27
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Auswirkung der COVID-19-Pandemie auf die Versorgung von Schwerverletzten: Analyse aus dem TraumaRegister DGU® Translated title: Impact of the COVID-19 pandemic on the care of major trauma patients: analysis from the TraumaRegister DGU®

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Hintergrund

          Die Behandlung von Schwerverletzten bedarf intensivmedizinischer Kapazitäten, welche insbesondere während der COVID-19-Pandemie eine entscheidende Ressource darstellten. Das Ziel dieser Studie war es deshalb, die Auswirkung auf die Versorgung von Schwerverletzten unter Berücksichtigung der intensivmedizinischen Behandlung COVID-19-positiver Patienten zu analysieren.

          Methoden

          Demografische, präklinische und intensivmedizinische Behandlungsdaten aus dem TraumaRegister DGU® der Deutschen Gesellschaft für Unfallchirurgie (DGU) der Jahre 2019 und 2020 wurden analysiert. Eingeschlossen wurden nur Schwerverletzte aus dem Bundesland Bayern. Die stationären Behandlungsdaten der COVID-19-Patienten in Bayern im Jahr 2020 wurden mittels IVENA eHealth ermittelt.

          Ergebnisse

          Im Untersuchungszeitraum wurden 8307 Schwerverletzte im Bundesland Bayern behandelt. Insgesamt zeigte sich kein Rückgang der Anzahl der Schwerverletzten im Jahr 2020 ( n = 4032) im Vergleich zu 2019 ( n = 4275) ( p = 0,4). Hinsichtlich der COVID-19-Fallzahlen wurden in den Monaten April und Dezember mit täglich über 800 Patienten auf einer Intensivstation Maximalwerte erreicht. In der kritischen Phase (≥ 100 COVID-19-Patienten auf Intensivstation) zeigte sich eine verlängerte Rettungszeit (64,8 ± 32,5 vs. 67,4 ± 30,6 min; p = 0,003). Die Verweildauer und die Behandlung von Schwerverletzten auf einer Intensivstation wurden nicht durch die COVID-19-Pandemie negativ beeinflusst.

          Diskussion

          Die intensivmedizinische Versorgung von Schwerverletzten konnte während der kritischen Phasen der COVID-19-Pandemie gewährleistet werden. Die verlängerten präklinischen Rettungszeiten zeigen mögliches Optimierungspotenzial der horizontalen Integration von Präklinik und Klinik auf.

          Translated abstract

          Background

          The treatment of major trauma patients requires intensive care capacity, which is a critical resource particularly during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, the aim of this study was to analyze the impact on major trauma care considering the intensive care treatment of COVID-19 positive patients.

          Methods

          Demographic, prehospital, and intensive care treatment data from the TraumaRegister DGU® of the German Trauma Society (DGU) in 2019 and 2020 were analyzed. Only major trauma patients from the state of Bavaria were included. Inpatient treatment data of COVID-19 patients in Bavaria in 2020 were obtained using IVENA eHealth.

          Results

          In total, 8307 major trauma patients were treated in the state of Bavaria in the time period investigated. The number of patients in 2020 ( n = 4032) compared to 2019 ( n = 4275) was not significantly decreased ( p = 0.4). Regarding COVID-19 case numbers, maximum values were reached in the months of April and December with more than 800 intensive care unit (ICU) patients per day. In the critical period (> 100 patients with COVID-19 on ICU), a prolonged rescue time was evident (64.8 ± 32.5 vs. 67.4 ± 30.6 min; p = 0.003). The length of stay and ICU treatment of major trauma patients were not negatively affected by the COVID-19 pandemic.

          Conclusion

          The intensive medical care of major trauma patients could be ensured during the high-incidence phases of the COVID-19 pandemic. The prolonged prehospital rescue times show possible optimization potential of the horizontal integration of prehospital and hospital.

          Related collections

          Most cited references22

          • Record: found
          • Abstract: found
          • Article: not found

          The impact of the COVID-19 pandemic on cancer care

          The COVID-19 pandemic has disrupted the spectrum of cancer care, including delaying diagnoses and treatment and halting clinical trials. In response, healthcare systems are rapidly reorganizing cancer services to ensure that patients continue to receive essential care while minimizing exposure to SARS-CoV-2 infection.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            Update of the trauma risk adjustment model of the TraumaRegister DGU™: the Revised Injury Severity Classification, version II

            Introduction The TraumaRegister DGU™ (TR-DGU) has used the Revised Injury Severity Classification (RISC) score for outcome adjustment since 2003. In recent years, however, the observed mortality rate has fallen to about 2% below the prognosis, and it was felt that further prognostic factors, like pupil size and reaction, should be included as well. Finally, an increasing number of cases did not receive a RISC prognosis due to the missing values. Therefore, there was a need for an updated model for risk of death prediction in severely injured patients to be developed and validated using the most recent data. Methods The TR-DGU has been collecting data from severely injured patients since 1993. All injuries are coded according to the Abbreviated Injury Scale (AIS, version 2008). Severely injured patients from Europe (ISS ≥4) documented between 2010 and 2011 were selected for developing the new score (n = 30,866), and 21,918 patients from 2012 were used for validation. Age and injury codes were required, and transferred patients were excluded. Logistic regression analysis was applied with hospital mortality as the dependent variable. Results were evaluated in terms of discrimination (area under the receiver operating characteristic curve, AUC), precision (observed versus predicted mortality), and calibration (Hosmer-Lemeshow goodness-of-fit statistic). Results The mean age of the development population was 47.3 years; 71.6% were males, and the average ISS was 19.3 points. Hospital mortality rate was 11.5% in this group. The new RISC II model consists of the following predictors: worst and second-worst injury (AIS severity level), head injury, age, sex, pupil reactivity and size, pre-injury health status, blood pressure, acidosis (base deficit), coagulation, haemoglobin, and cardiopulmonary resuscitation. Missing values are included as a separate category for every variable. In the development and the validation dataset, the new RISC II outperformed the original RISC score, for example AUC in the development dataset 0.953 versus 0.939. Conclusions The updated RISC II prognostic score has several advantages over the previous RISC model. Discrimination, precision and calibration are improved, and patients with partial missing values could now be included. Results were confirmed in a validation dataset.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found
              Is Open Access

              Global impact of COVID-19 pandemic on road traffic collisions

              Background Various strategies to reduce the spread of COVID-19 including lockdown and stay-at-home order are expected to reduce road traffic characteristics and consequently road traffic collisions (RTCs). We aimed to review the effects of the COVID-19 pandemic on the incidence, patterns, and severity of the injury, management, and outcomes of RTCs and give recommendations on improving road safety during this pandemic. Methods We conducted a narrative review on the effects of COVID-19 pandemic on RTCs published in English language using PubMed, Scopus, and Google Scholar with no date restriction. Google search engine and websites were also used to retrieve relevant published literature, including discussion papers, reports, and media news. Papers were critically read and data were summarized and combined. Results Traffic volume dropped sharply during the COVID-19 pandemic which was associated with significant drop in RTCs globally and a reduction of road deaths in 32 out of 36 countries in April 2020 compared with April 2019, with a decrease of 50% or more in 12 countries, 25 to 49% in 14 countries, and by less than 25% in six countries. Similarly, there was a decrease in annual road death in 33 out of 42 countries in 2020 compared with 2019, with a reduction of 25% or more in 5 countries, 15–24% in 13 countries, and by less than 15% in 15 countries. In contrast, the opposite occurred in four and nine countries during the periods, respectively. There was also a drop in the number of admitted patients in trauma centers related to RTCs during both periods. This has been attributed to an increase in speeding, emptier traffic lanes, reduced law enforcement, not wearing seat belts, and alcohol and drug abuse. Conclusions The COVID-19 pandemic has generally reduced the overall absolute numbers of RTCs, and their deaths and injuries despite the relative increase of severity of injury and death. The most important factors that affected the RTCs are decreased mobility with empty lines, reduced crowding, and increased speeding. Our findings serve as a baseline for injury prevention in the current and future pandemics.
                Bookmark

                Author and article information

                Contributors
                patrick.pflueger@tum.de
                Journal
                Unfallchirurgie (Heidelb)
                Unfallchirurgie (Heidelb)
                Unfallchirurgie (Heidelberg, Germany)
                Springer Medizin (Heidelberg )
                2731-7021
                2731-703X
                21 June 2023
                21 June 2023
                2024
                : 127
                : 1
                : 62-68
                Affiliations
                [1 ]GRID grid.6936.a, ISNI 0000000123222966, Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, , Technische Universität München, ; München, Deutschland
                [2 ]Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, ( https://ror.org/00yq55g44) Witten, Deutschland
                [3 ]GRID grid.6936.a, ISNI 0000000123222966, Fakultät für Medizin, Zentrale Interdisziplinäre Notaufnahme, Klinikum rechts der Isar, , Technische Universität München, ; München, Deutschland
                Article
                1325
                10.1007/s00113-023-01325-w
                10786995
                37341734
                ccb41e7f-dfac-448a-9bd2-096539f28e49
                © The Author(s) 2023

                Open Access Dieser Artikel wird unter der Creative Commons Namensnennung 4.0 International Lizenz veröffentlicht, welche die Nutzung, Vervielfältigung, Bearbeitung, Verbreitung und Wiedergabe in jeglichem Medium und Format erlaubt, sofern Sie den/die ursprünglichen Autor(en) und die Quelle ordnungsgemäß nennen, einen Link zur Creative Commons Lizenz beifügen und angeben, ob Änderungen vorgenommen wurden.

                Die in diesem Artikel enthaltenen Bilder und sonstiges Drittmaterial unterliegen ebenfalls der genannten Creative Commons Lizenz, sofern sich aus der Abbildungslegende nichts anderes ergibt. Sofern das betreffende Material nicht unter der genannten Creative Commons Lizenz steht und die betreffende Handlung nicht nach gesetzlichen Vorschriften erlaubt ist, ist für die oben aufgeführten Weiterverwendungen des Materials die Einwilligung des jeweiligen Rechteinhabers einzuholen.

                Weitere Details zur Lizenz entnehmen Sie bitte der Lizenzinformation auf http://creativecommons.org/licenses/by/4.0/deed.de.

                History
                : 6 April 2023
                Funding
                Funded by: Technische Universität München (1025)
                Categories
                Originalien
                Custom metadata
                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2024

                sars-cov-2,schockraum,notfallversorgung,unfall,intensivstation,emergency room,emergency patient care,trauma,intensive care unit

                Comments

                Comment on this article