[High-risk needlestick injuries and virus transmission : A prospective observational study]. / Hochrisikonadelstichverletzungen und Virustransmission : Eine prospektive Beobachtungsstudie.

BACKGROUND: Needlestick injuries (NSI) of healthcare personnel (HCP) are work-related accidents with a risk of transmission of blood-borne human immunodeficiency virus (HIV), hepatitis B and C viruses (HBV, HCV). Along with preventive measures to avoid accidental NSI, preventing the risk and diagnosis of an infection from NSI are given a high priority. Thus, follow-up monitoring of NSI is of great interest. OBJECTIVE: Evaluation of the follow-up monitoring after NSI with respect to early recognition of transmission of HIV, HCV and HBV as well as adherence and psychological burden of HCP. METHODS: Clinical and serological investigations of the injured HCP including determining the individual risk of infection in the situation of NSI, analysis of accident protocols by the accident insurance consultant and use of a self-developed standardized questionnaire. RESULTS: No virus transmissions from NSI were found during the observation period (23 March 2014 until 31 October 2017). A total of 112 NSI with infectious index patients (HIV 35.7%, HCV 54.5%, HBV 2.7%, coinfection 7.1%) and 3 incidents from unknown index patients were analyzed. Of the index patients six received the first diagnosis of a blood-borne infection (2 HCV infections, 4 HIV infections) after NSI. In nearly all incidents (98.3%) the HCP took measures to disinfect and flush the injury and 85.1% of the HCP exposed to HIV or unknown infection risk undertook postexposure prophylaxis (HIV-PEP) within 2 h and another 12.8% within 10 h. Follow-up examination was attended by 97.4% of the HCP, three quarters of the HCP felt concerned following NSI and 12.2% were very concerned. CONCLUSION: Through adequate management and follow-up of NSI low transmission rates can be achieved after exposure to blood-borne viruses within the occupational environment.

[Increasing overhead ressources of the trauma room]. / Steigender Vorhalteaufwand für den Schockraum.

BACKGROUND: Every year up to 35,000 people in Germany are severely injured in accidents in traffic, during work or leisure activities. The 24-h availability of the trauma room as well as surgical and intensive care unit capacities are essential to provide optimal acute care. This study analyzed the frequency of utilization of the resource trauma room in a level I trauma center in the past. METHODS: Data of a level I trauma center from 2005 to 2016 including trauma room alerts deployed by the rescue coordination center and the number of patients found to be severely injured (ISS ≥ 16) during trauma room diagnostics were analyzed retrospectively. Additionally, alerts due to trauma mechanism, accompanying by the emergency physician, ventilation and resuscitation were evaluated via a web-based interdisciplinary care capacity system (IVENA) from 2012 to 2016. Therefore, a comparison between the number of trauma room alerts and the number of severely injured patients was performed for the time after 2012. RESULTS: For the time from 2012 to 2016, data obtained by IVENA showed a continuous increase in the number of trauma room alerts (n = 367 to n = 623). At the same time, the number of patients admitted under resuscitation (n = 15 to n = 45) as well as ventilated patients (n = 78 to n = 139) increased significantly; however, there was also an increase in the number of trauma alerts due to trauma mechanisms (n = 84 to n = 194) as well as the number of patients admitted to the trauma room not accompanied by an emergency physician (n = 38 to n = 132). The ratio between the number of trauma room alerts and severely injured patients (ISS ≥ 16) increased from 3.1 in 2012 to 5.4 in 2015 and 4.6 in 2016. CONCLUSION: The data at hand showed a constant number of severely injured trauma patients admitted to a level I trauma center over the past few years. At the same time, there was a significant increase in utilization of the trauma room; however, in a considerable number of patients admitted to the trauma room the diagnostic process resulted in non-traumatic diagnostic findings. In the analyzed cohort, especially patients admitted to the trauma room due to trauma mechanism or without an accompanying emergency physician contributed to this development, necessitating an increased operational readiness of the trauma room team.

[Imaging techniques in modern trauma diagnostics]. / Bildgebende Verfahren der modernen Schockraumdiagnostik.

Modern trauma room management requires interdisciplinary teamwork and synchronous communication between a team of anaesthesists, surgeons and radiologists. As the length of stay in the trauma room influences morbidity and mortality of a severely injured person, optimizing time is one of the main targets. With the direct involvement of modern imaging techniques the injuries caused by trauma should be detected within a very short period of time in order to enable a priority-orientated treatment. Radiology influences structure and process quality, management and development of trauma room algorithms regarding the use of imaging techniques. For the individual case interventional therapy methods can be added. Based on current data and on the Frankfurt experience the current diagnostic concepts of trauma diagnostics are presented.

[Imaging techniques in modern trauma diagnostics]. / Bildgebende Verfahren der modernen Schockraumdiagnostik.

Modern trauma room management requires interdisciplinary teamwork and synchronous communication between a team of anaesthesists, surgeons and radiologists. As the length of stay in the trauma room influences morbidity and mortality of a severely injured person, optimizing time is one of the main targets. With the direct involvement of modern imaging techniques the injuries caused by trauma should be detected within a very short period of time in order to enable a priority-orientated treatment. Radiology influences structure and process quality, management and development of trauma room algorithms regarding the use of imaging techniques. For the individual case interventional therapy methods can be added. Based on current data and on the Frankfurt experience the current diagnostic concepts of trauma diagnostics are presented.

Sera from severe trauma patients with pneumonia and without infectious complications have differential effects on neutrophil biology.

BACKGROUND: Major trauma patients (TP) developing imbalanced immune response are at high risk for infectious post-injury complications including pneumonia. Neutrophils play a central role in the host defense against bacteria and thereby pathogenesis of infections. While there are numerous studies about neutrophil function after trauma, data about their biology in patients who suffer from pneumonia following trauma are sparse. Here, we studied the effect of serum isolated from patients who do and do not develop infection (inf.) on the biology of neutrophils from healthy volunteers. METHODS: Sera samples from eighteen TP with an injury severity score above 16 were obtained. Nine patients were grouped to no inf. group (TP without pneumonia), and nine to inf. group (TP with pneumonia). Samples were obtained at admission to emergency department (ED), a day prior pneumonia diagnosis (1 d prior inf) or at the day of diagnosis (1 d prior inf). Samples from the equal post-injury days in the corresponding no inf. group were used. Neutrophils from nine healthy volunteers were isolated. Effects for sera isolated from infected and non-infected patients on neutrophil biology were analyzed. Migratory capacity of neutrophils towards TP's serum, their CD11b and CD62L membrane receptor expression and oxidative burst activity after stimulation with TP's serum were determined and compared between groups. RESULTS: Migratory capacity of neutrophils was significantly increased after trauma and persisted during the study period. CD11b expression in all groups was significantly increased. CD62L expression decreased generally in samples from ED and recovered later to baseline. Stratifying no inf. and inf. groups showed significantly decreased migratory capacity, increased CD11b and significantly decreased CD62L expression in the no inf. group. These differences persisted during the complete observational period. ROS production was strongly reduced in the no inf. group compared to the inf. group at later experimental time points. CONCLUSIONS: This data indicate that patients at risk for pneumonia development have differentially and early activated neutrophils following trauma compared to patients who are not at risk for post-injury complication. Studies about the differential biology of neutrophils and their immediately after trauma modified activity depending on the post-injury clinical course are warranted, and may deliver predictive or even therapeutic strategies to control inflammation.

[Aggression and subjective risk in emergency medicine : A survey]. / Aggression und subjektive Gefährdung in der Notfallmedizin : Eine Umfrage.

BACKGROUND: Healthcare personnel may be faced with different degrees of violence and aggression, particularly concerning preclinical care. However, systematic data with respect to the frequency and type of violence in emergency medicine in Germany has not been researched. METHODS AND OBJECTIVES: At an anesthesiology congress, an anonymous survey was distributed about the different kinds and extent of violent acts that the participants had experienced during their work in emergency medicine. Moreover, the participants' subjective feelings toward professional and personal safety when handling emergency cases were explored. RESULTS: Every fourth participant in the survey (25.2 %) had experienced occupational physical violence within the last 12 months. Verbal harassment or insults within the last twelve months were reported by 58.2 % of the participants. While 80 % of the participants feel "entirely" or "mostly" safe with regard to the professional aspect of their occupation, personal safety was considered "entirely" in only 9.3 % and "mostly" in 46.4 % of the cases. Nearly every third participant (31.8 %) feels only "partially" safe and every eighth participant feels "rather not" or "not at all" safe during emergency medicine missions. Men appreciate their expertise as well as their personal safety more so than women (p < 0.001). CONCLUSION: Aggression and violence towards healthcare personnel in emergency medicine occur on a regular basis in the German healthcare system. Little research has been conducted in this area, so the issue has not yet been perceived as a relevant problem. Appropriate training for healthcare personnel in emergency medicine should be targeted at developing the skills needed when encountered with aggression and occupational violence.

[Risk estimation of blood-borne infections by emergency room personnel]. / Risikoeinschätzung von blutübertragbaren Infektionen durch die Schockraummitarbeiter.

BACKGROUND: Emergency department personnel are at risk of occupational exposure to blood-borne pathogens. Previous studies have shown that the prevalence of human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) virus infections among trauma patients is higher compared to the general population. OBJECTIVES: The aim of the study was to investigate the compliance rates of trauma team members in applying standard precautions, knowledge about the transmission risk of blood-borne infections and perceived risk of acquiring HIV, HBV and HCV. METHODS: An anonymous questionnaire was distributed to 100 trauma team members including physicians, nurses and medical students from different medical departments (e.g. surgery, radiology, anesthesia and internal medicine). RESULTS: The results of the questionnaire showed that trauma team members had insufficient knowledge of the risk of blood-borne pathogens, overestimated the risk of HCV infection and underused standard precautions during treatment of emergency trauma patients. CONCLUSION: Further educational measures for emergency department personnel are required to increase the knowledge of occupational infections and compliance with standard precautions. Every healthcare worker needs to be sufficiently vaccinated against HBV. In the case of injury awareness of all measures of post-exposure prophylaxis is of utmost importance for affected personnel.

[Prevalence of blood-borne pathogens among 275 trauma patients : A prospective observational study]. / Prävalenz blutübertragbarer Virusinfektionen bei 275 Schockraumpatienten : Eine prospektive Beobachtungsstudie.

BACKGROUND: Previous studies have indicated that the prevalence of human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) virus infections among trauma patients seems to be higher compared to the general population. OBJECTIVE: This study investigated the seroprevalence of blood-borne pathogens among patients with suspected severe multiple trauma in a German university hospital (level I trauma center). METHODS: Routine blood samples taken from trauma patients at the university hospital Frankfurt were tested for HBV, HCV and HIV (from 1 February 2014 to 31 January 2015). RESULTS: Overall, 275 patients with a median injury severity score (ISS) of 9 points (range 0-54) were included in the study representing 84.4 % of all trauma room admissions during this time period. Altogether 3.3 % (n = 9) of the patients were infected with blood-borne pathogens, where 7 patients were infected with HCV and 2 patients had an active HBV infection. None of the patients were tested HIV positive and only one initial diagnosis for HCV was made. A further six samples (five HCV and one HIV) showed a weak reaction in the screening assay that could not be verified by the confirmatory assay. CONCLUSION: To the best of our knowledge this study is the first report on the prevalence of blood-borne infections among trauma patients at a level I trauma center in an urban area in Germany. Compared to the general population the prevalence of blood-borne infections was higher but considerably lower than indicated in previous international studies. Considering the broad implications of occupationally transmitted blood-borne infections occupational safety is of paramount importance.

[Occupational exposure to blood in multiple trauma care]. / Arbeitsbedingte Blutexpositionen in der Polytraumaversorgung.

BACKGROUND: Trauma care personnel are at risk of occupational exposure to blood-borne pathogens. Little is known regarding compliance with standard precautions or occupational exposure to blood and body fluids among multiple trauma care personnel in Germany. AIM: Compliance rates of multiple trauma care personnel in applying standard precautions, knowledge about transmission risks of blood-borne pathogens, perceived risks of acquiring hepatitis B, hepatitis C and human immunodeficiency virus (HIV) and the personal attitude towards testing of the index patient for blood-borne pathogens after a needlestick injury were evaluated. MATERIAL AND METHODS: In the context of an advanced multiple trauma training an anonymous questionnaire was administered to the participants. RESULTS: Almost half of the interviewees had sustained a needlestick injury within the last 12 months. Approximately three quarters of the participants were concerned about the risk of HIV and hepatitis. Trauma care personnel had insufficient knowledge of the risk of blood-borne pathogens, overestimated the risk of hepatitis C infection and underused standard precautionary measures. Although there was excellent compliance for using gloves, there was poor compliance in using double gloves (26.4 %), eye protectors (19.7 %) and face masks (15.8 %). The overwhelming majority of multiple trauma care personnel believed it is appropriate to test an index patient for blood-borne pathogens following a needlestick injury. CONCLUSION: The process of treatment in prehospital settings is less predictable than in other settings in which invasive procedures are performed. Periodic training and awareness programs for trauma care personnel are required to increase the knowledge of occupational infections and the compliance with standard precautions. The legal and ethical aspects of testing an index patient for blood-borne pathogens after a needlestick injury of a healthcare worker have to be clarified in Germany.

Needlestick injuries: causes, preventability and psychological impact.

Needlestick injuries (NSI) pose a significant health hazard among healthcare personnel (HCP). The aim of our prospective observational study was to evaluate the psychological impact of NSI and assess measures to prevent NSI. The target group was the medical staff and students of Frankfurt University Hospital who had experienced a NSI (n = 370) during the 12-month study period. Data were retrieved from accident insurance reports, occupational follow-up examinations and a standardized anonymous questionnaire sent to the affected HCP. Analysis of the completed questionnaires (232/370) revealed that stress (48.3 %) and tiredness (36.6 %) were common factors contributing to the NSI and that >80 % of the respondents were concerned about the consequences of the NSI. Higher levels of anxiety were reported when the patient was known to have a chronic virus infection. Stressful working conditions, lack of adequate protective medical/technical equipment and poor work routines were suggested as factors contributing to NSI.

[TEAM®-G (Trauma Evaluation and Management Germany). Serves as a basis for an interdisciplinary training in the emergency room]. / TEAM®-G ("Trauma Evaluation and Management Germany"). Grundlage für ein interdisziplinäres und interprofessionelles Schockraumtraining.

BACKGROUND: The implementation of ATLS® in the daily routine of trauma management in the emergency department is a challenge. This goal cannot be reached by educating ATLS® to a few team members only. In order to enforce the implementation of ATLS® in a level I trauma centre, a generic in-house training was introduced in 2009 with inter-professional integration of all specialists of the trauma team. MATERIALS AND METHODS: The TEAM® course (trauma evaluation and management concept of the American College of Surgeons) was the theoretical basis of the training. This educational program was developed for medical students and multidisciplinary team members. Prior training, a questionnaire for self-assessment was completed by n=84 team members to assess their knowledge about ATLS® principles. The hands-on training time was 90 min. N=10 members of the trauma team worked out three scenarios of multiple injured patients. These were provided as near-reality manikin simulations by a specialist trainer. After the training participants re-evaluated and analysed improvement by the training. Duration of trauma management and the number of missed injuries were analysed one year prior and one year after the training and served as a marker of the process and outcome quality of trauma care. RESULTS: Prior the training, 57% of trainees specified their knowledge related to the ATLS® can be improved. Their expectations were generally satisfied by the training. The mean time of trauma management in the ED could not be reduced one year after the training (36±16 min) compared to one year prior the training (39±18 min), however, the detection of missed injuries (5.6% vs. 3.2%, p<0.05) was significantly diminished after the training. CONCLUSION: Apart form education of ATLS® providers the inauguration of an interdisciplinary and interprofessionel team training may enhance implementation of ATLS- algorithms into daily routine.

[Preclinical care of children with multiple trauma]. / Präklinische Versorgung von polytraumatisierten Kindern.

Severe multiple trauma in children is rare with approximately 380-550 cases per year in Germany. In addition to the S3 guideline "Polytrauma", which was published more than a decade ago, the S2K guideline "Severe multiple trauma care in childhood" was published in 2020. Accidents and especially the resulting traumatic brain injuries still represent the most frequent cause of death in children. While prehospital treatment according to Prehospital Trauma Life Support (PHTLS®) is basically analogous to that in adults which is based on the ABCDE concept (airway, breathing, circulation, disability, exposure), knowledge of age-dependent anatomical-physiological characteristics is essential. For simplification, various tools and dosing aids, such as the pediatric emergency ruler and specific emergency tables, are available. Further treatment after initial preclinical care should take place in an interdisciplinary manner in designated pediatric trauma centers.

Revalidation and update of the TASH-Score: a scoring system to predict the probability for massive transfusion as a surrogate for life-threatening haemorrhage after severe injury.

BACKGROUND: The Trauma Associated Severe Haemorrhage (TASH)-Score has been recognized as an easy-to-calculate scoring system to predict the probability for massive transfusion (MT) as a surrogate for life-threatening haemorrhage after injury. Changes with respect to management and outcome of these patients over time prompted a revalidation and an update of the TASH-Score. METHODS: The performance of the TASH-Score developed from the 1993-2003 TR-DGU database (Trauma Registry Deutsche Gesellschaft für Unfallchirurgie/German Trauma Society) was revalidated on 5834 datasets from the 2004-2007 TR-DGU database with respect to discrimination, precision and calibration. The performance of the TASH-Score applied onto the 2004-2007 TR-DGU database was compared to its initial performance, and the logistic function to calculate the probability for MT was modified for score adjustment. RESULTS/CONCLUSIONS: When the original TASH-Score was applied onto the 2004-2007 TR-DGU database, a slight increase in discrimination was observed while precision was considerably lower. The predicted rate for MT within the development dataset was 13·9% while the observed incidence was 14·1%. In contrast, the predicted rate for MT within the revalidation dataset was 11·7%, while the observed rate was 8·4%. The logistic function to calculate MT probability was modified, and the TASH-Score was again evaluated against the most recent TR-DGU 2004-2007 database. The high performance of the score was not only restored but enhanced reflected by an increased ROC/AUC of 0·905. The score can be calculated quickly upon arrival of the patient in the emergency department and may be supportive to correct coagulopathy, to activate logistics and for research.

[Pelvic injuries in childhood and adolescence: Retrospective analysis of 5-year data from a national trauma centre]. / Beckenverletzungen im Kindes- und Jugendalter: Eine retrospektive Analyse eines überregionalen Traumazentrums über 5 Jahre.

BACKGROUND: Pelvic fractures are uncommon injuries in paediatric trauma patients because of specific anatomical features. Due to the low incidence there is no standardized therapeutic algorithm. MATERIAL AND METHODS: This retrospective review evaluates paediatric pelvic fractures of a Level I Trauma Centre over 5 years. In addition, we compared the data with adult pelvic fractures and reviewed the literature. A total of 37 pelvic fractures (≤16 years) were documented, with an incidence of 9.9% in the child with multiple injuries. The most common injury mechanisms were traffic accidents, followed by falls from heights. RESULTS: Type A injuries occurred in 50% (type B: 16%, type C: 27%, acetabular injuries: 11%). Osteosynthesis was performed in nine cases. Therapeutic intervention was necessary in three cases of haemodynamically relevant bleeding; 97% of all children had associated injuries (mean ISS: 38). CONCLUSION: Our data showed some differences to the literature. Pelvic fractures are predictors for high injury severity. Despite similar fracture pattern, in contrast to adults most injuries could be treated non-operatively. In unstable or dislocated fractures open reduction and stabilization must be performed.

[Traumatic vertebral body fractures and osteoporosis: value of cement augmentation]. / Traumatische Wirbelsäulenfrakturen und Osteoporose : Stellenwert der Zementaugmentation.

Traumatic vertebral body fractures are different from the osteoporotic vertebral sintering fractures with regard to accruement, classification and surgical treatment. The standard therapeutic regimen for traumatic vertebral fracture implies sufficient analgetic as well as antiosteoporotic medication and physiotherapy. In cases of A1 fractures and A2.1/A2.2 fractures, minimally invasive treatment strategies have proven to be appropriate treatment options when conservative treatment fails. Unstable fractures, the presence of neurological deficits or stenosis of the canal require conventional operative treatment. Due to reduced bone quality and age-dependent biomechanical changes, distinct operative procedures and strategies - cement augmentation of pedicle screws, additional cement augmentation of the fractured vertebra - for complex traumatic vertebral fractures have been established.

[Time intervals during and after emergency room treatment. An analysis using the trauma register of the German Society for Trauma Surgery]. / Zeitintervalle während und nach Schockraumversorgung. Eine Analyse anhand des Traumaregisters der Deutschen Gesellschaft für Unfallchirurgie (DGU).

BACKGROUND: The prognosis of severely injured patients depends on a rapid diagnosis and early initiation of therapeutic procedures. MATERIAL AND METHODS: To that end a total of 6,927 prospectively documented severely injured patients with an Injury Severity Score (ISS) > or =16 from the Trauma Registry of the German Trauma Society (DGU, 2002-2007) were analyzed with respect to time intervals during emergency trauma treatment. RESULTS: In cases of indicated emergency surgery the average +/-time in the emergency department was 42+/-34 min, in cases of early surgery 75+/-41 min and in cases of transfer to the intensive care unit (ICU) 83+/-43 min, respectively. The time from the last diagnostic procedure until the end of emergency treatment was 12 min (emergency surgery), 26 min (early surgery) and 32 min (ICU), respectively. Level I (78 min) and level II (72 min) trauma centres showed similar mean times in the emergency department while level III trauma centres had a mean time of 86 min. According to this analysis no general correlation between shorter duration of emergency trauma care and reduced mortality could be observed. CONCLUSION: The duration of time intervals depends on injury severity, treatment after completion of emergency trauma care and the level of the trauma centre. Time management in emergency trauma care can potentially be optimized after completion of the last diagnostic procedure in the emergency room.

[Quality of prehospital and early clinical care of pediatric trauma patients of school age compared to an adult cohort. A matched-pair analysis of 624 patients from the DGU trauma registry]. / Prä- und frühklinische Versorgungsqualität pädiatrischer Traumapatienten im Schulalter im Vergleich mit dem Erwachsenenkollektiv. Matched-Pair-Analyse an 624 Patienten aus dem Traumaregister der DGU.

Conflicting reports exist regarding the quality of prehospital treatment of pediatric trauma patients. The purpose of this investigation was to determine whether prehospital treatment and emergency management in pediatric trauma patients were similar to that in adult patients. All patients who had been prospectively documented in the registry of the German Trauma Society (DGU) between 2002 and 2005 were selected for this study. A total of 312 matched pairs of adult and pediatric patients suffering from identical injuries were defined and compared with respect to cause of trauma, diagnostic and therapeutic interventions, and outcome. Within the study group, 63% were male, and the average age was 10.5+/-2.7 (SD) years in the pediatric group and 33.9+/-9.3 years in the adult group. There was no significant difference regarding prehospital intubation, reanimation, fluid management, chest drainage, ground and air transport to the hospital, time to arrival or interval in the emergency room. In contrast, significant differences (p<0.05) were observed in terms of the cause of trauma and pre-existing diseases. Pediatric trauma patients were not triaged or treated differently from adult trauma patients in respect to key issues of prehospital and early clinical trauma management.

[Changes in geriatric traumatology. An analysis of 14,869 patients from the German Trauma Registry]. / Veränderungen in der Alterstraumatologie. Eine Analyse an 14.869 Patienten aus dem deutschen Traumaregister.

The increasing average age in the industrialized nations is leading to an increasing number of elderly traumatized patients. Against this background, an analysis of the age-specific characteristics of geriatric traumatized patients is necessary. In this study, 14,869 patients > or = 18 years were analysed, who were prospectively documented in the registry of the German Trauma Society (DGU) between 1996 and 2005. Patients between 18 and 59 years were defined as the control group; their proportion declined from 81.1% in 1996-2000 to 75.4% in 2001-2005. The average age rose from 41.0 years (1996) to 45.3 years (2005). With increasing age a significant increase in severe head injuries of up to 58.9% (> or = 80 years) could be observed. Older patients stayed for a significantly shorter time in hospital and on the ICU. With a comparable injury severity, the lethality after trauma increased with age (18-59 years 13.8%, 60-69 years 24.1%, 70-79 years 35.5%, > or = 80 years 43.6%). The multiply traumatized geriatric patient is different from the normal group in regard to type of injury, therapy and outcome and should therefore be treated taking this fact into consideration.

[Imaging techniques in modern trauma diagnostics]. / Bildgebende Verfahren der modernen Schockraumdiagnostik.

Modern trauma room management requires interdisciplinary teamwork and synchronous communication between a team of anaesthesists, surgeons and radiologists. As the length of stay in the trauma room influences morbidity and mortality of a severely injured person, optimizing time is one of the main targets. With the direct involvement of modern imaging techniques the injuries caused by trauma should be detected within a very short period of time in order to enable a priority-orientated treatment. Radiology influences structure and process quality, management and development of trauma room algorithms regarding the use of imaging techniques. For the individual case interventional therapy methods can be added. Based on current data and on the Frankfurt experience the current diagnostic concepts of trauma diagnostics are presented.