger factors, patterns of clinical reaction, site of occurrence and treatment modalities of reported reaction in infants and children below 12 years of age in Germany. Paediatricians throughout Germany were asked by questionnaire to report accidental anaphylactic reactions over the previous 12 months. Severity of reported reactions was classified in grades I-IV according to reported symptoms. Hundred and three cases of anaphylaxis were evaluated. Median age was 5 years, 58% were boys. Site of occurrence was the child's home in the majority of cases (58%). Foods were the most common causative allergen (57%), followed by insect stings (13%) and immunotherapy (SIT) (12%); in 8% anaphylactic agent was unknown. Among foods, peanuts and tree nuts were the most frequent allergens (20% of food allergens in each case). Severe reactions with cardiovascular involvement occurred in 24% of cases. No fatal reaction was observed. Recurrent episodes of anaphylaxis were reported in 27% of cases, half of these caused by the same allergen again. For treatment, 20% of children received adrenaline, in 8% of cases intravenously. Thirty-six per cent of patients with grade-IV reactions received adrenaline, 24% intravenously. In 17% of all children an adrenaline self-injector was prescribed after the episode. Our data: (i) shows an uncertainty of physicians in diagnosing anaphylaxis, (ii) reveals remarkable under-treatment of the majority of children with anaphylaxis, (iii) reflects the need for guidelines and training for physicians in managing children with anaphylaxis and (iv) should encourage the development of self-management programmes for patients and families.

Temporal, seasonal, and geographical incidence patterns of Type I diabetes mellitus in children under 5 years of age in Germany

To estimate the national incidence of Type I (insulin-dependent) diabetes mellitus in children under 5 years of age in Germany and to analyse temporal, seasonal, and geographical patterns of the diabetes incidence. During 1993-1995 newly diagnosed subjects were prospectively registered by the hospital-based 'German Paediatric Surveillance Unit' with monthly inquiries in all paediatric departments in Germany. Level of ascertainment was estimated by capture-recapture-analysis using two independent regional data sources. During 1993-1995 the national incidence was 8.10 (95 %-CI: 7.61, 8.61) per 100 000 person-years, ranging in-between lower rates in west European countries and higher rates in northern Europe. Degree of ascertainment was about 85 %. Male to female ratio was 1.11 (95 %-CI: 0.98, 1.25). Compared with results of previous regional studies in the east and the south-west of Germany a 3- and 1.3-fold incidence increase was observed, respectively. Multivariate Poisson regression analysis showed season, geographical region, and interactions of age at onset with sex and calendar year to be independent significant predictors of the incidence. Incidence variation by age was different between boys and girls. A significant incidence increase by calendar year was found in 3- and 4-year-old children only. In summer and fall the incidence was higher than in winter and springtime, in the northern parts of the country higher than in the southern parts. This study reports first national incidence data of Type I diabetes in children under the age of 5 years in Germany. Observed marked temporal, seasonal, and geographical incidence variations strongly support the causal role of environmental factors in disease aetiology.

The epidemiology of multiple trauma

Trauma is the leading cause of death for people up to 40 years of age in Germany. Most of the patients were injured in traffic accidents where special injury patterns could be detected: head injuries in bicycle and pedestrian accidents, lower extremity injuries in motorcycle accidents, and chest and pelvis injuries in car accidents. After falls from a height, the most common injuries were fractures of the thoracic and lumbar spine. The treatment of polytrauma patients requires high health care resources and demands sophisticated medical support. It is estimated that every trauma patient costs daily approximately DM 4,700. It is not only the acute medical care that burdens our social system, but also the long period of rehabilitation and reintegration. The number of preventable trauma deaths can be significantly reduced in special trauma centers, and the high costs could be damaging for smaller hospitals. A plea is made for more preventive measures and legislative changes to reduce the number of traffic accidents. The medical care of trauma patients should be in special trauma centers.