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Die professionelle Behandlung von schwer verletzten Patienten beginnt unter den Bedingungen des strukturierten Rettungsdiensts bereits am Unfallort. Die aktuelle S3-Leitlinie schwerstverletzter Patienten dient hierbei als Orientierungshilfe. Die Empfehlungen der Leitlinie sind in den prioritätengesteuerten Ablauf der präklinischen Behandlung nach den Prinzipien des ABC-DE-Schemas eingebettet. Dabei orientiert sie sich in den Behandlungsindikationen an objektivierbaren Kriterien der tatsächlich gestörten Funktionen. Wichtige Empfehlungen zur Indikation und Durchführung der Notfallnarkose, Intubation und Beatmung, der Volumentherapie, der Diagnose und Therapie von Thoraxverletzungen, dem Vorgehen bei Schädel-Hirn-Trauma und bei Verdacht auf Wirbelsäulen-und Beckenverletzungen, dem prioritätengerechten Management von Extremitätenverletzungen sowie Hinweise auf die Wahl des Zielkrankenhauses und Ausblicke auf die Möglichkeiten einer Gerinnungstherapie in der Präklinik werden dargestellt. Abstract !The professional treatment of trauma patients with multiple injuries is already initiated at the accident site within the framework of organised emergency services. The current S3 guideline for the management of trauma patients with multiple injuries provides guidance for such cases. The guideline's recommendations have been embedded in the priority-based process of the preclinical treatment following the principles of the ABCDE concept. With regard to treatment indications, the guideline focuses on the objective, measurable criteria of the actually impaired functions. Important recommendations with respect to the indications and conduction of emergency anaesthesia, intubation and ventilation, volume therapy, diagnosis and treatment of thoracic injuries, procedures in cases of traumatic brain injury and suspected spinal and pelvic injuries, priority-based management of extremity injuries, considerations when selecting a hospital for admission, and the perspective of anticoagulant therapy options are all presented.Einleitung ! Im aktuellen Jahresbericht des TraumaRegisters DGU ® (Deutsche Gesellschaft für Unfallchirurgie) der Akademie der Unfallchirurgie (AUC) wurden im Jahr 2010 15 511 schwer und schwerstverletzte Patienten in 367 teilnehmenden Kliniken statistisch erfasst und behandelt (TraumaRegister DGU ® Jahresbericht 2011). Diese dokumentierte Fallzahl bedeutet jedoch für den einzelnen Notarzt, dass Schwerstverletzte mit einem Injury Severity Score (ISS) ≥ 16 im Gegensatz zu Patienten z. B. mit Herz-Kreislauf-Erkrankungen eine eher seltene Entität darstellen. Werden diese Daten auf den einzelnen regelmäßig tätigen Notarzt extrapoliert, werden von ihm im Jahr durchschnittlich ca. 2 -3 schwerstverletzte Patienten versorgt. • " Tab. 1 zeigt das durchPräklinische Versorgung des Schwerstverletzten nach der aktuellen S3-Leitlinie "Schwerstverletztenversorgung"

Background The current German S3 guideline for polytrauma lists five criteria for prehospital intubation: apnea, severe traumatic brain injury (GCS ≤8), severe chest trauma with respiratory failure, hypoxia, and persistent hemodynamic instability. These guideline criteria, used in adults in daily practice, have not been previously studied in a collection of severely injured children. The aim of this study was to assess the extent to which the criteria are implemented in clinical practice using a multivariate risk analysis of severely injured children. Methods Data of 289,698 patients from the TraumaRegister DGU® were analyzed. Children meeting the following criteria were included: Maximum Abbreviated Injury Scale 3+, primary admission, German-speaking countries, years 2008–2017, and declaration of intubation. Since children show age-dependent deviating physiology, four age groups were defined (years old: 0–2; 3–6; 7–11; 12–15). An adult collective served as a control group (age: 20–50). After a descriptive analysis in the first step, factors leading to prehospital intubation in severely injured children were analyzed with a multivariate regression analysis. Results A total of 4489 children met the inclusion criteria. In this cohort, young children up to 2 years old had the significantly highest injury severity (Injury Severity Score: 21; p ≤ 0.001). Falls from both high (> 3 m) and low heights (< 3 m) were more common in children than in adults. The same finding applied to the occurrence of severe traumatic brain injury. When at least one intubation criterion was formally present, the group up to 6 years old was least likely to actually be intubated (61.4%; p ≤ 0.001). Multivariate regression analysis showed that Glasgow Coma Scale score ≤ 8 in particular had the greatest influence on intubation (odds ratio: 26.9; p ≤ 0.001). Conclusions The data presented here show for the first time that the existing criteria in the guideline for prehospital intubation are applied in clinical practice (approximately 70% of cases), compared to adults, in the vast majority of injured children. Although severely injured children still represent a minority of all injured patients, future guidelines should focus more on them and address them in a specialized manner.

Background The impact of spinal injuries on clinical outcome in most severely injured patients is currently being controversially discussed. At the same time, most of the studies examine patients with post-traumatic neurological disorders. The aim of this study was therefore to analyse severely injured patients with spinal injuries but without neurological symptoms with regard to their clinical outcome. Here the focus was then on the question, whether spinal injury is an independent risk factor increasing length of stay in the intensive care unit and in the hospital in total. Material and Methods Data of the TraumaRegister DGU® were retrospectively analysed. Inclusion criteria were: Injury Severity Score ≥ 16, primary admission, age ≥ 16 years, time interval 2009 – 2016, and a full data set on length of stay in the hospital and the intensive care unit, respectively. Following a univariate analysis in the first step, independent risk factors for the length of stay in the intensive care unit and in the hospital in total were investigated using a multivariate regression analysis. Results 98,240 patients met the inclusion criteria. In this population, patients with Abbreviated Injury Scale (AIS) 2 and 3 spinal injuries were significantly younger (up to 60 years), and injuries were significantly more commonly caused by falls from a great height and traffic accidents (age ≤ 60 years: AISSpine 0: 58.4%, AISSpine 3: 65%; p < 0.001). Multivariate analysis showed that spinal injury without neurological symptoms is an independent risk factor for increased length of stay in the intensive care unit (odds ratio: + 1.1 d) and in the hospital in total (AIS 3 odds ratio: + 3.4 d). Conclusion It has been shown for the first time that spinal injury without initial neurological symptoms has a negative impact on the length of stay of most severely injured patients in the intensive care unit and in the hospital in total and thus represents an independent risk factor in this group of patients.

In der aktuellen Literatur werden schwerstverletzte Patienten mit urogenitalen (UG) Begleitverletzungen nur selten betrachtet. Fokussiert sind die Analysen dann häufig auf Nierenverletzungen, sodass andere UG-Traumen wie z. B. Harnleiterverletzungen nur marginal untersucht wurden. Diese Studie möchte Patienten mit UG-Verletzungen charakterisieren und den Effekt dieser Verletzungen auf Letalität und Liegedauer analysieren. Material und Methodik: Einschlusskriterien dieser retrospektiven Analyse aus dem TraumaRegister DGU ® waren: Injury Severity Score (ISS) ≥ 16 im Zeitraum von 2009-2016 mit Angaben zu Alter und Liegedauer. In einer deskriptiven Analyse wurden Schlüsselwörter Traumaregister • Multivariate Regressionsanalyse • Letalität • Urogenitale Verletzungen • Liegezeit im Krankenhaus Der Urologe 1