[Trauma and accident documentation in Germany compared with elsewhere in Europe]

[Unintentional injuries in the German adult population. Results of the "German Health Update" survey 2010]

In Germany, more than 20,000 people were killed in accidents and 8.7 million people suffered nonfatal unintentional injuries (UI) in 2011. This report gives an overview of the occurrence of nonfatal UI in the German adult population. The representative health survey "German Health Update" 2010 (phone survey) collected data on nonfatal accidents in the adult population within a recall period of 12 months (n = 22,050). Interviewees reporting medically treated UI responded to 19 further questions about accident locations, accident mechanisms, injuries, and consequences of up to three UI within 1 year. Overall, detailed data on 2,117 UI were collected. About 7.9 % of the German adult population suffers at least one medically treated UI within 1 year. Men are more often affected than women and young people more frequently than older people. The majority of all UI occurs at home or during leisure-time activities. One in five UI results from accidents on public footways, roads, and squares. Falls account for almost every third UI and about one in five accidents causes fractures. Two thirds of all UI require inpatient treatment. Two in three UI lead to temporary sick leave averaging 29.7 days of absenteeism. Among UI at home and in leisure-time activities, falls have particularly serious consequences. Moreover, falls play an important role in UI among pedestrians and cyclists. UI affect large parts of the German adult population and are clearly patterned by gender, age, and accident location. Therefore, prevention activities should consider target group-specific needs and setting-specific circumstances of UI.

Trauma care in Germany: an inclusive system

BACKGROUND

Development of trauma systems is a demanding process. The United States and Germany both have sophisticated trauma systems. This manuscript is a summary of political, economic, and medical changes that have led to the development of both trauma systems and the current high-quality standards.

QUESTIONS/PURPOSES

We specifically asked three questions: (1) What tasks are involved in developing a modern trauma system? (2) What is the approach to achieve this task? (3) Do these systems work?

METHODS

We conducted a systematic review of relevant articles by searching electronic databases (PubMed, Embase, Cochrane library) using the following search terms: "trauma system", "polytrauma", "trauma networks", and "trauma registry". Of 2573 retrieved manuscripts, the authors made a personal selection of studies. A personal study selection from our experiences was added when their contribution to the topic was judged important.

RESULTS

Worldwide, similar tasks concerning trauma care have to be addressed. In most societies, traffic accidents and firearm-related injuries contribute to a high number of trauma victims. The German approach has been to decrease the number of accidents through injury prevention and to provide better care by establishing an emergency medical system. For in-hospital treatment, clinical care has constantly improved and a close interaction with members from the American Association for the Surgery of Trauma and the Orthopaedic Trauma Association has helped a great deal to achieve these improvements. The German healthcare system was developed as a powerful healthcare tool covering patients from injury to rehabilitation. In addition, trauma and injury research has been strengthened to deal with various questions of trauma care.

CONCLUSIONS

Organized injury prevention programs and systematized professional patient care can address the issues associated with the global burden of trauma. These trauma systems require constant monitoring and improvement.

Bicyclist-bicyclist crashes--a medical and technical crash analysis

BACKGROUND

The purpose of this study was to analyze the actual injury situation of bicyclists focusing on accidents involving more than one bicyclist. A medical and technical analysis was performed as a basis for preventive measures.

METHODS

Technical and medical data were collected at the scene, shortly after the accident. Technical analysis included speed at crash, type of collision, impact angle, environment, lane used, and relative velocity. Medical analysis included injury patterns and severity (Abbreviated Injury Scale [AIS], Injury Severity Score [ISS]).

RESULTS

Five hundred seventy-eight injured bicyclists in 289 accidents from 1999 to 2008 were included into the study. Sixty-one percent were male (n = 350) and 39 percent were female (n = 228). Sixty-seven percent ranged between 18 and 64 years of age, 12 percent each between 13 and 17 years of age and older than 65 years, 8 percent between 6 and 12 years, and 1 percent between 2 and 5 years. Ninety-two percent of crashes took place in urban areas and 8 percent in rural areas. Ninety-seven percent of crashes occurred in dry conditions and 3 percent in wet conditions. Eighty-three percent of all accidents occurred during the daytime, 10 percent at night, and 7 percent at dawn. The helmet use rate was only 7.5 percent for all involved bicyclists. The mean Abbreviated Injury Scale (AIS) score was 1.31.

CONCLUSION

The prevalence of bicycle-to-bicycle crashes is high. Most of these accidents occur in urban areas. Bicyclists should be considered as minimally or unprotected road users, with an unsatisfactorily low rate of helmet use. Though the average level and patterns of injuries is moderate, most of the severe injuries involved the head and extremities. However, there was no significant correlation between frequent helmet use and sustained injuries to the head of major AIS.

The role of SIGN in the development of a global orthopaedic trauma database

BACKGROUND

The global burden of injury is receiving recognition as a major public health problem but inadequate information delays many proposed solutions. Many attempts to collect reliable data on orthopaedic trauma have been unsuccessful. The Surgical Implant Generation Network (SIGN) database is one of the largest collections of fracture cases from lower and middle income countries.

QUESTIONS/PURPOSES

We describe the information in the SIGN database then address two questions: In the context of the design and implementation of a global trauma database, what lessons does the SIGN database teach? Does the SIGN program have a role in the evolution of a wider global system?

METHODS

The SIGN database is Internet based. After treating a patient with a SIGN nail surgeons enter radiographs and details of the case.

RESULTS

Over 26000 cases are in the SIGN database. The database has been used as a source of cases for followup studies. Analysis shows the data are of sufficient quality to allow studies of fracture patterns but not for outcome studies or bone measurement. WHERE DO WE NEED TO GO?: A global database with more comprehensive coverage of injuries, causes, treatment modalities and outcomes is needed. HOW DO WE GET THERE?: The SIGN database itself will not become a global trauma database (GTD) but the personnel of the SIGN program have much to offer in the design and adoption of a GTD. Studies of suitable methods of data collection and the incentive to use them are required.

Trauma care in Germany: major differences in case fatality rates between centers

BACKGROUND

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).

METHODS

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.

RESULTS

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.

CONCLUSION

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.