Skip to main content
SpringerLink
Log in

The epidemiology of amputation injuries in the Austrian helicopter emergency medical service: a retrospective, nationwide cohort study

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Data on the epidemiological characteristics of traumatic amputations in prehospital emergency care, especially in the context of air rescue, are scarce. Therefore, we aimed to describe the epidemiology of total and subtotal amputation injuries encountered by the OEAMTC helicopter emergency medical service (HEMS) in Austria, based on an almost nationwide sample.

Methods

We retrospectively reviewed all HEMS rescue missions flown for amputation injuries in 2009. Only primary missions were analyzed.

Results

In total, 149 out of 16,100 (0.9 %) primary HEMS rescue missions were for patients suffering from amputation injuries. Among these, HEMS physicians diagnosed 63.3 % (n = 94) total and 36.9 % (n = 55) subtotal amputations, with both groups showing a predominance of male victims (male:female ratios were 8:1 and 6:1, respectively).The highest rate occurred among adults between 45 and 64 years of age (35.6 %, n = 53). The most common causes were working with a circular saw (28.9 %, n = 43) and processing wood (16.8 %, n = 25). The majority of the cases included digital amputation injuries (77.2 %, n = 115) that were mainly related to the index finger (36.2 %, n = 54). One hundred forty patients (94.0 %) showed a total GCS of more than 12. Amputations were most prevalent in rural areas (84.6 %, n = 126) and between Thursday and Saturday (55.0 %, n = 82). The replantation rate after primary air transport was low (28 %).

Conclusions

In the HEMS, amputation injuries are infrequent and mostly not life-threatening. However, HEMS crews need to maintain their focus on providing sufficient and fast primary care while facilitating rapid transport to a specialized hospital. The knowledge of the epidemiological characteristics of amputation injuries encountered in the HEMS gained in this study may be useful for educational and operational purposes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. European Commission. Causes and circumstances of accidents at work in the EU. Luxembourg: Office for Official Publications of the European Communities, 2009. http://www.ec.europa.eu/social/BlobServlet?docId=2785&langId=en. Accessed 20 April 2011.

  2. Conn JM, Annest JL, Ryan GW, Budnitz DS. Non-work-related finger amputations in the United States, 2001–2002. Ann Emerg Med. 2005;45(6):630–5. doi:10.1016/j.annemergmed.2004.10.012.

    Article  PubMed  Google Scholar 

  3. Hostetler SG, Schwartz L, Shields BJ, Xiang H, Smith GA. Characteristics of pediatric traumatic amputations treated in hospital emergency departments: United States, 1990–2002. Pediatrics. 2005;116(5):e667–74. doi:10.1542/peds.2004-2143.

    Article  PubMed  Google Scholar 

  4. Conner KA, McKenzie LB, Xiang H, Smith GA. Pediatric traumatic amputations and hospital resource utilization in the United States, 2003. J Trauma. 2010;68(1):131–7. doi:10.1097/TA.0b013e3181.

    Article  PubMed  Google Scholar 

  5. Injury Database Austria. 2008. http://www.bmsk.gv.at/cms/site/attachments/4/9/1/CH0147/CMS1224077606935/idb_austria_jahresbericht_2008_pdf. Accessed 19 April 2012.

  6. Bledsoe BE, Wesley AK, Eckstein M, Dunn TM, O’Keefe MF. Helicopter scene transport of trauma patients with nonlife-threatening injuries: a meta-analysis. J Trauma. 2006;60(6):1257–65. doi:10.1097/01.ta.0000196489.19928.c0. (discussion 65-6).

    Article  PubMed  Google Scholar 

  7. Kuhne C, Zettl R, Ruchholtz S. Selection of the designated medical center after trauma. Nofall Rettungsmed. 2008;11:381–5.

    Article  Google Scholar 

  8. Ozer K, Kramer W, Gillani S, Williams A, Smith W. Replantation versus revision of amputated fingers in patients air-transported to a level 1 trauma center. J Hand Surg Am. 2010;35(6):936–40. doi:10.1016/j.jhsa.2010.02.031.

    Article  PubMed  Google Scholar 

  9. Statistics Austria. Austria within the European Union. 2007. http://www.statistik.at/web_de/services/wirtschaftsatlas_oesterreich/oesterreich_innerhalb_der_eu/index.html. Accessed 19 April 2012.

  10. Kruger AJ, Lockey D, Kurola J, Di Bartolomeo S, Castren M, Mikkelsen S, Lossius HM. A consensus-based template for documenting and reporting in physician-staffed pre-hospital services. Scand J Trauma Resusc Emerg Med. 2011;19:71. doi:10.1186/1757-7241-19-71.

    Article  PubMed  Google Scholar 

  11. Dillingham TR, Pezzin LE, MacKenzie EJ. Incidence, acute care length of stay, and discharge to rehabilitation of traumatic amputee patients: an epidemiologic study. Arch Phys Med Rehabil. 1998;79(3):279–87. pii:S0003-9993(98)90007-7.

    Article  PubMed  CAS  Google Scholar 

  12. Boyle D, Parker D, Larson C, Pessoa-Brandao L. Nature, incidence, and cause of work-related amputations in Minnesota. Am J Ind Med. 2000;37(5):542–50. doi:10.1002/(SICI)1097-0274(200005)37:5<542:AID-AJIM10>3.0.CO.

    Article  PubMed  CAS  Google Scholar 

  13. Kobayashi L, Inaba K, Barmparas G, Criscuoli M, Lustenberger T, Talving P, Lam L, Demetriades D. Traumatic limb amputations at a level I trauma center. Eur J Trauma Emerg Surg. 2011;37:67–72.

    Article  Google Scholar 

  14. Gavrilova N, Harijan A, Schiro S, Hultman CS, Lee C. Patterns of finger amputation and replantation in the setting of a rapidly growing immigrant population. Ann Plast Surg. 2010;64(5):534–6. doi:10.1097/SAP.0b013e3181bffcaf.

    PubMed  CAS  Google Scholar 

  15. Richards WT, Barber MK, Richards WA, Mozingo DW. Hand injuries in the state of Florida, are centers of excellence needed? J Trauma. 2010;68(6):1480–90. doi:10.1097/TA.0b013e3181bb8c70.

    Article  PubMed  Google Scholar 

  16. Atroshi I, Rosberg HE. Epidemiology of amputations and severe injuries of the hand. Hand Clin. 2001;17(3):343–50. (vii).

    PubMed  CAS  Google Scholar 

  17. Lindfors N, Raatikainen T. Incidence, epidemiology, and operative outcome of replantation or revascularisation of injury to the upper extremity. Scand J Plast Reconstr Surg Hand Surg. 2010;44(1):44–9. doi:10.3109/02844310903259074.

    PubMed  Google Scholar 

  18. Nylander G, Vilkki S, Ostrup L. The need for replantation surgery after traumatic amputations of the upper extremity–an estimate based upon the epidemiology of Sweden. J Hand Surg Br. 1984;9(3):257–60.

    Article  PubMed  CAS  Google Scholar 

  19. Liang HW, Chen SY, Hsu JH, Chang CW. Work-related upper limb amputations in Taiwan, 1999–2001. Am J Ind Med. 2004;46(6):649–55. doi:10.1002/ajim.20098.

    Article  PubMed  Google Scholar 

  20. Vilkki SK, Goransson H. Traumatic amputations and the need for a replantation service in Finland. Ann Chir Gynaecol. 1982;71(1):2–7.

    PubMed  CAS  Google Scholar 

  21. Waikakul S, Sakkarnkosol S, Vanadurongwan V, Un-nanuntana A. Results of 1018 digital replantations in 552 patients. Injury. 2000;31(1):33–40. pii:S0020-1383(99)00196-5.

    Article  PubMed  CAS  Google Scholar 

  22. Lindqvist A, Gerdin B. Hand injury from powered wood splitters. Scand J Plast Reconstr Surg Hand Surg. 2008;42(5):246–52. doi:10.1080/02844310802271196.

    Article  PubMed  Google Scholar 

  23. American Collegue of Surgeons Committee on Trauma. Management of complex extremity trauma. 2005. http://www.facs.org/trauma/publications/mancompexttrauma.pdf. Accessed 19 April 2012.

  24. Kaplan FT, Raskin KB. Indications and surgical techniques for digit replantation. Bull Hosp Jt Dis. 2001;60(3–4):179–88.

    PubMed  Google Scholar 

  25. Battiston B, Tos P, Clemente A, Pontini I. Actualities in big segments replantation surgery. J Plast Reconstr Aesthet Surg. 2007;60(7):849–55. doi:10.1016/j.bjps.2007.02.017.

    Article  PubMed  Google Scholar 

  26. Buntic R, Bunke H. Replantation and revascularization. In: Weinzweig J, editors. Plastic surgery secrets plus. 2nd ed. Philadelphia: Mosby; 2010. p. 851–854.

  27. Soucacos PN. Indications and selection for digital amputation and replantation. J Hand Surg Br. 2001;26(6):572–81. doi:10.1054/jhsb.2001.0595.

    Article  PubMed  CAS  Google Scholar 

  28. Beris AE, Lykissas MG, Korompilias AV, Mitsionis GI, Vekris MD, Kostas-Agnantis IP. Digit and hand replantation. Arch Orthop Trauma Surg. 2010;130(9):1141–7. doi:10.1007/s00402-009-1021-7.

    Article  PubMed  Google Scholar 

  29. Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.

    Article  PubMed  CAS  Google Scholar 

  30. Schluter PJ. The trauma and injury severity score (TRISS) revised. Injury. 2011;42(1):90–6.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful for the support of the OEAMTC Christophorus Air Rescue Service and AUVA in providing HEMS data and clinical data from AUVA trauma centers, respectively.

Conflict of interest

All other authors reported no conflicts of interest.

Author information

Authors and Affiliations

  1. Section of Plastic, Aesthetic and Reconstructive Surgery, General Hospital Wr. Neustadt, Wr. Neustadt, Austria

    H. F. Selig & L. P. Kamolz

  2. Department of Anaesthesiology and General Intensive Care and Pain Therapy, Medical University of Vienna, Vienna, Austria

    H. F. Selig, P. Nagele & M. Hüpfl

  3. Department of Anesthesiology, Washington University School of Medicine, St. Louis, USA

    P. Nagele

  4. Department of Anaesthesiology and Critical Care Medicine, AUVA Trauma Center, Salzburg, Austria

    W. G. Voelckel

  5. OEAMTC Christophorus Air Rescue Service, Vienna, Austria

    W. G. Voelckel & H. Trimmel

  6. Department of Anaesthesiology, Emergency Medicine and General Intensive Care, General Hospital Wr. Neustadt, Wr. Neustadt, Austria

    H. Trimmel

  7. Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria

    D. B. Lumenta

  8. Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria

    D. B. Lumenta & L. P. Kamolz

  9. Clinic for Hand Surgery, Rhön-Klinikum AG, Bad Neustadt/Saale, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Germany

    H. F. Selig

Authors
  1. H. F. Selig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Nagele
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. G. Voelckel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Trimmel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Hüpfl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. B. Lumenta
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L. P. Kamolz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. F. Selig.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Selig, H.F., Nagele, P., Voelckel, W.G. et al. The epidemiology of amputation injuries in the Austrian helicopter emergency medical service: a retrospective, nationwide cohort study. Eur J Trauma Emerg Surg 38, 651–657 (2012). https://doi.org/10.1007/s00068-012-0211-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-012-0211-0

Keywords

Search

Navigation