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PURPOSE: Ectopic pregnancies include cesarean scar (CSP), cornual and cervical pregnancies. Various treatment modalities have been- described, but no standardized procedure has been defined so far. The aim of our analysis was to evaluate the diagnostics and treatment at the Department of Obstetrics and Gynecology, LMU University Hospital, Munich. METHODS: In this retrospective, single-center analysis, 24 patients treated between 2015 and 2020 were analyzed. After verification of the diagnosis by imaging and HCG-analysis, the treatment was individually determined: therapy with methotrexate (MTX) locally with or without simultaneous systemic treatment, surgical treatment via curettage, excision with uterine reconstruction even hemi hysterectomy. RESULTS: Ten patients presented with CSP, six with cervical and eight with cornual pregnancies. Median age was 34.6 years. CSP was treated with local MTX in six cases; five required additional treatment with systemic MTX or curettage. Primary curettage or surgery was performed in four cases. In cervical pregnancies the primary therapy with local MTX injection and systemic treatment was performed in 50%. One patient was treated with MTX and insertion of a Bakri balloon. Trachelectomy was required in one case. 50% of cornual pregnancies were treated with MTX locally and intramuscularly and 50% received surgery. CONCLUSION: Treatment strategies were based on the patient's individual risk parameters. The results of this study show, that simultaneous treatment with local and systemic MTX had good outcomes and could avoid surgeries.
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Abortivos não Esteroides , Gravidez Cornual , Gravidez Ectópica , Gravidez , Feminino , Humanos , Adulto , Abortivos não Esteroides/uso terapêutico , Gravidez Cornual/diagnóstico , Gravidez Cornual/cirurgia , Estudos Retrospectivos , Cesárea/efeitos adversos , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/cirurgia , Metotrexato/uso terapêutico , Cicatriz/etiologia , Resultado do TratamentoRESUMO
Two men were wrongfully convicted of murder in 2017 and sentenced to life imprisonment. After a physical altercation inside a flat, the victim (A) was found dead approximately 60 m away outside a residential address. He had sustained a number of injuries including a stab wound to the left side of his neck which was found to have divided the right carotid artery. The location where A was found was not regarded as a crime scene and not subjected to a specialist forensic examination by scientists as it was assumed that the fatal injury was sustained in the flat. The pathologist, who subsequently carried out the autopsy on A, was not asked to attend the scene. A review of the blood distribution at the scene in conjunction with the pathology findings indicated however that the fatal neck wound had been inflicted outside the flat, near to where the victim was found. An appeal against the convictions for murder was upheld in 2021 and a re-trial ordered. Following this second trial, both accused were acquitted of murder and released from custody. The new pathology and blood pattern evidence introduced at the second trial was a major part of the defense strategy which led to the acquittal of the accused. The case illustrates that a more inclusive and detailed crime scene strategy had been undertaken, including an assessment of the bloodstains present, in conjunction with discussion with the pathologist, then the likelihood is that the two men subsequently charged with murder would have been eliminated as suspects and a miscarriage of justice would have been avoided.
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Manchas de Sangue , Lesões do Pescoço , Ferimentos Perfurantes , Humanos , Masculino , Homicídio , Ferimentos Perfurantes/patologiaRESUMO
BACKGROUND: Prehospital resuscitative thoracotomy (PHRT) is a controversially discussed measure for the acute treatment of traumatic cardiac arrest (TCA) recommended by the current guidelines of the European Resuscitation Council (ERC). The aim of this work is the comprehensive presentation and summary of the available literature with the underlying hypothesis that the available publications show the feasibility and survival following PHRT in patients with TCA with a good neurological outcome. METHOD: A systematic literature search was performed in the databases PubMed, EMBASE, Google Scholar, Springer LINK and Cochrane. The study selection, data extraction and evaluation of bias potential were performed independently by two authors. The outcome of patients with TCA after PHRT was selected as the primary endpoint. RESULTS: A total of 4616 publications were found of which 21 publications with a total of 287 patients could be included in the analyses. For a detailed descriptive analysis, 15 publications with a total of 205 patients were suitable. The TCA of these patients was most commonly caused by pericardial tamponade, thoracic vascular injuries and severe extrathoracic multiple injuries. In 24% of the cases TCA occurred in the presence of the emergency physician. Clamshell thoracotomy (53%) was used preclinically more often than anterolateral thoracotomy (47%). Of the PHRT patients after TCA 12% (25/205) left the hospital alive, 9% (nâ¯= 19/205) with good neurological outcome and 1% (nâ¯= 3/205) with poor neurological outcome (according to the Glasgow outcome scale, GOS). CONCLUSION: The prognosis of TCA seems to be much better than has long been assumed. Decisive for the success of resuscitation efforts in TCA seems to be the immediate, partly invasive treatment of all reversible causes. The measures for TCA recommended by the ERC resuscitation guidelines, seem to be poorly implemented, especially in the preclinical setting. A controversy regarding the recommendations of the guidelines is the question of whether a PHRT can be successfully implemented and if the comprehensive introduction in Germany seems to be meaningful. Despite the recommendation of the guidelines, this systematic review and meta-analysis underlines the lack of high-quality evidence on PHRT, whereby a survival probability to hospital discharge of 12% was reported, of which 75% had a good neurological outcome. The risk of bias of the results in individual publications as well as in this review is high. Further systematic research in the field of preclinical trauma resuscitation is particularly necessary also for acceptance of the guidelines.
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Serviço Hospitalar de Emergência , Ressuscitação , Traumatismos Torácicos , Toracotomia , Alemanha , Humanos , MesotelinaRESUMO
INTRODUCTION: More than half of all traumatic deaths happen in prehospital settings. Until now, there have been no long-term studies examining the actual additive treatment during trauma-associated cardiopulmonary resuscitation (tCPR), including pleural decompression, pericardiocentesis, tourniquets and external stabilization of the pelvis. The present cohort study evaluated forensic autopsy reports of trauma deaths occurring at the scene with respect to additive actions in preclinical tCPR as well as the potentially preventable nature of the individual death cases. MATERIAL AND METHODS: All autopsy protocols from the Institutes of Legal Medicine in Leipzig and Chemnitz, Germany within the years 2011-2017 were retrospectively examined and all trauma deaths with professional prehospital tCPR at the scene, during transport or shortly after arriving at the emergency room were analyzed. In addition to epidemiological parameters all forms of medical procedure performed by emergency physicians and the injury patterns were recorded. Thus, the questions whether any of the trauma deaths were preventable and if failures in work-flow management were evident could be retrospectively answered through a structured Delphi method. RESULTS: Overall, 3795 autopsy protocols were listed containing 154 trauma cases (4.1%) with various preclinical tCPR attempts (male patients 70.1%; mean age 48 ± 21 years). Most of them died at the accident site (84.4%), some during transport (2.6%) or directly after admission to a hospital (13.0%). Only 23 patients (14.9%) received 25 additional interventions exceeding the normal scope (pleural decompression 80.0%, pericardiocentesis 8.0% and external stabilization of the pelvis 12.0%). A relevant number of potentially reversible causes for trauma-associated cardiac arrest was determined. There were deficits in the performance of pleural decompression in cases of tension pneumothorax. Even if isolated traumatic hemopericardium was a rare occurrence in the examined cases, the rate of pericardiocentesis was still too low. Also, more focus needs to be placed on provisional external pelvic stabilization of trauma patients which was performed too rarely even though an instable pelvic ring was apparent during the postmortem external examination. None of the cases received a rescue thoracotomy even if a few patients might have derived benefit from this and none of the cases showed injury patterns with tourniquet indications. Furthermore, no single case of death due to incorrect or missing airway management was determined. Errors in work-flow management were found in 37.0% and potentially preventable deaths occurred cumulatively in 12.3% of the cases. The potentially preventable deaths were particularly related to penetrating chest injuries caused by a sharp force. DISCUSSION: The percentage of patients who might benefit from additive treatment implemented in tCPR efforts was shown to be equal between the local situations in Leipzig and Chemnitz compared to previous reports in Berlin. A need for optimizing the professional resuscitation process still remains as not all reversible causes were appropriately addressed. Further training and education should intensively address the mentioned deficits and continuous awareness of necessary additional medical procedures in the preclinical setting in cases of traumatic cardiac arrest is inevitable. Cooperation with forensic institutes can help to impart particular issues and treatment options of emergency medicine in cases of potentially reversible causes of traumatic cardiac arrest.
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Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia , Adulto , Idoso , Manuseio das Vias Aéreas , Autopsia , Reanimação Cardiopulmonar , Causas de Morte , Estudos de Coortes , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/etiologia , Pneumotórax/terapia , Estudos Retrospectivos , Traumatismos Torácicos/complicações , Traumatismos Torácicos/terapiaRESUMO
INTRODUCTION: Cardiopulmonary resuscitation (CPR) may lead to injuries. Forensic experts are sometimes confronted with claims that fatal injuries were caused by chest compressions during CPR rather than by assaults. We want to answer, how often CPR-associated injuries are present in younger children and if they may mimic injuries caused by abuse. MATERIAL AND METHODS: All autopsy records of the Institute of Legal Medicine in Leipzig, Germany in a 6-year study period were used (2011-2016). There were 3664 forensic autopsies in total, comprising 97 autopsies of children ≤4 years. After exclusion criteria we were able to include 51 cases in the study. Following this, all CPR-related variables were collected according to the 'Utstein style'. Standard procedures were used for statistical evaluation of the data. RESULTS: The most common cause of cardiac arrest was SIDS. The mean duration of CPR was 50min. Bystander CPR was performed in 43.1%. In no single case death was declared without at least partly professional CPR. Most of the children were first resuscitated out-of-hospital (41.2%). 27.5% of the children had at least one CPR injury without preference to an age group. None of the recorded CPR-associated injuries were considered significant or life-threatening. The duration of CPR or presence of bystander CPR did not correlate to the presence of any detected injury. CONCLUSION: Skeletal injuries and relevant injuries to the soft tissue and organs seem to occur only very rarely after pediatric CPR. Whenever such injuries are diagnosed, the children should be examined thoroughly for potential abuse.
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Reanimação Cardiopulmonar/efeitos adversos , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/patologia , Asfixia/mortalidade , Maus-Tratos Infantis/diagnóstico , Pré-Escolar , Diagnóstico Diferencial , Feminino , Alemanha , Parada Cardíaca/mortalidade , Parada Cardíaca/terapia , Cardiopatias Congênitas/mortalidade , Humanos , Hipóxia Encefálica/mortalidade , Lactente , Recém-Nascido , Masculino , Miocardite/mortalidade , Pneumonia/mortalidade , Intoxicação/mortalidade , Insuficiência Respiratória/mortalidade , Estudos Retrospectivos , Morte Súbita do Lactente/epidemiologiaRESUMO
Severe bleeding is a typical result of traumatic injuries. Hemorrhage is responsible for almost 50% of deaths within the first 6 h after trauma. Appropriate bleeding control and coagulation therapy depends on an integrated concept of local hemostasis by primary pressure with the hands, compression, and tourniquets accompanied by prevention of hypothermia, acidosis and hypocalcemia. Additionally, permissive hypotension is accepted for suitable patients and tranexamic acid should be administered early. Multiple publications prove that prehospital transfusion of blood products (e. g. red blood cells and plasma) and coagulation factors (e. g. fibrinogen) is feasible and safe, but only required for <5% of polytrauma patients in the civilian setting.
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Serviços Médicos de Emergência/métodos , Hemorragia/terapia , Antifibrinolíticos/uso terapêutico , Hemorragia/etiologia , Hemostasia , Humanos , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapiaRESUMO
BACKGROUND: Stanford acute type A aortic dissection (ATAAD) is a potentially lethal condition. Epidemiology studies show a statistical incidence in Europe of approximately 2-16 cases/100,000 inhabitants/year. In Germany, the estimated incidence (here subsumed under "thoracic aortic dissection" with 4.63 cases/100,000 inhabitants/year) is mainly extracted from medical death certificates by the German Federal Statistical Office. The prehospital incidence of ATAAD deaths is largely unknown. Since patients often die in the pre-hospital setting, the incidence of ATAAD is therefore likely to be higher than current estimates. MATERIAL AND METHODS: For the period from 2010 to 2014, we retrospectively analyzed all in-hospital ATAAD data from two of the largest cardiac surgical centers that treat ATAAD in the Berlin-Brandenburg region. In addition, autopsy reports of all forensic medicine institutes and of one large pathological provider in the region were analyzed to identify additional non-hospitalized ATAAD patients. Based on these findings, the regional incidence of ATAAD was calculated. RESULTS: In addition to in-hospital ATAAD patients (n=405), we identified additional 145 lethal ATAAD cases among 14,201 autopsy reports. The total of 550 ATAAD cases led to an estimated incidence of 11.9 cases/100,000 inhabitants/year for the whole Berlin-Brandenburg region. Arterial hypertension, pre-existing aortic dilatation, and hereditary connective tissue disorder were found in, respectively, 62.7%, 10%, and 1.8% of patients. CONCLUSION: ATAAD is more frequent than previously reported. Our results show that when patients who die outside of cardiac surgery centers are included, the incidence of ATAAD significantly exceeds the rate reported by the Federal Statistical Office.
Assuntos
Aorta/patologia , Aneurisma Aórtico/epidemiologia , Aneurisma Aórtico/patologia , Dissecção Aórtica/epidemiologia , Dissecção Aórtica/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dissecção Aórtica/mortalidade , Aneurisma Aórtico/mortalidade , Berlim/epidemiologia , Feminino , Alemanha/epidemiologia , Hospitalização/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND: Medical decisions in an emergency medical services (EMS) situation are always extremely time- critical and sensitive, potentially leading to medicolegal consequences. Advance health care directives (AHCDs) are crucial components in the patients' participative decision making. When a patient refuses resuscitation, and/or other life-extending treatments, emergency physicians face possible ethical, medical, and medicolegal conflicts. METHODS: As part of the RIMANO II Study [Risk Management Präklinische (prehospital) Notfallmedizin (emergency medicine)], all 18 "emergency physician bases" of the Berlin Fire Department were polled regarding the influence of AHCDs in regard to emergency medical decision making. The assessment was based on anonymous questionnaires. Furthermore, emergency medical suggestions for improvement of AHCDs were gathered. Descriptive statistics and qualitative methods were used for evaluation. RESULTS: A total of 112 responses from emergency physicians could be incorporated into the study. Anesthesiologists represented the largest group (n = 55, 49 %), followed by internists (n = 40, 36 %). The median length of experience in EMS was 7 years [interquartile range (IQR) 4-14 years]. Patients' "do not resuscitate" orders were obeyed in 78/112 cases (70 %, 95 % CI 69-78 %). In 49/112 cases (44 %, 95 % CI 34-53 %), the request to not be hospitalized was granted. The length of EMS experience, type of medical specialty, the number of EMS cases and ways in which AHCDs were handled were all contributing factors to the various emergency medical interventions. CONCLUSION: AHCDs appear to have an influence in the emergency medical decision process. However, it is presently unclear as to what a standardized and universally comprehensible AHCD should look like, in order to provide a framework that is both acceptable and necessary in a prehospital emergency medicine environment, ensuring medicolegal certainty for the parties involved.
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Diretivas Antecipadas/legislação & jurisprudência , Tomada de Decisões , Serviços Médicos de Emergência/legislação & jurisprudência , Papel do Médico , Alemanha , Humanos , Tutores Legais/legislação & jurisprudência , Medicina , Ordens quanto à Conduta (Ética Médica)/legislação & jurisprudência , Gestão de Riscos/legislação & jurisprudência , Inquéritos e Questionários , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Suspensão de Tratamento/legislação & jurisprudênciaRESUMO
There are considerable similarities and intersections between forensic medicine and emergency medicine. This applies especially to frustraneously resuscitated patients or other lethal clinical courses of traumatized patients who are subject to latter forensic autopsy. Cooperation between departments of emergency and forensic medicine not only has emergency medical training potential, but also the possibility of retrospective evaluation of medical emergency measures - both in individual cases and with regard to epidemiological aspects. In particular, the widespread registration of autopsied pre-hospital trauma deaths that occurred despite on-scene resuscitation attempts is useful. The pre-hospital situation represents a hotspot, but also a blind spot in the overall trauma mortality. In recent clinical registers, preclinical deaths go mostly unrecorded, despite the undisputed benefits of clinical registers.
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Medicina de Emergência , Medicina Legal , Autopsia , Causas de Morte , Medicina de Emergência/educação , Alemanha , Humanos , Ressuscitação , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/terapiaRESUMO
Glucagonoma syndrome is an extremely rare pancreatic neuroendocrine tumour often associated with necrolytic migratory erythema. While glucagonomas are neoplasms of adulthood, we report the first case in a paediatric patient. We present the case of a 15-year-old girl with a 4-year history of a rash, consistent with necrolytic migratory erythema, found to have a localized glucagonoma. Immediately following resection of the tumour, there was complete resolution of her rash and systemic symptoms. Detection of the cutaneous rash of necrolytic migratory erythema can aid in the early diagnosis of a glucagonoma, as well as the prevention of metastatic disease. To our knowledge, this is the first reported paediatric patient with glucagonoma syndrome.
RESUMO
Tension pneumothorax can occur at any time during cardiopulmonary resuscitation (CPR) with external cardiac massage and invasive ventilation either from primary or iatrogenic rib fractures with concomitant pleural or parenchymal injury. Airway injury can also cause tension pneumothorax during CPR. This article presents the case of a 41-year-old woman who suffered cardiopulmonary arrest after undergoing elective mandibular surgery. During CPR the upper airway could not be secured by orotracheal intubation due to massive craniofacial soft tissue swelling. A surgical airway was established with obviously unrecognized iatrogenic tracheal perforation and subsequent development of tension pneumomediastinum and tension pneumothorax during ventilation. Neither the tension pneumomediastinum nor the tension pneumothorax were decompressed and accordingly resuscitation efforts remained unsuccessful. This case illustrates the need for a structured approach to resuscitate patients with ventilation problems regarding decompression of tension pneumomediastinum and/or tension pneumothorax during CPR.
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Reanimação Cardiopulmonar/efeitos adversos , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/terapia , Pneumotórax/etiologia , Pneumotórax/terapia , Traqueia/lesões , Adulto , Manuseio das Vias Aéreas , Evolução Fatal , Feminino , Parada Cardíaca/complicações , Parada Cardíaca/terapia , Massagem Cardíaca , Humanos , Doença Iatrogênica , Intubação Intratraqueal , Mandíbula/cirurgiaRESUMO
BACKGROUND: Despite continuous innovation in trauma care, fatal trauma remains a significant medical and socioeconomic problem. Traumatic cardiac arrest (tCA) is still considered a hopeless situation, whereas management errors and preventability of death are neglected. We analyzed clinical and autopsy data from tCA patients in an emergency-physician-based rescue system in order to reveal epidemiologic data and current problems in the successful treatment of tCA. MATERIAL AND METHODS: Epidemiological and autopsy data of all unsuccessful tCPR cases in a one-year-period in Berlin, Germany (n=101, Group I) and clinical data of all cases of tCPR in a level 1 trauma centre in an 6-year period (n=52, Group II) were evaluated. Preventability of traumatic deaths in autopsy cases (n=22) and trauma-management failures were prospectively assessed. RESULTS: In 2010, 23% of all traumatic deaths in Berlin received tCPR. Death after tCPR occurred predominantly prehospital (PH;74%) and only 26% of these patients were hospitalized. Of 52 patients (Group II), 46% required tCPR already PH and 81% in the emergency department (ED). In 79% ROSC was established PH and 53% in the ED. The survival rate after tCPR was 29% with 27% good neurological outcome. Management errors occurred in 73% PH; 4 cases were judged as potentially or definitive preventable death. CONCLUSION: Trauma CPR is beyond routine with the need for a tCPR-algorithm, including chest/pericardial decompression, external pelvic stabilization and external bleeding control. The prehospital trauma management has the highest potential to improve tCPR and survival. Therefore, we suggested a pilot prehospital tCPR-algorithm.
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Algoritmos , Reanimação Cardiopulmonar , Parada Cardíaca/epidemiologia , Parada Cardíaca/terapia , Erros Médicos/estatística & dados numéricos , Adulto , Berlim , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/prevenção & controle , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida , Ferimentos e Lesões/complicaçõesAssuntos
Descompressão Cirúrgica , Medicina de Emergência , Pneumotórax/prevenção & controle , Traumatismos Torácicos/terapia , Ferimentos Penetrantes/cirurgia , Autopsia , Lista de Checagem , Descompressão Cirúrgica/métodos , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Pneumotórax/etiologia , Guias de Prática Clínica como Assunto , Radiografia Torácica , Traumatismos Torácicos/complicações , Fatores de Tempo , Tomografia Computadorizada por Raios X , Ferimentos Penetrantes/complicaçõesRESUMO
BACKGROUND: The limited evidence available on the diagnosis and treatment of olecranon and prepatellar bursitis indicates nationally varying treatment approaches. Therefore the aim of this study was to survey the current treatment concepts of olecranon and prepatellar bursitis in Austria. MATERIAL AND METHODS: An online questionnaire comprising of demographic data, questions regarding diagnostics and differentiation between septic bursitis (SB) and non-septic bursitis (NSB) as well as two case reports for therapy appraisal were sent to members of the Austrian Society of Orthopaedics and Orthopaedic Surgery (ÖGO) and the Austrian Society of Traumatology (ÖGU). RESULTS: The overall response rates were 46 % (ÖGU)/12 % (ÖGO). Differentiation between SB and NSB was predominantly based on medical history/clinical presentation (ÖGU: 100 %/ÖGO: 84 %) and blood sampling (ÖGU: 82 %/ÖGO: 77 %). 64/36 % of surveyed members of ÖGO/OGU performed a bursal aspiration. 95/55 % of Austrian ÖGU opinion leaders favoured a surgical treatment approach in cases of SB/NSB. Conversely, ÖGO members rather favoured a conservative treatment approach (28/27 %). CONCLUSION: Significant differences were found between ÖGO and ÖGU, with the latter favouring a surgical treatment approach in cases of SB and NSB. However, the international literature argues for a conservative treatment approach. Further high quality research is needed to establish an evidence-based treatment approach.
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Anti-Inflamatórios/uso terapêutico , Artroplastia/estatística & dados numéricos , Bursite/epidemiologia , Bursite/terapia , Drenagem/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Áustria/epidemiologia , Bursite/diagnóstico , Humanos , Olécrano , Patela , Prevalência , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND: Fatal trauma is one of the leading causes of death in Western industrialized countries. The aim of the present study was to determine the preventability of traumatic deaths, analyze the medical measures related to preventable deaths, detect management failures, and reveal specific injury patterns in order to avoid traumatic deaths in Berlin. MATERIALS AND METHODS: In this prospective observational study all autopsied, direct trauma fatalities in Berlin in 2010 were included with systematic data acquisition, including police files, medical records, death certificates, and autopsy records. An interdisciplinary expert board judged the preventability of traumatic death according to the classification of non-preventable (NP), potentially preventable (PP), and definitively preventable (DP) fatalities. RESULTS: Of the fatalities recorded, 84.9 % (n = 224) were classified as NP, 9.8 % (n = 26) as PP, and 5.3 % (n = 14) as DP. The incidence of severe traumatic brain injury (sTBI) was significantly lower in PP/DP than in NP, and the incidence of fatal exsanguinations was significantly higher. Most PP and NP deaths occurred in the prehospital setting. Notably, no PP or DP was recorded for fatalities treated by a HEMS crew. Causes of DP deaths consisted of tension pneumothorax, unrecognized trauma, exsanguinations, asphyxia, and occult bleeding with a false negative computed tomography scan. CONCLUSIONS: The trauma mortality in Berlin, compared to worldwide published data, is low. Nevertheless, 15.2 % (n = 40) of traumatic deaths were classified as preventable. Compulsory training in trauma management might further reduce trauma-related mortality. The main focus should remain on prevention programs, as the majority of the fatalities occurred as a result of non-survivable injuries.
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Causas de Morte , Serviços Médicos de Emergência/organização & administração , Tratamento de Emergência/normas , Traumatologia/educação , Ferimentos e Lesões/mortalidade , Adulto , Idoso , Berlim/epidemiologia , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Tratamento de Emergência/mortalidade , Tratamento de Emergência/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Serviços Preventivos de Saúde , Estudos Prospectivos , Ferimentos e Lesões/terapiaRESUMO
BACKGROUND: Independent of the rescue system type, a rescue time of less than 60 min for trauma patients is usually required and considered to be crucial for the outcome. The goal of this study was to investigate the impact of the rescue time on hospital survival in severely injured patients. METHODS: With the help of the German Trauma Registry of the DGU, the population and rescue time were systematically analyzed with regard to the survival rate. A lower mortality rate was observed with a higher injury severity in metropolitan cities compared to small towns. RESULTS: A multivariate regression analysis revealed no clinically relevant impact of the rescue time length in the German rescue system on survival. This can be explained by a higher amount of preclinical medical procedures during longer rescue times. CONCLUSIONS: Within the German rescue system, the length of rescue time has no relevant impact on the survival of trauma patients admitted to a clinic. This could be explained by the higher numbers of preclinical measures and due to the limitations of a register study with selection bias. Therefore, we advocate that the necessary and suitable preclinical medical procedures be performed to stabilize the patient, even in cases that have exceeded the 60-min gold standard time window. In conclusion the "golden hour" concept today might better be interpreted as an individual and appropriate "golden period" of trauma.