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Unterschiede im Outcome schwerverletzter Kinder in Abhängigkeit von der Versorgungsstufe

Differences in the outcome of seriously injured children depending on treatment level

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Zusammenfassung

Einleitung

Viele Publikationen vor allem aus anderen Ländern legen nahe, dass die Versorgung von schwerverletzten Kindern in speziellen kindertraumatologischen Zentren besser ist als in allgemeinen Traumazentren. Daten aus Deutschland liegen bisher nicht vor. Für die Empfehlungen im Weißbuch Schwerverletztenversorgung der Deutschen Gesellschaft für Unfallchirurgie (DGU) zum Thema Kindertraumatologie wurden bisher diese verfügbaren Daten aus dem Ausland verwendet. Ziel unserer Arbeit war es, anhand verfügbarer Daten in Deutschland zu analysieren, ob das Outcome schwerverletzter Kinder abhängig von der Versorgungsstufe und von der Verfügbarkeit eines Kinderchirurgen ist.

Material und Methoden

Es wurden Daten aus dem TraumaRegister DGU® der Deutschen Gesellschaft für Unfallchirurgie (DGU) aus dem Zeitraum 2002–2012 verwendet; Kinder im Alter von 1–15 Jahren, die im Zeitraum von 2002–2012 in einem deutschen Krankenhaus behandelt wurden. Die Verletzungsschwere musste mindestens 9 Punkte im Injury Severity Score (ISS) betragen, und die Patienten mussten auf einer Intensivstation behandelt worden sein. Verstorbene Patienten mit einem ISS ≥9 wurden ebenfalls eingeschlossen, um besonders schwer verletzte Kinder, welche die Intensivstation nicht mehr erreicht haben, ebenfalls zu berücksichtigen.

Ergebnisse

Aus Kliniken ohne einen Kinderchirurgen wurde signifikant häufiger innerhalb der ersten 48 h das Kind weiterverlegt (p < 0,001). Die durchschnittliche Krankenhausliegedauer war etwas kürzer in Kliniken mit einem Kinderchirurgen bei gering längerer Intensivstationsliegezeit. In Kliniken ohne einen Kinderchirurgen wurden häufiger Operationen bei verletzten Kindern durchgeführt, was mit p = 0,045 knapp signifikant war. Die Sterblichkeit sowie die errechnete RISC 2-Prognose waren mit und ohne Kinderchirurg gleich. Der GOS unterschied sich ebenfalls nicht in den Gruppen mit und ohne Kinderchirurg.

Diskussion

Insgesamt ist die Versorgung von schwerverletzten und polytraumatisierten Kindern in Deutschland über alle Versorgungsstufen mit und ohne Kinderchirurg gut.

Abstract

Introduction

Many publications, mainly from other countries, suggest that the treatment of seriously injured children might be better in specialised paediatric trauma centres than in general trauma centres. Data from Germany are not available yet, but those from abroad were used for the recommendations made by the German Association for Trauma Surgery (DGU) on the topic of paediatric trauma in the “White Paper on Trauma Care”. The goal of this study was to analyse whether the outcome of severely injured children is dependent on treatment level and on the availability of a paediatric surgeon based on the given data.

Materials and Methods

Data from the “TraumaRegister DGU” between 2002 and 2012 were used. Children aged 1–15 years treated during the period 2002–2012 were included. Severity had to reach a minimum Injury Severity Score (ISS) of 9 and the treatment had to involve a stay at an Intensive Care Unit. Patients with an ISS ≥9 who died were also included to take into consideration children with particularly severe injuries.

Results

Hospitals without a paediatric surgeon transferred the patients significantly more frequently (p < 0.001). Mean hospital stay was shorter in centres with a paediatric surgeon, with slightly longer median stays at an Intensive Care Unit. Hospitals without a paediatric surgeon performed slightly more frequent surgical interventions on injured children (barely significant at p = 0.045). The death rate and the calculated Revised Injury Severity Classification (RISC) II prognosis were the same with or without the presence of a paediatric surgeon. No difference was found in the Glasgow Outcome Score (GOS) between the group with and the group without involvement of a paediatric surgeon.

Discussion

Overall, the medical care of seriously injured and polytraumatised children in Germany is good at all levels of treatment whether a paediatric surgeon is involved or not.

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Literatur

  1. Bayer J, Pache G, Hammer TO et al (2013) German trauma centers: level-dependent differences in polytrauma care regarding resources and diagnostic concepts. Chirurg 84:316–321

    Article  CAS  PubMed  Google Scholar 

  2. Bayer J, Reising K, Kuminack K et al (2015) Is whole-body computed Tomography the standard work-up for severely-injured children? Results of a survey among German trauma centers. Acta Chir Orthop Traumatol Cech 82:332–336

    CAS  PubMed  Google Scholar 

  3. Bouillon B, Flohé S, Kühne C et al (2012) Weißbuch Schwerverletztenversorgung. Mitteilungen und Nachrichten, 2. Aufl. Bd. Supplement 1. Deutsche Gesellschaft für Unfallchirurgie e.V., Berlin

    Google Scholar 

  4. Debus F, Lefering R, Frink M et al (2013) Polytrauma in children and adolescents : choice of the primary care clinic and importance of pediatric traumatology competence centers. Unfallchirurg 118:432–438. doi:10.1007/s00113-013-2518-7

    Article  Google Scholar 

  5. Ernstberger A, Koller M, Nerlich M (2011) Quality circle in a trauma network of the German Association for Trauma Surgery. Upgrading patient care. Unfallchirurg 114:172–181

    Article  CAS  PubMed  Google Scholar 

  6. Frink M, Kuhne C, Debus F et al (2013) The TraumaNetzwerk DGU project. Goals, conception, and successes achieved. Unfallchirurg 116:61–71 (quiz 72–63)

    Article  CAS  PubMed  Google Scholar 

  7. Hall JR, Reyes HM, Meller JL et al (1996) The outcome for children with blunt trauma is best at a pediatric trauma center. J Pediatr Surg 31:72–76 (discussion 76–77)

    Article  CAS  PubMed  Google Scholar 

  8. Lefering R, Huber-Wagner S, Nienaber U et al (2014) Update of the trauma risk adjustment model of the TraumaRegister DGU: the Revised Injury Severity Classification, version II. Crit Care 18:476

    Article  PubMed  PubMed Central  Google Scholar 

  9. Matsushima K, Schaefer EW, Won EJ et al (2013) Injured adolescents, not just large children: difference in care and outcome between adult and pediatric trauma centers. Am Surg 79:267–273

    PubMed  Google Scholar 

  10. Morrison W, Wright JL, Paidas CN (2002) Pediatric trauma systems. Crit Care Med 30:S448–S456

    Article  PubMed  Google Scholar 

  11. Odetola FO, Miller WC, Davis MM et al (2005) The relationship between the location of pediatric intensive care unit facilities and child death from trauma: a county-level ecologic study. J Pediatr 147:74–77

    Article  PubMed  Google Scholar 

  12. Osler TM, Vane DW, Tepas JJ et al (2001) Do pediatric trauma centers have better survival rates than adult trauma centers? An examination of the National Pediatric Trauma Registry. J Trauma 50:96–101

    Article  CAS  PubMed  Google Scholar 

  13. Oyetunji TA, Haider AH, Downing SR et al (2011) Treatment outcomes of injured children at adult level 1 trauma centers: are there benefits from added specialized care? Am J Surg 201:445–449

    Article  PubMed  Google Scholar 

  14. Petrosyan M, Guner YS, Emami CN et al (2009) Disparities in the delivery of pediatric trauma care. J Trauma 67:S114–S119

    Article  PubMed  Google Scholar 

  15. Polites SF, Zielinski MD, Zarroug AE et al (2015) Benchmarks for splenectomy in pediatric trauma: how are we doing? J Pediatr Surg 50:339–342

    Article  PubMed  Google Scholar 

  16. Potoka DA, Schall LC, Gardner MJ et al (2000) Impact of pediatric trauma centers on mortality in a statewide system. J Trauma 49:237–245

    Article  CAS  PubMed  Google Scholar 

  17. Pracht EE, Tepas JJ 3rd, Langland-Orban B et al (2008) Do pediatric patients with trauma in Florida have reduced mortality rates when treated in designated trauma centers? J Pediatr Surg 43:212–221

    Article  PubMed  Google Scholar 

  18. Ruchholtz S (2007) The trauma network of the German Society of Accident Surgery. Chirurg (Suppl):266–267

    CAS  PubMed  Google Scholar 

  19. Ruchholtz S, Kuhne CA, Siebert H et al (2007) Trauma network of the German Association of Trauma Surgery (DGU). Establishment, organization, and quality assurance of a regional trauma network of the DGU. Unfallchirurg 110:373–379

    Article  CAS  PubMed  Google Scholar 

  20. Ruchholtz S, Lewan U, Debus F et al (2014) TraumaNetzwerk DGU((R)): optimizing patient flow and management. Injury 45(Suppl 3):S89–S92

    Article  PubMed  Google Scholar 

  21. Sherman HF, Landry VL, Jones LM (2001) Should level I trauma centers be rated NC-17? J Trauma 50:784–791

    Article  CAS  PubMed  Google Scholar 

  22. Strohm PC, Schmittenbecher PP (2011) Fracture stabilization in polytraumatized children. Unfallchirurg 114:323–332

    Article  CAS  PubMed  Google Scholar 

  23. Stylianos S, Nathens AB (2007) Comparing processes of pediatric trauma care at children’s hospitals versus adult hospitals. J Trauma 63:S96–S100 (discussion S106–S112)

    Article  PubMed  Google Scholar 

  24. Wang NE, Saynina O, Vogel LD et al (2013) The effect of trauma center care on pediatric injury mortality in California, 1999 to 2011. J Trauma Acute Care Surg 75:704–716

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Sozialstiftung Bamberg, Klinikum am Bruderwald, Buger Strasse 80, 96049, Bamberg, Deutschland

    Peter C. Strohm

  2. Klinik für Orthopädie und Unfallchirurgie, Albert-Ludwigs-Universität, Freiburg i. Br., Deutschland

    Jörn Zwingmann, Jörg Bayer, Mirjam V. Neumann, Hagen Schmal & Kilian Reising

  3. Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Witten, Deutschland

    Rolf Lefering

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  1. Peter C. Strohm
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  2. Jörn Zwingmann
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  3. Jörg Bayer
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  4. Mirjam V. Neumann
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  5. Rolf Lefering
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  6. Hagen Schmal
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  7. Kilian Reising
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Correspondence to Peter C. Strohm.

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Interessenkonflikt

P.C. Strohm, J. Zwingmann, J. Bayer, M.V. Neumann, R. Lefering, H. Schmal und K. Reising geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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W. Mutschler, München

H. Polzer, München

B. Ockert, München

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Strohm, P.C., Zwingmann, J., Bayer, J. et al. Unterschiede im Outcome schwerverletzter Kinder in Abhängigkeit von der Versorgungsstufe. Unfallchirurg 121, 306–312 (2018). https://doi.org/10.1007/s00113-017-0346-x

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  • DOI: https://doi.org/10.1007/s00113-017-0346-x

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