Comorbidity scores are important predictors of in-hospital mortality after traumatic spinal cord injury (tSCI), but the impact of specific pre-existing diseases is unknown. This retrospective cohort study aims at identifying relevant comorbidities and explores the influence of end-of-life decisions. In-hospital mortality of all patients admitted to the study center after acute tSCI from 2011 to 2017 was assessed. A conditional inference tree analysis including baseline data, injury characteristics, and Charlson Comorbidity Index items was used to identify crucial predictors. End-of-life decisions were recorded. Three-hundred-twenty-one patients were consecutively enrolled. The median length of stay was 95.7 days (IQR 56.8–156.0). During inpatient care, 20 patients (6.2%) died. These patients were older (median: 79.0 (IQR 74.7–83.2) vs. 55.5 (IQR 41.4–72.3) years) and had a higher Charlson Comorbidity Index score (median: 4.0 (IQR 1.75–5.50) vs. 0.0 (IQR 0.00–1.00)) compared to survivors. Pre-existing kidney or liver disease were identified as relevant predictors of in-hospital mortality. End-of-life decisions were observed in 14 (70.0%) cases. The identified impairment of kidney and liver, important for drug metabolism and elimination, points to the need of careful decisions on pharmaceutical treatment regimens after tSCI. Appropriate reporting of end-of-life decisions is required for upcoming studies.

Purpose Severe accidents are the leading cause of long-term impairment and death in children. A common diagnostic procedure for children exposed to high-injury trauma is full-body contrast-enhanced CT (fbCT). However, the number of fbCT without detected injuries is relevant. In 2007, full-body MRI (fbMRI) was implemented as a diagnostic approach for children sustaining high-energy trauma. The aim of this cross-sectional retrospective study was to analyze fbMRI as a diagnostic tool for children after high-energy trauma focusing on feasibility, radiological findings, and limitations. Methods Diagnostics using fbMRI (from apex of the head to the pelvis) was performed if a child was stable and suffered a high-energy trauma in a Level I Trauma Center in Germany. 105 fbMRIs in patients exposed to high-energy trauma aged ≤ 16 years were performed between January 2007 and December 2018. Four fbMRIs were excluded as conducted for reasons other than trauma. Time between arrival in the emergency department and fbMRI, additional diagnostic procedures, injuries, and non-trauma related pathologies were analyzed. Results Mean time between arrival in the emergency department and fbMRI was 71 min (± SD 132 min). Two scans were discontinued and changed to a faster diagnostic procedure. 45% of children had additional X-rays and 11% CT scans. The MRIs showed intracranial abnormalities in 27%, extremities injuries in 26%, spinal injuries in 18%, pelvic, and thoracic injuries in 7% of the cases. Conclusion Overall fbMRI is a diagnostic alternative for hemodynamically stable, conscious children after high-energy trauma with the advantages of a radiation-free technique. However, MRI diagnostics take longer than CT scans. Prospective studies will be needed to identify the limiting factors of fbMRIs as primary diagnostic procedure compared to CT scans. Trial registration German Clinical Trials Register (DRKS; DRKS00017015). Level of evidence Case series, level of evidence V.

Supplemental Digital Content is available in the text This case-control study revealed associations of adverse events in spinal surgery with secondary complications, neurological recovery and dysphagia after traumatic injury to cervical spinal cord. In addition, length of stay and treatment costs were higher when spinal surgery adverse events occurred in patients with spinal fractures involving spinal cord injury.

Zusammenfassung Hintergrund und Fragestellung Eine hochwertige Weiterbildung ist ein Schlüsselfaktor für gute und sichere Patienten- und Patientinnenversorgung. In Deutschland werden derzeit Weiterbildungsordnungen und Logbücher mit dem Ziel überarbeitet, die Weiterbildung in eine kompetenzbasierte Weiterbildung zu überführen. Ziel der Studie ist die Analyse der täglichen Realität der orthopädisch-chirurgischen Weiterbildung in Deutschland anhand der Elemente der Weiterbildung. Methoden Im März 2020 wurde eine Onlinebefragung von Weiterzubildenden mit 44 Fragen zu den Themen Weiterbildungsordnung, Logbuch, Bildungsressourcen, Evaluation, Weiterbildungsbefugte und Arbeitszeitverteilung durchgeführt. Ergebnisse Insgesamt 237 Personen beantworteten die Umfrage, 208 erfüllten die Einschlusskriterien. Die Weiterzubildenden empfinden einen Mangel an klaren Standards in der Weiterbildungsordnung. 25 % der Weiterzubildenden erhalten keine strukturierten Lernressourcen wie beispielsweise Simulationen oder Kurse. Weiterbildungsgespräche werden in 58 % der Fälle durchgeführt. Die meisten Weiterzubildenden schätzen die Expertise ihrer Weiterbildenden in der Orthopädie/Unfallchirurgie, während sie deren Kompetenz in Supervision und Feedbackgeben als unterdurchschnittlich bewerten. Administratives Arbeiten umfasst 220 min der täglichen Arbeitszeit, im Schnitt verbleiben 60 min pro Tag und Weiterzubildenden, um operative Tätigkeiten zu erlernen. Diskussion Die Studie deckt Inkonsistenzen mit der aktuellen Weiterbildungsordnung und ein Defizit an Supervision und Evaluation auf. Die Überführung in kompetenzbasierte Weiterbildung sollte daher nicht ausschließlich auf einer Anpassung der Weiterbildungsordnung beruhen, sondern auf allen Ebenen der Weiterbildung anvisiert werden (Lernressourcen Ausbildung der Weiterbildenden, Evaluation).