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Wertigkeit klinischer Leitsymptome bei der Primärversorgung schwerverletzter Patienten

Value of clinical key symptoms in the primary treatment of severely injured patients

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Zusammenfassung

Hintergrund

Die primäre Diagnostik schwerverletzter Patienten im Schockraum ist im Rahmen des „primary survey“ zunächst klinisch geprägt. In der S3-Leitlinie für die Behandlung polytraumatisierter Patienten werden hierzu Schlüsselempfehlungen gegeben.

Fragestellung

Wie verlässlich sind sogenannte klinische Leitsymptome bzw. „red flags“, die im Schockraum erhoben werden und dazu veranlassen, weitere diagnostische bzw. therapeutische Maßnahmen einzuleiten?

Material und Methode

Es erfolgt eine Bewertung der Leitsymptome als Synopsis aus wissenschaftlicher Literatur unter besonderer Berücksichtigung der Aspekte der Wahrscheinlichkeitsrechnung und ärztlichen Erfahrung.

Ergebnisse

Die Erhebung von Leitsymptomen im Rahmen der klinischen Untersuchung darf aufgrund der unzureichenden Sicherheit nicht alleinige Grundlage für die weitere Diagnostik und Therapie sein. Somit wird letztlich auch die Sinnhaftigkeit des stringenten Vorgehens nach dem Advanced-Trauma-Life-Support(ATLS)-Algorithmus bestätigt. „Red flags“ können als Warnhinweise aber bereits frühzeitig den Blick für relevante Verletzungsmuster schärfen. Eine rationale bildgebende Diagnostik muss sich anschließen.

Abstract

Background

The initial diagnostic procedure of severely injured patients in the emergency room (ER) during the primary survey is first and foremost a clinical examination. The clinical S3 guidelines provide recommendations for the treatment of patients with severe and multiple injuries.

Objectives

The study was performed to investigate the reliability of clinical key symptoms or red flags registered in the ER that lead to further diagnostic or therapeutic procedures.

Material and methods

An evaluation of key symptoms as a synopsis of the current literature considering aspects of probability calculation and medical experience was carried out.

Results

Key symptoms registered during the clinical examination are not sufficiently safe to be solely relied upon for further diagnostic and therapeutic decisions. This confirms the sense of purpose of the strict approach according to the advanced trauma life support (ATLS) algorithm. Red flags can serve as a warning to focus on relevant injuries early on. A rational imaging diagnostic procedure must follow.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland

    S. Piatek, G. Pliske, A. Ballaschk, K. Witzel & F. Walcher

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  1. S. Piatek
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Piatek, S., Pliske, G., Ballaschk, A. et al. Wertigkeit klinischer Leitsymptome bei der Primärversorgung schwerverletzter Patienten. Unfallchirurg 118, 666–674 (2015). https://doi.org/10.1007/s00113-015-0047-2

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