Evaluation of the characteristics of injured workers and employer compliance with OSHA's reporting requirement for work-related amputations.

INTRODUCTION: In 2014, the Federal Occupational Safety and Health Administration (OSHA) enacted a standard requiring employers to report work-related amputations to OSHA within 24 hours. We studied the characteristics of the injured workers and employer compliance with the regulation in Michigan. METHODS: Two independent data sets were used to compare work-related amputations from 2016 to 2018: employer reports to OSHA and the Michigan Multi-Source Injury and Illness Surveillance System (MMSIISS). We deterministically linked employer reports to OSHA with the MMSIISS by employee name, employer name, date, and type of amputation. RESULTS: We identified 1366 work-related amputations from 2016 to 2018; 575 were reported by employers to OSHA and 1153 were reported by hospitals to the MMSIISS. An overlap of 362 workers were reported in both systems, while 213 workers were only reported by employers to OSHA and 791 workers were only reported by hospitals. Employer compliance with the regulation was 42.1%. Employer compliance with reporting was significantly less in: agriculture, forestry, fishing, and hunting (14.6%); construction (27.4%); retail trade (20.7%); arts, entertainment, and recreation (7.7%); accommodation and food services (13.0%); and other services (27.0%). Large employers and unionized employers were significantly more likely (67.9% and 92.7%, respectively) and small employers were significantly less likely (18.2%) to comply with the reporting rule. Enforcement inspections at 327 workplaces resulted in 403 violations; of those, 179 (54.7%) employers had not corrected the amputation hazard before the time of inspection. DISCUSSION: Michigan employers reported less than half of the work-related amputations required by OSHA's reporting regulation. Noncompliance was greatest in small employers, and agriculture, forestry, fishing, and hunting; construction; arts, entertainment, and recreation; accommodation and food services; and retail and other service industries. Inspections found that over half of the employers had not corrected the hazard that caused the amputation at the time of the inspection's initial opening date; in these cases, abatement of any hazards identified would have occurred after the inspection. Improved compliance in employer reporting of work-related amputations will identify hazards posing a high risk of recurrence of injury to other workers from the same injury source. Greater compliance can also help target safety-related preventive and intervention efforts in industries that might otherwise be overlooked.

Surgical Stabilization of Rib Fractures in Severe Injury Is Not Associated With Worse Outcomes.

INTRODUCTION: This study aimed to determine whether surgical stabilization of rib fractures (SSRF) is associated with worse outcomes in individuals with multicompartmental injuries. MATERIALS AND METHODS: A retrospective review of a prospective trauma registry was performed for adult blunt trauma patients (aged ≥ 18 y) with Injury Severity Score ≥ 15 and radiographic evidence of rib fractures (2015-2020). Individuals without concomitant head, abdomen/pelvis, or lower extremity Abbreviated Injury Scale scores ≥ 3 were excluded. Propensity match on demographic and clinical variables was performed comparing patients treated nonoperatively (NO) to those undergoing SSRF. A chart review was performed for additional data. Primary outcome was hospital length of stay (LOS). Secondary outcomes were in-hospital mortality, intensive care unit LOS, and duration of mechanical ventilation. RESULTS: One thousand nine hundred ninety three patients fit the inclusion criteria (NO = 1,951, SSRF = 42). After matching, there were 98 in the NO group and 42 in the SSRF group. Mean age was 51 y, 61.4% were male, and 71.4% were of White race. Median time to fixation was 5 d. The SSRF group had more severe chest trauma as evidenced by a higher RibScore (3.2 versus 1.7, P < 0.001) and had a longer LOS (18 versus 9 d, P < 0.001), intensive care unit LOS (13 versus 3 d, P = 0.007), and duration of mechanical ventilation (8 versus 2 d, P = 0.013) on univariate analysis. Multivariable regression analysis demonstrated no association between SSRF and these short-term outcomes. CONCLUSIONS: Despite delayed average time to intervention, SSRF in a trauma-patient population with multicompartmental injuries and competing management priorities is not associated with worse short-term outcomes.

Reports to OSHA of severe occupational injuries due to animals, 2015-2021.

BACKGROUND: Workers can be injured by animals such as mammals and insects. Previous studies found that most animal-related occupational fatalities were caused by horses and cattle. We analyzed characteristics of recent nonfatal severe animal-related injuries in US workers. METHODS: The severe injury reports (SIR) database, collected by the Occupational Safety and Health Administration, contains employer self-reports of inpatient hospitalizations and amputations. We used 2015-2021 SIR data to assess properties of animal-related injuries, including the type of animal involved, the nature of the injury, and the industry of the employer. Industry-specific incidence rates were calculated. RESULTS: We identified 788 severe animal-related injuries during the 7-year study period. Mammals caused over half of these injuries (476; 60.4%), followed by insects, arachnids, and mites (183; 23.2%) and reptiles (127; 16.1%). Two-thirds (529; 67.1%) of animal-related injuries were traumatic, while 211 (28.0%) injuries were due to poisoning or allergic reaction. The highest observed incidence was in livestock merchant wholesalers (59.6 severe injuries per 100,000 workers per year); injuries in this industry were often due to cattle. Mail delivery and landscape architecture, two industries in which animal contact is atypical, were also among the 10 industries with the highest incidence. CONCLUSIONS: Workers in many industries experienced severe injuries due to animals. Among workers whose job involves animal contact, cattle workers appear to be at highest risk. Outdoor workers in some industries require protection from bites of dogs, snakes, and insects.

Evaluation of the characteristics of workers injured on the job requiring hospitalization, and employer compliance with OSHA's reporting requirement for these work-related hospitalizations.

BACKGROUND: The Occupational Safety and Health Administration (OSHA) implemented a new standard in 2014 requiring employers to report nearly all work-related inpatient hospitalizations within 24 h of the event. We examined the characteristics of the injured workers who were reported and the compliance of Michigan employers with the regulation. METHODS: From 2016 to 2018, we compared reports of acute nonmotor-vehicle work-related injuries and illnesses from two independent datasets, employer reports to OSHA and the Michigan Multi-Source Injury and Illness Surveillance System (MMSIISS) which collects injured worker hospital records from the 134 hospitals in Michigan. We matched records from employer reports to OSHA with the MMSIISS by employee's first and last name, company name, date of injury/illness, and type of injury/illness. RESULTS: We identified 2887 workers hospitalized with severe injuries/illnesses from 2016 to 2018 in Michigan; 1260 workers were reported by employers to OSHA and 2238 workers were reported by hospitals to the MMSIISS. There was an overlap of 611 workers reported in both systems, while 649 workers were only reported by employers to OSHA and 1627 workers were only reported by hospitals to the MMSIISS. Employer compliance with the regulation over the 3 years showed a nonsignificant increase; from 42.0% to 43.6% to 45.0%. Fractures were the most frequent type of injury (1238, 42.9%), then head injuries, including skull fractures (470, 16.3%). The median length of hospital stay was 3 days. Manufacturing (709, 25.5%) and construction (563, 20.3%), accounted for the greatest number of hospitalizations. Employer-reported cases to OSHA significantly undercounted hospitalized workers in agriculture, forestry, fishing, and hunting; construction; finance and insurance; real estate and rental and leasing; administrative and support and waste management and remediation services; arts, entertainment, and recreation; accommodation and food services; and other services except public administration. Companies with 250 or more employees were significantly more likely to comply and small companies with 10 or fewer employees were significantly less likely to comply with the reporting rule. Enforcement inspections at 465 of the workplaces where a hospitalization had occurred resulted in $1,017,835 in fines and identified 608 violations. Of the 465 inspections, 246 (52.9%) of the employers had not corrected the hazard before the inspection. CONCLUSIONS: This study identified that workers sustained severe injuries and illnesses on the job and that over half of the companies where a worker suffered an injury/illness leading to hospitalization were not in compliance with OSHA's reporting regulation. Furthermore, at the time of an inspection 1-5 months later, 50% of the companies had not corrected the hazard causing the hospitalization. Improvement in the reporting of work-related injuries/illnesses that result in hospitalization will identify more ongoing hazards in the workplace and improve where to focus preventive actions.

Determining the pharmacologic window of bisphosphonates that mitigates severe injury-induced osteoporosis and muscle calcification, while preserving fracture repair.

Following severe injury, biomineralization is disrupted and limited therapeutic options exist to correct these pathologic changes. This study utilized a clinically relevant murine model of polytrauma including a severe injury with concomitant musculoskeletal injuries to identify when bisphosphonate administration can prevent the paradoxical decrease of biomineralization in bone and increased biomineralization in soft tissues, yet not interfere with musculoskeletal repair. INTRODUCTION: Systemic and intrinsic mechanisms in bone and soft tissues help promote biomineralization to the skeleton, while preventing it in soft tissues. However, severe injury can disrupt this homeostatic biomineralization tropism, leading to adverse patient outcomes due to a paradoxical decrease of biomineralization in bone and increased biomineralization in soft tissues. There remains a need for therapeutics that restore the natural tropism of biomineralization in severely injured patients. Bisphosphonates can elicit potent effects on biomineralization, though with variable impact on musculoskeletal repair. Thus, a critical clinical question remains as to the optimal time to initiate bisphosphonate therapy in patients following a polytrauma, in which bone and muscle are injured in combination with a severe injury, such as a burn. METHODS: To test the hypothesis that the dichotomous effects of bisphosphonates are dependent upon the time of administration relative to the ongoing biomineralization in reparative bone and soft tissues, this study utilized murine models of isolated injury or polytrauma with a severe injury, in conjunction with sensitive, longitudinal measure of musculoskeletal repair. RESULTS: This study demonstrated that if administered at the time of injury, bisphosphonates prevented severe injury-induced bone loss and soft tissue calcification, but did not interfere with bone repair or remodeling. However, if administered between 7 and 21 days post-injury, bisphosphonates temporally and spatially localized to sites of active biomineralization, leading to impaired fracture callus remodeling and permanence of soft tissue calcification. CONCLUSION: There is a specific pharmacologic window following polytrauma that bisphosphonates can prevent the consequences of dysregulated biomineralization, yet not impair musculoskeletal regeneration.

Ten-year trends of adult trauma patients in Central Denmark Region from 2010 to 2019: A retrospective cohort study.

BACKGROUND: Trauma causes significant economic and societal burdens, and the trauma patient population and their prognosis change over time. This study aims to analyze 10-year trends of trauma patients at a major trauma center in Central Denmark Region. METHODS: Five thousand three hundred and sixty-six patients aged ≥16 years with Injury Severity Score (ISS) > 0 admitted by trauma team activation at a major trauma center between January 1, 2010, and December 31, 2019, were included. An annual percent change with a 95% confidence interval was used to estimate trends in the mechanism of injuries. Multiple logistic regression with mortality as the outcome was adjusted for age, sex, and ISS. Admission year was used as continuous variable in logistic regressions. RESULTS: The median age increased from 37 in 2010 to 49 in 2019, and the proportion of patients aged ≥65 doubled. The annual incidence of minor injuries (ISS 1-15) decreased from 181.3/105 inhabitants in 2010 to 112.7/105 in 2019. Severe injuries (ISS > 15) increased from 10.1/105 inhabitants in 2010 to 13.6/105 in 2019. The proportion of patients with ISS > 15 increased from 18.1% in 2010 to 31.1% in 2019. Multivariable logistic regression indicates lower 30-day mortality for all trauma patients over the study period when adjusting for age, sex, and ISS (odds ratio: 0.94, 95% CI: 0.90-0.99). The 30-day mortality for severely injured patients with ISS > 15 seems to decrease during the study period when adjusting for age, sex, and ISS (Odds ratio: 0.92, 95% CI: 0.87-0.97). Fall injuries increased by 4.1% annually (95% CI: 2.3%-6.1%). CONCLUSIONS: Ten-year trends of trauma patients at a major trauma center show an increasing median age, injury severity, and number of fall injuries. The 30-day mortality of trauma patients decreased slightly for both minor injuries and severe injuries when adjusting for age, sex, and injury severity.

Timing return-to-competition: a prospective registration of 45 different types of severe injuries in Germany's highest football league.

INTRODUCTION: Many professional football players sustain at least one severe injury over the course of their career. Because detailed epidemiological data on different severe injuries in professional football have been missing so far, this study describes the frequency and return-to-competition (RTC) periods of different types of severe football injuries. MATERIAL AND METHODS: This epidemiological investigation is a prospective standardised injury analysis based on national media longitudinal registration. Injuries were classified according to the consensus statement by Fuller et al. (2006). The analysis includes injuries sustained by players of the first German football league during the seasons 2014-2015 to 2017-2018. LEVEL OF EVIDENCE: II. RESULTS: Overall, 660 severe injuries were registered during the four seasons (mean 165 per season; 9.2 per season per team; incidence in 1000 h: 0.77). The body region most frequently affected by severe injury was the knee (30.0%; 49.5 injuries per season/SD 13.2) followed by the thigh (26.4%; 43.5 injuries/SD 4.2) and the ankle (16.7%; 27.5 injuries/SD 5.0). The distribution of injuries over the course of a season showed a trend for ACL ruptures to mainly occur at the beginning of a season (45.8%), overuse syndromes such as achillodynia (40.9%) and irritation of the knee (44.4%) during the winter months and severe muscle and ankle injuries at the end of a season. ACL ruptures showed the longest RTC durations (median 222 days). CONCLUSION: This study presents detailed epidemiological data on severe injuries in professional football. The body region most frequently affected by severe injuries was the knee. Several types of severe injuries showed a seasonal injury pattern. The appropriate timing of RTC after an injury is one of the most important and complex decisions to be made. This study provides information on the typical time loss due to specific severe football injuries, which may serve as a guideline.

Surviving Nonsurvivable Injuries: Patients Who Elude the 'Lethal' Abbreviated Injury Scale Score of Six.

BACKGROUND: The Abbreviated Injury Scale (AIS) score is used widely to quantify injury severity by body region. The maximal AIS score is 6, which defines a nonsurvivable injury. This study was undertaken to define mortality after AIS-6 injuries in order to determine if they are uniformly lethal and, if not, if differences between survivors and nonsurvivors exist which may aid in prognostication or refinement of the current AIS system. METHODS: All patients in the National Trauma Data Bank (2007-2017) with ≥1 AIS-6 injury were included. Exclusions were age <16 years, AIS-6 coding in the face/extremities (i.e., coding errors, as there are no AIS-6 injuries in these regions), and missing data. In-hospital mortality defined study groups, i.e., survivors vs. nonsurvivors. Univariable analysis compared clinical/injury data and outcomes. Multivariable analysis examined independent factors associated with mortality. RESULTS: 19,247 patients met inclusion/exclusion criteria. Of these, 25% (n=4,886) survived to hospital discharge and 75% (n=14,361) died. The most common discharge destination among survivors was home (n=2,187,45%) Nonsurvivors had significantly worse GCS in the field (3 vs. 14, p<0.001) and ED (3 vs. 15, p<0.001). Median AIS was higher among nonsurvivors in the Head (5 vs. 3, p<0.001), Abdomen (3 vs. 2, p<0.001), and External regions (1 vs. 1, p<0.001). Median time to death was 0.65h, with maximum time to death 8.76h. Multivariable analysis revealed External AIS-6 injuries were associated with greatest odds of mortality (OR 34.002, p<0.001) followed by Head AIS-6 (OR 10.501, p<0.001). CONCLUSION: AIS-6 injuries are not uniformly fatal, with 25% of such patients surviving to hospital discharge. Therefore, AIS-6 injuries may not be as catastrophic as previously considered. External and Head AIS-6, i.e. extensive burns and severe traumatic brain injuries, were associated with greatest odds of mortality. When death occurs after AIS-6 injury, it occurs rapidly, with all mortalities in this series occurring <9h after arrival. We suggest that the AIS-6 verbiage be revised to remove 'nonsurvivable'.

Injury epidemiology in men's professional team sports: is media analysis helpful?

INTRODUCTION: Epidemiological injury surveillance in professional sports is often based on online media analysis in order to collect necessary data. However, the validation of this study protocol is lacking. Therefore, this study aimed to identify the validity of injury surveillance in men's professional team sports based on media reports. METHODS: In a retrospective cohort study, the validity of media-data-relating injuries was investigated in participating teams of the highest two German divisions in men's professional basketball (BB) and handball (HB) in the season 2018/2019. Injury protocols completed by the team physicians were compared to those of sports media injury reports. RESULTS: The study population was composed of 133 athletes (54 BB and 79 HB). Of 343 injuries reported by the team physicians, 151 (44%) could be identified by means of sports media reports. Severe injuries (n = 75, 72%) were reported more likely in sports media compared to less severe injuries (n = 76, 32%, p < 0.00001). Odds ratio (OR) was 5.33 (95% CI 3.22-8.82). No differences regarding injury reporting could be seen between the two team sports. CONCLUSION: For severe injuries, media analysis may be a sufficient method for data collection in popular men's professional ball sports. An underestimation of true injury prevalence lies within the range of previous reported investigations concerning the validation of injury surveillance methods. Non-severe injuries could not be verified via media analysis in professional handball and basketball.

Physiologic risk factors for early acute kidney injury in severely injured patients.

BACKGROUND: The evaluation of the predictive value of the neutrophil gelatinase-associated lipocalin (NGAL) for an early acute kidney injury (AKI) development in severely injured patients. Determination of the time-dependent roles of trauma-related physiologic markers of tissue hypoxia, systemic inflammation and rhabdomyolysis in AKI development. METHODS: 81 adult patients were screened for the presence of AKI for eight consecutive days following the injury. Arterial levels of plasma NGAL, lactate, interleukin-6, procalcitonin, and myoglobin were investigated at 24 hours (T1), 48 hours (T2), and 96 hours (T3) after the injury. RESULTS: The incidence of AKI was 32.1 %. Patients with AKI were older, but no significant difference in injury severity was observed. NGAL levels were significantly higher in the AKI group at T1, T2, and T3 when compared to the non-AKI group. Lactate levels were significantly higher in the AKI group at T2 only, and IL-6 levels were significantly higher in the AKI group at T2 and T3. Procalcitonin and myoglobin levels were significantly higher in the AKI group at T1, T2, and T3, when compared to the non-AKI group. Positive correlations were found between plasma NGAL and all screened physiological factors at all defined time points. CONCLUSION: Development of AKI after blunt trauma is very complex and multifactorial. Activation of the systemic inflammatory response and rhabdomyolysis (high concentration of myoglobin) were strongly involved in AKI development. Blood NGAL levels after injury were significantly higher in patients, who developed posttraumatic AKI. Plasma NGAL, lactate, procalcitonin, interleukin-6, and myoglobin had potential to be useful parameters for risk stratification and prediction of AKI after trauma (Tab. 6, Ref. 40).

[Differences in the outcome of seriously injured children depending on treatment level]. / Unterschiede im Outcome schwerverletzter Kinder in Abhängigkeit von der Versorgungsstufe.

INTRODUCTION: Many publications, mainly from other countries, suggest that the treatment of seriously injured children might be better in specialised paediatric trauma centres than in general trauma centres. Data from Germany are not available yet, but those from abroad were used for the recommendations made by the German Association for Trauma Surgery (DGU) on the topic of paediatric trauma in the "White Paper on Trauma Care". The goal of this study was to analyse whether the outcome of severely injured children is dependent on treatment level and on the availability of a paediatric surgeon based on the given data. MATERIALS AND METHODS: Data from the "TraumaRegister DGU" between 2002 and 2012 were used. Children aged 1-15 years treated during the period 2002-2012 were included. Severity had to reach a minimum Injury Severity Score (ISS) of 9 and the treatment had to involve a stay at an Intensive Care Unit. Patients with an ISS ≥9 who died were also included to take into consideration children with particularly severe injuries. RESULTS: Hospitals without a paediatric surgeon transferred the patients significantly more frequently (p < 0.001). Mean hospital stay was shorter in centres with a paediatric surgeon, with slightly longer median stays at an Intensive Care Unit. Hospitals without a paediatric surgeon performed slightly more frequent surgical interventions on injured children (barely significant at p = 0.045). The death rate and the calculated Revised Injury Severity Classification (RISC) II prognosis were the same with or without the presence of a paediatric surgeon. No difference was found in the Glasgow Outcome Score (GOS) between the group with and the group without involvement of a paediatric surgeon. DISCUSSION: Overall, the medical care of seriously injured and polytraumatised children in Germany is good at all levels of treatment whether a paediatric surgeon is involved or not.

[Volume therapy in the severely injured patient : Recommendations and current guidelines]. / Volumentherapie beim schwerverletzten Traumapatienten : Empfehlungen und aktuelle Leitlinien.

BACKGROUND: Volume therapy is a cornerstone of early resuscitation of severely injured trauma patients, but the optimal strategy remains under debate. A recent Cochrane review could not find evidence for or against early volume replacement or large versus small amounts of fluid. METHOD: Current recommendations and guidelines regarding volume therapy in severely injured patients are summarized based upon the updated European Trauma Guideline on the management of major bleeding and coagulopathy following trauma (fourth edition) and the S3-Guideline Polytrauma and combined with a selective review of the literature. RESULTS AND DISCUSSION: Current guidelines and recommendations advocate the initiation of volume replacement at a reduced level in bleeding and hypotensive trauma patients in terms of "permissive hypotension," with the aim of maintaining mean arterial blood pressure (MAP) at 65 mm Hg and/or target systolic blood pressure at 80-90 mm Hg so as not to exacerbate the bleeding until its source can be controlled. Advanced Trauma Life Support principles, together with independent measurements of hemoglobin, base excess, and/or lactate, are recommended as sensitive tests for assessing the extent of bleeding and shock. Isotonic crystalloid solutions should be used as first-line volume replacement in bleeding, hypotensive trauma patients. Specific recommendations apply for patients with traumatic brain injury.

[The new treatment procedures of the DGUV from the perspective of an injury type procedure (VAV) clinic]. / Die neuen Heilverfahren der DGUV aus der Sicht einer VAV-Klinik.

The new treatment procedures of the German Statutory Accident Insurance (DGUV) have ramifications for the injury type procedure clinics (VAV) from medical, economic and structural aspects. Whereas the latter can be assessed as positive, the medical and economical aspects are perceived as being negative. Problems arise from the partially unclear formulation of the injury type catalogue, which results in unpleasant negotiations with the occupational insurance associations with respect to financial remuneration for services rendered. Furthermore, the medical competence of the VAV clinics will be reduced by the preset specifications of the VAV catalogue, which opens up an additional field of tension between medical treatment, fulfillment of the obligatory training and acquisition of personnel as well as the continually increasing economic pressure. From the perspective of the author, the relinquence of medical competence imposed by the regulations of the new VAV catalogue is "throwing the baby out with the bathwater" because many VAV clinics nationwide also partially have competence in the severe injury type procedure (SAV). A concrete "competence-based approval" for the individual areas of the VAV procedure would be sensible and would maintain the comprehensive care of insured persons and also increase or strengthen the willingness of participating VAV hospitals for unconditional implementation of the new VAV procedure.

Incidence and severity of reported acute sports injuries in 35 sports using insurance registry data.

Acute injuries in sport are still a problem where limited knowledge of incidence and severity in different sports at national level exists. In Sweden, 80% of the sports federations have their mandatory injury insurance for all athletes in the same insurance company and injury data are systematically kept in a national database. The aim of the study was to identify high-risk sports with respect to incidence of acute and severe injuries in 35 sports reported to the database. The number and incidences of injuries as well as injuries leading to permanent medical impairment (PMI) were calculated during 2008-2011. Each year approximately 12,000 injuries and 1,162,660 licensed athletes were eligible for analysis. Eighty-five percent of the injuries were reported in football, ice hockey, floorball, and handball. The highest injury incidence as well as PMI was in motorcycle, handball, skating, and ice hockey. Females had higher risk of a PMI compared with males in automobile sport, handball, floorball, and football. High-risk sports with numerous injuries and high incidence of PMI injuries were motorcycle, handball, ice hockey, football, floorball, and automobile sports. Thus, these sports ought to be the target of preventive actions at national level.

[Limb salvage versus amputation after severe lower extremity injury : Cases from clinical practice]. / Die Entscheidung zum Gliedmaßenerhalt oder zur Amputation nach schwerem Trauma der unteren Extremität : Fälle aus der klinischen Praxis.

Following severe lower extremity injury, the potential outcome of a salvage procedure might often be questionable. Objective criteria should help in decision-making. From the clinical practice of a level I trauma center, we demonstrate three case reports and approaches following severe lower extremity injury.

[The new treatment procedure of the German statutory accident insurance: From the perspective of a community hospital]. / Die neuen Heilverfahren der DGUV: Aus der Sicht eines Städtischen Krankenhauses.

The requirements of the German statutory accident insurance (DGUV) for the new treatment procedure were presented on 1 January 2013 in a new catalogue. The implementation of the certification of hospitals for the very severe injury procedure (SAV) by the DGUV should have been completed by 2014. These requirements placed high demands on trauma-oriented hospitals because of the high structural and personnel prerequisites. The background to the new organization was the wish of the DGUV for quality improvement in patient treatment in hospitals for patients with very severe occupational and occupation-related trauma by placement in qualified centers with high case numbers. No increase in income was planned for the hospitals to cope with the necessary improvements in quality. After 2 years of experience with the SAV we can confirm for a community hospital that the structural requirements could be improved (e.g. establishment of departments of neurosurgery, plastic surgery and thoracic surgery) but the high requirements for qualification and attendance of physicians on duty are a continuous problem and are also costly. The numbers of severely injured trauma patients have greatly increased, particularly in 2015. The charges for the complex treatment are not adequately reflected in the German diagnosis-related groups system and no extra flat rate funding per case is explicitly planned in the DRG remuneration catalogue. The invoicing of a center surcharge in addition to the DRG charges has not been introduced.

[The new medical treatment procedure of the German Statutory Accident Insurance: From the perspective of BG hospitals]. / Die neuen Heilverfahren der DGUV: Aus Sicht der BG Kliniken.

The Hospital Group of the Statutory Accident Insurance (BG hospitals) was affected by the new requirements for severe injury procedures (SAV) in the same manner as all other maximum care hospitals. Simultaneously, the BG clinics were merged to form a centrally organized hospital group. A substantial need for adjustment existed for specialties, such as neurosurgery and visceral surgery at some sites. Needless to say, all trauma victims benefit from the high standards required by the Statutory Accident Insurance regardless of their insurance status. The provision of medical treatment with respect to its implementation into routine practice must be further optimized and additions, e.g. for the occurrence of complications are necessary.

[New regulations for inpatient treatment of the statutory accident insurance: From the perspective of a university medical center]. / Neuordnung des stationären Heilverfahrens der Gesetzlichen Unfallversicherung: Aus Sicht einer Universitätsklinik.

BACKGROUND: New regulations of the German statutory accident insurance for inpatient treatment have been introduced. The aims of the new regulations are to improve cost-effectiveness and the quality of medical care. The introduction of the injury type catalogue and the severe injuries type procedure (SAV) has led to a concentration of resources. The purpose of these innovations is an increase in the quality of treatment of patients with complex injuries. CONCLUSION: The introduction of the new regulations resulted in a centralization of medical care in order to optimize the quality of treatment of complex injuries from occupational accidents. Hence, the high demands concerning infrastructure and human resources expected of a level one university medical center are taken into account.

How regional trauma systems improve outcomes.

Management of severely injured patients is complex and requires organised, expert care. Regionalised trauma systems are relatively new in the UK and aim to deliver optimal, timely care to injured patients at the most appropriate location. This article discusses the drivers, organisation, processes and outcomes of regionalised trauma care. It also describes the challenges and benefits of working within a trauma system to enable emergency practitioners to reflect on their roles in contemporary trauma care.

Unconventional mobility, conventional trauma: a comparative analysis of e-scooter-related fractures.

PURPOSE: The present research aimed to compare the different types of fractures to those caused by e-scooter use as well as reveal the severity of e-scooter injuries via an epidemiological analysis of fractures over the course of 6 months. METHODS: This retrospective study assessed medical records of patients with fractures or dislocations admitted to a Turkish level three trauma centre emergency orthopaedic department between June 2021 and January 2022. Using a two-group design, the first group encompassed all fractures and dislocations treated, while the second focused on e-scooter-related cases. Comparative analysis covered fracture patterns and factors within the e-scooter group, like demographics, injury mechanism, and timing. Surgical need and types were explored for e-scooter injuries. RESULTS: Among 4481 upper extremity fractures, finger fractures (27.47%) and distal radius fractures (25.37%) were common, while e-scooter-related cases exhibited radius and ulna shaft fractures (23.07%). Of 2400 lower extremity fractures, toe fractures (30.2%) and metatarsal fractures (19.66%) predominated, with e-scooter-related injuries largely featuring metatarsal fractures (30%). The surgery rate in all patients was 8.92%, whereas the surgery rate specifically for e-scooter injuries was 48.2%. Significantly greater occurrence of lower extremity fractures was evident in e-scooter-related injuries compared to upper extremities (p = 0.011). Collisions involving stationary or moving objects were linked to injuries in the lower extremities, whereas falls were primarily associated with injuries in the upper extremities. Treatment included surgery (48.2%) and conservative management (52.8%), with ORIF (35.7%) and CRIF (10.7%) utilised. CONCLUSION: E-scooter-related fractures and dislocations are typically more severe, often requiring surgery, compared to other fractures during the same period. The study emphasises the link between injury type and increased risk of lower extremity fractures or dislocations.