Causes of Death in the Seriously Injured -Why do Severely Injured Patients Die Today? / Todesursachen von Schwerverletzten - Woran stirbt das Polytrauma heute?

HINTERGRUND: Trauma ist die häufigste Todesursache bei unter 45-Jährigen und trotzdem gibt es nur wenig Daten zu den genauen Todesursachen Schwerverletzter nach Klinikeinlieferung in Deutschland aus den letzten 10 Jahren. Ziel der Arbeit ist 1. eine Auswertung der Daten der verstorbenen Schwerverletzten eines überregionalen TraumaZentrums aus den letzten 10 Jahren. Erforscht werden sollen Verlässlichkeit der Daten, Häufigkeit der Todesursachen und Zusammenhänge mit dem Unfallmechanismus und 2. die Nachvollziehbarkeit der Daten im TraumaRegister DGU. PATIENTEN UND METHODEN: Es erfolgte die Auswertung der Daten von 203 verstorbenen schwerverletzten Patienten aus dem Universitätsklinikum Jena, die von 2007 bis 2017 verunfallt sind. ERGEBNISSE: Eine eindeutige Festlegung der Todesursache ist anhand von Klinikdaten in ca. 85% der Fälle möglich. Häufigste Todesursache von Schwerverletzten nach Klinikeinlieferung ist mit 59,6% das Schädel-Hirn-Trauma, gefolgt von 17% Organversagen, 14% Hämorrhagie und 9,4% sonstigen Todesursachen. Die Verifizierung anhand von Daten aus dem TraumaRegister DGU ist möglich. Es besteht ein klarer Zusammenhang zwischen Unfallmechanismus und Todesursache. SCHLUSSFOLGERUNGEN: Welche Todesursache angegeben wird, unterliegt immer auch einer subjektiven Einschätzung. Insbesondere bestehen Schwierigkeiten bei Patienten, die vor weiterer Diagnostik im Schockraum versterben. Häufigste Todesursache ist heute das Schädel-Hirn-Trauma. Es ist sinnvoll, die Todesursache im TraumaRegister DGU extra zu erfassen, da diese anhand von anderen Registerdaten nur teilweise abgeleitet werden kann. Die Zusammenhänge zwischen Unfallmechanismus und Todesursache könnten ggf. für Präventionsmaßnahmen genutzt werden. BACKGROUND: The leading cause of death among people under 45 years of age is trauma. However, there is little information from the last 10 years on the exact causes of death of seriously injured people after hospital admission in Germany. The aim of the study is to evaluate the data of a level I trauma centre from the last 10 years. The reliability of the data, frequency of the causes of death and correlations with the mechanism of injury as well as the confirmability of the data in the TraumaRegister DGU are to be investigated. MATERIALS AND METHODS: The University Hospital Jena data were analysed for 203 deceased trauma patients from accidental death between 2007 and 2017. RESULTS: A clear determination of the cause of death is possible in about 85% of cases on the basis of hospital data. The most frequent cause of death of severely injured patients after admission to the hospital is traumatic brain injury (59.6%), followed by organ failure (17%), haemorrhage (14%) and other causes of death (9.4%). Verification using data from the TraumaRegister DGU is possible. There is a clear correlation between mechanism of injury and cause of death. CONCLUSIONS: The cause of death is very often a subjective assessment of the recording doctor. In particular, there are difficulties with patients who die in the resuscitation room before further diagnosis. The most frequent cause of death today is traumatic brain injury. For future evaluations, the new information in the TraumaRegister DGU is helpful because the cause of death can only be partially derived from other registry data. The correlation between the type of accident and the cause of death could be used for preventive measures.

Risk factors for reoperation after initial burr hole trephination in chronic subdural hematomas.

BACKGROUND: The optimal management of chronic subdural hematomas remains a challenge. Twist drill craniotomy or burr hole trephination are considered optimal initial treatments, but the reoperation rate for hematoma recurrence and other complications is still high. Therefore, evaluation of possible risk factors for initial treatment failure is crucial. In this context, we performed a study to define a possible subpopulation that may benefit from a more invasive initial treatment regime. METHODS: We retrospectively reviewed the medical charts of 193 patients with 250 chronic subdural hematomas who had undergone burr hole trephination as first-line therapy in our institution between January 2005 and October 2012. To identify risk factors for reoperation, a multivariable logistic regression analysis was performed with reoperation as the dependent variable. Surgical complications, including acute rebleeding, infection and chronic hematoma recurrence, were analyzed separately using a logistic regression model. RESULTS: The mean age of the cohort was 71.4 years. The male/female ratio was 137:56. Reoperation was necessary in 56 cases (29%) for recurrent hematomas and surgical complications. Predictors for reoperation for surgical complications were midline shift (odds ratio [OR] (per mm) 1.16, 95% confidence interval [CI]: 1.05-1.29, p=0.006), arterial hypertension (OR 5.44, 95% CI: 1.45-20.41, p=0.012) and bilateral hematomas (OR 4.22, 95% CI: 1.22-14.58, p=0.023). There was a trend toward a higher risk of surgically-relevant hematoma recurrence in patients with prior treatment with vitamin K antagonists (OR 1.76, 95% CI: 0.75-4.13, p=0.191). CONCLUSION: Burr hole trephination is the therapy of choice in most chronic subdural hematomas, but the rate of recurrent hematomas is high. Every hematoma should be treated individually especially in relation to midline-shift and pre-existing conditions. Further prospective studies evaluating types of treatment and hematoma density are needed.