1
|
Lopes MCBT, Bustillo RA, Whitaker IY. In-hospital complications after trauma due to road traffic accidents. Eur J Trauma Emerg Surg 2023; 49:1855-1862. [PMID: 37017763 DOI: 10.1007/s00068-023-02264-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/28/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE The study aimed to verify the association between in-hospital complications and characterization and clinical variables including hospital care and trauma severity. METHODS This analysis with the prospective cohort data was conducted at a municipal hospital in São Paulo, Brazil, and included participants aged 14 years or older, with traumatic injuries from traffic accidents. Data was collected from January 2015 to July 2016 and included demographics variables, type of traumatic event, clinical parameters, length of stay in the Emergency department and in the Intensive Care Unit, length of hospital stay, survival probability, trauma severity and mortality. RESULTS Of the 327 patients, 25.1% had in-hospital complications and their occurrence was statistically associated with higher mean age, run-overs and higher trauma severity. The length of stay in the emergency room, hospital stay, ICU stay, percentage of deaths, and hospital readmission were higher in patients with complications. The number of complications was correlated with trauma severity, ICU stay, and mortality. CONCLUSION Complications were associated with older age, run-overs, greater trauma severity, length of stay and readmission after hospital discharge.
Collapse
Affiliation(s)
| | | | - Iveth Yamaguchi Whitaker
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Rua Napoleão de Barros, 754, Sao Paulo, SP, CEP: 04024-002, Brazil
| |
Collapse
|
2
|
Maegele M, Aletti F, Efron PA, Relja B, Orfanos SE. NEW INSIGHTS INTO THE PATHOPHYSIOLOGY OF TRAUMA AND HEMORRHAGE. Shock 2023; 59:6-9. [PMID: 36867756 DOI: 10.1097/shk.0000000000001954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
ABSTRACT Circulatory shock from trauma and hemorrhage remains a clinical challenge with mortality still high within the first hours after impact. It represents a complex disease involving the impairment of a number of physiological systems and organs and the interaction of different pathological mechanisms. Multiple external and patient-specific factors may further modulate and complicate the clinical course. Recently, novel targets and models with complex multiscale interaction of data from different sources have been identified which offer new windows of opportunity. Future works needs to consider patient-specific conditions and outcomes to mount shock research onto the next higher level of precision and personalized medicine.
Collapse
Affiliation(s)
- Marc Maegele
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center, Institute for Research in Operative Medicine, University Witten-Herdecke, Cologne, Germany
| | - Federico Aletti
- Instituto de Ciência e Tecnologia, Universidade Federal de São Paulo, São José dos Campos, Brazil
| | - Philip A Efron
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Laboratory of Inflammation Biology and Surgical Science, UF Health Critical Care Organization, Florida
| | - Borna Relja
- Department of Radiology and Nuclear Medicine, Experimental Radiology, Otto-von-Guericke University, Magdeburg, Germany
| | - Stylianos E Orfanos
- 1st Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| |
Collapse
|
3
|
Wasfie T, White H, Casey T, Hella J, Barber K, Shapiro B. The Impact of Alcohol Level on Elderly Trauma Patients Presenting to the Emergency Department. Am Surg 2023:31348231157909. [PMID: 36803071 DOI: 10.1177/00031348231157909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Alcohol is a chemical substance that alters cognitive ability and judgment. We looked at our elderly patients that arrived at the Emergency Department (ED) following trauma and evaluated the factors that may influence outcome. Retrospective analysis of patients seen in ED with positive alcohol was performed. Statistical analysis was performed to identify the confounding factors for outcomes. Records collected on 449 patients with a mean age of 42 ± 16.9 years. There were 314 males (70%) and 135 females (30%). Average GCS was 14, and average ISS was 7.0. Mean alcohol level was 176 g/dL ± 91.6. There were 48 patients aged 65 years and older with significantly higher hospital stay (4.1 and 2.8 days, P = .019) and ICU stay (2.4 and 1.2 days, P = .003) compared to the 64 and younger group. Elderly trauma patients had a higher mortality and length of stay due to a higher number of comorbidities.
Collapse
Affiliation(s)
- Tarik Wasfie
- Department of Surgery, 3577Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Hutton White
- Department of Surgery, 3577Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Taylor Casey
- 3078Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
| | - Jennifer Hella
- Department of Academic Research, 3577Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Kimberly Barber
- Department of Academic Research, 3577Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Brian Shapiro
- Department of Surgery, 3577Ascension Genesys Hospital, Grand Blanc, MI, USA
| |
Collapse
|
4
|
Is ROTEM Diagnostic in Trauma Care Associated with Lower Mortality Rates in Bleeding Patients?—A Retrospective Analysis of 7461 Patients Derived from the TraumaRegister DGU®. J Clin Med 2022; 11:jcm11206150. [PMID: 36294471 PMCID: PMC9605144 DOI: 10.3390/jcm11206150] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/08/2022] [Accepted: 10/14/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction: Death from uncontrolled trauma haemorrhage and subsequent trauma-induced coagulopathy (TIC) is potentially preventable. Point-of-care devices such as rotational thromboelastometry (ROTEM®) are advocated to detect haemostatic derangements more rapidly than conventional laboratory diagnostics. Regarding reductions in RBC transfusion, the use of ROTEM has been described as being efficient and associated with positive outcomes in several studies. Objective: The effect of ROTEM use was assessed on three different outcome variables: (i) administration of haemostatics, (ii) rate of RBC transfusions and (iii) mortality in severely injured patients. Methods and Material: A retrospective analysis of a large data set of severely injured patients collected into the TraumaRegister DGU® between 2009 and 2016 was conducted. The data of 7461 patients corresponded to the inclusion criteria and were subdivided into ROTEM-using and ROTEM-non-using groups. Both groups were analysed regarding (i) administration of haemostatics, (ii) rate of RBC transfusions and (iii) mortality. Results: A lower mortality rate in ROTEM-using groups was observed (p = 0.043). Furthermore, more patients received haemostatic medication when ROTEM was used. In ROTEM-using groups, there was a statistically relevant higher application of massive transfusion. Conclusions: In this retrospective study, the use of ROTEM was associated with reduced mortality and an increased application of haemostatics and RBC transfusions. Prospective evidence is needed for further evidence-based recommendations.
Collapse
|
5
|
Brown OS, Smith TO, Gaukroger AJ, Tsinaslanidis P, Hing CB. Increased proportion of alcohol-related trauma in a South London major trauma centre during lockdown: A cohort study. Chin J Traumatol 2022; 25:277-282. [PMID: 35039216 PMCID: PMC9458995 DOI: 10.1016/j.cjtee.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 11/01/2021] [Accepted: 11/22/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Alcohol has been associated with 10%-35% trauma admissions and 40% trauma-related deaths globally. In response to the COVID-19 pandemic, the United Kingdom entered a state of "lockdown" on March 23, 2020. Restrictions were most significantly eased on June 1, 2020, when shops and schools re-opened. The purpose of this study was to quantify the effect of lockdown on alcohol-related trauma admissions. METHODS All adult patients admitted as "trauma calls" to a London major trauma centre during April 2018 and April 2019 (pre-lockdown, n = 316), and 1st April-31st May 2020 (lockdown, n = 191) had electronic patient records analysed retrospectively. Patients' blood alcohol level and records of intoxication were used to identify alcohol-related trauma. Trauma admissions from pre-lockdown and lockdown cohorts were compared using multiple regression analyses. RESULTS Alcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown (lockdown 60/191 (31.4%), vs. pre-lockdown 62/316 (19.6%); (odds ratio (OR): 0.83, 95% CI: 0.38-1.28, p < 0.001). Lockdown was also associated with increased weekend admissions of trauma (lockdown 125/191 weekend (65.5%) vs. pre-lockdown 179/316 (56.7%); OR: 0.40, 95% CI: 0.79 to -0.02, p = 0.041). No significant difference existed in the age, gender, or mechanism between pre-lockdown and lockdown cohorts (p > 0.05). CONCLUSIONS The United Kingdom lockdown was independently associated with an increased proportion of alcohol-related trauma. Trauma admissions were increased during the weekend when staffing levels are reduced. With the possibility of further global "waves" of COVID-19, the long-term repercussions of dangerous alcohol-related behaviour to public health must be addressed.
Collapse
Affiliation(s)
- Oliver S. Brown
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom,Corresponding author.
| | - Toby O. Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Andrew J. Gaukroger
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Caroline B. Hing
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
6
|
Leiblein M, Sturm R, Franz N, Mühlenfeld N, Relja B, Lefering R, Marzi I, Wagner N. The Influence of Alcohol on the Base Excess Parameter in Trauma Patients. Shock 2021; 56:727-732. [PMID: 33756506 DOI: 10.1097/shk.0000000000001782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The base excess (BE) parameter can be used as an indicator of mortality. However, study results on the influence of alcohol on the validity of BE as a prognostic parameter in alcohol-intoxicated patients are controversial. Thus, this study examined the hypothesis: An increasing blood alcohol level reduces the prognostic value of the BE parameter on mortality. PATIENTS AND METHODS In a retrospective analysis of the multicenter database of the TraumaRegister DGU, patients from 2015 to 2017 were grouped depending on their blood alcohol level (BAL) into a BAL+ and BAL- group. The hypothesis was verified using logistic regression with an assumed significance level of 1% (P < 0.01). RESULTS Eleven thousand eight hundred eighty-nine patients were included; 9,472 patients in the BAL- group and 2,417 patients in the BAL+ group. Analysis of the BE showed lower values in the BAL+ group (BAL-: -1.8 ± 4.4 mmol/L vs. BAL+: -3.4 ± 4.6 mmol/L). There is a trend toward lower BE levels when BAL increases. Assuming a linear relationship, then BE decreases by 0.6 points per mille alcohol (95% CI: 0.5-0.7; P < 0.001). The mortality rate was significantly lower in the BAL+ group (BAL-: 11.1% vs. BAL+: 7.9%). The logistic regression analysis showed a significant beneficial influence of BAL+ on the mortality rate (OR 0.706, 95% CI 0.530-0.941, P = 0.018). To analyze whether a low BE (≤-6 mmol/L) has different prognostic effects in patients with and without alcohol, logistic regression models were calculated. However, the effect of BE ≤ -6 mmol/L was similar in both models (regression coefficients in BAL-/+ patients: 0.379/0.393). CONCLUSIONS The data demonstrate an existing influence of alcohol on the BE parameter; however, this does not negatively affect the BE as a prognostic parameter at a threshold of ≤ -6 mmol/L.
Collapse
Affiliation(s)
- Maximilian Leiblein
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Ramona Sturm
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Niklas Franz
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Nils Mühlenfeld
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Borna Relja
- Experimental Radiology, Department of Radiology and Nuclear Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Nils Wagner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| |
Collapse
|
7
|
Oviedo-Trespalacios O, Çelik AK, Marti-Belda A, Włodarczyk A, Demant D, Nguyen-Phuoc DQ, Rubie E, Oktay E, Argandar GD, Rod JE, Natividade JC, Park J, Bastos JT, Martínez-Buelvas L, Pereira da Silva MDF, Velindro M, Sucha M, Orozco-Fontalvo M, Barboza-Palomino M, Yuan Q, Mendes R, Rusli R, Ramezani S, Useche SA, de Aquino SD, Tsubakita T, Volkodav T, Rinne T, Enea V, Wang Y, King M. Alcohol-impaired Walking in 16 Countries: A Theory-Based Investigation. ACCIDENT; ANALYSIS AND PREVENTION 2021; 159:106212. [PMID: 34098429 DOI: 10.1016/j.aap.2021.106212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
Alcohol is a global risk factor for road trauma. Although drink driving has received most of the scholarly attention, there is growing evidence of the risks of alcohol-impaired walking. Alcohol-impaired pedestrians are over-represented in fatal crashes compared to non-impaired pedestrians. Additionally, empirical evidence shows that alcohol intoxication impairs road-crossing judgements. Besides some limited early research, much is unknown about the global prevalence and determinants of alcohol-impaired walking. Understanding alcohol-impaired walking will support health promotion initiatives and injury prevention. The present investigation has three aims: (1) compare the prevalence of alcohol-impaired walking across countries; (2) identify international groups of pedestrians based on psychosocial factors (i.e., Theory of Planned Behaviour (TPB) and perceptions of risk); and (3) investigate how segments of pedestrians form their intention for alcohol-impaired walking using the extended TPB (i.e. subjective norm, attitudes, perceived control, and perceived risk). A cross-sectional design was applied. The target behaviour question was "have you been a pedestrian when your thinking or physical ability (balance/strength) is affected by alcohol?" to ensure comparability across countries. Cluster analysis based on the extended TPB was used to identify groups of countries. Finally, regressions were used to predict pedestrians' intentions per group. A total of 6,166 respondents (Age M(SD) = 29.4 (14.2); Males = 39.2%) completed the questionnaire, ranging from 12.6% from Russia to 2.2% from Finland. The proportion of participants who reported never engaging in alcohol-impaired walking in the last three months ranged from 30.1% (Spain) to 83.1% (Turkey). Four groups of countries were identified: group-1 (Czech Republic, Spain, and Australia), group-2 (Russia and Finland), group-3 (Japan), and group-4 (final ten countries including Colombia, China, and Romania). Pedestrian intentions to engage in alcohol- impaired walking are predicted by perceptions of risk and TPB-psychosocial factors in group-1 and group-4. Favourable TPB-beliefs and low perceived risk increased alcohol-impaired walking intentions. Conversely, subjective norms were not significant in group-2 and only perceived risk predicted intention in group-3. The willingness of pedestrians to walk when alcohol-impaired differs significantly across the countries in this study. Perceived risk was the only common predictor among the 16 countries.
Collapse
Affiliation(s)
| | | | | | | | - Daniel Demant
- Queensland University of Technology (QUT), Australia; University of Technology Sydney, Australia
| | - Duy Q Nguyen-Phuoc
- The University of Danang - University of Science and Technology, Vietnam
| | | | | | | | - J E Rod
- Queensland University of Technology (QUT), Australia
| | | | | | | | | | | | | | | | | | | | | | - Rui Mendes
- Polytechnic Institute of Coimbra, Portugal
| | | | | | | | | | | | | | | | | | | | - Mark King
- Queensland University of Technology (QUT), Australia
| |
Collapse
|
8
|
Yeates EO, Grigorian A, Schellenberg M, Owattanapanich N, Barmparas G, Margulies D, Juillard C, Garber K, Cryer H, Tillou A, Burruss S, Figueras RA, Mladenov G, Brenner M, Firek C, Costantini T, Santorelli J, Curry T, Wintz D, Biffl WL, Schaffer KB, Duncan TK, Barbaro C, Diaz G, Johnson A, Chinn J, Naaseh A, Leung A, Grabar C, Nahmias J. COVID-19 in trauma: a propensity-matched analysis of COVID and non-COVID trauma patients. Eur J Trauma Emerg Surg 2021; 47:1335-1342. [PMID: 34031703 PMCID: PMC8143988 DOI: 10.1007/s00068-021-01699-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/13/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE There is mounting evidence that surgical patients with COVID-19 have higher morbidity and mortality than patients without COVID-19. Infection is prevalent amongst the trauma population, but any effect of COVID-19 on trauma patients is unknown. We aimed to evaluate the effect of COVID-19 on a trauma population, hypothesizing increased mortality and pulmonary complications for COVID-19-positive (COVID) trauma patients compared to propensity-matched COVID-19-negative (non-COVID) patients. METHODS A retrospective analysis of trauma patients presenting to 11 Level-I and II trauma centers in California between 1/1/2019-6/30/2019 and 1/1/2020-6/30/2020 was performed. A 1:2 propensity score model was used to match COVID to non-COVID trauma patients using age, blunt/penetrating mechanism, injury severity score, Glasgow Coma Scale score, systolic blood pressure, respiratory rate, and heart rate. Outcomes were compared between the two groups. RESULTS A total of 20,448 trauma patients were identified during the study period. 53 COVID trauma patients were matched with 106 non-COVID trauma patients. COVID patients had higher rates of mortality (9.4% vs 1.9%, p = 0.029) and pneumonia (7.5% vs. 0.0%, p = 0.011), as well as a longer mean length of stay (LOS) (7.47 vs 3.28 days, p < 0.001) and intensive care unit LOS (1.40 vs 0.80 days, p = 0.008), compared to non-COVID patients. CONCLUSION This multicenter retrospective study found increased rates of mortality and pneumonia, as well as a longer LOS, for COVID trauma patients compared to a propensity-matched cohort of non-COVID patients. Further studies are warranted to validate these findings and to elucidate the underlying pathways responsible for higher mortality in COVID trauma patients.
Collapse
Affiliation(s)
- Eric O. Yeates
- Department of Surgery, University of California, Irvine (UCI), 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| | - Areg Grigorian
- Department of Surgery, University of California, Irvine (UCI), 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
- Department of Surgery, University of Southern California (USC), Los Angeles, CA USA
| | - Morgan Schellenberg
- Department of Surgery, University of Southern California (USC), Los Angeles, CA USA
| | | | - Galinos Barmparas
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Daniel Margulies
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Catherine Juillard
- Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA USA
| | - Kent Garber
- Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA USA
| | - Henry Cryer
- Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA USA
| | - Areti Tillou
- Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA USA
| | - Sigrid Burruss
- Department of Surgery, Loma Linda University, Loma Linda, CA USA
| | | | - Georgi Mladenov
- Department of Surgery, Loma Linda University, Loma Linda, CA USA
| | - Megan Brenner
- Department of Surgery, University of California, Riverside/Riverside University Health System, Moreno Valley, CA USA
| | - Christopher Firek
- Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Riverside University Health System, Moreno Valley, CA USA
| | - Todd Costantini
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA USA
| | - Jarrett Santorelli
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA USA
| | - Terry Curry
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA USA
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA USA
| | - Walter L. Biffl
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA USA
| | - Kathryn B. Schaffer
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA USA
| | - Thomas K. Duncan
- Department of Surgery, Ventura County Medical Center, Ventura, CA USA
| | - Casey Barbaro
- Department of Surgery, Ventura County Medical Center, Ventura, CA USA
| | - Graal Diaz
- Department of Surgery, Ventura County Medical Center, Ventura, CA USA
| | - Arianne Johnson
- Santa Barbara Cottage Hospital, Cottage Health Research Institute, Santa Barbara, CA USA
| | - Justine Chinn
- Department of Surgery, University of California, Irvine (UCI), 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| | - Ariana Naaseh
- Department of Surgery, University of California, Irvine (UCI), 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| | - Amanda Leung
- Department of Surgery, University of California, Irvine (UCI), 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| | - Christina Grabar
- Department of Surgery, University of California, Irvine (UCI), 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| | - Jeffry Nahmias
- Department of Surgery, University of California, Irvine (UCI), 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| |
Collapse
|
9
|
Lustenberger T, Lefering R. Focus on "The German TraumaRegister DGU ® (TR-DGU)". Eur J Trauma Emerg Surg 2020; 46:447-448. [PMID: 32514734 PMCID: PMC7280174 DOI: 10.1007/s00068-020-01394-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Thomas Lustenberger
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.
| | | |
Collapse
|