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Schockraummanagement bei Verletzungen der Wirbelsäule im Rahmen eines Polytraumas

Eine systematische Literaturübersicht

Emergency room management of the multiply injured patient with spine injuries

A systematic review of the literature

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Zusammenfassung

Verletzungen der Wirbelsäule sind häufig Teil einer Polytraumatisierung. In dieser Übersicht werden die Diagnostik und Sofortmaßnahmen während der Schockraumphase untersucht, um Empfehlungen für das aktuelle Vorgehen herauszuarbeiten. Klinische Studien wurden über systematische Literatursuchen (Medline, Cochrane und Handsuchen) zusammengetragen und nach Evidenzgüte klassifiziert (Level 1–5 nach Oxford-Schema).

Anamnese- und klinische Untersuchungskriterien haben zwar niedrige Werte hinsichtlich der Spezifität und dem positiven prädiktiven Wert, ihr negativer prädiktiver Wert und ihre Sensitivität liegen jedoch zwischen 90% und 100%. In der bildgebenden Diagnostik übertrifft die Computertomographie (CT) die konventionelle Röntgendiagnostik in Bezug auf Sensitivität, Spezifität, positiven und negativen prädiktiven Wert deutlich.

Die Anamnese soll erhoben und die klinische Untersuchung mit Fokussierung auf die Wirbelsäule durchgeführt werden. Die bildgebende Diagnostik umfasst das Röntgen der Wirbelsäule in 2 Ebenen und ergänzende CT-Untersuchung als Standard oder als derzeit optimales Vorgehen das Multislice-Spiral-CT vom Kopf bis zum Becken nach Kreislaufstabilisierung und vor Verlegung auf die Intensivstation.

Abstract

Injuries to the spine are often part of life-threatening multiple trauma. In this review diagnostics and emergency room management were investigated in order to formulate effective recommendations for the emergency strategy.

Clinical trials were systematically collected (MEDLINE, Cochrane, and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system).

The patient’s history and clinical symptoms have low rates for specificity and positive predictive value, whereas their negative predictive value and sensitivity are high between 90 and 100%, respectively. CT imaging reaches higher rates for sensitivity, specificity, and positive and negative predictive values in comparison to conventional radiographic series.

The patient’s history should be asked and clinical investigation should be done in any case. Imaging diagnostics preferably as multislice spiral CT should be performed after stabilization of the patient’s general condition and before admission to the intensive care unit.

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Authors and Affiliations

  1. Berufsgenossenschaftliche Unfallklinik, Murnau

    A. Woltmann & V. Bühren

  2. BG-Unfallklinik, Prof.-Küntscher-Straße 8, 82418, Murnau

    A. Woltmann

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Woltmann, A., Bühren, V. Schockraummanagement bei Verletzungen der Wirbelsäule im Rahmen eines Polytraumas. Unfallchirurg 107, 911–918 (2004). https://doi.org/10.1007/s00113-004-0829-4

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