DÄ internationalArchive29-30/2013Obvious Structural Deficiencies
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The authors presented a valuable and relevant analysis of the Trauma Registry (TR-DGU) of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie; DGU) in their article. In contrast to small single-center studies, the presented study is important because it features comprehensive German data of trauma patients over a time period from 1993 to 2008. In the meantime, such analyses have become essential and are therefore of crucial importance.

Retrospective studies are often limited in terms of identifying causes because not all relevant influencing factors can be identified post hoc, and the interpretation of the data can therefore become difficult (2). Although this retrospective study did not find any major differences for the analyzed target variables between the old and new German states, it highlights some important issues very clearly: the mean duration from the accident to the arrival of the emergency medical services in Germany was 19±13 minutes and 17±13 minutes, respectively, and therefore exceeds the response times stipulated in different federal states, mostly a maximum of 10–12 minutes, but no longer than 15 minutes in any federal state (3). Strictly speaking, the response time starts with the incoming call at the dispatch unit (not with the accident), but this accounts for a maximum of 1–2 minutes and is therefore negligible in the evaluation. In Germany, the time from the accident to hospital admission (76±35 versus 69±35 mins) and the duration of treatment in the shock-room (65±40 versus 72±43 min) are much longer in actual reality than is stipulated in the interdisciplinary S3 guideline on polytrauma, from the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF).

In order to improve the prognosis in polytraumatized patients, this serious structural deficiency in Germany’s emergency medical services will have to be eliminated. This would then mean a further reduction in polytrauma-induced mortality, since adherence to the “golden hour of shock” will become possible under these circumstances.

DOI: 10.3238/arztebl.2013.0504a

PD Dr. med. Jochen Hinkelbein

Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln

jochen.hinkelbein@uk-koeln.de

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Mand C, Müller T, Lefering R, Ruchholtz S, Kühne CA: A comparison of the treatment of severe injuries between the former East and West German states. Dtsch Arztebl Int 2013; 110(12): 203–10. VOLLTEXT
2.
Hammer GP, du Prel JB, Blettner M: Avoiding Bias in Observational Studies. Dtsch Arztebl Int 2009;106(41): 664–8. VOLLTEXT
3.
Hinkelbein J, Gröschel J, Krieter H: Definition von Zeitpunkten und Zeitabschnitten zur Beschreibung der Struktur- und Prozessqualität im organisatorischen Rettungsablauf. Notarzt 2004; 20: 125–32. CrossRef
e1.
Behrendt H, Schmiedel R, Auerbach K: Überblick über die Leistungen des Rettungsdienstes in der Bundesrepublik Deutschland im Zeitraum 2004/2005. Notfall & Rettungsmedizin 2009; 12: 383–8. CrossRef
e2.
Deutsche Gesellschaft für Unfallchirurgie and Sektion NIS: TraumaRegister DGU – Jahresbericht 2012. www.traumaregister.de
Last accessed on 27 April 2012.
e3.
Wutzler S, Westhoff J, Lefering R, Laurer HL, Wyen H, Marzi I: Zeitintervalle während und nach Schockraumversorgung. Eine Analyse anhand des Traumaregisters der Deutschen Gesellschaft für Unfallchirurgie (DGU). Unfallchirurg 2010; 113: 36–43. CrossRef MEDLINE
e4.
Mand C, Müller T, Lefering R, Ruchholtz S, Kühne CA: A comparison of the treatment of severe injuries between the former East and West German states. Dtsch Arztebl Int 2013; 110(12): 203–10.
e5.
Mand C, Müller T, Lefering R, Ruchholtz S, Kühne CA: A comparison of the treatment of severe injuries between the former East and West German states. Dtsch Arztebl Int 2013; 110(12): 203–10.
e6.
Hammer GP, du Prel JB, Blettner M: Avoiding Bias in Observational Studies. Dtsch Arztebl Int 2009;106(41): 664–8. VOLLTEXT
e7.
Hinkelbein J, Gröschel J, Krieter H: Definition von Zeitpunkten und Zeitabschnitten zur Beschreibung der Struktur- und Prozessqualität im organisatorischen Rettungsablauf. Notarzt 2004; 20: 125–32.
1.Mand C, Müller T, Lefering R, Ruchholtz S, Kühne CA: A comparison of the treatment of severe injuries between the former East and West German states. Dtsch Arztebl Int 2013; 110(12): 203–10. VOLLTEXT
2.Hammer GP, du Prel JB, Blettner M: Avoiding Bias in Observational Studies. Dtsch Arztebl Int 2009;106(41): 664–8. VOLLTEXT
3.Hinkelbein J, Gröschel J, Krieter H: Definition von Zeitpunkten und Zeitabschnitten zur Beschreibung der Struktur- und Prozessqualität im organisatorischen Rettungsablauf. Notarzt 2004; 20: 125–32. CrossRef
e1. Behrendt H, Schmiedel R, Auerbach K: Überblick über die Leistungen des Rettungsdienstes in der Bundesrepublik Deutschland im Zeitraum 2004/2005. Notfall & Rettungsmedizin 2009; 12: 383–8. CrossRef
e2. Deutsche Gesellschaft für Unfallchirurgie and Sektion NIS: TraumaRegister DGU – Jahresbericht 2012. www.traumaregister.de
Last accessed on 27 April 2012.
e3. Wutzler S, Westhoff J, Lefering R, Laurer HL, Wyen H, Marzi I: Zeitintervalle während und nach Schockraumversorgung. Eine Analyse anhand des Traumaregisters der Deutschen Gesellschaft für Unfallchirurgie (DGU). Unfallchirurg 2010; 113: 36–43. CrossRef MEDLINE
e4.Mand C, Müller T, Lefering R, Ruchholtz S, Kühne CA: A comparison of the treatment of severe injuries between the former East and West German states. Dtsch Arztebl Int 2013; 110(12): 203–10.
e5.Mand C, Müller T, Lefering R, Ruchholtz S, Kühne CA: A comparison of the treatment of severe injuries between the former East and West German states. Dtsch Arztebl Int 2013; 110(12): 203–10.
e6.Hammer GP, du Prel JB, Blettner M: Avoiding Bias in Observational Studies. Dtsch Arztebl Int 2009;106(41): 664–8. VOLLTEXT
e7.Hinkelbein J, Gröschel J, Krieter H: Definition von Zeitpunkten und Zeitabschnitten zur Beschreibung der Struktur- und Prozessqualität im organisatorischen Rettungsablauf. Notarzt 2004; 20: 125–32.

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