gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Optimized triage, diagnostic work-up and ER-care of poly- and brain trauma patients in a critical care hospital

Meeting Abstract

  • B. Prümer - Radiologie, Clemenshospital Münster
  • S. Terwey - Neurochirurgische Klinik, Clemenshospital Münster
  • P. Bell - Radiologie, Clemenshospital Münster
  • C. Reckels - Radiologie, Clemenshospital Münster
  • U. Haverkamp - Radiologie, Clemenshospital Münster
  • A. Sepehrnia - Neurochirurgische Klinik, Clemenshospital Münster
  • A.R. Fischedick - Radiologie, Clemenshospital Münster

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP01-12

DOI: 10.3205/09dgnc260, URN: urn:nbn:de:0183-09dgnc2604

Published: May 20, 2009

© 2009 Prümer et al.
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Outline

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Objective: A swift and standardized investigation procedure of polytrauma patients is of vital importance for an optimized diagnostic workup, therapy stratification, and has implications for the patients’ prognosis. Neurosurgery is one of the major columns, because evacuating an intracranial hemorrhage strongly influences the final overall outcome.

Methods: This study covers the investigation of 296 polytraumatized patients admitted to our hospital during a time period of four years. The patients were grouped according to their state of health and consciousness and to the means of transportation. They were analyzed with respect to the duration of diagnostic work-up, time to operation suite (if necessary), and their final outcome (survival, rehabilitation & daily life).

Results: 203 patients were admitted by ambulance and 93 by helicopter. The average GCS read 8.2 (2.0–14) and 6.5 (4–11), respectively. The diagnostic workup was performed on a MDCT, (Aquilion 64, Toshiba) in a three step trauma triage concept (A: head&neck, B: thorax&abdomen and C: lower limbs – if necessary). In 38% of the cases only step A, in 33% steps A and B, and in 3% all steps (A + B + C) were done. MDCT-Imaging included 0.5 mm acquisition, 5 mm axial, 8 mm coronal MIP (torso), and 3 mm sagittal (spine) reconstructions. The average time to perform the diagnostic procedures – including initial ER-treatment – was 54 minutes (20–128 minutes). There was an inverse correlation between the GCS and the duration of reanimation, while the time for diagnostic procedures varied only little, however paralleled the GCS down to a score of 5 and then necessitated a moderate increase of imaging work-up for a GCS below 5. The prognosis was favorable for patients with an initial high GCS above 10, while we saw a poor prognosis with a GCS below 6. Another independent predictor of a favorable outcome was the duration of preoperative stabilization and diagnostic work-up. If this preparation took less than 42 minutes we saw an improved outcome with one third of patients back in daily life within 10 weeks.

Conclusions: The average time for life saving and diagnostic procedures should take less than 1 hour (best results with < 42 minutes). The prognosis is favorable for patients with an initial GCS > 10, while a poor outcome becomes more likely with a GCS < 6. The duration of preoperative stabilization and diagnostic work-up is an independent factor for prediction of posttraumatic outcome and evaluation of the patient’s prognosis.