Abstract:
BACKGROUND:Trauma is the third leading cause of death worldwide after cardiovascular and oncologic diseases. Predominant causes of trauma-related death (TD) are severe traumatic brain injury (sTBI), hemorrhagic shock, and multiple organ failure. An analysis of TD is required in order to review the quality of trauma care and grasp how well the entire trauma network functions, especially for the most severely injured patients. Furthermore, autopsies not only reveal hidden injuries, but also verify clinical assumed causes of death. MATERIAL:During the study period of 3 years, a total of 517 trauma patients were admitted to our supraregional University Centre of Orthopaedics and Traumatology in Dresden. 13.7% (71/517) of the patients died after trauma, and in 25 cases (35.2%), a forensic autopsy was instructed by the federal prosecutor. The medical records, death certificates, and autopsy reports were retrospectively evaluated and the clinical findings matched to autopsy results. RESULTS:The observed mortality rates (13.7%) were 4.2% less than expected by the calculated RISC II probability of survival (mortality rate of 17.9%). The most frequent trauma victims were due to falls >3 m (n = 29), followed by traffic accidents (n = 28). The median ISS was 34, IQR 25, and the median New ISS (NISS) was 50, IQR 32. Locations of death were in emergency department (23.9%), ICU (73.2%), OR and ward (1.4%, respectively). Clinicians classified 47.9% of deaths due to sTBI (n = 34), followed by 9.9% thoracic trauma and multiple organ failure (n = 7), 8.4% multiple trauma (n = 6), and 2.8% hypoxia and exsanguination (n = 2). In 18.3%, cases were unspecific or other causes of death recorded on the death certificates. Evident differences with evident clinical consequences were ascertained in 4% (n = 1) and marginal clinical consequences in 24% (6/25). In 16% (4/25), marginal differences with minor forensic consequences were revealed. CONCLUSIONS:Even in a supraregional trauma center, specialized in multiple trauma management (4.2% survival benefit), room for improvement exists in more than a quarter of all casualties. This underlines the need for higher autopsy rates to uncover missed injuries and to understand the pathomechanism in each trauma fatality. This would also help to uncover potential insufficiencies in clinical routines with regard to diagnostics. The interdisciplinary cooperation of trauma surgeons and forensic pathologists can increase the quality of trauma patient care.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Schmidt U,Oramary D,Kamin K,Buschmann CT,Kleber Cdoi
10.1007/s00268-019-05347-7subject
Has Abstractpub_date
2020-04-01 00:00:00pages
1137-1148issue
4eissn
0364-2313issn
1432-2323pii
10.1007/s00268-019-05347-7journal_volume
44pub_type
杂志文章abstract::Clinical, endoscopic, and laboratory data were collected prospectively in 701 patients with bleeding peptic ulcer. The overall rebleeding rate was 16.1% and increased the risk of a fatal outcome by 17 fold (1.2% versus 20.6%, p less than 0.001). Rebleeding was documented in more than 75% of the group who did not survi...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF01664889
更新日期:1990-03-01 00:00:00
abstract::This paper describes a model humanitarian mission to Guyana; it illustrates the value of excellent ongoing care in collaboration with local physicians and surgeons, cooperation with local government and medical officials, and frequent periodic follow-up missions (always to the same hospital, working with the same staf...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-015-3049-x
更新日期:2015-08-01 00:00:00
abstract::Whether for hepatic trauma or transplantation, a surgeon's knowledge of hepatic anatomy commonly determines a patient's outcome. The first medically relevant anatomic studies of the liver emerged with the endeavors of Herophilus and Erasistratus between 310 and 280 bc. Yet it was not until after the development of ane...
journal_title:World journal of surgery
pub_type: 传,历史文章,杂志文章
doi:10.1007/s002689900238
更新日期:1997-03-01 00:00:00
abstract:BACKGROUND:This study aimed to evaluate the recurrence rates, timings, locations, and risk factors, and survival in patients with lymph node-negative superficial esophageal squamous cell carcinomas (ESCCs). METHODS:We investigated 167 patients with pathological T1 thoracic ESCC who underwent curative esophagectomy wit...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-016-3454-9
更新日期:2016-07-01 00:00:00
abstract::Most people would agree that successful parathyroidectomy depends on two important variables: the surgeon's recognition and excision of the abnormal parathyroid gland(s) and the pathologist's confirmation that the removed tissue is parathyroid tissue. Frozen section is usually employed to confirm the identity of parat...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s002680010218
更新日期:2000-11-01 00:00:00
abstract:BACKGROUND:The objective of this study was to determine whether rat insulin promoter (RIP) could, in a mouse model, direct expression of an adenovirus-mediated reporter gene specifically into pancreatic islets via systemic delivery. METHODS:Five hundred and eight base pairs of the RIP DNA sequence were constructed int...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-005-0688-3
更新日期:2006-08-01 00:00:00
abstract:BACKGROUND:In uremic patients, metabolism of 1-84 parathyroid hormone (PTH) and fragments are delayed, and in these patients, the usefulness of intraoperative PTH assay may be problematic. We evaluated the usefulness of the QuiCk-IntraOperative Bio-Intact PTH (QPTH) assay for uremic patients with secondary hyperparathy...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-006-0601-8
更新日期:2007-04-01 00:00:00
abstract:BACKGROUND:Anastomotic leakage is a serious clinical problem after colorectal resections and is associated with a significantly increased length of stay, morbidity and mortality. The aim of the present study was to evaluate the effect of changes in clinical practice on anastomotic leakage rate after colorectal resectio...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-017-4423-7
更新日期:2018-07-01 00:00:00
abstract::The aim of this study was to investigate the epidemiologic characteristics and changing patterns of gallstone disease in Korea over a recent 20-year period. A total of 4020 gallstone patients who had undergone surgery at Seoul National University Hospital during 1981-2000 were analyzed according to periods: period I (...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-003-6879-x
更新日期:2004-02-01 00:00:00
abstract:BACKGROUND:Despite its wide use, catheter tract recurrence after percutaneous biliary drainage (PBD) is rarely reported. However, one recent large-scale study reported a catheter tract recurrence rate as high as 5.2 % in patients with perihilar or distal bile duct cancer. We report on our 20 years of experience with ca...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-012-1844-1
更新日期:2013-02-01 00:00:00
abstract:BACKGROUND:This study reviews the 15 year program of our Department of Pediatric Surgery for the treatment and follow-up of children born with a cleft in Benin and Togo. METHODS:We analyzed files of children born in Africa with a cleft. They were referred to us through a nongovernmental organization (NGO) between 1993...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-012-1607-z
更新日期:2012-08-01 00:00:00
abstract:BACKGROUND:Although 18F-fluorodeoxyglucose (FDG) positron emission tomography combined with computed tomography (PET/CT) is a potentially powerful, non-invasive imaging tool in differentiating adrenal metastasis from benign disease, some adenomas also exhibit high FDG uptake, therefore mimicking metastasis (i.e., false...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-015-3035-3
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:The objective of the present study was to identify logistic regression models with better survival prediction than the Trauma and Injury Severity Score (TRISS) method in assessing blunt trauma (BT) victims in Japan and Thailand. An additional aim was to demonstrate the feasibility of probability of survival ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-012-1498-z
更新日期:2012-04-01 00:00:00
abstract:BACKGROUND:Parathyroid glands (PGs) can be particularly hard to distinguish from surrounding tissue and thus can be damaged or removed during thyroidectomy. Postoperative hypoparathyroidism is the most common complication after thyroidectomy. Very recently, it has been found that the parathyroid tissue shows near-infra...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-016-3571-5
更新日期:2016-09-01 00:00:00
abstract::Percutaneous dilatational tracheostomy (PDT) is being increasingly used. Concerns have been raised as to its safety, especially when it is done at the bedside. A prospective evaluation was conducted of 100 consecutive, unselected critically ill patients with PDT. The mean intensive care unit (ICU) stay before PDT was ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s002680010180
更新日期:2000-09-01 00:00:00
abstract:INTRODUCTION:The association between socioeconomic status (SES) and relative survival of rectal cancer is little investigated. We hypothesized that the impact on risk of death by SES would be much smaller when differences in background mortality (comorbidity, lifestyle factors) were taken into account, i.e. in modellin...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-014-2735-4
更新日期:2014-12-01 00:00:00
abstract:BACKGROUND:This prospective, non-randomized, comparative study evaluated morbidity of chemotherapy administration via a totally implantable venous access device (TIVAD) versus peripheral intravenous access (PIVA), and satisfaction in breast cancer patients in a limited-resource setting. METHODS:Consecutive patients re...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-013-2378-x
更新日期:2014-05-01 00:00:00
abstract:INTRODUCTION:Acute intestinal ischemia is in most cases a lethal condition with a low survival rate. Risk factors of perioperative mortality are poorly defined. The aim of this study was to define risk factors that predict an adverse outcome of acute mesenteric ischemia (AMI). METHODS:A total of 132 consecutive patien...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-005-0560-5
更新日期:2006-08-01 00:00:00
abstract::The safe and permissible limits of hepatectomy in obstructive jaundice patients and the usefulness of preoperative portal embolization (PE) for increasing the limit for safe hepatectomy were examined. We classified 416 patients with hepatectomy performed over 9 years under the following headings: normal liver function...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-004-7128-7
更新日期:2004-05-01 00:00:00
abstract:BACKGROUND:This study was undertaken to determine the efficacy of the clinical indications for performing staging laparoscopy for locally advanced gastric cancer to detect peritoneal metastasis or positive cytology findings. METHODS:The study included 231 patients with T4 gastric cancer without hematogenous or clinica...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-011-1290-5
更新日期:2011-12-01 00:00:00
abstract:INTRODUCTION:Large-bowel obstruction and perforation are still frequently occurring entities for the acute care surgeon. In these cases, Hartmann's procedure is the most commonly used surgical technique. However, recent papers demonstrate that colon resection and primary anastomosis (RPA) in the emergency setting is a ...
journal_title:World journal of surgery
pub_type: 临床试验,杂志文章
doi:10.1007/s00268-012-1513-4
更新日期:2012-05-01 00:00:00
abstract::Surgical innovation relies on patient safety and quality of life, which require a drastic iatrogenic impact reduction. A parallel development toward less invasive approaches has occurred in the field of surgery, interventional radiology, and endoscopy. Minimally invasive techniques provide unquestionable benefits to p...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-014-2879-2
更新日期:2015-03-01 00:00:00
abstract::Sixty-one patients who were diagnosed with mucosal gastric cancer have been successfully treated with two laparoscopic techniques at our institute from March 1992 to March 1997. One is laparoscopic wedge resection of the stomach using a lesion-lifting method for lesions of the anterior wall, the lesser curvature, and ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/pl00013167
更新日期:1999-02-01 00:00:00
abstract::Pancreatic endocrine tumors (PETs) may be sporadic or inherited in the multiple endocrine neoplasia type 1 (MEN-1) syndrome. The inherited form is caused by mutations of the MEN-1 gene, which functions as a tumor suppressor gene and maps to chromosome 11q13. These tumors tend to have a better prognosis than their spor...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-002-4062-4
更新日期:2002-07-01 00:00:00
abstract:BACKGROUND:Surgical site infection (SSI) is a common cause of major morbidity after liver resection. This study aimed to identify the risk factors for incisional and organ/space SSIs after liver resection. METHODS:Our liver surgery database was retrospectively analyzed for patients treated between January 2009 and Nov...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-014-2922-3
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:Pain syndromes of somatic and neuropathic origin are considered to be the main causes of chronic pain after open inguinal hernia repair. Nerve-identification during open hernia repair is suggested to be associated with less postoperative chronic pain. The aim of this study was to define clinically relevant s...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-006-0376-y
更新日期:2007-02-01 00:00:00
abstract:PURPOSE:The prognosis for stage III melanoma patients is mixed, and there is need for new prognostic factors to be incorporated into a revision of melanoma TNM staging. We analyzed the possible role of the timing of lymph node involvement as an important prognostic factor. METHODS:Among 249 melanoma patients who under...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-008-9895-z
更新日期:2009-03-01 00:00:00
abstract::Pepsinogen C is a proteolytic enzyme involved in the digestion of proteins in the stomach; it is also synthesized by a significant percentage of female breast carcinomas. In addition, it has been demonstrated that pepsinogen C is one of the few proteins induced by androgens in breast carcinoma cells. Here we evaluate ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/pl00012325
更新日期:1999-05-01 00:00:00
abstract::Herniographic examinations were performed on more than 4,000 patients. The method was found to be of great value in patients with obscure symptoms in the groin or pelvis. Herniography shows not only hernial sacs but also the general condition and tissue strength of the inguinal part of the abdominal wall. The differen...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF01658871
更新日期:1989-09-01 00:00:00
abstract::In 141 patients with chronic pancreatitis and an inflammatory enlargement of the head of the pancreas, a duodenum-preserving resection of the head of the pancreas was performed within a 16-year period. The hospital mortality was 0.7%; the late mortality was 5%. Seventy-seven percent of the patients were completely fre...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF01670550
更新日期:1990-01-01 00:00:00