Traumascores für den Schockraum - eine kritische Übersicht

Abstract

For more than 30 years various scoring systems have been used as a method to asses the injury severity of multi-system trauma. They have been used as a tool for triage, for emergency-room quality management, for educational reasons or, nowadays, in order to evaluate the cost effectiveness of either a complete hospital or a single department. This review provides the knowledge to score multi-system traumatized patients after their first treatment in the emergency-room. It shows advantages, disadvantages, and limitations of various traumascores which includes knowledge about the used parameters, the type of validation, the medical system in their country of origin, and of course their mathematical background. Relevant examples like physiological trauma scores (GCS, RTS, MEES), anatomic, injury pattern based scores (ISS, NISS, ICISS), biological aspects, mixed scoring systems (PTS, TRISS, ASCOT) and future developments ("Rixen-pattern", RISC) are illustrated. These scores are explained in detail and discussed as to their practicability.

Perioperative administration of buffered versus non-buffered crystalloid intravenous fluid to improve outcomes following adult surgical procedures: a Cochrane systematic review

“…The remaining six publications of five trials used colloid solutions in their experimental and control arms, comparing a buffered hydroxyethyl starch (HES) solution versus a non-buffered HES solution. High molecular weight (MW) HES was used in four RCTs (Martin et al 2002; Moretti et al 2003; Gan et al 1999; Wilkes et al 2001), and two used low MW HES (Kulla et al 2008; Base et al 2011).…”

“…Although each study clearly disclosed these funding sources, we considered these studies to be at unclear risk of bias. Two other studies did not report sufficient detail about outcomes of interest, and we therefore considered them to be at unclear risk of bias (Kulla et al 2008; Heidari et al 2011).…”

“…Eight trials with a total of 459 participants reported urine output during the intraoperative period and on the first postoperative day (Kim et al 2013; O’Malley et al 2005; Kulla et al 2008; Gan et al 1999; Wilkes et al 2001; Waters et al 2001; Scheingraber et al 1999; Takil et al 2002). Mean urine output reported intraoperatively was 872 ml for the buffered fluid group and 799 ml for the non-buffered fluid group.…”

Notärztliche Diagnosequalität bei eingeklemmten Verkehrsunfallopfern – eine retrospektive Erhebung

“…Die prähospitale Dokumentation der medizinischen Versorgung erfolgt aufbauend auf dem national standardisierten MIND2 mittels einer Digital-Pen-and-Paper Lösung [17,18] . Dies beinhaltet auch die Erfassung der Abbreviated Injury Scale (AIS) und des Injury Severity Score (ISS) [22] . Utstein-Trauma-Style, der zur Dokumentation von Umfang und Schweregrad einer Verletzung insgesamt 10 verschiedene Körperregionen sowie neben "keine Verletzung" auch 6 Schweregrade der Verletzung differenziert [19] .…”

Besteht ein Zusammenhang zwischen der Einschätzung der Vitalgefährdung und der notfallmedizinischen Erfahrung des Notarztes?

“…B. Revised Trauma Score, RTS; Trauma Injury Severity Score, TRISS; [8]) üblich. Vielmehr beurteilt der Notarzt die vitale Bedrohung des Patienten nach dem klinischen Eindruck.…”