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Early Total Care (ETC) im Vergleich zu Damage Control Orthopedics (DCO) bei der Behandlung polytraumatisierter Patienten mit Femurschaftfrakturen

Nutzen und Kosten

Comparison of early total care (ETC) and damage control orthopedics (DCO) in the treatment of multiple trauma with femoral shaft fractures

Benefit and costs

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Zusammenfassung

Einleitung

Femurfrakturen stellen eine häufige Verletzung polytraumatisierter Patienten dar. Das Versorgungskonzept des Damage Control Orthopedics (DCO) konkurriert mit dem des Early Total Care (ETC).

Material und Methoden

In einer retrospektiven Studie (2003–2007) wurden 73 polytraumatisierte Patienten mit Femurschaftfrakturen erfasst. Das Gesamtkollektiv wurde anhand der Verletzungsschwere (Injury Severity Score [ISS], 16–24 leicht, 25–39 mittelschwer, über 40 schwer) und des Versorgungskonzepts (DCO vs. ETC) unterteilt. Beim Vergleich der beiden unterschiedlichen Therapiekonzepte wurden klinische Daten und Kostenaspekte analysiert.

Ergebnisse

Beim leichten Polytrauma war die Dauer von Beatmung und Intensivaufenthalt in der DCO-Gruppe verlängert, die Gesamtkosten und die Kostenunterdeckung waren in der ETC-Gruppe erniedrigt. Beim mittelschweren Polytrauma zeigte sich in der DCO-Gruppe eine geringere Inzidenz von „adult respiratory distress syndrome“ (ARDS), die Kostenanalyse erbrachte in dieser ebenfalls eine höhere Kostenunterdeckung im Vergleich zur ETC-Gruppe.

Schlussfolgerung

Beim leichten Polytrauma scheint die Schere zwischen Kosten und Erlösen bei Behandlung nach dem ETC-Konzept weniger stark zu klaffen. Die Behandlungsstrategie sollte anhand des Verletzungsmusters festgelegt werden. Die Kosten sollten durch das Institut für das Entgeltsystem im Krankenhaus (INEK) entsprechend abgebildet werden.

Abstract

Introduction

Femoral fractures are common injuries in multiple trauma patients. The treatment concept of damage control orthopedics (DCO) is in competition with the concept of early total care (ETC).

Patients and methods

In a retrospective study (2003-2007) 73 multiple trauma patients with femoral shaft fractures were included. The cohort was subdivided according to the Injury Severity Score (ISS) (16-24, 25-39 and more than 40) and treatment strategy (ETC versus DCO). Patients were analyzed for outcome and cost aspects.

Results

In the patient group with an ISS 16-24 ventilation time and intensive care treatment were longer after DCO treatment, overall costs and deficient cost cover were higher in the DCO group. In the patient group with an ISS 25-39 cost aspects showed a higher cover deficient in the DCO group.

Conclusion

From an economic point of view the cost deficits for the ETC group were lower than in the DCO group. The treatment strategy should be selected by the pattern of injuries. The costs should be addressed by the Institute for the Hospital Remuneration System (INEK).

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  1. Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    T. Stübig, P. Mommsen, C. Krettek, C. Probst, M. Frink, C. Zeckey, H. Andruszkow & F. Hildebrand

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  1. T. Stübig
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  2. P. Mommsen
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  3. C. Krettek
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  4. C. Probst
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  5. M. Frink
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  7. H. Andruszkow
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  8. F. Hildebrand
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Correspondence to T. Stübig.

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Stübig, T., Mommsen, P., Krettek, C. et al. Early Total Care (ETC) im Vergleich zu Damage Control Orthopedics (DCO) bei der Behandlung polytraumatisierter Patienten mit Femurschaftfrakturen. Unfallchirurg 113, 923–930 (2010). https://doi.org/10.1007/s00113-010-1887-4

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