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Bläsius FM, Laubach M, Lefering R, Hildebrand F, Andruszkow H. Author Correction: Adherence to the transfer recommendations of the German Trauma Society in severely injured children: a retrospective study from the TraumaRegister DGU. Sci Rep 2024; 14:2248. [PMID: 38278817 PMCID: PMC10817961 DOI: 10.1038/s41598-023-43529-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024] Open
Affiliation(s)
- Felix Marius Bläsius
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Markus Laubach
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Centre for Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, 4059, Australia
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, Ostmerheimer Straße 200, Haus 38, 51109, Cologne, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Hagen Andruszkow
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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Bläsius FM, Laubach M, Lefering R, Hildebrand F, Andruszkow H. Adherence to the transfer recommendations of the German Trauma Society in severely injured children: a retrospective study from the TraumaRegister DGU. Sci Rep 2023; 13:12152. [PMID: 37500701 PMCID: PMC10374559 DOI: 10.1038/s41598-023-39335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023] Open
Abstract
Particularly for pediatric trauma patients, it is of utmost importance that the right patient be treated in the right place at the right time. While unnecessary interhospital transfers must be avoided, the decision against transfer should not lead to higher complication rates in trauma centers without added pediatric qualifications. We therefore identified independent predictive factors for an early transfer of severely injured patients and compared these factors with the current transfer recommendations of the German Trauma Society. Additionally, the quality of the self-assessment based on the mortality of children who were not transferred was evaluated. A national dataset from the TraumaRegister DGU® was used to retrospectively identify factors for an early interhospital transfer (< 48 h) to a superordinate trauma center. Severely injured pediatric patients (age < 16 years) admitted between 2010 and 2019 were included in this analysis. Adjusted odds ratios (OR) with 95% confidence intervals (CI) for early transfer were calculated from a multivariable model. Prognostic factors for hospital mortality in non-transferred patients were also analyzed. In total, 6069 severely injured children were included. Of these, 65.2% were admitted to a Level I trauma center, whereas 27.7% and 7.1% were admitted to Level II and III centers, respectively. After the initial evaluation in the emergency department, 25.5% and 50.1% of children primarily admitted to a Level II or III trauma center, respectively, were transferred early. Statistically significant predictors of an early transfer were: Serious traumatic brain injury (OR 1.76, 95% CI 1.28-2.43), Injury severity score (ISS) ≥ 16 points (ISS 16-24: OR 2.06, 95% CI 1.59-2.66; ISS 25-33: OR 3.0, 95% CI 2.08-4.31; ISS 34-75: OR 5.42, 95% CI 3.0-9.81, reference category: ISS 9-15), age < 10 years (age 0-1: OR 1.91, 95% CI 1.34-2.71; age 2-5: 2.04, 95% CI 1.50-2.78; age 6-9: 1.62, 95% CI 1.23-2.14; reference category: age 10-15). The most important independent factor for mortality in non-transferred patients was age < 10 years (age 0-1: 5.35, 95% CI 3.25-8.81; age 2-5: 2.46, 95% CI 1.50-4.04; age 6-9: OR 1.7, 95% CI 1.05-2.75; reference category: age 10-15). Knowing the independent predictors for an early transfer, such as a young patient's age, a high injury severity, serious traumatic brain injury (TBI), may improve the choice of the appropriate trauma center. This may guide the rapid decision for an early interhospital transfer. There is still a lack of outcome data on children with early interhospital transfers in Germany, who are the most vulnerable group.
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Affiliation(s)
- Felix Marius Bläsius
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Markus Laubach
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Centre for Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, 4059, Australia
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, Ostmerheimer Straße 200, Haus 38, 51109, Cologne, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Hagen Andruszkow
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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Girshausen R, Horst K, Herren C, Bläsius F, Hildebrand F, Andruszkow H. Polytrauma scoring revisited: prognostic validity and usability in daily clinical practice. Eur J Trauma Emerg Surg 2022:10.1007/s00068-022-02035-5. [PMID: 35819474 DOI: 10.1007/s00068-022-02035-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Scores are widely used for the assessment of injury severity and therapy guidance in severely injured patients. They differ vastly regarding complexity, applicability, and prognostic accuracy. The objective of this study was to compare well-established with more recently developed trauma scores as well as intensive care unit (ICU) scores. METHODS Retrospective analysis of severely injured patients treated at a level I trauma centre from 2010 to 2015. INCLUSION CRITERIA Age ≥ 18 years, Injury Severity Score ≥ 16 and ICU treatment. Primary endpoint was in-hospital mortality. Several scores (ISS, APACHE II, RTS, Marshall Score, SOFA, NISS, RISC II, EAC and PTGS) were assessed to determine their predictive quality for mortality. Statistical analysis included correlation analysis and receiver operating characteristic (ROC). RESULTS 444 patients were included. 71.8% were males, mean age was 51 ± 20.26 years. 97.4% sustained a blunt trauma. The area under the ROC curve (AUROC) revealed RISC II (0.92) as strongest predictor regarding mortality, followed by APACHE II (0.81), Marshall score (0.69), SOFA (0.70), RTS (0.66), NISS (0.62), PTGS (0.61) and EAC (0.60). ISS did not reach statistical significance. CONCLUSIONS RISC II provided the strongest predictive capability for mortality. In comparison, more simple scores focusing on injury pattern (ISS, NISS), physiological abnormalities (RTS, EAC), or a combination of both (PTGS) only provided inferior mortality prediction. Established ICU scores like APACHE II, SOFA and Marshall score were proven to be helpful tools in severely injured trauma patients.
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Affiliation(s)
- Robert Girshausen
- Department of Orthopedics, Trauma and Reconstructive Surgery and Harald Tscherne Laboratory, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Klemens Horst
- Department of Orthopedics, Trauma and Reconstructive Surgery and Harald Tscherne Laboratory, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Christian Herren
- Department of Orthopedics, Trauma and Reconstructive Surgery and Harald Tscherne Laboratory, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Felix Bläsius
- Department of Orthopedics, Trauma and Reconstructive Surgery and Harald Tscherne Laboratory, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery and Harald Tscherne Laboratory, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Hagen Andruszkow
- Department of Orthopedics, Trauma and Reconstructive Surgery and Harald Tscherne Laboratory, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
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Bläsius FM, Laubach M, Andruszkow H, Lichte P, Pape HC, Lefering R, Horst K, Hildebrand F. Strategies for the treatment of femoral fractures in severely injured patients: trends in over two decades from the TraumaRegister DGU ®. Eur J Trauma Emerg Surg 2021; 48:1769-1778. [PMID: 33590272 PMCID: PMC7883956 DOI: 10.1007/s00068-020-01599-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/28/2020] [Indexed: 11/04/2022]
Abstract
Purpose Treatment strategies for femoral fracture stabilisation are well known to have a significant impact on the patient’s outcome. Therefore, the optimal choices for both the type of initial fracture stabilisation (external fixation/EF, early total care/ETC, conservative treatment/TC) and the best time point for conversion from temporary to definitive fixation are challenging factors. Patients Patients aged ≥ 16 years with moderate and severe trauma documented in the TraumaRegister DGU® between 2002 and 2018 were retrospectively analysed. Demographics, ISS, surgical treatment strategy (ETC vs. EF vs. TC), time for conversion to definitive care, complication (MOF, sepsis) and survival rates were analysed. Results In total, 13,091 trauma patients were included. EF patients more often sustained high-energy trauma (car: 43.1 vs. 29.5%, p < 0.001), were younger (40.6 vs. 48.1 years, p < 0.001), were more severely injured (ISS 25.4 vs. 19.1 pts., p < 0.001), and had higher sepsis (11.8 vs. 5.4%, p < 0.001) and MOF rates (33.1 vs. 16.0%, p < 0.001) compared to ETC patients. A shift from ETC to EF was observed. The time until conversion decreased for femoral fractures from 9 to 8 days within the observation period. Sepsis incidences decreased in EF (20.3 to 12.3%, p < 0.001) and ETC (9.1–4.8%, p < 0.001) patients. Conclusions Our results show the changes in the surgical treatment of severely injured patients with femur fractures over a period of almost two decades caused by the introduction of modern surgical strategies (e.g., Safe Definitive Surgery). It remains unclear which subgroups of trauma patients benefit most from these strategies.
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Affiliation(s)
- Felix M Bläsius
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Markus Laubach
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.,Centre for Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Hagen Andruszkow
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Philipp Lichte
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Hans-Christoph Pape
- Department of Trauma, Universitaetsspital, University of Zurich, Zurich, Switzerland
| | - Rolf Lefering
- Faculty of Health, Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany
| | - Klemens Horst
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Frank Hildebrand
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
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Kaczmarek C, Andruszkow H, Herren C, Pishnamaz M, Hildebrand F, Röhl A, Lichte P. [Medical ID and emergency apps: A useful tool in emergency situations or a waste of time?]. Med Klin Intensivmed Notfmed 2020; 116:339-344. [PMID: 32270256 PMCID: PMC8102457 DOI: 10.1007/s00063-020-00675-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/23/2019] [Accepted: 12/22/2019] [Indexed: 11/26/2022]
Abstract
Hintergrund Um in Notfallsituationen eine effektive Versorgung des Patienten zu gewährleisten, sind Informationen über Vorerkrankungen und bisherige Medikamenteneinnahme essenziell. Daher haben Smartphonehersteller entsprechende Anwendungssoftware (App) entwickelt, auf die im Notfall zugegriffen werden kann, um jene Informationen zu erhalten. Ziel der Studie war es herauszufinden, ob Notfall-Apps von Smartphoneinhabern aktiv genutzt werden und ob diese in Notfallsituationen von den behandelnden Notärzten eingesehen werden. Methode Zur Datenerhebung wurde eine anonymisierte Umfrage über das Nutzungsverhalten der Notfall-Apps bei verunfallten Patienten der unfallchirurgischen Ambulanz eines universitären Maximalversorgers über einen Zeitraum von 3 Monaten durchgeführt. Parallel fand eine Befragung von Notärzten verschiedener Standorte zu ihren beruflichen Erfahrungen mit den Apps statt. Ergebnisse Insgesamt wurden 192 Patienten und 103 Notärzte befragt. Die Notfall-Apps waren 45 % (n = 79) der Befragten nicht bekannt; nur bei 10 % (n = 19) der Befragten war die App mit Daten hinterlegt. Weiterhin zeigte sich, dass insgesamt 21 % (n = 41) der Personen einen Notizzettel mit Vorerkrankungen und Medikamenten bei sich trugen. Von den Befragten Ärzten gaben 42 % (n = 44) an, schon einmal von der App gehört zu haben; nur 6 % (n = 5) durchsuchten jedoch routinemäßig bei nichtansprechbaren Patienten das Smartphone. Erfolgreich genutzt wurde die App bisher nur von 14 % der Ärzte (n = 14). Schlussfolgerung Aufgrund der geringen Bekanntheit erscheint es in zeitkritischen Situationen nicht empfehlenswert, das Smartphone der Patienten nach Notfall-Apps zu durchsuchen. Bei Patienten über 55 ist es zurzeit erfolgsversprechender, die Brieftasche nach Informationen zu Vorerkrankungen zu kontrollieren.
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Affiliation(s)
- C Kaczmarek
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
- St. Elisabeth-Krankenhaus Geilenkirchen, Geilenkirchen, Deutschland.
| | - H Andruszkow
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - C Herren
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - M Pishnamaz
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - F Hildebrand
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - A Röhl
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - P Lichte
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
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Hofman M, Andruszkow H, Heyer FL, Kobbe P, Hildebrand F, Poeze M. Risk factors of non-union in intramedullary stabilized diaphyseal long bone fractures: identifying the role of fracture stabilization strategies and concomitant injuries. Eur J Trauma Emerg Surg 2020; 47:1903-1910. [PMID: 32140749 PMCID: PMC8629802 DOI: 10.1007/s00068-020-01335-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/18/2020] [Indexed: 12/01/2022]
Abstract
Purpose Concomitant chest injury is known to negatively affect bone metabolism and fracture healing, whereas traumatic brain injury (TBI) appears to have positive effects on bone metabolism. Osteogenesis can also be influenced by the timing of fracture stabilization. We aimed to identify how chest injuries, TBI and fracture stabilization strategy influences the incidence of non-union. Methods Patients with long bone fractures of the lower extremities who had been treated between 2004 and 2014 were retrospectively analysed. Non-union was defined as fracture healing not occurring in the expected time period and in which neither progression of healing nor successful union is expected without intervention. Diverse clinical and radiological parameters were statistically analysed using the Statistical Package for the Social Sciences (SPSS). Results The total number of operations before consolidation was an independent predictor (odds ratio [OR] = 6.416, p < 0.001) for the development of non-union in patients with long bone fractures. More specifically, patients treated according to the damage control orthopaedics (DCO) principle had a significantly higher risk of developing a non-union than patients treated according to the early total care (ETC) principle (OR = 7.878, p = 0.005). Concomitant chest injury and TBI could not be identified as influencing factors for non-union development. Conclusion Our results indicate that the number of operations performed in patients with long bone fractures should be kept as low as possible and that the indication for and the timing of DCO treatment should be meticulously noted to minimize the risk of non-union development.
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Affiliation(s)
- Martijn Hofman
- Department of Orthopedic Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Hagen Andruszkow
- Department of Orthopedic Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Frans L. Heyer
- Division of Traumasurgery,, Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Philipp Kobbe
- Department of Orthopedic Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopedic Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Martijn Poeze
- Division of Traumasurgery,, Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
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Hofman M, Kolejewska A, Greven J, Andruszkow H, Kobbe P, Tolba R, Hildebrand F, Poeze M. Gait analysis and muscle weight analysis after lower extremity fractures in a small animal model. Gait Posture 2020; 77:207-213. [PMID: 32058285 DOI: 10.1016/j.gaitpost.2020.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Besides adequate healing of bone and soft tissues, mobility represents a significant factor in functional outcome after lower extremity fractures. Although gait analysis is gaining clinical interest and importance in the rehabilitation of patients with fractures, it is rarely used in experimental fracture healing research. The aim of this study is to establish an accurate gait analysis method for fracture healing research in small animal models and to evaluate the influence of a lower extremity fracture on gait pattern and muscle atrophy in rats. RESEARCH QUESTION How does an intramedullary stabilized femur fracture influence the gait pattern and muscle atrophy during fracture healing in rats? METHODS An isolated femur fracture with intramedullary stabilization was induced in 26 Sprague Dawley rats. Different gait parameters (e.g. intensity, print area, stand duration, duty cycle, and swing speed) were evaluated with the CatWalk gait analysis system during the fracture healing process. Furthermore, muscle weight analysis was performed at different time points. RESULTS The gait analyses with the CatWalk system showed a high correlation with the osteogenesis of fracture healing in this model. Muscle atrophy increased during the early fracture healing stages and then decreased in the later stages. SIGNIFICANCE We are the first to show that the CatWalk system is a useful tool to perform gait analyses after lower extremity fractures in a murine model. These results could form a basis for future gait analyses research in fracture healing studies to improve knowledge about bone regeneration and rehabilitation after lower extremity fractures.
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Affiliation(s)
- Martijn Hofman
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Aneta Kolejewska
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Johannes Greven
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Hagen Andruszkow
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Philipp Kobbe
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Rene Tolba
- Institute of Laboratory Animal Science, University of Aachen Medical Center, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Frank Hildebrand
- Department of Orthopaedic Trauma and Reconstructive Surgery, University of Aachen Medical Center, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Martijn Poeze
- Department of Surgery, Division of Traumasurgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, Netherlands.
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Wutzler S, Bläsius FM, Störmann P, Lustenberger T, Frink M, Maegele M, Weuster M, Bayer J, Caspers M, Seekamp A, Marzi I, Andruszkow H, Hildebrand F. Pneumonia in severely injured patients with thoracic trauma: results of a retrospective observational multi-centre study. Scand J Trauma Resusc Emerg Med 2019; 27:31. [PMID: 30871601 PMCID: PMC6419484 DOI: 10.1186/s13049-019-0608-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/28/2019] [Indexed: 01/03/2023] Open
Abstract
Background While the incidence and aspects of pneumonia in ICU patients has been extensively discussed in the literature, studies on the occurrence of pneumonia in severely injured patients are rare. The aim of the present study is to elucidate factors associated with the occurrence of pneumonia in severely injured patients with thoracic trauma. Setting Level-I University Trauma Centres associated with the TraumaRegister DGU®. Methods A total of 1162 severely injured adult patients with thoracic trauma documented in the TraumaRegister DGU® (TR-DGU) were included in this study. Demographic data, injury severity, duration of mechanical ventilation (MV), duration of ICU stay, occurrence of pneumonia, bronchoalveolar lavage, aspiration, pathogen details, and incidences of mortality were evaluated. Statistical evaluation was performed using SPSS (Version 25.0, SPSS, Inc.) software. Results The overall incidence of pneumonia was 27.5%. Compared to patients without pneumonia, patients with pneumonia had sustained more severe injuries (mean ISS: 32.6 vs. 25.4), were older (mean age: 51.3 vs. 47.5) and spent longer periods under MV (mean: 368.9 h vs. 114.9 h). Age, sex (male), aspiration, and duration of MV were all independent predictors for pneumonia occurrence in a multivariate analysis. The cut-off point for duration of MV that best discriminated between patients who would and would not develop pneumonia during their hospital stay was 102 h. The extent of thoracic trauma (AISthorax), ISS, and presence of pulmonary comorbidities did not show significant associations to pneumonia incidence in our multivariate analysis. No significant difference in mortality between patients with and without pneumonia was observed. Conclusions Likelihood of pneumonia increases with age, aspiration, and duration of MV. These parameters were not found to be associated with differences in outcomes between patients with and without pneumonia. Future studies should focus on independent parameters to more clearly identify severely injured subgroups with a high risk of developing pneumonia. Level of evidence Level II - Retrospective medical record review.
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Affiliation(s)
- Sebastian Wutzler
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany
| | - Felix M Bläsius
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074, Aachen, Germany.
| | - Philipp Störmann
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany
| | - Thomas Lustenberger
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany
| | - Michael Frink
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Marburg, Baldingerstraße, D-35043, Marburg, Germany
| | - Marc Maegele
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim, Medical Centre (CMMC), Ostmerheimer Str. 200, D-51109, Köln, Germany
| | - Matthias Weuster
- Department of Trauma Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Jörg Bayer
- Department of Orthopaedics and Trauma Surgery, Medical Centre Albert-Ludwings-University of Freiburg, Sir-Hans-A.-Krebs-Straße, D-79106, Freiburg, Germany
| | - Michael Caspers
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim, Medical Centre (CMMC), Ostmerheimer Str. 200, D-51109, Köln, Germany
| | - Andreas Seekamp
- Department of Trauma Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany
| | - Hagen Andruszkow
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074, Aachen, Germany
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Horst K, Andruszkow H, Weber CD, Pishnamaz M, Knobe M, Bläsius FM, Lichte P, Lefering R, Hildebrand F. Surgical treatment strategies in pediatric trauma patients: ETC vs. DCO-an analysis of 316 pediatric trauma patients from the TraumaRegister DGU ®. Eur J Trauma Emerg Surg 2019; 45:801-808. [PMID: 30758537 DOI: 10.1007/s00068-019-01092-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/07/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE External fixation within the damage control concept in unstable multiple trauma patients is widely accepted. Literature about its usage in the pediatric trauma population, however, is rare. The aim of the present study was to elucidate the factors associated with the application of external fixation in the severely injured child. METHODS Patients with severe trauma aged 0-54 years documented in the TraumaRegister DGU® were included in this study. Demographic data, pattern of injury, injury severity, use of the damage control orthopedics (DCO) or early total care (ETC) concept, duration of mechanical ventilation, intensive care stay, and total hospital stay as well as the occurrence of complications and mortality were evaluated. Statistical evaluation was performed using SPSS (Version 21.0.0) using Chi square tests and linear regression models. RESULTS While injury severity was comparable between children and adults, type of accident and injury patterns showed significant differences, Overall, the majority of surgical fracture stabilization in AISExtremity ≥ 3 injuries followed the DCO concept in adults (60.3%) and the ETC protocol in children (49.4%). Conservative treatment was chosen for only 11.6% of all children and 9.6% of all adults. An increasing injury severity, AISExtremity ≥ 3 and AISExtremity ≥ 3 in ≥ 2 body regions, and a more advanced age were found to be independent factors in the use of the DCO concept in children. CONCLUSION Use of external fixation increases with age and plays a minor role in the very young trauma population. However, this does not produce a difference in outcome between children and adults.
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Affiliation(s)
- Klemens Horst
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany.
| | - Hagen Andruszkow
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany
| | - Christian David Weber
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany
| | - Miguel Pishnamaz
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany
| | - Matthias Knobe
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany
| | - Felix Marius Bläsius
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany
| | - Philipp Lichte
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany
| | - Rolf Lefering
- IFOM, Institute for Research in Operative Medicine, Faculty of Health, University Witten/Herdecke, Ostmerheimer Straße 200, 51109, Cologne, Germany
| | - Frank Hildebrand
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany
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Fitschen-Oestern S, Lippross S, Klueter T, Weuster M, Varoga D, Tohidnezhad M, Pufe T, Rose-John S, Andruszkow H, Hildebrand F, Steubesand N, Seekamp A, Neunaber C. Correction to: A new multiple trauma model of the mouse. BMC Musculoskelet Disord 2019; 20:72. [PMID: 30744619 PMCID: PMC6371601 DOI: 10.1186/s12891-018-2330-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Stefanie Fitschen-Oestern
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Sebastian Lippross
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Tim Klueter
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Matthias Weuster
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Deike Varoga
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Mersedeh Tohidnezhad
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
| | - Thomas Pufe
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
| | - Stefan Rose-John
- Department of Biochemistry, Medical Faculty, Olshausenstr. 40, 24098, Kiel, Germany
| | - Hagen Andruszkow
- Department of Trauma Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Trauma Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nadine Steubesand
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Andreas Seekamp
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Claudia Neunaber
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
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Fitschen-Oestern S, Lippross S, Klueter T, Weuster M, Varoga D, Tohidnezhad M, Pufe T, Rose-John S, Andruszkow H, Hildebrand F, Steubesand N, Seekamp A, Neunaber C. A new multiple trauma model of the mouse. BMC Musculoskelet Disord 2017; 18:468. [PMID: 29157219 PMCID: PMC5697084 DOI: 10.1186/s12891-017-1813-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 11/06/2017] [Indexed: 01/07/2023] Open
Abstract
Background Blunt trauma is the most frequent mechanism of injury in multiple trauma, commonly resulting from road traffic collisions or falls. Two of the most frequent injuries in patients with multiple trauma are chest trauma and extremity fracture. Several trauma mouse models combine chest trauma and head injury, but no trauma mouse model to date includes the combination of long bone fractures and chest trauma. Outcome is essentially determined by the combination of these injuries. In this study, we attempted to establish a reproducible novel multiple trauma model in mice that combines blunt trauma, major injuries and simple practicability. Methods Ninety-six male C57BL/6 N mice (n = 8/group) were subjected to trauma for isolated femur fracture and a combination of femur fracture and chest injury. Serum samples of mice were obtained by heart puncture at defined time points of 0 h (hour), 6 h, 12 h, 24 h, 3 d (days), and 7 d. Results A tendency toward reduced weight and temperature was observed at 24 h after chest trauma and femur fracture. Blood analyses revealed a decrease in hemoglobin during the first 24 h after trauma. Some animals were killed by heart puncture immediately after chest contusion; these animals showed the most severe lung contusion and hemorrhage. The extent of structural lung injury varied in different mice but was evident in all animals. Representative H&E-stained (Haematoxylin and Eosin-stained) paraffin lung sections of mice with multiple trauma revealed hemorrhage and an inflammatory immune response. Plasma samples of mice with chest trauma and femur fracture showed an up-regulation of IL-1β (Interleukin-1β), IL-6, IL-10, IL-12p70 and TNF-α (Tumor necrosis factor- α) compared with the control group. Mice with femur fracture and chest trauma showed a significant up-regulation of IL-6 compared to group with isolated femur fracture. Conclusions The multiple trauma mouse model comprising chest trauma and femur fracture enables many analogies to clinical cases of multiple trauma in humans and demonstrates associated characteristic clinical and pathophysiological changes. This model is easy to perform, is economical and can be used for further research examining specific immunological questions.
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Affiliation(s)
- Stefanie Fitschen-Oestern
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Arnold-Heller Straße 7, 24105, Campus Kiel, Kiel, Germany.
| | - Sebastian Lippross
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Arnold-Heller Straße 7, 24105, Campus Kiel, Kiel, Germany
| | - Tim Klueter
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Arnold-Heller Straße 7, 24105, Campus Kiel, Kiel, Germany
| | - Matthias Weuster
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Arnold-Heller Straße 7, 24105, Campus Kiel, Kiel, Germany
| | - Deike Varoga
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Arnold-Heller Straße 7, 24105, Campus Kiel, Kiel, Germany
| | - Mersedeh Tohidnezhad
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, D-52074, Aachen, Germany
| | - Thomas Pufe
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, D-52074, Aachen, Germany
| | - Stefan Rose-John
- Department of Biochemistry, Medical Faculty, Olshausenstr. 40, 24098, Kiel, Germany
| | - Hagen Andruszkow
- Department of Trauma Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Trauma Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nadine Steubesand
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Arnold-Heller Straße 7, 24105, Campus Kiel, Kiel, Germany
| | - Andreas Seekamp
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Arnold-Heller Straße 7, 24105, Campus Kiel, Kiel, Germany
| | - Claudia Neunaber
- Department of Trauma Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
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Horst K, Andruszkow H, Weber CD, Pishnamaz M, Herren C, Zhi Q, Knobe M, Lefering R, Hildebrand F, Pape HC. Thoracic trauma now and then: A 10 year experience from 16,773 severely injured patients. PLoS One 2017; 12:e0186712. [PMID: 29049422 PMCID: PMC5648226 DOI: 10.1371/journal.pone.0186712] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 10/09/2017] [Indexed: 01/11/2023] Open
Abstract
Background and purpose Thoracic trauma remains to be a relevant injury to the polytraumatised patient. However, literature regarding how far changes in clinical guidelines for pre- and in-hospital trauma management and diagnostic procedures affect the outcome of multiple injured patients with severe chest injury during a long-term observation period is sparse. Methods Multiple traumatised patients (age≥16y) documented in the TraumaRegister DGU® (TR-DGU) from January 1st 2005 to December 31st 2014 with severe chest trauma (AIS≥3) were included in this study. Demographic data, the pattern of injury, injury severity, radiographic emergency procedures, indication for intubation, duration of mechanical ventilation, emergency surgery, occurrence of complications and mortality were evaluated per year and over time. Results A total of 16,773 patients were analysed. The use of whole body computer tomography increased (p<0.001), while the incidence of plain x-rays decreased (p<0.001). Furthermore, incidence of AISThorax = 3 graded injuries increased (p<0.001) while AISThorax = 4 decreased (p<0.001). Both, rate of patients being intubated at the time of ICU admission decreased (p<0.001) and the time of mechanical ventilation decreased (p<0.001). Additionally, need for emergency surgery, lung failure, sepsis, and multi organ failure all decreased (p<0.001). However, mortality remained unchanged. Interpretation Severity of severe chest trauma and associated complications decreased while diagnostics and treatment improved over time. However, mortality remained unchanged. Our results are in line with those expected in the context of the incidence of CT diagnostics, which has increased parallel to the clinical outcome Thus, our data demonstrate a positive trend in the treatment of patients with severe chest trauma.
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Affiliation(s)
- Klemens Horst
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
- Harald Tscherne Research Laboratory, RWTH Aachen University, Aachen, Germany
- * E-mail:
| | - Hagen Andruszkow
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Christian D. Weber
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Miguel Pishnamaz
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Christian Herren
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Qiao Zhi
- Harald Tscherne Research Laboratory, RWTH Aachen University, Aachen, Germany
| | - Matthias Knobe
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Rolf Lefering
- IFOM - Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten / Herdecke University, Cologne, Germany
| | - Frank Hildebrand
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
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13
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Gombert A, Barbati ME, Storck M, Kotelis D, Keschenau P, Pape HC, Andruszkow H, Lefering R, Hildebrand F, Greiner A, Jacobs MJ, Grommes J. Treatment of blunt thoracic aortic injury in Germany-Assessment of the TraumaRegister DGU®. PLoS One 2017; 12:e0171837. [PMID: 28346475 PMCID: PMC5367684 DOI: 10.1371/journal.pone.0171837] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/26/2017] [Indexed: 12/30/2022] Open
Abstract
Purpose Using the data delivered by the German Trauma Register DGU® from 2002 till 2013, the value of different therapies of blunt thoracic aortic injury (BTAI) in Germany was analyzed. Methods Prospectively collected data of patients suffering from BTAI were retrospectively analyzed with focus on the different treatment modalities for grade I–IV injuries. Results 821 patients suffering from BTAI were identified: 51.6% (424) grade I injury, 35.4% (291) grade II or III injury and 12.9% (106) grade IV injury (77.5% men [44.94 ± 20.6 years]). The main patterns of injury were high- speed accidents and falls (78.0% [n = 640], 21.8% [n = 171] respectively). Significant differences between grade I and grade II/III as well as IV injuries could be assessed for the incidence of cardiopulmonary resuscitation, a Glasgow Coma Scale score below 8 and a systolic blood pressure below 90 mmHg (p-value: <0.001). In the primary admission subgroup, 44.1% (197/447) of the patients received best medical treatment, 55.9% received surgical intervention (250/447): Thereof 37.2% (93/250) received open surgery and 62.8% (147/250) had been treated by endovascular means. Significantly lower 24-h- and in-hospital-mortality rates were encountered after endovascular treatment for all gradings of BTAI (p-value: <0.001). Yet this subgroup of patients showed the lowest incidence of further severe injuries and cardiac arrest. Conclusion Endovascular therapy became the treatment of choice for BTAI in Germany. Patients who have been treated by surgical means showed the highest survival rate, especially endovascular therapy showed a favorable low mortality rate.
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Affiliation(s)
- Alexander Gombert
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Mohammad E Barbati
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Storck
- Klinikum Karlsruhe, Academic Teaching Hospital Univ. Freiburg, Karlsruhe, Germany
| | - Drosos Kotelis
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Paula Keschenau
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Hans-Christoph Pape
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital RWTH Aachen, Aachen, Germany
| | - Hagen Andruszkow
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital RWTH Aachen, Aachen, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
| | - Frank Hildebrand
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital RWTH Aachen, Aachen, Germany
| | - Andreas Greiner
- Department of Vascular Surgery, University Hospital Charité Berlin, Berlin, Germany
| | - Michael J Jacobs
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Jochen Grommes
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
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Sellei RM, Andruszkow H, Weber C, Damen TO, Pape HC, Hildebrand F. [Diagnostics and treatment decisions in acute compartment syndrome. Results of a survey in German hospitals]. Unfallchirurg 2017; 119:125-32. [PMID: 25015736 DOI: 10.1007/s00113-014-2609-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The presented survey was intended to evaluate whether a standardization of diagnostics and therapy for acute compartment syndrome has been achieved. MATERIALS AND METHODS University hospitals, academic teaching hospitals, and county hospitals in Germany were included. RESULTS A total of 38% (n=120) of all contacted hospitals participated in this study with questions mainly answered by consulting physicians (68%). In general the importance of the clinical examination was considered as being more important than other diagnostic measures. In cases where further diagnostics were necessary, the intramuscular pressure measurement was used most frequently. Of the participants 50% performed surgical fasciotomy based on the clinical examination in combination with the intramuscular pressure measurement; however, there were considerable differences between the participating hospitals with respect to the anatomical position of intramuscular measurements, the limiting value of the intramuscular pressure and the surgical technique for performing fasciotomy. CONCLUSION According to the presented analysis the diagnosis and indications for surgical treatment in patients developing an acute compartment syndrome do not seem to be sufficiently clarified. The establishment of unified treatment guidelines could help to reduce the number of delayed diagnoses of compartment syndrome.
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Affiliation(s)
- R M Sellei
- Klinik für Unfallchirurgie und Orthopädische Chirurgie, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Deutschland. .,Klinik für Unfall- und Wiederherstellungschirurgie , Universitätsklinikum Aachen, Aachen, Deutschland.
| | - H Andruszkow
- Klinik für Unfall- und Wiederherstellungschirurgie , Universitätsklinikum Aachen, Aachen, Deutschland
| | - C Weber
- Klinik für Unfall- und Wiederherstellungschirurgie , Universitätsklinikum Aachen, Aachen, Deutschland
| | - T O Damen
- Klinik für Unfall- und Wiederherstellungschirurgie , Universitätsklinikum Aachen, Aachen, Deutschland
| | - H-C Pape
- Klinik für Unfall- und Wiederherstellungschirurgie , Universitätsklinikum Aachen, Aachen, Deutschland
| | - F Hildebrand
- Klinik für Unfall- und Wiederherstellungschirurgie , Universitätsklinikum Aachen, Aachen, Deutschland
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Almahmoud K, Teuben M, Andruszkow H, Horst K, Lefering R, Hildebrand F, Pape HC, Pfeifer R. Trends in intubation rates and durations in ventilated severely injured trauma patients: an analysis from the TraumaRegister DGU®. Patient Saf Surg 2016; 10:24. [PMID: 27822309 PMCID: PMC5094000 DOI: 10.1186/s13037-016-0109-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/13/2016] [Indexed: 01/15/2023] Open
Abstract
Background Endotracheal intubation in severely injured patients is known to be a risk factor for systemic complications. We aimed to examine the changes in intubation rates and durations in severely injured trauma patients, and rates of the systemic complications associated with ventilation changes by using a large trauma registry over the period of 13 years. Methods Patient demographics, Injury Severity Score (ISS), ventilation days, ventilation free days (VFD), and prevalence of systemic complications (sepsis and multiple organ failure (MOF)) were obtained from the TraumaRegister DGU® and were compared over the study period. Results During the study period (2002 – 2014), 35,232 patients were recorded in TraumaRegister DGU®. 72.7 % of patients (n = 25,629) were intubated, and 27.3 % (n = 9603) of patients did not require mechanical ventilation throughout their hospital stay. The mean age was 48 ± 21 years, mean ISS was 27.9 ± 11.5, mean length of ICU stay was 11.7 ± 13.8 days, mean time on mechanical ventilator was 7.1 ± 11.3 days, and mean ventilation free days (spontaneous respiration) was 19.5 ± 11.9 days. We observed a reduction in the intubation rates (87.5 % in 2002 versus 63.6 % in 2014), and early extubation (10 ventilation days in 2002, and 5.9 days in 2014) over time. Conclusion Our study reveals a reduction in intubation rates and ventilation duration during the observation period. Moreover, we were able to observe decreased incidence of systemic complications such as sepsis over the 13 year study period, while no changes in incidence of MOF were registered. The exact relationship can not be proven in our study. This needs to be addressed in further analysis.
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Affiliation(s)
- Khalid Almahmoud
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Michel Teuben
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Hagen Andruszkow
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Klemens Horst
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, 51109 Cologne, Germany
| | - Frank Hildebrand
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Hans Christoph Pape
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Roman Pfeifer
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
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16
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Maier KJ, Bücking B, Horst K, Andruszkow H, Hildebrand F, Knobe M. [The rotationally stable screw-anchor with trochanteric stabilizing plate (RoSA/TSP) : First results in unstable trochanteric femur fractures]. Unfallchirurg 2016; 120:1054-1064. [PMID: 27770169 DOI: 10.1007/s00113-016-0265-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In unstable trochanteric fractures, the extramedullary rotationally stable screw-anchor (RoSA) combines the benefits of the load and rotational stability of the blade with the advantages of the screw (pull-out resistance, compression capability) in a single load carrier, and was designed to prevent femoral neck shortening by using an additional locked trochanteric stabilizing plate (TSP). OBJECTIVES The aim of the current prospective cohort study was the clinical evaluation of the RoSA/TSP system regarding the mechanical re-operation rate and the amount of postoperative femoral neck shortening. METHODS From September 2011 to January 2014 80 patients with unstable trochanteric fractures underwent internal extramedullary fixation with the RoSA/TSP (Königsee Implantate GmbH, Allendorf, Germany). Due to fracture stability and after induction of compression, additional long locked antitelescoping screws (AT, n = 1-4) were placed reaching the femoral head. Radiological (femoral neck shortening) and clinical re-examination of patients (n = 61) was performed 6-10 weeks and 6-10 months later. RESULTS In the 61 re-examined patients (76 %) femoral neck shortening was very low with 2 mm 6-10 months after operation. Re-operations occurred in 8 % (n = 6) and in 4 % (n = 3) as prophylactic surgical intervention. Whereas one-third (4 %) of re-operations occurred due to iatrogenic surgical problems from the first operation two-thirds of patients (8 %) had a re-operation due to delay of bone union (3× nonunion, 3 planned removals of AT-screws to improve healing). The in-hospital mortality was 3 % (n = 2). CONCLUSIONS The fixation of unstable trochanteric femur fractures using the RoSA/TSP in a first clinical setting led to a great primary stability, with significant advantages with regard to limited femoral neck shortening. However, the rigidity of the construct with its consequences regarding bone healing can be challenging for the surgeon. Nevertheless, in some cases of revision it could be beneficial for stability.
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Affiliation(s)
- K-J Maier
- Abteilung für Allgemein-, Viszeral- und Unfallchirurgie, RoMed Klinik, Bad Aibling, Deutschland
| | - B Bücking
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Marburg, Deutschland
| | - K Horst
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - H Andruszkow
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - F Hildebrand
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - M Knobe
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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Pape HC, Andruszkow H, Pfeifer R, Hildebrand F, Barkatali BM. Options and hazards of the early appropriate care protocol for trauma patients with major fractures: Towards safe definitive surgery. Injury 2016; 47:787-91. [PMID: 27090109 DOI: 10.1016/j.injury.2016.03.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- H C Pape
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - H Andruszkow
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - R Pfeifer
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - F Hildebrand
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - B M Barkatali
- Department of Trauma and Orthopaedics, University Teaching Hospital, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, United Kingdom.
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Pastor T, Gradl G, Klos K, Ganse B, Horst K, Andruszkow H, Hildebrand F, Pape HC, Knobe M. Displaced intra-articular calcaneal fractures: is there a consensus on treatment in Germany? Int Orthop 2016; 40:2181-2190. [PMID: 26899483 DOI: 10.1007/s00264-016-3134-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 02/08/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Open reduction in displaced intra-articular calcaneal fractures entails a high rate of wound healing deficits and infections as well as an uncertain outcome, which leads to remaining ambiguity in treatment preferences. METHODS Between January and July 2011, we emailed 575 German chairpersons of trauma and/or orthopaedic departments, asking them to complete a 31-question web-based survey regarding three broad domains: fracture classification, surgical treatment algorithms and risk factors for wound healing deficits. RESULTS The response rate was 47 %. With an incidence of 77 %, open reduction via an extended lateral approach and plate fixation was the main treatment option for displaced intra-articular fractures of the joint-depression-type (Sanders II or III). Percutaneous techniques were only preferred in individual cases, with mainly precarious wound situations (59 %) as well as in patients with a reduced general health condition (ASA 3 and 4; 41 %). The re-operation rate due to infections and wound healing deficits after an extended lateral approach was reported with a percentage of 0-5 % by 88 % of the respondents. Participants stated that especially a poor microcirculation of the foot, disregard of soft tissue conserving techniques, overall condition of the patient, smoking, long time-to-surgery and operation time are the main reasons for wound healing deficits. CONCLUSION Given the extended lateral approach as the preferred treatment option, we found minimally invasive techniques and primary arthrodesis of the lower ankle joint play a minor role in treating intra-articular calcaneal fractures in Germany. Ninety percent of our respondents stated less than 5 % of patients required re-operations due to infections and wound healing deficits. Level of Evidence Level V, expert opinion.
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Affiliation(s)
- Tatjana Pastor
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany
| | - Gertraud Gradl
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany
| | - Kajetan Klos
- Department of Orthopaedic Trauma, St. Vincenz and Elisabeth Hospital Mainz, Mainz, Germany
| | - Bergita Ganse
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany
| | - Klemens Horst
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany
| | - Hagen Andruszkow
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany
| | - Hans-Christoph Pape
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany
| | - Matthias Knobe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany.
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Andruszkow H, Schweigkofler U, Lefering R, Frey M, Horst K, Pfeifer R, Beckers SK, Pape HC, Hildebrand F. Impact of Helicopter Emergency Medical Service in Traumatized Patients: Which Patient Benefits Most? PLoS One 2016; 11:e0146897. [PMID: 26771462 PMCID: PMC4714808 DOI: 10.1371/journal.pone.0146897] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 12/24/2015] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION The Helicopter Emergency Medical Service (HEMS) was established for the prehospital trauma care of patients. Improved rescue times and increased coverage areas are discussed as specific advantages of HEMS. We recently found evidence that HEMS exerts beneficial effects on outcomes for severely injured patients. However, it still remains unknown which group of trauma patients might benefit most from HEMS rescue. Consequently, the unique aim of this study was to reveal which patients might benefit most from HEMS rescue. METHODS Trauma patients (ISS ≥9) primarily treated by HEMS or ground emergency medical services (GEMS) between 2002 and 2012 were analysed using the TraumaRegister DGU. A multivariate regression analysis was used to reveal the survival benefit between different trauma populations. RESULTS The study included 52 281 trauma patients. Of these, 68.8% (35 974) were rescued by GEMS and 31.2% (16 307) by HEMS. HEMS patients were more severely injured compared to GEMS patients (ISS: HEMS 24.8±13.5 vs. GEMS 21.7±18.0) and more frequently suffered traumatic shock (SBP sys <90mmHg: HEMS 18.3% vs. GEMS 14.8%). However, logistic regression analysis revealed that HEMS rescues resulted in an overall survival benefit compared to GEMS (OR 0.81, 95% CI [0.75-0.87], p<0.001, Nagelkerke's R squared 0.526, area under the ROC curve 0.922, 95% CI [0.919-0.925]). Analysis of specific subgroups demonstrated that patients aged older than 55 years (OR 0.62, 95% CI [0.50-0.77]) had the highest survival benefit after HEMS treatment. Furthermore, HEMS rescue had the most significant impact after 'low falls' (OR 0.68, 95% CI [0.55-0.84]) and in the case of minor severity injuries (ISS 9-15) (OR 0.66, 95% CI [0.49-0.88]). CONCLUSIONS In general, trauma patients benefit from HEMS rescue with in-hospital survival as the main outcome parameter. Focusing on special subgroups, middle aged and older patients, low-energy trauma, and minor severity injuries had the highest survival benefit when rescued by HEMS. Further studies are required to determine the potential reasons of this benefit.
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Affiliation(s)
- Hagen Andruszkow
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
- * E-mail:
| | - Uwe Schweigkofler
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389 Frankfurt am Main, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Magnus Frey
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Klemens Horst
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Roman Pfeifer
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Stefan Kurt Beckers
- Emergency Medical Service Aachen, Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße 30, Germany
| | - Hans-Christoph Pape
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
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Hildebrand F, Lefering R, Andruszkow H, Zelle BA, Barkatali BM, Pape HC. Development of a scoring system based on conventional parameters to assess polytrauma patients: PolyTrauma Grading Score (PTGS). Injury 2015; 46 Suppl 4:S93-8. [PMID: 26542873 DOI: 10.1016/s0020-1383(15)30025-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The impact of conventional laboratory data to identify polytrauma patients at risk of complications is established. However, it has not been assessed in terms of prognostic accuracy for systemic complications (ARDS, organ failure). We therefore assessed the most predictive parameters for systemic complications and developed a scoring system for early grading of polytrauma patients. METHODS A population based trauma registry was used. INCLUSION CRITERIA age >16 years, Abbreviated Injury Score (AIS) of the abdomen or chest ≥ 3 points and treatment in an intensive care unit, or Injury Severity Score (ISS) ≥ 16 points. The primary endpoint was hospital mortality. Patients were graded according their risk of death: low risk of death (5-14% mortality), intermediate risk patients (15-39% mortality) and high risk (>40%). Routine clinical and laboratory parameters on admission were assessed to determine their specific relevance to describe the risk profile of the patient. Based on these data, a scoring system for the description of the clinical status was developed. Statistical analysis included uniand multivariate analysis. RESULTS 11.436 patients were included, the mean ISS was 22.7 ± 11.2 points, 73% were male, and 95.6% had blunt injuries. The most sensitive parameters were found to be the following ones: systolic blood pressure, INR, thrombocytes, base deficit, NISS, packed red blood cells administered. The multivariate analysis revealed the following threshold levels: BP 76-90 mmHg: r = 0.249, OR 1.283: Base deficit 8-10 r = 0.474, OR 1.606; INR 1.4-2 r = 0.160, OR 1.174; NISS 35-39 r = 0.9, OR 2.46; pBRC 3-14: r = 0.671, OR 1.957. The following ranges of score values were found to be associated with different patient status: <6 points: stable patients; 6-11 points: borderline condition; >11 points: unstable patients. When using this score, 80.6% were stable, 14.6% in a borderline condition and 4.8% unstable. CONCLUSION We developed a scoring system to discriminate polytrauma patients on admission that are at risk of systemic complications. Systolic blood pressure, INR, thrombocytes, base deficit, NISS, packed red blood cells administered are able to provide a prognosis of patients at risk of posttraumatic complications. Further prospective studies should be performed to verify this new scoring system.
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Affiliation(s)
- Frank Hildebrand
- Department of Orthopaedic Trauma at Aachen University, NRW, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Cologne, NRW, Germany
| | - Hagen Andruszkow
- Department of Orthopaedic Trauma at Aachen University, NRW, Germany; Harald Tscherne Research Laboratory for Orthopaedic Trauma at Aachen, NRW, Germany
| | - Boris A Zelle
- The University of Texas Health Science Center at San Antonio, TX USA
| | - Bilal M Barkatali
- Department of Trauma and Orthopaedics, Royal Bolton Foundation NHS Trust, UK
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Horst K, Andruszkow H, Weber C, Dienstknecht T, Hildebrand F, Tarkin I, Pape HC. Standards of external fixation in prolonged applications to allow safe conversion to definitive extremity surgery: the Aachen algorithm for acute ex fix conversion. Injury 2015; 46 Suppl 3:S13-8. [PMID: 26458293 DOI: 10.1016/s0020-1383(15)30005-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
External fixation has become an important tool in orthopedic surgery. Technology has improved the design and material as well as the construct of the fixator. As most patients are converted from external fixation to definite stabilization during later clinical course, prevention of complications such as infection is of high importance. Based on the current literature, principles of temporary external fixation were summarized. We focused on minimizing the risk of infection and introduce a standardized algorithm how to proceed when converting from external to internal fixation, which also was examined for effectiveness.
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Affiliation(s)
- Klemens Horst
- Department of Orthopaedic Trauma at Aachen University Medical Center, Aachen Germany; Harald Tscherne Lab for Orthopaedic Trauma, Aachen Germany
| | - Hagen Andruszkow
- Department of Orthopaedic Trauma at Aachen University Medical Center, Aachen Germany; Harald Tscherne Lab for Orthopaedic Trauma, Aachen Germany
| | - Christian Weber
- Department of Orthopaedic Trauma at Aachen University Medical Center, Aachen Germany
| | - Thomas Dienstknecht
- Department of Orthopaedic Trauma at Aachen University Medical Center, Aachen Germany
| | - Frank Hildebrand
- Department of Orthopaedic Trauma at Aachen University Medical Center, Aachen Germany
| | - Ivan Tarkin
- Division of Orthopaedic Trauma, University of Pittsburgh Med. Ctr., Pittsburgh, USA
| | - Hans-Christoph Pape
- Department of Orthopaedic Trauma at Aachen University Medical Center, Aachen Germany.
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Abstract
Orthopaedic trauma is an increasingly common problem in geriatric patients. As demands of daily life and recreational activities are increasing in these patients, surgeons need to be able to manage geriatric fractures to achieve good functional results. Reduced bone quality in the elderly presents a considerable challenge and may preclude the use of established surgical stabilisation techniques that are performed in younger trauma patients. Furthermore, pre-existing medical conditions and considerable comorbidities in the elderly could complicate standard surgical procedures that younger patients would be offered. In this respect, application of external fixators represents a validated, minimally-invasive treatment opportunity. This review article summarises the use of external fixation in geriatric trauma patients for wrist fractures, proximal femoral fractures, pelvic fractures, and ankle fractures. Modern modifications, like pin coating with hydroxyapatite, and aspects of pin care will be discussed.
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Affiliation(s)
- Hagen Andruszkow
- Department of Orthopaedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Aachen, Germany
| | - Roman Pfeifer
- Department of Orthopaedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Aachen, Germany
| | - Klemens Horst
- Department of Orthopaedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Aachen, Germany
| | - Hans-Christoph Pape
- Department of Orthopaedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Aachen, Germany.
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Lichte P, Andruszkow H, Kappe M, Horst K, Pishnamaz M, Hildebrand F, Lefering R, Pape HC, Kobbe P. Increased in-hospital mortality following severe head injury in young children: results from a nationwide trauma registry. Eur J Med Res 2015; 20:65. [PMID: 26272597 PMCID: PMC4536600 DOI: 10.1186/s40001-015-0159-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 08/05/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In the current literature, the outcome of paediatric brain injury is controversially discussed. According to the majority of the studies, there seems to be a decreased mortality but worse recovery in paediatric, traumatic brain injury in comparison with adults. However, there is a lack of information concerning the differences in various stages of development in patients younger than 18 years. The aim of our study was to verify the in-hospital outcome of different paediatric age groups in comparison to adults with respect to the treatment strategy. METHODS We performed a retrospective analysis of the TraumaRegister DGU(®) from 2002 to 2012. Inclusion criteria were an Abbreviated Injury Scale (AIS) head ≥3 points and an AIS ≤2 points of the remaining body regions. The collective was divided into different subgroups according to age (1-3, 4-6, 7-10, 11-14, 15-17) and an adult control group aged between 18 and 55 years. We descriptively analysed the endpoint rate of sepsis, multiple organ failure, and mortality. Additionally, the Glasgow Outcome Scale (GOS) at discharge was observed. RESULTS Overall, 1110 children and 6491 adult control patients were included. Comparing the rate of intubation on-scene, the rate of cranial CT scans, the rate of craniotomies, and the rate and length of intensive care treatment, we could only identify minor differences between the age groups. The treatment after discharge from hospital was markedly different due to a very low rate of in-patient rehabilitation treatment in children. On one hand, the rate of systemic complications, such as sepsis and multiple organ failure increased with increasing age. On the other hand, we found a significantly increased mortality in children younger than 7 years after very (AIS head = 5) severe brain injury. The in-hospital functional outcome in survivors, according to the GOS, was beneficial for younger children in comparison to adolescents and adults. CONCLUSIONS We were unable to identify marked age-related differences in the therapeutic approach. Nevertheless, we were able to demonstrate marked differences of outcome. Children younger than 7 years significantly die more often due to direct impact of severe trauma. But if they survive, they seem to develop less systemic complications and profit from a better functional outcome.
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Affiliation(s)
- Philipp Lichte
- Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Hagen Andruszkow
- Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Miriam Kappe
- Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Klemens Horst
- Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. .,Harald Tscherne Research Laboratory for Orthopedic Trauma, Department of Orthopaedic Trauma Surgery, University Hospital RWTH Aachen, Aachen, Germany.
| | - Miguel Pishnamaz
- Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. .,Harald Tscherne Research Laboratory for Orthopedic Trauma, Department of Orthopaedic Trauma Surgery, University Hospital RWTH Aachen, Aachen, Germany.
| | - Frank Hildebrand
- Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany.
| | - Hans-Christoph Pape
- Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Philipp Kobbe
- Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
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Hildebrand F, Pape HC, Horst K, Andruszkow H, Kobbe P, Simon TP, Marx G, Schürholz T. Impact of age on the clinical outcomes of major trauma. Eur J Trauma Emerg Surg 2015; 42:317-32. [PMID: 26253883 DOI: 10.1007/s00068-015-0557-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/31/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE In view of demographic changes over the past few decades, the average age of trauma patients is progressively increasing. We therefore aimed to summarize the specific characteristics of geriatric trauma and to identify potential fields for further research to improve the care of elderly trauma patients. METHODS Review of the literature. RESULTS Due to the diverse risk factors (e.g., pre-existing conditions, limited physiological reserve), geriatric patients are prone to developing severe complications, even after less severe trauma. Yet, age is not considered as the only predictor of worse outcomes, and it should not be considered the only criterion for limiting care in those patients. It is crucial that age-specific treatment guidelines are developed to optimize the outcomes for senior trauma patients. Based on the current literature, these guidelines should emphasize the importance of field triage directly to a trauma center, along with the activation of the trauma team. Furthermore, early intensive monitoring, aggressive resuscitation, and time of surgical intervention are of upmost importance to reduce mortality. CONCLUSION The impact of several factors [age, premedical conditions (PMC), decreased physiological reserves, and impaired immune function] on the post-traumatic course of elderly trauma patients needs to be clarified in future experimental and clinical studies for the early identification of geriatric high-risk patients and for the development of age-adapted therapeutic strategies.
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Affiliation(s)
- F Hildebrand
- Department of Orthopaedic Trauma, Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany. .,Harald Tscherne Research Laboratory for Orthopaedic Trauma, Aachen University, Aachen, Germany.
| | - H-C Pape
- Department of Orthopaedic Trauma, Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - K Horst
- Department of Orthopaedic Trauma, Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.,Harald Tscherne Research Laboratory for Orthopaedic Trauma, Aachen University, Aachen, Germany
| | - H Andruszkow
- Department of Orthopaedic Trauma, Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.,Harald Tscherne Research Laboratory for Orthopaedic Trauma, Aachen University, Aachen, Germany
| | - P Kobbe
- Department of Orthopaedic Trauma, Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - T-P Simon
- Department of Intensive Care Medicine, Aachen University, Aachen, Germany
| | - G Marx
- Department of Intensive Care Medicine, Aachen University, Aachen, Germany
| | - T Schürholz
- Department of Intensive Care Medicine, Aachen University, Aachen, Germany
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25
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Horst K, Hildebrand F, Kobbe P, Pfeifer R, Lichte P, Andruszkow H, Lefering R, Pape HC. Detecting severe injuries of the upper body in multiple trauma patients. J Surg Res 2015; 199:629-34. [PMID: 26169033 DOI: 10.1016/j.jss.2015.06.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/19/2015] [Accepted: 06/11/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The clavicle limits the upper thoracic cage and connects the body and upper extremities. The clavicle is easy to examine and is visible on standard emergency room radiographs. We hypothesized that clavicular fracture in polytrauma patients would indicate the presence of further injuries of the upper extremities, head, neck, and thorax. METHODS A population-based trauma registry was used. All patients were documented between 2002 and 2013. Inclusion criteria were age ≥16 y and injury severity score (ISS) ≥16. Patients were divided into two groups according to the presence or absence of a clavicular fracture (group C+ and group C-). Scoring was based on the abbreviated injury scale, ISS, and new injury severity score. Trauma mechanisms, demographics, and the posttraumatic clinical course were compared. RESULTS In total, 4790 patients with clavicular fracture (C+) and 41,775 without (C-) were included; the mean ISS was 30 ± 11 (C+) versus 28 ± 12 (C-). Patients with clavicular fracture had a longer stay on the intensive care unit with 12 ± 14 versus 10 ± 13 d. Injuries to the thoracic wall, severe lung injuries as well as injuries to the cervical spine were significantly increased in C+ patients. Thoracic injuries as well as injuries of the shoulder girdle and/or arm showed an increased abbreviated injury scale in the C+ group. CONCLUSIONS A clinically relevant coincidence of clavicular fractures with injuries of the chest and upper extremity was found. As clavicular fractures can be diagnosed easily, it might also help to reduce the incidence of missed injuries of the chest and upper extremity. Therefore, special attention should be paid on thoracic as well as upper extremity injures during the second and tertiary surveys in case of clavicular fractures.
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Affiliation(s)
- Klemens Horst
- Department for Orthopaedic Trauma, RWTH Aachen University Hospital, Aachen, Germany.
| | - Frank Hildebrand
- Department for Orthopaedic Trauma, RWTH Aachen University Hospital, Aachen, Germany
| | - Philipp Kobbe
- Department for Orthopaedic Trauma, RWTH Aachen University Hospital, Aachen, Germany
| | - Roman Pfeifer
- Department for Orthopaedic Trauma, RWTH Aachen University Hospital, Aachen, Germany
| | - Philipp Lichte
- Department for Orthopaedic Trauma, RWTH Aachen University Hospital, Aachen, Germany
| | - Hagen Andruszkow
- Department for Orthopaedic Trauma, RWTH Aachen University Hospital, Aachen, Germany
| | - Rolf Lefering
- IFOM-The Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| | - Hans Christoph Pape
- Department for Orthopaedic Trauma, RWTH Aachen University Hospital, Aachen, Germany
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Jabakhanji SB, Meier TM, Ramakers-van Kuijk MA, Brink PRG, Andruszkow H, Krafft T, Pape HC. Agreements and practical experience of trauma care cooperation in Central Europe: the "Boundless Trauma Care Central Europe" (BTCCE) project. Injury 2015; 46:519-24. [PMID: 25795394 DOI: 10.1016/j.injury.2015.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Samira B Jabakhanji
- Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands; Euregio Maas-Rijn in Crisis, Euregio Office Public Health and Safety, The Netherlands
| | - Theresa M Meier
- Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands; Euregio Maas-Rijn in Crisis, Euregio Office Public Health and Safety, The Netherlands
| | - Marian A Ramakers-van Kuijk
- Department of Health, Medicine and Life Sciences; International Health, Maastricht University, The Netherlands; Euregio Maas-Rijn in Crisis, Euregio Office Public Health and Safety, The Netherlands
| | - Peter R G Brink
- Department of Traumatology, Maastricht University Medical Center, Maastricht, The Netherlands; Euregio Maas-Rijn in Crisis, Euregio Office Public Health and Safety, The Netherlands
| | - Hagen Andruszkow
- Department of Orthopedic Trauma and Reconstructive Surgery, University Hospital Aachen, Aachen, Germany; Euregio Maas-Rijn in Crisis, Euregio Office Public Health and Safety, The Netherlands
| | - Thomas Krafft
- Department of Health, Medicine and Life Sciences; International Health, Maastricht University, The Netherlands; Euregio Maas-Rijn in Crisis, Euregio Office Public Health and Safety, The Netherlands
| | - Hans-Christoph Pape
- Department of Orthopedic Trauma and Reconstructive Surgery, University Hospital Aachen, Aachen, Germany; Euregio Maas-Rijn in Crisis, Euregio Office Public Health and Safety, The Netherlands.
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Lichte P, Kobbe P, Almahmoud K, Pfeifer R, Andruszkow H, Hildebrand F, Lefering R, Pape HC. Post-traumatic thrombo-embolic complications in polytrauma patients. Int Orthop 2015; 39:947-54. [PMID: 25690923 DOI: 10.1007/s00264-015-2698-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 01/27/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Thrombo-embolic events after trauma are considered to be life-threatening complications. Our aim was to determine the incidence of arterial and venous thrombo-embolic events (TE) in severely-injured trauma patients, and its associated risk factors by using a large trauma registry. METHODS Patients' data from the TraumaRegister DGU® (TR-DGU) were screened for TE (DVT [symptomatic deep vein thrombosis], PE [symptomatic pulmonary embolism], MI [myocardial infarction], and stroke) through the clinical course of severely injured adult trauma patients from January 2005 to December 2012. Univariate analysis was used to compare the clinical outcomes (endpoints: mortality, ICU and hospital length of stay, ventilator days), and a multivariate regression analysis was used to assess the independent risk factors associated with each TE event. RESULTS From a cohort of 40,846 trauma patients, 1122 (2.8%) patients developed a TE during their post-traumatic clinical course (313, 0.8% DVT; 425, 1.0% PE; 160, 0.4% MI and 231, 0.6% stroke). ICU length of stay [LOS], total LOS, days on mechanical ventilation, and incidence of multiple organ failure (MOF) and sepsis were significantly increased in patients with TE complications. Injury severity, major pelvic injury, and one or more operations were found to be independent risk factors for the development of DVT. Age ≥ 60 years, male gender, and more than one operation were risk factors for PE development. For MI age was the only significant risk factor. The occurrence of a stroke is increased in patients with an age ≥ 60 years, major head injury (AIS head ≥ 3), and more than one operation. Finally, mortality rates were significantly higher in the TE group when compared to the non-TE cohort (21.8% vs. 12.7%; p < 0.001). CONCLUSION TE complications were associated with longer ICU and hospital stay as well as a higher mortality. Overall, age and repeated operations were the most important risk factors for the development of TE events.
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Affiliation(s)
- Philipp Lichte
- Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany,
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Andruszkow H, Hildebrand F, Lefering R, Pape HC, Hoffmann R, Schweigkofler U. Ten years of helicopter emergency medical services in Germany: do we still need the helicopter rescue in multiple traumatised patients? Injury 2014; 45 Suppl 3:S53-8. [PMID: 25284235 DOI: 10.1016/j.injury.2014.08.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Helicopter emergency medical service (HEMS) has been established in the preclinical treatment of multiple traumatised patients despite an ongoing controversy towards the potential benefit. Celebrating the 20th anniversary of TraumaRegister DGU(®) of the German Trauma Society (DGU) the presented study intended to provide an overview of HEMS rescue in Germany over the last 10 years analysing the potential beneficial impact of a nationwide helicopter rescue in multiple traumatised patients. PATIENTS AND METHODS We analysed TraumaRegister DGU(®) including multiple traumatised patients (ISS ≥ 16) between 2002 and 2012. In-hospital mortality was defined as main outcome. An adjusted, multivariate regression with 13 confounders was performed to evaluate the potential survival benefit. RESULTS 42,788 patients were included in the present study. 14,275 (33.4%) patients were rescued by HEMS and 28,513 (66.6%) by GEMS. Overall, 66.8% (n=28,569) patients were transported to a level I trauma centre and 28.2% (n=12,052) to a level II trauma centre. Patients rescued by HEMS sustained a higher injury severity compared to GEMS (ISS HEMS: 29.5 ± 12.6 vs. ISS GEMS 27.5 ± 11.8). Helicopter rescue teams performed more on-scene interventions, and mission times were increased in HEMS rescue (HEMS: 77.2 ± 28.7 min. vs. GEMS: 60.9 ± 26.9 min.). Linear regression analysis revealed that the frequency of HEMS rescue has decreased significantly between 2002 and 2012. In case of transportation to level I trauma centres a decrease of 1.7% per year was noted (p<0.001) while a decline of 1.6% per year (p<0.001) was measured for level II trauma centre admissions. According to multivariate logistic regression HEMS was proven a positive independent survival predictor between 2002 and 2012 (OR 0.863; 95%-CI 0.800-0.930; Nagelkerkes-R(2) 0.539) with only little differences between each year. CONCLUSIONS This study was able to prove an independent survival benefit of HEMS in multiple traumatised patients during the last 10 years. Despite this fact, a constant decline of HEMS rescue missions was found in multiple trauma patients due to unknown reasons. We concluded that HEMS should be used more often in case of trauma in order to guarantee the proven benefit for multiple traumatised patients.
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Affiliation(s)
- Hagen Andruszkow
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Frank Hildebrand
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Str. 200, 51109 Cologne, Germany.
| | - Hans-Christoph Pape
- Department of Orthopaedic Trauma at Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Reinhard Hoffmann
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik, Frankfurt, Germany.
| | - Uwe Schweigkofler
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik, Frankfurt, Germany.
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Hildebrand F, Radermacher P, Ruchholtz S, Huber-Lang M, Seekamp A, Flohé S, van Griensven M, Andruszkow H, Pape HC. Relevance of induced and accidental hypothermia after trauma-haemorrhage-what do we know from experimental models in pigs? Intensive Care Med Exp 2014; 2:16. [PMID: 26266916 PMCID: PMC4512998 DOI: 10.1186/2197-425x-2-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 04/06/2014] [Indexed: 12/17/2022] Open
Abstract
Recent experimental research has either focused on the role of accidental hypothermia as part of the lethal triad after trauma or tried to elucidate the effects of therapeutically induced hypothermia on the posttraumatic course. Induced hypothermia seems to reduce the mortality in experimental models of trauma-haemorrhage. As potential mechanisms, a decrease of cellular metabolism, beneficial effects on haemodynamic function and an attenuation of the inflammatory response have been described. However, negative side effects of hypothermia have to be considered, such as impairment of the coagulatory function and immunosuppressive effects. Furthermore, the optimal strategy for the induction of hypothermia (magnitude, duration, timing, cooling rate, etc.) and subsequent rewarming remains unclear. Nevertheless, this piece of information is essential before considering hypothermia as a treatment strategy for severely injured patients. This review aims to elaborate the differences between accidental and induced hypothermia and to summarize the current knowledge of the potential therapeutic use of induced hypothermia suggested in porcine models of trauma-haemorrhage.
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Affiliation(s)
- Frank Hildebrand
- Department of Orthopedic Trauma and Reconstructive Surgery and Harald Tscherne Laboratory, University of Aachen, Pauwelsstraße 30, Aachen, 52074, Germany,
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Horst K, Von Harten R, Weber C, Andruszkow H, Pfeifer R, Dienstknecht T, Pape HC. Assessment of coincidence and defect sizes in Bankart and Hill-Sachs lesions after anterior shoulder dislocation: a radiological study. Br J Radiol 2014; 87:20130673. [PMID: 24452107 DOI: 10.1259/bjr.20130673] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Bankart and Hill-Sachs lesions are often associated with anterior shoulder dislocation. The MRI technique is sensitive in diagnosing both injuries. The aim of this study was to investigate Bankart and Hill-Sachs lesions with MRI to determine the correlation in occurrence and defect sizes of these lesions. METHODS Between 2006 and 2013, 446 patients were diagnosed with an anterior shoulder dislocation and 105 of these patients were eligible for inclusion in the study. All patients were examined using MRI. Bankart lesions were classified as cartilaginous or bony lesions. Hill-Sachs lesions were graded I-III using a modified Calandra classification. RESULTS The co-occurrence of injuries was high [odds ratio (OR) = 11.47; 95% confidence interval (CI) = 3.60-36.52; p < 0.001]. Patients older than 29 years more often presented with a bilateral injury (OR = 16.29; 95% CI = 2.71-97.73; p = 0.002). A correlation between a Bankart lesion and the grade of a Hill-Sachs lesion was found (ρ = 0.34; 95% CI = 0.16-0.49; p < 0.001). Bankart lesions co-occurred more often with large Hill-Sachs lesions (O = 1.24; 95% CI = 1.02-1.52; p = 0.033). CONCLUSION If either lesion is diagnosed, the patient is 11 times more likely to have suffered the associated injury. The size of a Hill-Sachs lesion determines the co-occurrence of cartilaginous or bony Bankart lesions. Age plays a role in determining the type of Bankart lesion as well as the co-occurrence of Bankart and Hill-Sachs lesions. ADVANCES IN KNOWLEDGE This study is the first to demonstrate the use of high-quality MRI in a reasonably large sample of patients, a positive correlation of Bankart and Hill-Sachs lesions in anterior shoulder dislocations and an association between the defect sizes.
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Affiliation(s)
- K Horst
- Department for Orthopaedic Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
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Andruszkow H, Fischer J, Sasse M, Brunnemer U, Andruszkow JHK, Gänsslen A, Hildebrand F, Frink M. Interleukin-6 as inflammatory marker referring to multiple organ dysfunction syndrome in severely injured children. Scand J Trauma Resusc Emerg Med 2014; 22:16. [PMID: 24589345 PMCID: PMC3942614 DOI: 10.1186/1757-7241-22-16] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 02/11/2014] [Indexed: 01/08/2023] Open
Abstract
Background Despite the suggestion that the inflammatory response in traumatized children is functionally unique, prognostic markers predicting pediatric multiple organ failure are lacking. We intended to verify whether Interleukin-6 (IL-6) displays a pivotal role in pediatric trauma similar to adults. Methods Traumatized children less than 18 years of age with an Injury Severity Score >9 points and consecutive admission to the hospital’s pediatric intensive care unit were included. Organ function was evaluated according to the score by Marshall et al. while IL-6 levels were measured repetitively every morning. Results 59 traumatized children were included (8.4 ± 4.4 years; 57.6% male gender). Incidence of MODS was 11.9%. No differences were found referring to age, gender, injury distribution or overall injury severity between children with and without MODS. Increased IL-6 levels during hospital admission were associated with injury severity (Spearman correlation: r = 0.522, p < 0.001), while an inconsistent association towards the development of MODS was proven at that time point (Spearman correlation: r = 0.180, p = 0.231; Pearson's correlation: r = 0.297, p = 0.045). However, increased IL-6 levels during the first two days were no longer associated with the injury severity but a significant correlation to MODS was measured. Conclusions The presented prospective study is the first providing evidence for a correlation of IL-6 levels with injury severity and the incidence of MODS in traumatized children.
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Affiliation(s)
| | | | | | | | | | | | | | - Michael Frink
- Department for Trauma, Hand and Reconstructive Surgery, University Medical Center Marburg, Baldingerstr, 35043 Marburg, Germany.
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Andruszkow H, Deniz E, Urner J, Probst C, Grün O, Lohse R, Frink M, Krettek C, Zeckey C, Hildebrand F. Physical and psychological long-term outcome after traumatic brain injury in children and adult patients. Health Qual Life Outcomes 2014; 12:26. [PMID: 24571742 PMCID: PMC3941774 DOI: 10.1186/1477-7525-12-26] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 02/19/2014] [Indexed: 12/03/2022] Open
Abstract
Background Several studies have indicated that younger age is associated with worse recovery after pediatric traumatic brain injury (TBI) compared to elder children. In order to verify this association between long-term outcome after moderate to severe TBI and patient’s age, direct comparison between different pediatric age groups as well as an adult population was performed. Methods This investigation represents a retrospective cohort study at a level I trauma center including patients with moderate to severe, isolated TBI with a minimum follow-up of 10 years. According to their age at time of injury, patients were divided in pre-school (0–7 years), school (8–17 years) and adult (18–65 years) patients. Physical examination and standardized questionnaire on physical and psychological aspects (Glasgow Outcome Scale, Barthel Index, Impact of Event Scale, Hospital Anxiety and Depression Scale, short form 12) were performed. Results 135 traumatized patients were included. Physical and psychological long-term outcome was associated with injury severity but not with patients’ age at time of injury. Outcome recovery measured by Glasgow Outcome Scale was demonstrated with best results for pre-school aged children (p = 0.009). According to the Hospital Anxiety and Depression Scale an increased incidence of anxiety (p = 0.010) and depression (p = 0.026) was evaluated in older patients. Conclusion Long-term outcome perceptions after moderate to severe TBI presented in this study question current views of deteriorated recovery for the immature brain. The sustained TBI impact seemed not to reduce the child’s ability to overcome the suffered impairment measured by questionnaire based psychological, physical and health related outcome scores. These results distinguish the relevance of rehabilitation and family support in the long term.
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Affiliation(s)
- Hagen Andruszkow
- Department of Orthopaedic Trauma, Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
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Affiliation(s)
- H. Andruszkow
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Aachen
| | - F. Hildebrand
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Aachen
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Andruszkow H, Hildebrand F, Pfeifer R, Horst K, Pape HC. Professionalism in Health Care. Patient Saf Surg 2014. [DOI: 10.1007/978-1-4471-4369-7_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
Treatment of patients with multiple trauma is known to require validated established algorithms, experienced medical staff and intensive interdisciplinary cooperation between the medical disciplines. In order to predict the risk for potential complications and mortality, adequate assessment of patients with multiple trauma is crucial for further treatment decisions. Therefore, different scoring systems have been developed to assess injury severity and to predict the potential outcome after multiple trauma. These scores have in common that the severity of trauma is converted to a numeric value simplifying the physiological reality in general. But the anatomic as well as physiological impact after multiple trauma can hardly be represented comprehensively by a single numeric value. Consequently, the established scores can only be safely interpreted, if the individual limitations of each scoring system are known.
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Affiliation(s)
- H Andruszkow
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Aachen, Pauwelsstrasse 30, 52074, Aachen, Deutschland.
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Horst K, Dienstknecht T, Andruszkow H, Gradl G, Kobbe P, Pape HC. Radiographic changes in the operative treatment of acute acromioclavicular joint dislocation - tight rope technique vs. K-wire fixation. Pol J Radiol 2013; 78:15-20. [PMID: 24505220 PMCID: PMC3908503 DOI: 10.12659/pjr.889615] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/27/2013] [Indexed: 11/18/2022] Open
Abstract
Background Operative treatment of higher degree acromioclavicular joint luxation is common. A new option is made available by the tight rope technique. It claims to provide adequate outcome with the use of a minimally invasive technique. First clinical studies justified its medical use, but the equivalence to established surgical methods remains unclear. We therefore analyzed radiographic data from patients that were treated with the tight rope system (TR) and compared them to those treated with K-wires (KW) fixation. Material/Methods Retrospective study with inclusion criteria: surgery for acromioclavicular joint luxation between 2004 and 2011, classified as Rockwood type III, no concomitant injury, first event injury. We compared pre- and post-operative X-rays with those taken at the end of treatment. Clinical data from follow-ups and radiographic data were evaluated. The main outcome variable was the remaining distance between the acromion and clavicle (ACD), as well as the coracoid process and clavicle (CCD). Results 27 patients (TR: n=16; KW: n=11) with comparable demographics and injury severity were included. Surgery reduced ACD (TR: p=0.002; KW: p<0.001) and CCD (TR: p=0.001; KW: p=0.003). Heterotopic ossification or postoperative osteolysis was not significantly associated with either one of the procedures. Three patients (18.75%) in the TR group showed impaired wound healing, migrating K-wires were recorded in 2 patients (18.2%) and impingement syndrome occurred in 1 patient (9.1%) with K-wires. Posttraumatic arthritis was not seen. There was a loss of reduction in 2 cases within the TR-group (12.51%) and 1 in the KW-group (9.1%). At last follow up, ACD and CCD were wider in both groups compared to the healthy side. Conclusions This study shows that the Tight rope system is an effective alternative in the treatment of higher degree acromioclavicular luxation and comparable to the established methods.
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Affiliation(s)
- Klemens Horst
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Thomas Dienstknecht
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Hagen Andruszkow
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Gertraud Gradl
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Philipp Kobbe
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Hans-Christoph Pape
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
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Andruszkow H, Urner J, Deniz E, Probst C, Grün O, Lohse R, Frink M, Hildebrand F, Zeckey C. Subjective impact of traumatic brain injury on long-term outcome at a minimum of 10 years after trauma- first results of a survey on 368 patients from a single academic trauma center in Germany. Patient Saf Surg 2013; 7:32. [PMID: 24112807 PMCID: PMC3853225 DOI: 10.1186/1754-9493-7-32] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/07/2013] [Indexed: 11/22/2022] Open
Abstract
Background Traumatic Brain Injury (TBI) may lead to significant impairments in personal, social and professional life. However, knowledge of the influence on long-term outcome after TBI is sparse. We therefore aimed to investigate the subjective effects of TBI on long-term outcome at a minimum of 10 years after trauma in one of the largest study populations in Germany. Methods The current investigation represents a retrospective cohort study at a level I trauma center including physical examination or standardized questionnaires of patients with mild, moderate or severe isolated TBI with a minimum follow-up of 10 years. We investigated the subjective physical, psychological and social outcome evaluating the Glasgow Outcome Scale, short-form 12, and social as well as vocational living circumstances. Results 368 patients aged 0 to 88 years were included. Patients with severe TBI were younger compared to patients with moderate or mild TBI (p < 0.05). Patients with severe TBI lived more often as single after the trauma impact. A significantly worse outcome was associated with higher severity of TBI resulting in an increased incidence of mental disability. A professional decline was analyzed in case of severe TBI resulting in significant loss of salary. Conclusions The severity of TBI significantly influenced the subjective social and living conditions. Subjective mental and physical outcome as well as professional life depended on the severity of TBI 10 years after the injury.
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Affiliation(s)
- Hagen Andruszkow
- Department for Trauma and Reconstructive Surgery, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074 Germany.
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Andruszkow H, Dowrick AS, Frink M, Zeckey C, Krettek C, Hildebrand F, Edwards ER, Mommsen P. Surgical strategies in polytraumatized patients with femoral shaft fractures - comparing a German and an Australian level I trauma centre. Injury 2013; 44:1068-72. [PMID: 23639825 DOI: 10.1016/j.injury.2013.03.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 02/18/2013] [Accepted: 03/31/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Femoral shaft fractures are one of the most common injuries in multiple trauma patients. Due to their prognostic relevance, there is an ongoing controversial discussion as to the optimal treatment strategy in terms of Damage Control Orthopaedics (DCO) and Early Total Care (ETC). We aimed to describe the differences in fracture management and clinical outcome of multiple trauma patients with concomitant femoral shaft fractures treated at a German and an Australian level I trauma centre using the same inclusion criteria. METHODS Polytraumatized patients (ISS ≥ 16) with a femoral shaft fracture aged ≥ 16 years treated at a German and an Australian trauma centre between 2003 and 2007 were included. According to ETC and DCO management principles, we evaluated demographic parameters as well as posttraumatic complications and clinical outcome. RESULTS Seventy-three patients were treated at the German and 134 patients at the Australian trauma centre. DCO was performed in case of increased injury severity in both hospitals. Prolonged mechanical ventilation time, and length of ICU and hospital stay were demonstrated in DCO treatment regardless of the trauma centre. No differences concerning posttraumatic complications and survival were found between both centres. Survival of patients after DCO was similar to those managed using ETC despite a greater severity of injury and lower probability of survival. There was no difference in the incidence of ARDS. DCO was, however, associated with a greatly increased length of time on mechanical ventilation and length of stay in the ICU. CONCLUSION We found no differences concerning patient demographics or clinical outcomes in terms of incidence of ARDS, MODS, or mortality. As such, we propose that comparability between German and Australian trauma populations is justified. Despite a higher ISS in the DCO group, there were no differences in posttraumatic complications and survival depending on ETC or DCO treatment. Further research is required to confirm whether this is the case with other countries, too.
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Affiliation(s)
- Hagen Andruszkow
- Department of Trauma and Reconstructive Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
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Andruszkow H, Scharff B, Zapf A, Klein M, Lechler P, Hildebrand F, Frink M. Der Einfluss von Begleiterkrankungen und operativem Versorgungszeitpunkt auf die Mortalität bei Patienten mit Schenkelhalsfraktur. Z Orthop Unfall 2013; 151:338-42. [DOI: 10.1055/s-0032-1328665] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- H. Andruszkow
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Aachen
| | - B. Scharff
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover
| | - A. Zapf
- Institut für Medizinische Statistik, Universitätsklinikum Göttingen
| | - M. Klein
- Klinik für Orthopädie und Unfallchirurgie, Sana Klinikum Hameln-Pyrmont, Hameln
| | - P. Lechler
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Marburg
| | - F. Hildebrand
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Aachen
| | - M. Frink
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover
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Andruszkow H, Lefering R, Frink M, Mommsen P, Zeckey C, Rahe K, Krettek C, Hildebrand F. Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients. Crit Care 2013; 17:R124. [PMID: 23799905 PMCID: PMC4056624 DOI: 10.1186/cc12796] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 06/21/2013] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Physician-staffed helicopter emergency medical services (HEMS) are a well-established component of prehospital trauma care in Germany. Reduced rescue times and increased catchment area represent presumable specific advantages of HEMS. In contrast, the availability of HEMS is connected to a high financial burden and depends on the weather, day time and controlled visual flight rules. To date, clear evidence regarding the beneficial effects of HEMS in terms of improved clinical outcome has remained elusive. METHODS Traumatized patients (Injury Severity Score; ISS≥9) primarily treated by HEMS or ground emergency medical services (GEMS) between 2007 and 2009 were analyzed using the TraumaRegister DGU® of the German Society for Trauma Surgery. Only patients treated in German level I and II trauma centers with complete data referring to the transportation mode were included. Complications during hospital treatment included sepsis and organ failure according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) consensus conference committee and the Sequential Organ Failure Assessment (SOFA) score. RESULTS A total of 13,220 patients with traumatic injuries were included in the present study. Of these, 62.3% (n=8,231) were transported by GEMS and 37.7% (n=4,989) by HEMS. Patients treated by HEMS were more seriously injured compared to GEMS (ISS 26.0 vs. 23.7, P<0.001) with more severe chest and abdominal injuries. The extent of medical treatment on-scene, which involved intubation, chest and treatment with vasopressors, was more extensive in HEMS (P<0.001) resulting in prolonged on-scene time (39.5 vs. 28.9 minutes, P<0.001). During their clinical course, HEMS patients more frequently developed multiple organ dysfunction syndrome (MODS) (HEMS: 33.4% vs. GEMS: 25.0%; P<0.001) and sepsis (HEMS: 8.9% vs. GEMS: 6.6%, P<0.001) resulting in an increased length of ICU treatment and in-hospital time (P<0.001). Multivariate logistic regression analysis found that after adjustment by 11 other variables the odds ratio for mortality in HEMS was 0.75 (95% CI: 0.636 to 862). CONCLUSIONS Although HEMS patients were more seriously injured and had a significantly higher incidence of MODS and sepsis, these patients demonstrated a survival benefit compared to GEMS.
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Neunaber C, Oestern S, Andruszkow H, Zeckey C, Mommsen P, Kutter D, Stöfen M, Krettek C, Hildebrand F. Cytokine productive capacity of alveolar macrophages and Kupffer cells after femoral fracture and blunt chest trauma in a murine trauma model. Immunol Lett 2013; 152:159-66. [PMID: 23735227 DOI: 10.1016/j.imlet.2013.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/08/2013] [Accepted: 05/26/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Specific cellular and inflammatory factors that contribute to the severity of pulmonary dysfunction after blunt chest trauma and osteosynthesis of femoral fractures are yet not fully understood. Therefore, we investigated alterations of the cytokine productive capacity of alveolar macrophages (AM) and Kupffer cells (KC) after femoral fracture stabilized with intramedullary pin with or without blunt chest trauma. MATERIALS AND METHODS In male C57BL/6N mice an intramedullary pin was implanted in an intact femur as the sham procedure. In trauma groups mice either received an isolated femoral fracture with subsequent fracture stabilization with an intramedullary pin (group Fx) or a combined trauma of blunt chest trauma and femur fracture also stabilized by an intramedullary pin (group TTFx). Animals were sacrificed 0h, 6h, 12h, 24h and 3d after trauma induction. Cytokine concentrations were measured in plasma and supernatant of cultivated AM and KC by FACS analysis. Pulmonary and hepatic infiltration of polymorphonuclear leukocytes (PMN) was determined by Ly6G-staining. RESULTS At 6h, isolated femoral fracture with intramedullary stabilization resulted in a significantly increased productive capacity of KC (IL-6, TNF-α, CCL2, CCL3, CCL5 and CCL7) compared to sham animals. Combined trauma additionally resulted in an increased productive capacity of AM (IL-6, TNF-α, CCL2, CCL3, CCL4, CCL5 and CCL7) at 6h and the effect was prolonged up to 3d compared to controls. Combined trauma also led to a significant higher amount of plasma CCL2 at 3d and plasma CCL7 at 6h after the insult compared to group Fx. Compared to shams, pulmonary and hepatic infiltrations of PMNs were increased in group Fx and TTFx after 6h, but in the combined trauma model the effect was prolonged up to 3d. CONCLUSION An intramedullary stabilized femur fracture alone results in a significant activation of the immune response. The combination of femoral fracture and blunt chest trauma however, results in an increased and prolonged activation of the inflammatory response. Transferred to the clinical setting, these results emphasize the critical role of severe chest trauma for treatment strategies of femoral fractures in multiple trauma patients.
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Affiliation(s)
- Claudia Neunaber
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany.
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Andruszkow H, Frink M, Zeckey C, Krettek C, Hildebrand F, Mommsen P. Merits and capabilities of helicopter emergency medical service (HEMS) in traumatized patients. Technol Health Care 2013; 20:435-44. [PMID: 23079947 DOI: 10.3233/thc-2012-0691] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since the introduction of helicopter emergency medical service (HEMS) into the civilian rescue system, there is an ongoing discussion on its potential benefits in terms of time- and cost-effectiveness as well as clinical outcome improvement. Currently, the use of HEMS seems to provide a survival benefit in traumatized patients due to several aspects compared to ground emergency medical service (GEMS). First of all, HEMS facilitate rapid transport from the scene to hospital based on increased transportation velocity. Furthermore, HEMS medical crew members are experienced in trauma management resulting in improved on-scene management and patients' triaging. However, these aspects should be considered carefully as specific circumstances referring to rescue teams, on-scene management as well as preclinical durations, triaging of trauma patients and subsequent treatment at different hospitals have to be attended. In the present review current aspects of HEMS compared to GEMS are discussed.
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Mommsen P, Andruszkow H, Frömke C, Zeckey C, Wagner U, van Griensven M, Frink M, Krettek C, Hildebrand F. Effects of accidental hypothermia on posttraumatic complications and outcome in multiple trauma patients. Injury 2013; 44:86-90. [PMID: 22040695 DOI: 10.1016/j.injury.2011.10.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Revised: 10/10/2011] [Accepted: 10/11/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Accidental hypothermia seems to predispose multiple trauma patients to the development of posttraumatic complications, such as Systemic Inflammatory Response Syndrome (SIRS), sepsis, Multiple Organ Dysfunction Syndrome (MODS), and increased mortality. However, the role of accidental hypothermia as an independent prognostic factor is controversially discussed. The aim of the present study was to evaluate the incidence of accidental hypothermia in multiple trauma patients and its effects on the development of posttraumatic complications and mortality. PATIENTS AND METHODS Inclusion criteria for patients in this retrospective study (2005-2009) were an Injury Severity Score (ISS) ≥16, age ≥16 years, admission to our Level I trauma centre within 6h after the accident. Accidental hypothermia was defined as body temperature less than 35°C measured within 2 h after admission, but always before first surgical procedure in the operation theatre. The association between accidental hypothermia and the development of posttraumatic complications as well as mortality was investigated. Statistical analysis was performed with χ(2)-test, Student's t-test, ANOVA and logistic regression. Statistical significance was considered at p<0.05. RESULTS 310 multiple trauma patients were enrolled in the present study. Patients' mean age was 41.9 (SD 17.5) years, the mean injury severity score was 29.7 (SD 10.2). The overall incidence of accidental hypothermia was 36.8%. The overall incidence of posttraumatic complications was 77.4% (SIRS), 42.9% (sepsis) and 7.4% (MODS), respectively. No association was shown between accidental hypothermia and the development of posttraumatic complications. Overall, 8.7% died during the posttraumatic course. Despite an increased mortality rate in hypothermic patients, hypothermia failed to be an independent risk factor for mortality in multivariate analysis. CONCLUSIONS Accidental hypothermia is very common in multiply injured patients. However, it could be assumed that the increase of mortality in hypothermic patients is primarily caused by the injury severity and does not reflect an independent adverse effect of hypothermia. Furthermore, hypothermia was not shown to be an independent risk factor for posttraumatic complications.
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Affiliation(s)
- P Mommsen
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany.
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Andruszkow H, Frink M, Frömke C, Matityahu A, Zeckey C, Mommsen P, Suntardjo S, Krettek C, Hildebrand F. Tip apex distance, hip screw placement, and neck shaft angle as potential risk factors for cut-out failure of hip screws after surgical treatment of intertrochanteric fractures. Int Orthop 2012; 36:2347-54. [PMID: 23011721 DOI: 10.1007/s00264-012-1636-0] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 07/25/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the quality of osteosynthesis after intertrochanteric fractures evaluation of tip apex distance (TAD) and position of the hip screw have been established. Furthermore, a slightly valgus fracture reduction has been suggested to reduce the risk of cut-out failure. However, uniform recommendations for optimal screw positioning and fracture reduction are still missing. The purpose of our study was to confirm potential risk factors for cut-out of hip screws of intertrochanteric fractures and to provide recommendations for practical clinical use. METHODS A retrospective analysis of all patients with intertrochanteric fractures treated with a DHS or a gamma nail between January of 2007 and May of 2010 was performed at a level I trauma center. RESULTS Two hundred thirty-five patients with intertrochanteric fractures after intra- and extramedullary stabilization were analyzed. A TAD of more than 25 mm was demonstrated to be the most important factor for cut-out in stable and unstable fractures. Fracture reduction with a valgus NSA of 5-10° was associated with a trend towards a lower rate of screw cut-out while an anterior placement of the screw (Parker's ratio index of <40) significantly increased cut-out incidence. CONCLUSIONS According to our results, the TAD should not exceed 25 mm in stable (AO/OTA A1) as well as unstable (AO/OTA A2) fractures. An increased anterior hip screw placement should be avoided while fracture reduction with a slight valgus Neck Shaft seems favorable.
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Affiliation(s)
- Hagen Andruszkow
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Andruszkow H, Liodakis E, Lefering R, Krettek C, Hildebrand F, Haasper C. Knee injuries in severe trauma patients: a trauma registry study in 3.458 patients. J Trauma Manag Outcomes 2012; 6:7. [PMID: 22866995 PMCID: PMC3489801 DOI: 10.1186/1752-2897-6-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 07/23/2012] [Indexed: 11/25/2022]
Abstract
Background Purpose of the presented study is to answer the following questions: Are knee injuries associated with trauma mechanisms or concomitant injuries? Do injuries of the knee region aggravate treatment costs or prolong hospital stay in polytraumatized patients? Methods A retrospective analysis including 29.779 severely injured patients (Injury Severity Score [greater than or equal to] 16) from the Trauma Registry of the German Society for Trauma Surgery database (1993-2008) was conducted. Patients were subdivided into two groups; the "Knee" group (n=3.458, 11.6% of all patients) including all multiple trauma patients with knee injuries, and the "Non Knee" group (n=26.321) including the remaining patients. Patients with knee injuries were slightly younger, less often male gender and had a significantly increased ISS. Results Patients in the Knee group suffered significantly more traffic accidents compared to the Non Knee group (82% vs. 52%, p<0.001). These injuries were more often caused by car or motorbike accidents. Severe thoracic and limb injuries (AIS[greater than or equal to]3) were more frequently found in the Knee group (p<0.001) while head injury was distributed equally. The overall hospital stay, ICU stay, and treatment costs were significantly higher for the Knee group (38.1 vs. 25.5 days, 15.2 vs. 11.4 days, 40,116 vs. 25,336 Euro, respectively; all p<0.001). Conclusions Traffic accidents are associated with an increased incidence of knee injuries than falls or attempted suicides. Furthermore, severe injuries of the limbs and chest are more common in polytraumatized patients with knee injuries. At last, treatment of these patients is prolonged and consequently more expensive.
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Affiliation(s)
- Hagen Andruszkow
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625, Germany
| | - Emmanouil Liodakis
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Cologne-Merheim Medical Center, University Witten-Herdecke, Cologne, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625, Germany
| | - Frank Hildebrand
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625, Germany
| | - Carl Haasper
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625, Germany
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Mommsen P, Bradt N, Zeckey C, Andruszkow H, Petri M, Frink M, Hildebrand F, Krettek C, Probst C. Comparison of helicopter and ground Emergency Medical Service: A retrospective analysis of a German rescue helicopter base. Technol Health Care 2012; 20:49-56. [DOI: 10.3233/thc-2011-0655] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Philipp Mommsen
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Nikolas Bradt
- Trauma Department, Hannover Medical School, Hannover, Germany
| | | | | | - Max Petri
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Michael Frink
- Trauma Department, Hannover Medical School, Hannover, Germany
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Zeckey C, Hildebrand F, Glaubitz LM, Jürgens S, Ludwig T, Andruszkow H, Hüfner T, Krettek C, Stuhrmann M. Are polymorphisms of molecules involved in bone healing correlated to aseptic femoral and tibial shaft non-unions? J Orthop Res 2011; 29:1724-31. [PMID: 21538509 DOI: 10.1002/jor.21443] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 03/31/2011] [Indexed: 02/04/2023]
Abstract
Fracture healing is a well-organized process between several molecules and mediators. As known from other diseases, genetic polymorphisms may exhibit different expression patterns in these mediators. Concerning fracture healing, this may lead to an extended healing process or non-union. We investigated the incidence of polymorphisms in patients with aseptic non-unions after femoral and tibial shaft fractures as compared to patients with uneventful healing. Exclusion criteria were smoking, diabetes, bilateral fractures, systemic corticoid therapy, and septic non-unions. Analysis of allele frequencies and genotype distribution of various mediators were carried out following PCR. Clinical parameters such as injury severity and in-hospital were analyzed. Fifty patients following non-union (group NU) were enrolled, the control group consisted of 44 patients (group H). A significant association of a PDGF haplotype and non-unions following fracture could be observed. There was a significantly increased in-hospital time and amount of surgical procedures in group NU. Polymorphisms within the PDGF gene seem to be a genetic risk factor for the development of non-unions of the lower extremity following fracture. The early identification of high risk patients could result in an adapted therapeutical strategy and might contribute to a significant decrease of posttraumatic non-unions.
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Affiliation(s)
- Christian Zeckey
- Trauma Department, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany.
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Mommsen P, Zeckey C, Andruszkow H, Weidemann J, Frömke C, Puljic P, van Griensven M, Frink M, Krettek C, Hildebrand F. Comparison of different thoracic trauma scoring systems in regards to prediction of post-traumatic complications and outcome in blunt chest trauma. J Surg Res 2011; 176:239-47. [PMID: 22099585 DOI: 10.1016/j.jss.2011.09.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Revised: 08/12/2011] [Accepted: 09/09/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND As accurate assessment of thoracic injury severity in the early phase after trauma is difficult, we compared different thoracic trauma scores regarding their predictive ability for the development of post-traumatic complications and mortality. MATERIALS AND METHODS Two hundred seventy-eight multiple trauma patients (ISS ≥ 16) age > 16 y with severe blunt chest trauma (AIS(chest) ≥ 3) admitted between 2000 and 2009 to Level I Trauma center were included. Exclusion criteria were severe traumatic brain injury (AIS(head) ≥ 3) and penetrating thoracic trauma. The association between AIS(chest), Pulmonary Contusion score (PCS), Wagner-score and Thoracic Trauma Severity score (TTS), and duration of ventilation, length of ICU stay, development of post-traumatic complications, and mortality was investigated. Statistical analysis was performed with χ(2)-test, ANOVA, logistic regression, and receiver operating characteristic (ROC) curve. RESULTS Patients' mean age was 42.7 ± 17.0 y, the mean injury severity score was 28.7 ± 9.3 points. Overall, 60 patients (21.6%) developed ARDS, 143 patients (51.4%) SIRS, 110 patients (39.6%) sepsis, and 36 patients (13.0%) MODS. Twenty-two patients (7.9%) died. Among the examined thoracic trauma scores only the TTS was an independent predictor of mortality. With the TTS showing the best prediction power, the TTS, PCS, and Wagner-score were independent predictors of ventilation time, length of ICU stay, and the development of post-traumatic ARDS and MODS. CONCLUSIONS Thoracic trauma scores combining anatomical and physiologic parameters like the TTS seem to be most suitable for severity assessment and prediction of outcome in multiple trauma patients with concomitant blunt chest trauma.
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Affiliation(s)
- Philipp Mommsen
- Trauma Department, Hannover Medical School, Hannover, Germany.
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Brunnemer U, Zeckey C, Hildebrand F, Frink M, Mommsen P, van Griensven M, Andruszkow H, Krettek C, Barkhausen T. Androstenediol exerts salutary effects on chemokine response after trauma-hemorrhage and sepsis in mice. J Orthop Trauma 2011; 25:511-5. [PMID: 21738064 DOI: 10.1097/bot.0b013e3182251044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The pathogenesis of multiple organ dysfunction syndrome and sepsis after polytrauma is related to the posttraumatic immune response and the associated release of inflammatory mediators. There exists a gender dimorphism in the posttraumatic host response. Sex steroids are believed to beneficially modulate the posttraumatic immune response. The specific effect of androstenediol on chemokines after trauma is unknown. We investigated whether the application of androstenediol has an effect on plasma chemokine levels and the associated remote organ damage in a two-hit mouse-model of trauma-hemorrhage, cecal ligation, and cecal puncture. MATERIALS AND METHODS Traumatic hemorrhage was induced followed by androstenediol application and volume resuscitation. Thereafter, androstenediol was given once daily in combination with a vehicle (Intralipid). The control group was injected with a solution containing only the vehicle at the same time points as the treatment groups' androstenediol applications. Sepsis was induced by cecal ligation and cecal puncture 48 hours afterward. Four hours after cecal ligation and cecal puncture, plasma measurements of chemokines were performed. Pulmonary infiltration by polymorphonuclear lymphocytes was measured by immunhistochemical staining and myeloperoxidase measurements were taken. RESULTS Application of androstenediol led to significantly decreased monocyte chemoattractant protein-1, monocyte chemoattractant protein-3, macrophage inflammatory protein-1α, and macrophage inflammatory protein-1β levels compared with the control animals after trauma-hemorrhage, cecal ligation, and cecal puncture (P < 0.05). Pulmonary infiltration and myeloperoxidase activity were significantly decreased in androstenediol-treated animals (P < 0.05). CONCLUSION Androstenediol modulates the immune response after trauma-hemorrhage, cecal ligation, and cecal puncture by reducing systemic chemokine levels, which are known to direct immune cells into the tissue possibly leading to organ damage. Androstenediol represents a potential therapeutic agent after major trauma in high-risk patients.
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Affiliation(s)
- Ulf Brunnemer
- Trauma Department, Hannover Medical School, Hannover, Germany
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Zeckey C, Andruszkow H, Neunaber C, Frink M, Schirmer B, Mommsen P, Barkhausen T, Krettek C, Hildebrand F. Protective effects of finasteride on the pulmonary immune response in a combined model of trauma-hemorrhage and polymicrobial sepsis in mice. Cytokine 2011; 56:305-11. [PMID: 21767963 DOI: 10.1016/j.cyto.2011.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 06/21/2011] [Accepted: 06/22/2011] [Indexed: 12/13/2022]
Abstract
UNLABELLED Literature supports findings about a gender specific outcome following multiple trauma. Male sex hormones such as dihydrotestosterone (DHT) exert deleterious effects on the posttraumatic immune response whereas increased estradiol concentrations are correlated with improved outcome. Pretreatment with the 5α-reductase inhibitor finasteride resulted in an improved outcome following trauma-hemorrhage (TH) in mice. The present study tested the hypothesis that finasteride exerts beneficial effects on the posttraumatic immune response also in a combined setting of TH and sepsis when administered during the resuscitation process. MATERIAL AND METHODS Male C57BL/6N-mice were subjected to TH (blood pressure, 35 mm Hg, 60 min) followed by finasteride application and fluid resuscitation. Thereafter, finasteride was administered every 12h. 24h after TH, sepsis was induced by cecal ligation and puncture (CLP) or sham operation was performed. Plasma cytokines (MIP-1α, MIP-1β, TNF-α, MCP-1, IL-6), productive capacity by alveolar macrophages (AM) and systemic estradiol levels were determined 4 h thereafter. The expression of pro-inflammatory mediators in lung tissue was evaluated by PCR. Pulmonary infiltration of PMN was determined by immunohistochemical staining. RESULTS Finasteride treatment resulted in a reduced posttraumatic cytokine secretion of AM as well as in a decreased concentration of MCP-1 and MIP-1β in lung tissue. Systemic estradiol levels were increased following finasteride treatment. CONCLUSION Finasteride mediates salutary effects on the pulmonary immune response using a therapeutical approach following TH-CLP in mice. Thus, finasteride might represent a relevant therapeutic substance following major trauma also in the clinical setting.
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