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To date, the Trauma Registry (TraumaRegister DGU-® contains data of approximately 100.000 severely injured patients, 65% of which suffered from a road traffic crash. Thus, it is the world's largest data base for severely injured patients. The article describes the development of the registry and explains how it was rolled out over Germany using the established structure of the German Trauma Network (TraumaNetzwerk DGU-®). In addition, this article presents three typical use cases from the fields of quality management, policy making and system-wide interventions, clinical research and injury prevention. In conclusion, the TraumaRegister DGU-® is a well-established tool for various purposes related to the control and reduction of the burden of road injury. Its ongoing expansion to other countries will support the goal of international benchmarking of hospitals and trauma systems.
To elucidate the risk of pedestrians, bicycle and motorbike users, data of two accident research units from 1999 to 2014 were analysed in regard to demographic data, collision details, preclinical and clinical data using SPSS. 14.295 injured vulnerable road users were included. 92 out of 3610 pedestrians ("P", 2.5%), 90 out of 8307 bicyclists ("B", 1.1%) and 115 out of 4094 motorcycle users ("M", 2.8%) were diagnosed with spinal fractures. Thoracic fractures were most frequent ahead of lumbar and cervical fractures. Car collisions were most frequent mechanism (68, 62 and 36%). MAIS was 3.8, 2.8 and 3.2 for P, B and A with ISS 32, 16 and 23. AIS-head was 2.2, 1.3 and 1.5). Vulnerable road users are at significant risk for spine fractures. These are often associated with severe additional injuries, e.g. the head and a very high overall trauma severity (polytrauma).
While cyclists and pedestrians are known to be at significant risk for severe injuries when exposed to road traffic accidents (RTAs) involving trucks, little is known about RTA injury risk for truck drivers. The objective of this study is to analyze the injury severity in truck drivers following RTAs. Between 1999 and 2008 the Hannover Medical School Accident Research Unit prospectively documented 43,000 RTAs involving 582 trucks. Injury severity including the abbreviated injury scale (AIS) and the maximum abbreviated injury scale (MAIS) were analyzed. Technical parameters (e.g. delta-v, direction of impact), the location of accident, and its dependency on the road type were also taken into consideration. The results show that the safety of truck drivers is assured by their vehicles, the consequence being that the risk of becoming injured is likely to be low. However, the legs especially are at high risk for severe injuries during RTAs. This probability increases in the instance of a collision with another truck. Nevertheless, in RTAs involving trucks and regular passenger vehicles, the other party is in higher risk of injury.
When assessing the consequences of accidents normally the injury severity and the damage costs are considered. The injury severity is either expressed within the police categories (slight injury, severe injury or fatal injury) or the AIS code that rates the fatality risk of a given injury. Both injury metrics are assessing the consequences of the accident directly after the accident. However, not all consequences of accidents are visible directly after the accident and the duration of the consequences are different. Besides a physiological reduction of functionality social and psychological implications such as reduced mobility options, problems to continue the original job etc. are happening. In order to assess long term consequences of accidents the MHH Accident Research Unit established a brief questionnaire that is distributed to accident involved people of the Hannover subset of the GIDAS data set approx. one year after the accident beginning with the accident year 2013. The basic idea of using a brief questionnaire (in fact only one page) is to obtain a relatively large return rate because the questionnaire appears to be simple and quickly answered. This appears to be important because it is believed that the majority of accident involved people will not report long term consequences. In order to allow a more detailed survey amongst those responders that are reporting long term consequences they are asked for a written consent for the additional questionnaire that will be distributed at a time that is not yet defined. Long term consequences are reported for all addressed areas, medical, physiological, psychological and sociological by people without injuries, with minor injuries and with severe injuries.
Injury severity of e.g. pedestrians or bikers after crashes with cars that are reversing is almost unknown. However, crash victims of these injuries can frequently be seen in emergency departments and account for a large amount of patients every year. The objective of this study is to analyze injury severity of patients that were crashed into by reversing cars. The Hannover Medical School local accident research unit prospectively documented 43,000 road traffic accidents including 234 crashes involving reversing cars. Injury severity including the abbreviated injury scale (AIS) and the maximum abbreviated injury scale (MAIS) was analyzed as well as the location of the accident. As a result 234 accidents were included into this study. Pedestrians were injured in 141 crashes followed by 70 accidents involving bikers. The mean age of all crash victims was 57 -± 23 years. Most injuries took place on straight stretches (n = 81) as well as parking areas (n = 59), entries (n = 36) or crossroads (n = 24). The AIS of the lower extremities was highest followed by the upper extremities. The AIS of the neck was lowest. The mean MAIS was 1.3 -± 0.6. The paper concludes that the lower extremities show the highest risk to become injured during accidents with reversing cars. However, the risk of severe injuries is likely low.
[Introduction:] A large number of road users involved in road traffic crashes recover from their injuries, but some of them never recover fully and suffer from some kind of permanent disability. In addition to loss of life or reduced quality of life, road accidents carry many and diverse consequences to the survivors such as legal implications, economic burden, job absences, need of care from a third person, home and vehicle adaptations as well as psychological consequences. Within an EU funded project MOVE/C4/SUB/2011-294/SI2.628846 (REHABIL AID) these consequences were analyzed more detailed.
The average CO2 concentrations relevant to a motorcyclist wearing an integral helmet were measured twenty years ago and found to be alarmingly high. The present study examined gas concentrations typically inhaled by a motorcyclist. Average concentrations of CO2 for persons (n=4) wearing integral motorcycle helmets were measured in the laboratory and the field to facilitate comparison to previous work, and similarly high average concentrations were found: above 2% when stationary, well below 1% for speeds of 50km/h or more. Detailed measurements of the time-dependent CO2 concentrations during normal inhalation showed levels of about half of the corresponding average concentrations, including 1% at standstill, though higher concentrations (4% or more) are inhaled at the beginning of each breath. Opening the visor at standstill lowered the average inhaled concentration only to about 0.8%. The oxygen deficiency is equal to the CO2 concentration, and could also contribute negatively to motorcyclist cognitive abilities.
Ruptures and dissections of the thoracic and abdominal aortic vessel caused by traffic accidents are rare but potentially life-threatening injuries. They can occur by blunt trauma via seat belt or dashboard injury. The study aimed at evaluating the overall mortality, morbidity, neurological disorders, and differences in operative procedures of open repair and stenting. It shows that, with a change and improvement in diagnostic tools and surgical approach, mortality and morbidity of blunt aortic injuries were significantly reduced. Still an immediate life-threatening injury early diagnosis via multiple-slice and scans and surgical repair with minimally invasive stents showed excellent short-time results for selected patients.
Still correlated with high mortality rates in traffic accidents traumatic aortic ruptures were frequently detected in unprotected car occupants in the early years. This biomechanical analysis investigates the different kinds of injury mechanisms leading to traumatic aortic injuries in todays traffic accidents and how the way of traffic participation affects the frequency of those injuries over the years. Based on GIDAS reported traffic accidents from 1973 to 2014 are analyzed. Results show that traumatic aortic injuries are mainly observed in high-speed accidents with high body deceleration and direct load force to the chest. Mostly chest compression is responsible for the load direction to the cardiac vessels. The main observed load vector is from caudal-ventral and from ventral solely, but also force impact from left and right side and in roll-over events with chest compression lead to traumatic aortic injuries. Classically, the injury appeares at the junction between the well-fixed aortic arch and the pars decendens following a kind of a scoop mechanism, a few cases with a hyperflexion mechanism are also described. In our analysis the deceleration effect alone never led to an aortic rupture. Comparing the past 40 years aortic injuries shift from unprotected car occupants to today's unprotected vulnerable road users like pedestrians, cyclists and motorcyclists. Still the accident characteristics are linked with chest compression force under high speed impact, no seatbelt and direct body impact.
While many medical studies have dealt with the incidence, nature and treatment of polytrauma the injury-causing accident mechanisms are rarely discussed in detail, mostly due to the lack of documentation of the technical aspects. The present prospective study was started in late 2007 and collects data from traffic accidents with most severely injured in six south- German counties and two larger cities for the duration of one year. It is aimed at identifying and documenting all polytrauma cases (ISS ≥ 16) caused by traffic accidents and their crash circumstances. The data collection is based on an interdisciplinary concept to include both the police, emergency dispatch centers, hospitals and fire departments in the region and is completely anonymous. Potentially relevant cases where an emergency physician was called to the scene of a traffic accident are provided by the dispatch center. All three hospitals in the region suited for the treatment of polytraumatised patients record injuries, major diagnostic and surgery data. Data and images from the accident scene are provided by the police and by fire departments. The latter provide information which is usually not available from the police, like deployed airbags, vehicle extrication measures and detailed views of car interiors. The main objective of the study is to determine the structure of road users who sustain a polytrauma, their crash opponents and the injury patterns found in relation to the collision configuration and the protection by seat belts, air bags and other devices. With detailed documentation of vehicle damage and extrication measures the study is also intended to support the development of injury predictors for pre-hospital treatment and provide field data regarding further improvement of technical rescue.