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  • 1
    Electronic Resource
    Electronic Resource
    Injuries due to falls from a considerable height. A comparative analysis from injuries and clinical course after international or accidental fall (1999)
    Springer
    Der Unfallchirurg 102 (1999), S. 525-530 
    Details
    ISSN: 1433-044X
    Keywords: Key words Falls • Multiple trauma • ARDS • MOF • ; Outcome ; Schlüsselwörter Absturzverletzung • Polytrauma • ARDS • MOV • Letalität
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Ziel dieser Untersuchung war, Unterschiede im klinischen Verlauf zwischen Patienten mit suizidalem (S, n = 94) bzw. akzidentellem (A, n = 117) Absturztrauma (〉 4 m) herauszuarbeiten. Die Verletzungsschwere im „Injury Severity Score“ (S: 28 ± 1; A: 30 ± 1), Beatmungsdauer (S: 16 ± 2; A: 15 ± 1 d) und Letalität (S: 18 %; A: 22 %) waren vergleichbar. Signifikante Unterschiede fanden sich in der Geschlechtsverteilung [männlich/weiblich (m/w): S: 46/54; A: 73/27 %], der Anzahl von Lendenwirbelsäulen- (S: 34; A: 15 %), Becken- (S: 51, A: 38 %), Unterschenkel- (S: 47; A: 20 %), Pilon-tibiale- (S: 15; A: 5 %) und Fersenbeinfrakturen (S: 17; A: 9 %). Leberrupturen (S: 16; A: 6 %) traten signifikant häufiger nach akzidentellem Absturz auf. Nach akzidentellem Absturztrauma wurde signifikant häufiger ein Organ/Multiorganversagen (OV/MOV) diagnostiziert (S: 1; A: 8 %). Haupttodesursache in beiden Gruppen waren das OV/MOV (S: 47; A: 69 %) und das Schädel-Hirn-Trauma (S: 35; A: 19 %). Prognose, Rehabilitation und Langzeiterfolg der polytraumatisierter Patienten nach suizidalem Absturztrauma sind demnach von den Spätfolgen der Schädel-Hirn-Verletzungen, den Wirbelsäulenfrakturen, sowie der Knochen- und Gelenkzerstörung der unteren Extremität bestimmt. Demgegenüber ist die Prognose nach einem akzidentellem Absturz weitgehend von der Entwicklung eines OV/MOV in der primären intensivmedizinischen Phase abhängig.
    Notes: Summary The aim of this study was to compare the outcome and clinical course of multiple trauma patients with accidental or intentional (suicide related) fall from heights 〉 4 m. 211 patients with an injury severity score (ISS) 〉 17 were assigned to the following groups: I: intentional fall, n = 94; A: accidental fall, n = 117) and ISS (I: 28 ± 1; A: 30 ± 1), ventilation time (I: 16 ± 2; A: 15 ± 1) were not different. Significant differences were found in sex (m/f: I: 56/44; A: 73/27 %), fractures of lumbarspine (I: 34; A: 15 %), pelvis (I: 51; A: 38 %), lower leg (I: 47; A: 20 %), pilon (I: 15; A: 5 %), and os calcis (I: 17; A: 9 %). Liver lacerations occured more often after intentional fall (I: 16; A: 6 %). Single or multiple organ failure (MOF) was diagnosed significantly more often in group A (I: 1; A: 8 %). Main cause of death in both groups was single or multiple organ failure (MOF: I: 47; A: 69 %) or related to brain-injuries (I: 35; A: 19 %). Prognosis and rehabilitation of multiple trauma patients after intentional fall is related to brain-injuries, spine-fractures and the functional outcome of the injured lower leg. Prognosis of patients after accidental fall is related to the development of MOF during the ICU-course.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050445
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  • 2
    Electronic Resource
    Electronic Resource
    Kostenanalyse der Primärversorgung und intensivmedizinischen Behandlung polytraumatisierter Patienten (1997)
    Springer
    Der Unfallchirurg 100 (1997), S. 44-49 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Polytrauma ; Behandlungskosten ; Key words Multiple trauma ; Cost for
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Treatment costs of emergency therapy, surgery and intensive care were analysed in 20 randomly chosen, representative patients with severe multiple trauma (mean ISS 32 p). For an average stay of about 22.5 days in the ICU, the total costs were DM 106,924.36 (about 70,000 US $), which breaks down as DM 39,635.88 (=37%) for physicians and nurses, DM 67,289.08 (=63%) for materials, X-rays, laboratory investigations, drugs and blood components. The whole treatment caused daily costs of DM 4.752.22, or DM 3.30 per min. The first emergency diagnostic procedures and emergency therapy take a mean of 451.9 min from admission to the beginning of the ICU treatment and itself generates costs of about DM 12,325.99. In Germany a new system of compensation by diagnosis-related group was introduced in 1996. Therefore, these data indicate that treatment of severe multiple trauma is very expensive and trauma care could be economically by damaging for smaller hospitals. We conclude that treatment of multiply injured patients (ISS〉16 p) should be concentrated in selected trauma centres and compensated by payment of a special daily amount of about DM 5,000 (about 3,500 US $).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050094
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Distribution and function of alveolar cells in multiply injured patients with trauma-induced ARDS (1988)
    Springer
    Intensive care medicine 14 (1988), S. 602-609 
    Details
    ISSN: 1432-1238
    Keywords: ARDS ; Alveolar cells ; Bronchoalveolar lavage ; Lung contusion ; Polytrauma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To determine whether alveolar cells are involved in the pathogenesis of adult respiratory distress syndrome (ARDS), we assessed the distribution and function of alveolar cells from 30 polytraumatized patients with trauma-induced respiratory failure, 5 of whom also had lung contusion. Cells were obtained by bronchoalveolar lavage performed daily begining on the day of trauma and continuing for 14 days. Neutrophils constituted about 60% of lavage cells in ARDS patients with lung contusion 0–2 days after polytrauma and about 50% in ARDS patients without lung contusion. In ARDS patients with lung contusion the neutrophil fraction decreased to 52% 3–6 days after trauma and to 40% 7–14 days after trauma. In patients without lung contusion the neutrophil fraction increased to 77% and then decreased to 60% at these times. Total cell counts in ARDS patients with lung contusion were more than twice as high as in patients without lung contusion 0–2 days after trauma. The difference in total cell counts decreased during days 3–6 and disappeared by day 7. In all patients morphologically altered alveolar cells were observed 4 days and more after trauma. In non-survivors significantly more altered cells were found. The chemiluminescence-response pattern of the alveolar cells was enhanced throughout the study and correlated with the neutrophil fraction (r=0.6). The neutrophil fraction also correlated with the pulmonary vascular resistance during the first two days after trauma (r=0.53). We conclude that alveolar cells are involved in the pathogenesis of trauma-induced ARDS and that the alveolar cell distribution is different in patients with and without lung contusion during the development of posttraumatic respiratory failure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00256763
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Outcome and management of blunt liver injuries in multiple trauma patients (1999)
    Springer
    Langenbeck's archives of surgery 384 (1999), S. 453-460 
    Details
    ISSN: 1435-2451
    Keywords: Key words Blunt liver trauma ; Multiple injury ; Operative management ; Outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Background: In Germany, abdominal trauma in multiple- trauma patients can be observed in about 25–35% of all cases. Due to major bleeding complications, the initial treatment of blunt abdominal trauma in multiple-trauma patients has high priority. The aim of this study was to discuss management, treatment and outcome of blunt liver injury in multiple-trauma patients treated in our department. Methods: The clinical records of 1192 multiple-trauma patients [injury severity score (ISS) 3–18] treated at the Surgical Department of the University Clinic of Essen from January 1975 to February 1998 were reviewed. Seventy-five patients with an ISS above 18 operated on due to a blunt liver injury could be included. The mean age was 29.82±1.80 years (60 males and 15 females). The degree of injury in this group was high (ISS 37.12±1.06). Results: Twenty-three of the 75 (30.6%) patients died during their hospital stay. Deceased patients were older (27±2 years versus 37±4 years; P〈0.01) and had a higher ISS (ISS=34.5±1 versus 43.2±2; P〈0.01). In nine cases, death was strongly related to liver injury. Operational blood loss was higher in the group of multiply injured patients with liver injury and in those patients who did not survive (P〈0.05). An increased mortality could be seen in this selected patient group when compared with our large collective of multiply injured patients. The age of the patients, the ISS and operative blood loss were the significant factors that influenced the operative mortality after blunt hepatic injuries in our study.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004230050230
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    Paper (German National Licenses)
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