Einfluss des Transportmittels auf die Letalität bei polytraumatisierten Patienten

Frink, Michael; Probst, Christian; Hildebrand, Frank; Richter, Matthias; Hausmanninger, C.; Wiese, Birgitt; Krettek, Christian; Pape, Hans-Christian

doi:10.1007/s00113-006-1222-2

Cited by 35 publications

(18 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a comparable way to the presented results, Frink et al . were able to elucidate a survival benefit of helicopter transported patients [23]. The authors measured the difference between the TRISS-expected and observed mortality finding a considerable observed mortality reduction in HEMS patients while the expected mortality was comparable between the different transportation platforms.…”

Section: Discussionmentioning

confidence: 99%

Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients

et al. 2013

View full text Add to dashboard Cite

IntroductionPhysician-staffed helicopter emergency medical services (HEMS) are a well-established component of prehospital trauma care in Germany. Reduced rescue times and increased catchment area represent presumable specific advantages of HEMS. In contrast, the availability of HEMS is connected to a high financial burden and depends on the weather, day time and controlled visual flight rules. To date, clear evidence regarding the beneficial effects of HEMS in terms of improved clinical outcome has remained elusive.MethodsTraumatized patients (Injury Severity Score; ISS ≥9) primarily treated by HEMS or ground emergency medical services (GEMS) between 2007 and 2009 were analyzed using the TraumaRegister DGU® of the German Society for Trauma Surgery. Only patients treated in German level I and II trauma centers with complete data referring to the transportation mode were included. Complications during hospital treatment included sepsis and organ failure according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) consensus conference committee and the Sequential Organ Failure Assessment (SOFA) score.ResultsA total of 13,220 patients with traumatic injuries were included in the present study. Of these, 62.3% (n = 8,231) were transported by GEMS and 37.7% (n = 4,989) by HEMS. Patients treated by HEMS were more seriously injured compared to GEMS (ISS 26.0 vs. 23.7, P < 0.001) with more severe chest and abdominal injuries. The extent of medical treatment on-scene, which involved intubation, chest and treatment with vasopressors, was more extensive in HEMS (P < 0.001) resulting in prolonged on-scene time (39.5 vs. 28.9 minutes, P < 0.001). During their clinical course, HEMS patients more frequently developed multiple organ dysfunction syndrome (MODS) (HEMS: 33.4% vs. GEMS: 25.0%; P < 0.001) and sepsis (HEMS: 8.9% vs. GEMS: 6.6%, P < 0.001) resulting in an increased length of ICU treatment and in-hospital time (P < 0.001). Multivariate logistic regression analysis found that after adjustment by 11 other variables the odds ratio for mortality in HEMS was 0.75 (95% CI: 0.636 to 862).Afterwards, a subgroup analysis was performed on patients transported to level I trauma centers during daytime with the intent of investigating a possible correlation between the level of the treating trauma center and posttraumatic outcome. According to this analysis, the Standardized Mortality Ratio, SMR, was significantly decreased following the Trauma Score and the Injury Severity Score (TRISS) method (HEMS: 0.647 vs. GEMS: 0.815; P = 0.002) as well as the Revised Injury Severity Classification (RISC) score (HEMS: 0.772 vs. GEMS: 0.864; P = 0.045) in the HEMS group.ConclusionsAlthough HEMS patients were more seriously injured and had a significantly higher incidence of MODS and sepsis, these patients demonstrated a survival benefit compared to GEMS.

show abstract

Section: Discussionmentioning

confidence: 99%

Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Wie in vielen Studien gezeigt wurde, handelt es sich bei einer Großzahl der schwerverletzten Patienten um im Arbeitsleben stehende Personen männlichen Geschlechts [5,6]. Das durchschnittliche Alter zum Zeitpunkt des Unfalls beträgt 45,9 Jahre.…”

Section: Bedeutung Der Rehabilitation In Der Schwerverletztenversorgungunclassified

Rehabilitation von Schwerverletzten in Deutschland

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Die apparative Ausstattung nach DIN ist vergleichbar. Und insbesondere das präklinische Zeitintervall ist durch den RTH-Einsatz gegenüber bodengebundenen Rettungsmitteln nicht verkürzt [40]. Andererseits scheinen RTH häufiger in adäquater Zeit mit einem Schwerstverletzten ein Traumazentrum anzusteuern [39].…”

Section: Transportzeitpunktunclassified

Prehospital treatment of severely injured patients in the field

Probst

Hildebrand

Frink

et al. 2007

Chirurg

Self Cite

View full text Add to dashboard Cite

Life or extremity threatening injuries have to be diagnosed and treated rapidly by emergency physicians during prehospital care for severely injured patients. The cooperation with other rescue services, the fire brigade and the police must be coordinated and early transportation has to be organized. Rapid sequence intubation by trained personnel for correct indications, such as head injury or severe chest trauma is recommended as well as prehospital chest tube placement in cases of severe or penetrating thoracic injury. Crystalloids and colloidal solutions remain the first choice for intravenous volume replacement. The amount of fluid depends on the individual response, such as palpable peripheral and central pulse for blunt or penetrating trauma. Ultrasound or near infrared spectroscopy could not be routinely implemented for extended prehospital diagnostic procedures. Transportation to the closest appropriate hospital has to be accomplished as early as possible. Helicopters show positive outcomes if the destination is a level I trauma center, even if secondary alarm calls or more extensive measures prolong the prehospital interval.

show abstract

Einfluss des Transportmittels auf die Letalität bei polytraumatisierten Patienten

Cited by 35 publications

References 17 publications

Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients

Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients

Rehabilitation von Schwerverletzten in Deutschland

Prehospital treatment of severely injured patients in the field

Contact Info

Product

Resources

About