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Keywords
- Liver injury (1)
- Multiple trauma (1)
- Pulmonary failure (1)
- Thoracic trauma (1)
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High prevalence of anti-HCV antibodies in two metropolitan emergency departments in Germany: a prospective screening analysis of 28,809 patients
(2012)
- Background and Aims: The prevalence of hepatitis C virus (HCV) antibodies in Germany has been estimated to be in the range of 0.4–0.63%. Screening for HCV is recommended in patients with elevated ALT levels or significant risk factors for HCV transmission only. However, 15–30% of patients report no risk factors and ALT levels can be normal in up to 20–30% of patients with chronic HCV infection. The aim of this study was to assess the HCV seroprevalence in patients visiting two tertiary care emergency departments in Berlin and Frankfurt, respectively. Methods: Between May 2008 and March 2010, a total of 28,809 consecutive patients were screened for the presence of anti-HCV antibodies. Anti-HCV positive sera were subsequently tested for HCV-RNA. Results: The overall HCV seroprevalence was 2.6% (95% CI: 2.4–2.8; 2.4% in Berlin and 3.5% in Frankfurt). HCV-RNA was detectable in 68% of anti-HCV positive cases. Thus, the prevalence of chronic HCV infection in the overall study population was 1.6% (95% CI 1.5–1.8). The most commonly reported risk factor was former/current injection drug use (IDU; 31.2%) and those with IDU as the main risk factor were significantly younger than patients without IDU (p<0.001) and the male-to-female ratio was 72% (121 vs. 46 patients; p<0.001). Finally, 18.8% of contacted HCV-RNA positive patients had not been diagnosed previously. Conclusions: The HCV seroprevalence was more than four times higher compared to current estimates and almost one fifth of contacted HCV-RNA positive patients had not been diagnosed previously.
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Operatives und Nichtoperatives Management von Abdomianlverletzungen beim Polytrauma : meeting abstract
(2006)
- Einleitung: Die Behandlung stumpfer abdomineller Verletzungen hat sich innerhalb der letzten Jahre zugunsten der konservativen Therapie gewandelt. Die Untersuchung beschäftigt sich mit der Frage, ob nichtoperatives Management von Abdominalverletzungen eine sichere und in der Routine praktikable therapeutische Option darstellt und wie häufig eine Konversion von primär konservativen zu operativen Management durchgeführt werden muß. Methodik: In einem Zeitraum von 3 Jahren (September 2002 bis August 2005) wurden 1214 Patienten über den Schockraum der Uniklinik Frankfurt aufgenommen. Die Datenerhebung und der Behandlungsverlauf erfolgte prospektiv on-line über den gesamten Behandlungsverlauf mittels des on-line Dokumentationsprogrammes Traumawatch´. Ergebnisse: Der durchschnittliche ISS aller Patienten lag bei 15. Eine relevante abdominelle Beteiligung (AIS >3) bestand in 12,4% der Fälle (151 Patienten) mit einem mittleren ISS von 33. Es wurden 60 Leberverletzungen (39,7%), 50 Milzverletzungen (33,1%), Verletzungen des Darms und Mesenterium in 19 Fällen (12,6%), 15 Verletzungen der Niere und der Harnwege(9,9 %) und Verletzungen Bauchdecke bei 28 Patienten (18,5 %) festgestellt. Das Pankreas war bei 3 Patienten (2,0%) und das Zwerchfell bei 8 Patienten (5,3%) betroffen. In 77 Fällen (51%) wurden die Patienten mit Abdominaltrauma primär konservativ, in 74 Fällen (49%) operativ versorgt, 10 Patienten (7%) wurden laparoskopiert. Nur bei 2 Patienten (1,3%) musste eine Konversion von der primär konservativen Therapie in eine operative erfolgen. Es handelte sich hierbei um eine sekundäre Darmperforation und eine zweizeitige Milzruptur. Patienten mit einer Leberverletzung konnten in 65% der Fälle konservativ versorgt werden, Patienten mit Milzverletzung hingegen nur in 50% der Fälle. 32% der operierten Patienten wurden splenektomiert. 4 Patienten, alle mit einem AIS-Abdomen größer oder gleich 4, verstarben im Schockraum noch vor operativer Interventionsmöglichkeit. Schlussfolgerung: Nichtoperatives Vorgehen beim Polytrauma mit abdomineller Beteiligung ist bei hämodynamisch stabilem Patienten weitgehend sicher möglich. Insbesondere für Leberverletzungen bis einem Schweregrad Moore V stellt das primär konservatives Vorgehen eine geeignete therapeutische Option dar.
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Undergraduate medical education in emergency medical care : a nationwide survey at German medical schools
(2009)
- Background Since June 2002, revised regulations in Germany have required "Emergency Medical Care" as an interdisciplinary subject, and state that emergency treatment should be of increasing importance within the curriculum. A survey of the current status of undergraduate medical education in emergency medical care establishes the basis for further committee work. Methods Using a standardized questionnaire, all medical faculties in Germany were asked to answer questions concerning the structure of their curriculum, representation of disciplines, instructors' qualifications, teaching and assessment methods, as well as evaluation procedures. Results Data from 35 of the 38 medical schools in Germany were analysed. In 32 of 35 medical faculties, the local Department of Anaesthesiology is responsible for the teaching of emergency medical care; in two faculties, emergency medicine is taught mainly by the Department of Surgery and in another by Internal Medicine. Lectures, seminars and practical training units are scheduled in varying composition at 97% of the locations. Simulation technology is integrated at 60% (n=21); problem-based learning at 29% (n=10), e-learning at 3% (n=1), and internship in ambulance service is mandatory at 11% (n=4). In terms of assessment methods, multiple-choice exams (15 to 70 questions) are favoured (89%, n=31), partially supplemented by open questions (31%, n=11). Some faculties also perform single practical tests (43%, n=15), objective structured clinical examination (OSCE; 29%, n=10) or oral examinations (17%, n=6). Conclusion Emergency Medical Care in undergraduate medical education in Germany has a practical orientation, but is very inconsistently structured. The innovative options of simulation technology or state-of-the-art assessment methods are not consistently utilized. Therefore, an exchange of experiences and concepts between faculties and disciplines should be promoted to guarantee a standard level of education in emergency medical care.
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Predictors of pulmonary failure following severe trauma: a trauma registry-based analysis
(2013)
- Background: The incidence of pulmonary failure in trauma patients is considered to be influenced by several factors such as liver injury. We intended to assess the association of various potential predictors of pulmonary failure following thoracic trauma and liver injury. Methods: Records of 12,585 trauma patients documented in the TraumaRegister DGU® of the German Trauma Society were analyzed regarding the potential impact of concomitant liver injury on the incidence of pulmonary failure using uni- and multivariate analyses. Pulmonary failure was defined as pulmonary failure of ≥ 3 SOFA-score points for at least two days. Patients were subdivided according to their injury pattern into four groups: group 1: AIS thorax < 3; AIS liver < 3; group 2: AIS thorax ≥ 3; AIS liver < 3; group 3: AIS thorax < 3; AIS liver ≥ 3 and group 4: AIS thorax ≥ 3; AIS liver ≥ 3. Results: Overall, 2643 (21%) developed pulmonary failure, 12% (n= 642) in group 1, 26% (n= 697) in group 2, 16% (n= 30) in group 3, and 36% (n= 188) in group 4. Factors independently associated with pulmonary failure included relevant lung injury, pre-existing medical conditions (PMC), sex, transfusion of more than 10 units of packed red blood cells (PRBC), Glasgow Coma Scale (GCS) ≤ 8, and the ISS. However, liver injury was not associated with an increased risk of pulmonary failure following severe trauma in our setting. Conclusions: Specific factors, but not liver injury, were associated with an increased risk of pulmonary failure following trauma. Trauma surgeons should be aware of these factors for optimized intensive care treatment.
