ABSTRACT
BACKGROUND: For the medical team, the management of pregnant trauma patients is a particular challenge. The aim of this study is to compile this data and to determine differences between pregnant and not pregnant trauma patients. MATERIALS AND METHODS: We carried out a retrospective data analysis from the TraumaRegister DGU® with a comparison of 102 pregnant and 3135 not pregnant women of child-bearing age (16-45 years) from 2016-2018 who were treated in a trauma center. All patients were delivered to the resuscitation room and received intensive care treatment. RESULTS: In Germany, Austria and Switzerland 3.2% of all trauma patients (102 women) were pregnant. Women with an average age of 29 years suffered most often trauma as a result of a road traffic accident. Major trauma (Injury Severity Score [ISS] ≥16 points) was seen in 24.5% of the pregnant women and 37.4% of the nonpregnant women. A computer tomography (whole body computer tomography) was carried out in 32.7% of all pregnant women but in 79.8% of the nonpregnant women. As a result of the trauma, 2.9% of the pregnant and 3.5% of the not pregnant women died. The standardised mortality rate (SMR) was 0.42 in pregnant women and 0.63 in nonpregnant women. CONCLUSION: For the first time there is data regarding incidence, trauma mechanism, prehospital and in-hospital care as well as intensive care of pregnant trauma patients in Germany, Austria and Switzerland. Further research regarding foetal outcome and trauma-related injuries in pregnant women is needed to develop an adjusted management for these patients ready to implement in trauma centres. Gynaecologists and obstetricians should be implemented in the trauma room team when needed.
Subject(s)
Pregnant Women , Adult , Austria , Child , Female , Germany/epidemiology , Humans , Injury Severity Score , Pregnancy , Registries , Retrospective Studies , SwitzerlandABSTRACT
BACKGROUND: Life-threatening injuries during pregnancy are a rare occurrence. The TraumaRegister DGU® (TR-DGU) has been recording whether seriously injured women were pregnant since 2016. This information is not sufficient to enable a differentiated assessment of the quality of care because parameters, such as gestational age, state of pregnancy at discharge and survival of the child are missing. The TraumaRegister working group of the committee on emergency medicine, intensive care and severe trauma management (section NIS) of the German Trauma Society (DGU) therefore came to the conclusion that the fetal outcome or the intactness of the pregnancy after acute treatment is an important measure of the quality of care of pregnant women. They commissioned a task force to work out a suitable data set for a better analysis of such cases. This article presents the so-called fetus module in detail. METHODS: The data set was developed in an interdisciplinary process together with accredited experts from the German Society for Gynecology and Obstetrics (DGGG), the German Society for Perinatal Medicine (DGPM) and the Society for Neonatology and Pediatric Intensive Care Medicine (GNPI). RESULTS: The fetus module comprises 20 parameters describing the pregnancy, the condition of the mother and child on admission and discharge. CONCLUSION: The fetus module will provide important data to make the process and outcome quality of care of severely injured pregnant women measurable and to develop prognostic instruments with which predictions about high-risk constellations for the outcome of mother and child can be made.
Subject(s)
Multiple Trauma , Child , Female , Germany , Humans , Pregnancy , RegistriesABSTRACT
OBJECTIVES: To investigate the attributions offered spontaneously during interview by patients who have delusional beliefs. Specifically, to assess whether people with delusional beliefs reason in a way that is analysable. If so, to extend the findings from previous research to provide a detailed picture of the patients' accounts that could inform cognitive therapies for psychosis. METHOD: A group of 31 patients with delusional beliefs were interviewed using a semi-structured open-ended interview. Their causal attributions were identified and analysed in terms of standard definitions of attributional theory using the Leeds Attributional Coding System. RESULTS: Patients made an average of 96 attributions each. These showed a high degree of recognizable coherence in reasoning, including when directly discussing delusional beliefs. The patterns of attributing were partly consistent with previous research findings, with external attributions being offered for negative events. Several other aspects emerged, indicating a pervasive negativity, with non-delusional aspects of the illness being a major concern. When delusions were described as a cause of events, the dominant pattern of attributing was stable, internal, personal and uncontrollable, with negative outcomes. When delusions were reported as an outcome, the patient was more in control. CONCLUSIONS: The reasoning processes of patients with delusional beliefs are in many aspects normal and include patterns not identified by the ASQ. Attributing in relation to delusions differs from talk about other subjects. The qualitative attributional approach provided a detailed and rich picture of the world of these patients. Interpretable tendencies are described that should provide information useful to those practising and evaluating cognitive therapies.