[Challenges of digitalization in trauma care]

Digitalization in orthopaedics: a narrative review

Advances in technology and digital tools like the Internet of Things (IoT), artificial intelligence (AI), and sensors are shaping the field of orthopaedic surgery on all levels, from patient care to research and facilitation of logistic processes. Especially the COVID-19 pandemic, with the associated contact restrictions was an accelerator for the development and introduction of telemedical applications and digital alternatives to classical in-person patient care. Digital applications already used in orthopaedic surgery include telemedical support, online video consultations, monitoring of patients using wearables, smart devices, surgical navigation, robotic-assisted surgery, and applications of artificial intelligence in forms of medical image processing, three-dimensional (3D)-modelling, and simulations. In addition to that immersive technologies like virtual, augmented, and mixed reality are increasingly used in training but also rehabilitative and surgical settings. Digital advances can therefore increase the accessibility, efficiency and capabilities of orthopaedic services and facilitate more data-driven, personalized patient care, strengthening the self-responsibility of patients and supporting interdisciplinary healthcare providers to offer for the optimal care for their patients.

Effectiveness of the multi-/interdisciplinary neurorehabilitati-on program in young patients with incomplete myeloradicualar injuries after spinal cord injury

Nowadays young persons may be frequent victims of traumatic cervical spinal cord injury (CSCI). Material and methods A retrospective study (January 2019-March 2021) we conducted with the approval of the Ethics Commission of THEBA, to assess the results of the complex me-dical rehabilitation program during the subacute period. A selected group of 23 young tetraple-gic patients with traumatic CSCI, were admitted to the THEBA Neuromuscular Rehabilitation Clinic with incomplete (AIS-B, -C, -D) myeloradicular injuries. All patients were males, aged between 19 and 57 years (with a mean of 44.35 years, SD 12.9). Patients came from urban areas 11 (48%) and the remaining 12 (52%) from rural areas. Results The spine lesion location was located at C2 vertebral level (4 men), C3 (4 men), C4 (3 men), C5 (6 men); C6 (in 2 patients); C7 (in 2 men); T6 and T7 in 1 patient each. The patients' neurological levels of injury were: C1 (in 2 pati-ents), C2 (in 2 patients), C3 (in 4 patients), C5 (in 7 patients), C6 (in 4 patients) and C7 (in 2 pati-ents). The AIS/ Frankel degree at admission was: incomplete lesion AIS-B 3 patients, AIS-C 11 pa-tients, AIS-D 9 men. The average muscle strength at admission was 60.72 (SD 25.74). In the study group 20 patients were operated: anterior osteosynthesis was performed in 16 patients and pos-terior vertebral approach in 4 patients. The neurological evolution was favorable: at discharge there were only patients with incomplete AIS-C (8 men), respectively AIS-D (15 men) grade type of lesions, and their average muscle strength at discharge was 71.97 (SD 22.30). The following comorbidities were associated: arterial hypertension (in 2 patients), traumatic brain injury (in 14 patients), alcoholism (in 9 patients), pneumonia (in 6 patients), neoplastic disorders (in 1 pati-ent), gastric ulcer (in 2 patients), depression (in 2 patients). Complications of the immobilization syndrome were: enterocolitis (in 3 men), bronchopneumonia (in 3 patients), urinary tract infec-tions (in 13 patients) and bedsores (in 2 patients). Discussion Effectiveness of the final therapeutic approach was assessed (in percentage) by evaluating the progress of the muscle strength (quanti-fied and compared at discharge vs. admission) reported to the number of days of treatment. The external-internal variations of the numeric scores of the quality of life, FIM, Ashworth and Penn were evaluated. Statistics was performed for small groups (Anova and Pearson) to establish the effectiveness of the rehabilitation program, evaluating the level of correlation between the sco-res quantified with the aforementioned the scales. An inversely proportional relationship was found between spasticity and efficacy of physical therapy (F 0.000, Pearson -0.35), between the scores of Penn scale and the effectiveness of physical therapy (F test 0.000, Pearson -0.18), respec-tively directly proportional relationship between the kinetic therapy and FIM (F test 0.000, Pear-son 0.74), similar to the relationship between physical therapy and the scores assessing the quali-ty of life (F test 0.01, Pearson 0.02). Conclusions These results underline the importance of a multi-interdisciplinary team approach in the management of the tetraplegic patients after CSCI during the subacute post-lesional/ post-operative stage. Keywords: neurorehabilitation program, incomplete myeloradicualar injuries, spinal cord injury

[Influence of the general data protection regulation on data quality in registry data collection : Selection bias due to data protection requirements and the impact on key indicators for measuring the quality of care in a level 1 trauma center]

BACKGROUND

Due to the new general data protection regulations (GDPR), the requirements for correct patient information on the documentation of pseudonymized data in a registry have increased enormously. In particular, written consent applies to the TraumaRegister DGU® as it is not always possible to get written permission from severely injured patients in acute situations. Therefore, the study aimed to investigate the influence of undocumented cases due to a lack of clarification on the standardized mortality rate (SMR).

MATERIAL AND METHODS

In 2019, 274 patients meeting the criteria of the baseline dataset were retrospectively recorded. In the remaining 197 patients, the RISC II score could be calculated in all cases. In addition, due to state-specific law, all deceased patients were documented in our trauma center.

RESULTS

In this study with 197 primary care patients (72% male), 147 (74,6%) were informed and gave permission or died and were subsequently documented. The predicted mortality, actual mortality and SMR were 18.5%, 19.0% and 1.03, respectively. For patients who were not informed (n = 50), the predicted mortality, actual mortality, and SMR were 7.0%, 0% and 0. When these cases are included, the SMR is significantly more favorable at 0.93.

CONCLUSION

Due to the lack of written consent from surviving patients, only about 75% of all patients at Leipzig University Hospital could be documented for the TraumaRegister DGU®. On the other hand, since the local legal situation permits registry documentation of deceased patients, this has a detrimental effect on the standardized mortality rate (SMR), which is about 10% higher in our collective than it actually is.