W. Mutschler

Aufgrund fehlender Evidenz zur Einschätzung der Relevanz vaskulärer Traumata (VT) bei Schwerverletzten werden in der vorliegenden Studie Registerdaten aufgearbeitet. Damit kann der Effekt eines VT beim Schwerverletzten systematisch objektiviert werden. Zielsetzung war es, neben einer adäquaten Abbildung der Relevanz dieser Traumata auch ungünstige Prognosefaktoren zu identifizieren. Die Auswertung erfolgte retrospektiv aus Datensätzen des TraumaRegisters DGU® (TR-DGU). In 2 Subgruppen mit moderatem und schwerem VT untersuchten wir die Datensätze auf Unterschiede zu Nichtgefäßverletzten mit gleichem Injury Severity Score (ISS) in Bezug auf Morbidität, Mortalität sowie Verlaufs- und Prognoseparametern. Von insgesamt 42 326 wiesen 2961 (7 %) Patienten ein VT auf, in 2437 Fällen wurde ein schweres VT (Abbreviated Injury Scale [AIS] ≥ 3) diagnostiziert (5,8 %). Neben einer höheren Inzidenz eines Schocks, einer 2–3-fach höheren Volumen- und Erythrozytengabe zeigten die schweren VT eine 60 % höhere Rate an Multiorganversagen sowie eine doppelt so hohe Krankenhausmortalität (33,8 %). Deren massiv gesteigerte Frühsterblichkeit (8,0 vs. 25,2 %) verdeutlicht eindrucksvoll die Bedrohung der Schwerverletzten durch Vorliegen eines relevanten VT bei vergleichbarem ISS. Unseres Erachtens ist aufgrund einer unerwartet schlechten Prognose in den Daten des TR-DGU bei Gefäßverletzungen im Rahmen der Schwerverletztenversorgung zunächst eine erhöhte Aufmerksamkeit bei der Versorgung der Verletzten erforderlich. Auf der Basis unserer umfassenden Analyse der vorliegenden negativen Prognosefaktoren ist sicherlich langfristig eine weitere Anpassung an die Standards der Gefäßmedizin günstig. Der Einfluss der Versorgungsstufe der primär versorgenden Klinik und die Relevanz einer Weiterverlegung auf die Prognose und das klinische Outcome werden aktuell geklärt. There is a lack of evidence as to the relevance of vascular trauma (VT) in patients with severe injuries. Therefore, we reviewed registry data in the present study in order to systematically objectify the effect of VT in these patients. This study aimed to provide an adequate picture of the relevance of vascular trauma and to identify adverse prognostic factors. In a retrospective analysis of records from the TraumaRegister DGU® (TR-DGU) in two subgroups with moderate and severe VT, we examined the records for differences in terms of morbidity, mortality, follow-up and prognostic parameters compared to patients without VT with the same ISS. From a total of 42,326 patients, 2,961 (7 %) had a VT, and in 2,437 cases a severe VT (AIS ≥ 3) was diagnosed (5.8 %). In addition to a higher incidence of shock and a 2 to 3-fold increase in fluid replacement and erythrocyte transfusion, patients with severe VT had a 60 % higher rate of multiple organ failure, and in-hospital mortality was twice as high (33.8 %). The massively increased early mortality (8.0 vs. 25.2 %) clearly illustrates how severely injured patients are placed at risk by the presence of a relevant VT with a comparable ISS. In our opinion, due to an unexpected poor prognosis in the TR-DGU data for vascular injuries, increased attention is required in the care of severely injured patients. Based on our comprehensive analysis of negative prognostic factors, a further adjustment to the standards of vascular medicine could be advisable. The influence of the level of care provided by the admitting hospital and the relevance of a further hospital transfer to prognosis and clinical outcome is currently being analysed.

Low back pain (LBP) imposes a considerable social and economic burden as one of the most serious public health issues in the developed nations and is one of the most common reasons for patient presentation to primary health care providers, outpatient clinics or A&E departments. Currently point prevalence of acute LBP adds up to 40%, 1-year prevalence exceeds 70% and life time prevalence equates 80%. Despite these facts, the complex pattern generating LBP is still not satisfactory understood. Additionally, the complexity of diagnostics and treatment in lumbar pain syndrome provokes insecurity and restraint especially in younger clinicians when faced with a patient suffering from acute back pain. To counter these problems, alleviate operational sequences in A&Es, outpatient departments and health care centers minimize the risk of mis- or underdiagnoses of life threatening internistic conditions respectively spinal emergencies and provide patients with appropriate diagnostics and treatment this algorithm has been originated. The algorithm is based upon existing clinical guidelines of national and international scientific associations as well as on experienced data in the daily work of spine specialists. Hereby, consistency with the guidelines and recommendations of the literature on one hand and feasibility in the course of action in a day-to-day routine with as much practical relevance as possible on the other hand were the main goals to achieve. In synopsis, an algorithm was formed which evaluates the crucial differential diagnosis of lumbar back pain according to their clinical relevance and targets a plot of action according to reasonable diagnostic and therapeutic steps. By distinct yes-no decisions within the scope of history taken together with instructions according to clinical, laboratory, and radiological investigational steps, even clinicians without long-time experience in spine surgery should be able to handle patients with acute LBP in any situation according to the guidelines and treatment needed. The designated target in developing this algorithm was to render assistance to colleagues of primary health care providers, outpatient clinics, and A&E departments in the complexity of diagnostics and treatment in lumbar pain syndrome and its differential diagnosis. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared Van Tulderm, Becker A, Bekkeringt, Breena, Gil De Real, Hutchinsona, Koesb, Laerume, Malmivaaraa. European Guideline for the management of acute nonspecific back pain Chour, Fur, Carrinoj, Deyor. Imaging strategies fr Low back Pain: Systematic Review and Metaanalysis. The Lancet 2009;373:463–467 Koesb, Van Tulderm, Lin C, Macedol, Mcauleyj, Maher C. An updated Overview of clinical guidelines for the managemnt of non-specific low back pain. European spine Journal 2010;19:2075–2094 Chou R, Qaseema, Snow V, Casey D, Cross JT Jr., Shekellep, Owens. Diagnosis and treatment of low back pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American pain society. Annals of Internal Medicine 2007;147:478–491 Haswell K, Gilmour J, Moore B. Clinical decision rules for identification of low back pain patients with neurologic involvement in primary care. Spine (Phila Pa 1976). 2008;;33(1):68–73 New Zealand Guidelines Group. New Zealand acute low back pain guide