Untersuchung von Schockraumalarmierungskriterien basierend auf dem Unfallhergang – Ergebnisse einer Multizenterstudie

期刊论文
发表日期：

2024年8月5日

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Fabian Laue,
Gerrit Matthes,
Tobias Ahnert,
Markus Baacke,
Dan Bieler,
Michael Caspers,
Valentin Clemens,
Matthias Fröhlich,
Tobias Großner,
Lisa Hackenberg,
Paul Hagebusch,
René Hartensuer,
Kai Oliver Jensen,
Annette Keß,
Christian Kleber,
André Nohl,
Orkun Özkurtul,
Thomas Paffrath,
Vera Pedersen,
Tristan Pfläging,
Uwe Schweigkofler,
Kai Sprengel,
Philipp Störmann,
Heiko Trentzsch,
Christian Waydhas,
Rolf Lefering,
Fabian Laue,
Gerrit Matthes,
Tobias Ahnert,
Markus Baacke,
Dan Bieler,
Michael Caspers,
Valentin Clemens,
Matthias Fröhlich,
Tobias Großner,
Lisa Hackenberg,
Paul Hagebusch,
René Hartensuer,
Kai Oliver Jensen,
Annette Keß,
Christian Kleber,
André Nohl,
Orkun Özkurtul,
Thomas Paffrath,
Vera Pedersen,
Tristan Pfläging,
Uwe Schweigkofler,
Kai Sprengel,
Philipp Störmann,
Heiko Trentzsch,
Christian Waydhas,
Rolf Lefering,
Lars Becker,
Sascha Flohe,
Stefan Huber-Wagner,
Oliver Kamp,
Marion Laumann,
Carsten Mand,
Frithjof Wagner,
Bernd Wohlrath

摘要

Background

The provision of highly specialized trauma teams for the primary care of patients with severe injuries is mandatory by current standards, even with the acceptance of a high expenditure of resources. In particular, the use of criteria according to the accident mechanism for trauma team activation (TTA) increasingly leads to overtriage. The aim of the study is to evaluate criteria according to the accident mechanism regarding their suitability for needs-based trauma team activation.

Material and methods

The present study is a prospective, multicenter, noninterventional cross-sectional study. Data were collected in 12 level 1 trauma centers in Germany and Switzerland via a paper-based questionnaire followed by an anonymized summary in a web-based database. As a reference for analyzing the need for TTA, the newly defined post hoc consensus criteria of the emergency, intensive care and severely injured section (NIS, TAcTIC criteria) were used.

Results

Of the 2016 S3 guidelines TTA criteria for moderate risk of serious injury (MRSI), “fall from a height of more than 3m” (positive predictive value, PPV 32%) and “traffic accident with frontal impact with intrusion of more than 50–75 cm” (PPV 32%) had the best predictive values. Of the additional criteria examined for the first time according to the course of accident, “technical rescue required” (PPV 40%), “fall down stairs” (6 steps and more, PPV 35%), “e-bike riders” (PPV 30%) and “senior road users aged 80 years and over” (PPV 29%) were more likely to predict a requirement for TTA with an overtriage between 60% and 70%.

Conclusion

The data analysis showed that the selection of individual accident mechanisms based on the PPV can clearly increase the prediction probability of the requirement for TTA but that when they are used alone (in the absence of criteria that include injuries or disturbances of vital signs), they lead to a high overtriage of 60–70%. The course of the accident as the only indication of a possible serious injury should therefore not automatically lead to a TTA; however, this does not preclude a certain urgency and care in the further diagnostic and therapeutic work-up.