Abstract Background Blunt cerebrovascular injury (BCVI) is a rare but potentially devastating complication of pediatric blunt trauma. Delayed or missed diagnosis may result in ischemic stroke, permanent neurological deficits, or death. To avoid missed injuries, many trauma centers apply liberal computed tomography angiography (CTA) screening strategies, although this may expose children to substantial and potentially unnecessary radiation. Several adult- and pediatric-derived screening tools have been proposed, but their applicability in pediatric trauma populations remains controversial. This study aimed to evaluate the incidence of BCVI, imaging utilization, and the diagnostic performance of pediatric BCVI screening approaches in a German Level I trauma center cohort. Methods This retrospective observational cohort study included pediatric trauma patients aged 0–15 years who underwent CT imaging following blunt trauma between January 2005 and December 2020 at a Level I trauma center in Germany. Patients were identified through systematic review of electronic medical records and radiological databases. BCVI was defined as traumatic injury to the carotid or vertebral arteries detected by CTA or magnetic resonance imaging (MRI). Demographic, clinical, imaging, and outcome data were collected retrospectively. The McGovern score was calculated for patients with sufficient available data and evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) analysis. Additionally, the theoretical applicability of PECARN and Scandinavian pediatric head trauma guidelines was explored to assess potential reductions in CT utilization. Results A total of 956 pediatric trauma patients underwent CT imaging, of whom 668 (70%) additionally received CTA. BCVI was diagnosed in 6 patients, corresponding to an incidence of 0.6%. Five injuries were identified by CTA and one by MRI. All BCVI patients presented with focal neurological deficits at initial evaluation. The McGovern score could be calculated in 896 patients. Using a cutoff value of ≥ 3 points, all BCVI cases were correctly identified, resulting in a sensitivity of 100%, specificity of 83.8%, PPV of 4.0%, and NPV of 100%. ROC analysis demonstrated excellent discriminative ability with an area under the curve of 0.960 (95% CI 0.923–0.989). However, the small number of BCVI cases limited statistical power. Theoretical application of PECARN and Scandinavian guidelines suggested that a substantial proportion of CT examinations may have been avoidable. Conclusion BCVI is an uncommon but clinically significant injury in pediatric blunt trauma. Despite its low incidence, CTA utilization was high in our cohort, raising concerns regarding potential overuse of imaging and radiation exposure. Pediatric-specific screening tools such as the McGovern score may help identify low-risk patients while maintaining high sensitivity. However, larger prospective multicenter studies are required to validate pediatric BCVI screening strategies and optimize the balance between early diagnosis and radiation avoidance.

Blunt carotid injuries (BCI) in pediatric trauma patients are rare. Using data from the TraumaRegister DGU®, this study aims to identify screening parameters and calculate the prevalence of pediatric BCI. By proposing potential risk factors for a BCI, this research seeks to reduce unnecessary radiation exposure in pediatric trauma cases. These findings may enhance understanding of pediatric BCI and highlight the necessity of cautious diagnostic approaches that balance clinical needs with radiation risks. The TraumaRegister DGU® is a multicenter database established in 1993 to document the treatment of severely injured patients from initial injury to hospital discharge. Data are collected in four phases: demographics, injury patterns, treatments, and outcomes. Almost 700 hospitals, primarily from Germany, contribute to the registry annually. Statistical analysis was conducted using SPSS. For analysis, the dataset was divided into two groups: trauma patients diagnosed with BCI and trauma patients without BCI. The complete dataset from the TraumaRegister DGU® for 2006–2020 was screened for relevant cases. The dataset was limited to patients between 0 and 15 years old. Out of 9070 severely injured pediatric trauma patients analysed, 50 cases of pediatric BCI were identified, representing a prevalence of 0.6

BackgroundWith the revision of the German S3 guideline on polytrauma/severe injury management, mechanism-based criteria for trauma team activation (TTA) were largely abandoned. At the same time, the use of third-party service (TPS)-eCall systems, which transmit objective crash data, is gaining importance.ObjectiveWhat challenges and potentials arise in the use of TPS-eCall data for prehospital and clinical interpretation of crash mechanisms? Materials and methods Prospective observational study with trend analysis of activation frequency and case-based evaluation of all severely injured persons using emergency medical services (EMS), hospital, and registry data. All TPS-eCall incidents in the city of Essen between 01/2022 and 05/2025 were analyzed and linked to EMS data, treatment reports from a supraregional trauma center, and the TraumaRegister of the German Society for Trauma Surgery. Results A total of 209 TPS-eCall activations were recorded, showing a significant monthly increase (beta = 0.16; 95% CI 0.06-0.26; p < 0.01; R-2 = 0.21). In all, 25 persons were transported to the emergency department of the participating hospital, of whom 11 (44%) were treated by a trauma team. Four persons (16%) met the inclusion criteria of the TraumaRegister DGU (R). Interpretation problems of TPS-eCall data were present in all cases. Conclusion TPS-eCall systems can complement prehospital assessment. However, heterogeneous data quality, lack of standardization, and missing technical integration currently complicate interpretation. Nevertheless, the increasing number of cases and the expected improvement in data quality suggest that TPS-eCalls may play a relevant role in future prehospital decision-making.

Mit der Einführung der S3-Leitlinienaktualisierung Polytrauma/Schwerverletztenbehandlung wurden unfallmechanismusbasierte Kriterien für die Trauma-Team-Aktivierung (TTA) weitgehend verworfen. Gleichzeitig gewinnt die Nutzung von TPS-eCall-Systemen, die objektive Unfalldaten übermitteln, an Bedeutung. Welche Herausforderungen und Potenziale entstehen in der Anwendung von TPS-eCall-Daten in der präklinischen und klinischen Interpretation von Unfallmechanismen? Prospektive Beobachtungsstudie mit Trendanalyse der Einsatzhäufigkeiten sowie fallbasierter Auswertung aller schwer verletzten Personen anhand von Rettungsdienst‑, Klinik- und Registerdaten. Analysiert wurden alle Third-Party-Service(TPS)-eCall-Einsätze im Stadtgebiet Essen zwischen 01/2022 und 05/2025 mit Verknüpfung zu Rettungsdienstdaten, den Behandlungsberichten eines überregionalen Traumazentrums (ÜTZ) und dem TraumaRegister der Deutschen Gesellschaft für Unfallchirurgie. Es wurden 209 TPS-eCall-Alarmierungen registriert, mit signifikant steigendem Trend pro Monat (β = 0,16; 95

BACKGROUND:With the 2023 revision of the German S3 guideline "Polytrauma/severely injured patient care" the criteria for trauma team activation (TTA) were revised. Accident mechanism-based criteria were largely eliminated. The impact of these changes on emergency department (ED) management, over- and undertriage following traffic accidents, and hospital length of stay has not yet been systematically evaluated. OBJECTIVE:The aim of this study was to assess the effects of the guideline update on patient treatment in the emergency department of a level I trauma center. METHODS:In a prospective, single-center observational study, all patients presenting after motor vehicle accidents were recorded over a 2-year period (pre- vs. postguideline update). Primary endpoints were the frequency and appropriateness of TTA as well as the distribution of treatment locations. Secondary endpoint was hospital length of stay. RESULTS:A total of 1438 cases were analyzed. The number of red-triaged patients decreased significantly (257 vs. 157; p < 0.001). The overtriage rate among TTA patients declined (27.6% vs. 21%, p < 0.01) without a significant increase in undertriage. Mortality and hospital length of stay did not differ significantly between groups. CONCLUSION:The revision of TTA criteria led to a marked reduction in trauma team activations while maintaining quality of care. No significant increase in undertriage was observed. The updated TTA criteria may support resource-efficient patient care without compromising safety.

Mit der Aktualisierung der S3-Leitlinie „Polytrauma/Schwerverletzten-Behandlung“ im Jahr 2023 wurden die Kriterien zur Traumateamaktivierung (TTA) überarbeitet. Dabei wurden unfallmechanische Kriterien weitgehend entfernt. Die Auswirkungen der Leitlinienänderungen auf die Versorgung in der zentralen Notaufnahme (ZNA), auf die Über- und Untertriage nach Verkehrsunfällen sowie auf die Krankenhausverweildauer wurden bisher nicht nachuntersucht. Ziel der Arbeit war, die Auswirkung der Leitlinienaktualisierung auf die Behandlung in einer Zentralen Notaufnahme eines überregionalen Traumazentrums (ÜTZ) zu bewerten. In einer monozentrischen, prospektiven Beobachtungsstudie wurden über 2 Jahre (Prä- vs. Post-Leitlinienaktualisierung) alle Patient:innen nach motorisierten Verkehrsunfällen in einem ÜTZ erfasst. Primäre Endpunkte waren Häufigkeit und Adäquatheit der TTA sowie die Verteilung der Behandlungsorte. Sekundärer Endpunkt war die Verweildauer. Insgesamt wurden 1438 Fälle ausgewertet. Die Anzahl der rot triagierten Patient:innen sank signifikant (257 vs. 157; p < 0,001). Die Rate an Übertriage bei TTA sank (27,6

Over the past 50 years, the concept of the golden hour of shock was established as one of the central tenets of emergency trauma medicine. A shorter duration of prehospital care correlates with a positive change in outcome in numerous studies. Dispatching by the public safety answering points has hardly been discussed to date. Thanks to improved vehicle safety, additional accident data is now available to the emergency call centers. We investigated the effects of third-party system emergency calls (TPS-eCalls), which have become mandatory in new passenger cars in the EU in 2018, on dispatching in the emergency medical services (EMS). For this purpose, we linked the data of a public-safety answering point (PSAP) and an EMS. All emergency service deployments from 01/01/2023 to 31/12/2023 were evaluated. N = 1546 rescue missions were dispatched after motor vehicle accidents (MVA), 111 after TPS-eCall-alerts, 1435 after conventional alerts. Dispatching in the PSAP currently took longer after TPS-eCall alerts than conventional alerts (01:39 ± 01:40 min vs. 02:41 ± 02:01 min, p ≤ 0.001). The differences were only significant in the case of accidents involving ≤ 2 passengers. TPS-eCall data will be available increasingly. The future expansion data availability offers the opportunity to include objective accident data (airbag deployment, number of occupants, change of velocity) in the dispatching process. Adequate technical connection can improve dispatching and shorten preclinical treatment, especially for complex events with more than 2 passengers.

Introduction While epidemiology and treatment strategies of proximal humerus fractures have been well studied, post-hospital care is poorly analysed. Corresponding data is available in the context of hip fractures, but the evidence regarding proximal humerus fractures is weak. Aim of this study is to identify risk factors for institutionalisation required after discharge into inpatient aftercare for elderly patients treated for proximal humerus fractures. Materials and Methods For this retrospective single-centre investigation, n = 295 patients (age 70 (58,79) years, 63.7% female) admitted to hospital from home due to proximal humerus fractures were included and divided into two study groups: Patients being discharged home ( ‘Home’ ) vs being discharged into aftercare ( ‘Aftercare’ ). Differences regarding demographic and clinical data were analysed. Odds ratios (OR) of influencing factors (adjusted for age) were calculated by logistic regression analysis. Results Increased age notably increased the likelihood for discharge of patients into ‘Aftercare’ (OR 1.09 [1.06;1.12] per year of life). Age-independent indicators for ‘Aftercare’ were higher ASA score (OR 2.16 per ASA point [1.37;3.49]; P < .001), anterior surgical approach (OR 6.05 [1.93,27.1]; P < .006), duration of surgery (OR 1.01 per min [1.00,1.02]; P < .012), non-surgical complications (OR 3.82 [1.60,9.49]; P < .003), length of stay (OR 1.12 per day [1.04,1.22]; P < .005), ICU stay (OR 3.15 [1.71,6.00]; P < .001) and reversely surgery (OR 0.39 [0.19,0.80]; P < .010). Conclusion Increased Age and higher ASA score notably increase the likelihood for post-hospital discharge to an inpatient aftercare facility. Available literature in the context of hip fractures is confirmed. The results of this study may assist in identifying patients at risk and may serve as a stepstone in establishing a scoring system for elderly patients with proximal humerus fractures.

Background Pediatric emergencies are a challenge for emergency medical service (EMS) personnel regarding medical expertise and equipment. To address the special requirements in terms of size and weight, attempts are being made to systematically structure pediatric emergency backpacks. Objectives The aim of the study was to compare two pediatric emergency backpacks. One structured according to the xABCDE-system, the other to the Broselow-system based on patients' measurements. Methods In total, 115 participants underwent exercises and emergency scenario simulations with two pediatric emergency backpack systems in a prospective, randomized study. First, they performed a material search of six items to test the intuitiveness of both backpack systems. Later, they used the backpacks in the simulation of a pediatric resuscitation and carried out self-assessment and backpack system evaluation. Results The handling of the Broselow-system was easier for the participants. Particularly size-specific materials (laryngeal mask (xABCDE vs. Broselow: 61.2 +/- 31.3 vs. 24.5 +/- 14.2 s, p < 0.001)), but also other materials (Magillpliers (37.2 +/- 23.3 vs. 7.9 +/- 6.1 s, p < 0.001), peripheral venous catheter (12.7 +/- 5.7 vs. 6.6 +/- 2.7 s, p < 0.001), pupil lamp (both 17.9 +/- 6.9 vs. 16.0 +/- 6.9 s, p < 0.05)) were found faster. The participants were faster in the resuscitation simulation and selection of large-scale measures using the Broselow-system (e.g. laryngeal mask (187.6 +/- 72.6 vs. 155.1 +/- 63.5 s, p = 0.001) and preparation of the medication administration in the appropriate dosage (243.0 +/- 73.9 vs. 219.8 +/- 60.2 s, p < 0.05)) and rated the Broselow-system as well as their own performance better in all evaluation categories (p < 0.001). Conclusions: As the Broselow-system coded according to size and weight was ranked better in practical application and evaluation, the size and weight-based sorting should be preferred to pure xABCDE systems. The comparison of the different backpack systems should further be tested in more complex simulations and real operations.

Seit der Leitlinienaktualisierung zur Versorgung polytraumatisierter Patienten in Deutschland im Jahr 2023 werden zahlreiche Verkehrsunfallmechanismen nicht mehr als Sekundärkriterien für die Schockraumalarmierung genutzt. Das subjektive Unfallverständnis kann jedoch durch eCall-Notrufsysteme objektiviert werden. In der aktuellen Arbeit bewerten wir die Dokumentation in präklinischen und klinischen Behandlungen sowie eCall-Datensätzen nach Unfällen mit TPS-eCall-Alarmierungen. Es wurden prospektiv alle Anruf- und Behandlungsprotokolle nach TPS-eCall-Alarmierung des städtischen Rettungsdienstes sowie Weiterbehandlungen im ortsansässigen Überregionalen Traumazentrum vom 01.01. bis 31.03.23 ausgewertet. Nichttraumatologische Einsätze wurden herausgefiltert. Anschließend wurden Unfallangaben (z. B. Zeit, Ort, Geschwindigkeit) geprüft. Bei Transporten in die Studienklinik und Einwilligung wurden die Datensätze verknüpft. Die Studie wurde vom zuständigen Ethikkomitee bewilligt (20-9161-BO). Nach der Stichwortfilterung verblieben 19 durch TPS-eCalls ausgelöste Unfallereignisse mit 48 verunfallten Personen; 18 Personen wurden klinisch behandelt, 9 davon im klinischen Zuständigkeitsbereich der Autoren. Dokumentationsschwächen zeigen sich sowohl präklinisch als auch klinisch durch geschätzte, widersprüchliche oder sogar fehlende Angaben. TPS-eCalls verbesserten das Verständnis einzelner Unfallkomponenten. Zukünftig sind quantitative und qualitative Verbesserung der Datenverfügbarkeit in der Rettungskette und klinischen Behandlung durch eine weitere Implementierung der TPS-eCall-Systeme zu erwarten.

With the aging population, the number of geriatric trauma patients continues to rise, posing significant challenges for emergency care and trauma management. Structured trauma team activation (TTA) protocols aim to provide timely and adequate treatment for severely injured patients. However, evidence suggests that current triage criteria may inadequately address the specific needs of geriatric patients, potentially leading to undertriage and worse outcomes. The prospective, multicentre observational cohort study analysed trauma team activation and triage practices for patients aged ≥ 70 years across 12 Level 1 trauma centres across rural and urban regions in Germany and Switzerland. Data were prospectively collected from December 2020 to February 2021, following the STROBE guidelines. Triage decisions were compared with the TAcTIC (Trauma Team Activation and Trauma/Injury Care) consensus criteria to assess undertriage and overtriage rates. Key outcomes included trauma team activation rates, injury severity, transport characteristics, and early mortality. Among 3,753 trauma patients, 1,371 (36.5%) were geriatric (≥ 70 years). Trauma team activation was significantly lower in the geriatric group (15.8%) compared to younger patients (31.8%), despite similar injury severity. Post-hoc analysis revealed that 53.8% of geriatric patients requiring trauma care were undertriaged. Head injuries (47.7%) and pelvic fractures (5.7%) were more common in geriatric patients in comparison to the younger cohort. Mortality within 48 h was more than three times as high in geriatric patients (1.8% vs. 0.5%). A significant undertriage rate (53.8%) was identified among geriatric trauma patients, contributing to delayed care and increased mortality. Undertriage of geriatric trauma patients remains a critical issue, reflecting the insufficiency of current trauma activation protocols. Tailored triage criteria that even more consider age-related physiological differences, comorbidities, and frailty are urgently needed. Future updates to trauma guidelines should aim to reduce undertriage and improve outcomes for this vulnerable population. Not applicable.

Die Ruhigstellung von Frakturen und Luxationen gehört zur Basistechnik der unfallchirurgischen Versorgung. Das Wissen über die verschiedenen Materialien, Techniken und möglichen Komplikationen sollte in der Unfallchirurgie bekannt sein. Der klassische Weißgips ist trotz anderer Techniken weiterhin fester Bestandteil in der unfallchirurgischen Versorgung. Die Anlage eines solchen Gipses muss erlernt werden, da bei Nichtbeachtung der Grundlagen Schäden für den Patienten drohen. In vielen Kliniken wird die Anlage eines Gipses nach ärztlicher Indikationsstellung an die Pflege delegiert, hierdurch fehlt jungen ärztlichen Kollegen das Wissen über die Durchführung. Neben der Versorgung von Frakturen gehört die Ruhigstellung nach Luxationen, Entzündungen und ligamentären Verletzungen zu den Einsatzgebieten. Im Folgenden wird die Anlage eines Gipses anhand eines Fallbeispiels von der Indikation über die Durchführung bis hin zu den möglichen Komplikationen detailliert behandelt.

Eine Repositionstechnik dient dazu, die Gelenkflächen nach einer Luxation und/oder Fraktur wieder in Kongruenz zu bringen. Da Luxationen oft mit Begleitverletzungen einhergehen, ist es, gerade bei einer Mitbeteiligung von Gefäßen oder Nerven, wichtig, zeitnah zu reponieren. Bei Gefäß- oder Nervenbeteiligung ist ggf. eine Reposition ohne vorherige radiologische Dokumentation vertretbar. Die oft sehr schmerzhaften traumatischen (weniger die habituellen) Luxationen und ihre Reposition erfordern fast immer eine Analgosedierung. Im Anschluss wird das reponierte Gelenk in der Regel ruhiggestellt und eine Röntgenkontrolle durchgeführt. Weitere diagnostische Schritte wie etwa ein CT oder MRT werden ggf. nötig, um Begleitverletzungen zu erfassen, die das Prozedere (mit-)bestimmen. Alter und Anspruch des Patienten sind ebenfalls in die Behandlungsplanung einzubeziehen. Im Folgenden werden Repositionstechniken für diverse Gelenke, wie etwa Schulter, Hüfte, Knie, Ellenbogen sowie Finger und Zehen, beschrieben.

Das Thoraxtrauma stellt eine häufige Verletzung im Versorgungsalltag verunfallter Patienten dar. Durch den zunehmenden Alterswandel ist mit einer weiteren Zunahme, insbesondere nach niedrigenergetischen Traumata, zu rechnen. Zu erwartende Komplikationen nach konservativer vs. operativer Behandlung verschiedener Verletzungsmuster des Thoraxtraumas. Auswertung einer selektiven Literaturrecherche bezüglich der möglichen Komplikationen nach einem Thoraxtrauma und Formulierung von Handlungsanweisungen als Expertenempfehlung. Sowohl bei der konservativen als auch der operativen Therapie des Thoraxtraumas existieren spezifische Komplikationen, die dem Behandler bekannt sein müssen. Lungenkontusionen werden initial in der bildgebenden Untersuchung oft unterschätzt, führen jedoch häufig zu relevanten Problemen im weiteren Behandlungsverlauf. Nach konservativer Therapie von Rippenbrüchen können persistierende Schmerzen, funktionelle Einschränkungen bis hin zu Deformitäten durch z. B. eine sekundäre Dislokation zurückbleiben. Auch werden im Rahmen der initialen Diagnostik häufig Verletzungen nicht erkannt oder unterschätzt und lösen dadurch sekundäre Komplikationen aus. Die mit Abstand häufigsten Risiken der operativen Behandlung bestehen in der Fehlpositionierung von Thoraxdrainagen. Insgesamt sind postoperative Infektionen im Bereich des Thorax eher selten.

Immobilization of fractures and dislocations is a basic technique in orthopedic trauma surgery care. The orthopedic surgeon should be familiar with the various materials, techniques and possible complications. Despite other techniques, the classical white plaster cast remains an integral part of orthopedic trauma surgery care. The application of such a cast must be learned as failure to observe the basic principles can result in harm to the patient. In many hospitals, the application of a plaster cast is delegated to the nursing staff according to the physician's instructions. As a result, many young medical colleagues lack the knowledge of how to apply a plaster cast. In addition to the treatment of fractures, immobilization after dislocation, inflammation and ligamentous injuries are some of the areas of application. In this article the application of a plaster cast is described based on a case study, from the indications to the execution and possible complications.