Die Schockraumversorgung von schwer verletzen und polytraumatisierten Patienten hat sich als Modell auch für die Behandlung nichttraumatologischer akut-vital bedrohter Patienten etabliert. Für die Behandlung von Traumapatienten wird deshalb spezifisch der Begriff Traumateam verwendet. In diesem Beitrag werden die evidenzbasierten Anforderungen an den Traumaschockraum dargestellt. Im Weiteren werden die Grundlagen und Gründe erörtert, weshalb ein Traumateam das Outcome verbessert. Die Zusammensetzung eines Traumateams hängt partiell von den organisatorischen Regelungen der einzelnen Krankenhäuser, aber auch von deren Versorgungsstufe ab. Dies ist für die Zertifizierung als Traumazentrum von Relevanz. Die Kriterien für die Traumateamaktivierung sind ein entscheidendes Kriterium für die Qualität der Versorgung und für einen Ressourcen-schonenden Einsatz. Zur Qualitätskontrolle und Reduzierung von Über- und Untertriage wird dargestellt, anhand welcher Parameter beurteilt werden kann, wann eine Traumateamaktivierung angemessen war.

Accurate prehospital trauma triage remains challenging despite structured activation criteria, particularly in patients without overt physiologic instability. Prehospital point-of-care lactate has been proposed as a physiologic adjunct to support early identification of severely injured patients. This prospective multicenter cohort study evaluated the association between prehospital lactate and injury severity in trauma team-activated patients within a structured guideline-based trauma system. This prospective observational multicenter cohort study included adult trauma patients transported by emergency medical services to three Level I trauma centers and managed in the trauma room following trauma team activation (TTA). Prehospital lactate was measured by capillary earlobe sampling before or during transport and was not used for clinical decision-making. The primary outcome was severe injury, defined as Injury Severity Score (ISS) ≥16. Secondary outcomes were Abbreviated Injury Scale (AIS) ≥4 in at least one body region and intensive care unit (ICU) admission > 24 hours. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis and predefined lactate thresholds of ≥2 mmol/L and ≥4 mmol/L. A total of 108 patients were included, of whom 26 (24.1

BACKGROUND:Recent years have seen an increase in reported violent crime involving knives. Valid case numbers of severe stabbing injuries have not been available to date, and the poor state of the evidence hinders consideration of the matter not only on the medical level, but on the political level as well. In this study, we provide the first data on the evolution of case numbers of severe injury from knife crime in Germany. METHODS:We retrospectively analyzed data from the trauma registry of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU). Additional data from the Academy of Trauma Surgery (Akademie für Unfallchirurgie, AUC) were used for an analysis of geographic distribution. Patients were included if they sustained a documented severe stab injury that was suspected to be due to a violent crime in the period January 2013 to December 2024. The number of hospitals contributing data remained stable over the study period, with only small fluctuations. RESULTS:291 752 cases of severe injury were registered, of which 3664 (1.28%) involved stabbing in a suspected violent crime. The lowest number of such cases (212) was in 2013, and the highest (382) in 2023; there were 336 cases in 2024. The mean age of the patients was 34.2 ± 14.3 years; 85.6% were male. Emergency surgery was performed in 72% of cases. CONCLUSION:The absolute incidence of severe stab injuries of suspected criminal origin (212 to 382 cases per year) is low but on the rise, as is the percentage of such injuries among all severe injuries. Persons who died before reaching a hospital were not included in the data.

Pre-injury anticoagulation is a well-known risk factor associated with adverse outcomes in geriatric trauma patients, but its impact in younger populations remains unclear. The study aimed to evaluate the association between pre-injury antithrombotic therapy and clinical outcomes in trauma patients aged 40–60 years. Data were obtained from the TraumaRegister DGU® (2015–2023). Patients aged 40–60 years from European trauma centers with ISS ≥ 9 were included. Patients were categorized according to the presence or absence of pre-injury antithrombotic therapy. A matched-pair analysis was performed based on age group, sex, ASA classification, and injury severity by body region. The primary endpoint was in-hospital mortality; secondary outcomes included coagulopathy, transfusion requirements, emergency surgery, and organ failure. Analyses were primarily descriptive. A total of 64,215 patients were included, of whom 6.7

Shared mental models (SMMs) reflect the extent to which team members hold a similar understanding of roles and team processes. In trauma resuscitation, higher SMM alignment is considered a prerequisite for coordinated interprofessional teamwork. This study compared the effects of checklist-based versus algorithm-based in situ simulation training on teamwork-related SMMs in trauma room teams. In this multicenter, cluster-randomized pre–post study, 29 interprofessional trauma teams (186 participants) from six hospitals received either checklist-based training (n = 15 teams) incorporating the Trauma Room Manual checklists or algorithm-based training (n = 14 teams), both grounded in ATLS principles. Teams completed an SMM questionnaire adapted to the trauma setting, based on a previously published instrument, assessing similarity in (1) task responsibility and (2) team communication. Team-level similarity scores were calculated pre- and post-training. Training effects were analyzed using mixed repeated-measures ANOVA. Across both training formats, teamwork-related shared mental models increased significantly from pre- to post-training in total similarity, task responsibility, and communication. No significant between-group differences or time × group interactions were observed. The interaction for task responsibility approached significance (p =.06; η²p =.12). A single-day in situ simulation training improved teamwork-related shared mental models in interprofessional trauma teams. Checklist- and algorithm-based formats produced similar short-term gains. Future studies should evaluate long-term retention, implementation fidelity, and whether improved SMM alignment translates into measurable team performance and patient-safety outcomes.

To compare radiographic and long-term functional outcomes of conservatively and operatively treated traumatic lateral compression type 1 (LC-1) pelvic ring fractures, considering fracture morphology and injury severity. This single-center observational cohort study included adult patients with traumatic LC-1 pelvic ring injuries treated between 2012 and 2020. Radiographic outcomes were assessed using the Matta–Tornetta system, and functional outcomes were evaluated at long-term follow-up using the normalized Majeed Pelvic Score and SF-12. Baseline characteristics and complications were analyzed descriptively. Seventy-seven patients were included (38 conservative, 39 operative). Operatively treated patients had higher injury severity and more complex fracture morphology. Despite worse initial alignment, radiographic outcomes at follow-up were similar between groups, with most patients achieving excellent or good results. Radiographic consolidation was observed in nearly all patients. Long-term functional outcomes did not differ significantly between groups. In this observational cohort with substantial baseline differences, no significant differences in long-term functional outcomes were observed between treatment strategies. These findings support an individualized, morphology-based treatment approach. However, results should be interpreted with caution due to baseline imbalance and the non-randomized study design.

Older trauma patients are known to be undertriaged in the prehospital setting. However, it remains unclear whether these disparities translate into differences in the delivery of critical prehospital interventions. This study aimed to evaluate age-related differences in prehospital triage, allocation, and treatment within a physician-staffed emergency medical service system. A retrospective multicenter analysis of the TraumaRegister DGU® was conducted, including trauma patients aged ≥ 20 years between 2020 and 2023 with trauma team activation and subsequent intensive care unit admission. Patients were stratified into two age groups, 20–59 vs. ≥60 years, with additional subgroups up to 90–99 years. Prehospital interventions, transport modality, and trauma center allocation were analyzed. Furthermore, predefined high-risk scenarios (severe motor vehicle trauma, traumatic brain injury with GCS ≤ 8, and pneumothorax) were evaluated. A total of 67,069 patients were included, with comparable injury severity across age groups (mean ISS 20.2). Older patients were less frequently transported by air and less often allocated to supra-regional trauma centers. While overall intervention rates were similar, differences emerged in high-risk scenarios. Older patients received endotracheal intubation and tranexamic acid less frequently despite comparable injury severity. Prehospital chest tube placement rates were low and similar across age groups. Age-related differences in prehospital triage and allocation are associated with selective differences in treatment, particularly in high-risk situations. These findings suggest that prehospital care in older trauma patients is individualized rather than uniformly reduced, but highlight the need to refine triage algorithms and guideline implementation in an aging trauma population.

The shock room treatment of severely injured and polytraumatized patients has become established as a model for the treatment of non-traumatological critically ill patients. For the treatment of trauma patients the term trauma team is therefore used. This article presents the evidence-based requirements for the trauma shock room. In addition, the reasons why a trauma team improves the outcome are discussed. The composition of a trauma team depends partly on the organizational regulations of the individual hospitals but also on their level of care. This is relevant for certification as a trauma center. The criteria for trauma team activation is a decisive criterion for the quality of care and resource-saving use. For quality control and to reduce overtriage and undertriage, it is shown which parameters can be used to assess when trauma team activation has been appropriate.

Die Bereitstellung spezialisierter Schockraumteams zur Schwerverletztenversorgung ist nach den Vorgaben der S3-Leitlinie Polytrauma/Schwerverletztenversorgung der AMWF obligat und die Zusammensetzung durch das Weißbuch Schwerverletztenversorgung festgelegt. In jeder Versorgungsstufe wird das Basisteam aus den 4 Disziplinen Orthopädie und Unfallchirurgie, Anästhesie, Radiologie und der Notfallpflege der Notaufnahme zusammengesetzt, mit weiteren Anpassungen je nach Versorgungsstufe des Krankenhauses. Ziel der vorliegenden Studie ist die Untersuchung der gelebten Realität bei der Zusammensetzung der Schockraumteams. Bei der prospektiven, multizentrischen Beobachtungsstudie wurden in 12 überregionalen Traumazentren in Deutschland und der Schweiz insgesamt 3753 Patienten nach Unfällen in der Notaufnahme behandelt, darunter 964 Patienten (26

Die vorliegende Arbeit beschreibt den Einsatz von digitalen Lösungen für die Verbesserung der Versorgung von Traumapatienten in Deutschland. Im Mittelpunkt stehen die TraumaNetzwerke der Deutschen Gesellschaft für Unfallchirurgie (DGU). Der Einsatz von digitalen Lösungen umfasst Qualitätssicherungen durch das TraumaRegister, dass eine umfassende Datenanalyse ermöglicht, sowie Voranmeldung und Ressourcennutzung über Programme wie den Interdisziplinären Versorgungsnachweis IVENA eHealth, den Rescuetrack und das Rescue-Net. Zudem wird das Predictive Hospital Resource Planning, das die Ressourcenprognose mithilfe von künstlicher Intelligenz (KI) optimiert, vorgestellt. Telemedizinische Dienste wie Medgate und teleradiologische Lösungen (Nexus/Chili) bieten zusätzliche Unterstützung, insbesondere in ländlichen Gebieten. Die Arbeit zeigt, wie die Digitalisierung der medizinischen Versorgung entscheidend ist, um die Effizienz und Qualität in der Behandlung von Traumapatienten zu verbessern. Zudem zeigt die Arbeit mögliche Entwicklungen im Bereich der klinischen Entscheidungsfindung durch KI auf.

Zusammenfassung Einleitung Der Gemeinsame Bundesausschuss (G-BA) veröffentlichte im April 2018 eine Regelung zu einem gestuften System von Notfallstrukturen an Krankenhäusern (nach Sozialgesetzbuch V) und legte damit die Grundsätze für Notfallversorgung im stationären Sektor fest. Die Strukturanforderungen für die Versorgung von potenziell Schwerverletzten wird primär durch die Fachgesellschaft definiert und bedeutet eine hohe personelle Vorhaltung bei gleichzeitig jährlich zunehmender Auslastung bei steigenden Patientenzahlen. Ziel der Studie ist es, die tatsächliche Auslastung der traumatologischen Schockräume in zertifizierten Traumazentren zu erfassen. Methodik Hierzu wurde eine deutschlandweite Online-Umfrage unter 619 zertifizierten Traumazentren DGU® durchgeführt, um die Häufigkeit der Schockraumalarmierungen zu quantifizieren. Die Ergebnisse wurden retrospektiv mit den Daten aus den Jahresberichten 2021 und 2022 des TraumaRegister DGU® verglichen. Ergebnisse Die beteiligten Kliniken meldeten im Jahr 2021 22.479 und im Jahr 2022 24.366 Schockraumalarmierungen (Rücklaufquote der Online-Antworten von 24,1 %). Von diesen Alarmierungen entfielen 70 % auf überregionale Traumazentren. Die Vergleichsanalyse zeigte, dass die realen Fallzahlen 3‑ bis 5‑mal höher sind als die im TR-DGU® dokumentierten Daten. 80 % der Schockräume wurden aufgrund geringer Verletzungsschwere nicht im Register erfasst. Zusammenfassung Die Studie belegt die Diskrepanz zwischen der dokumentierten und der tatsächlichen Auslastung der Schockräume in deutschen Traumazentren und betont die Notwendigkeit, die finanzielle und personelle Berücksichtigung der Traumazentren an die reale Inanspruchnahme anzupassen, um eine weiterhin hohe Versorgungsqualität zu gewährleisten. Graphic abstract

Im Rahmen der Aktualisierung der S3-Leitlinie „Polytrauma und Schwerverletztenversorgung“ wurden Kriterien für die Zuweisung von Patienten, unterteilt in HRSI(„high risk of severe injury“, GoR [grade of recommendation] A)- und MRSI(„moderate risk of severe injury“, GoR B)-Kriterien, angepasst. Ziel dieser Arbeit ist die Erhebung der Gründe für eine Schockraumzuweisung durch den Rettungsdienst anhand dieser Kriteriengruppen. Die vorliegende Arbeit basiert auf einer Umfrage in 8 deutschen Traumazentren (ÜTZ und RTZ) zu den Gründen der Zuweisung von Patienten über den Schockraum. Von den 211 ausgewerteten Fragebögen wurde in 55,9

Our aim was to develop new evidence-based and consensus-based recommendations for bleeding control in patients with multiple and/or severe injuries in the prehospital setting. This guideline topic is part of the 2022 update of the German Guideline on the Treatment of Patients with Multiple and/or Severe Injuries. MEDLINE and Embase were systematically searched until June 2021. Further literature reports were obtained from clinical experts. Randomised controlled trials, prospective cohort studies, and comparative registry studies were included if they compared interventions for bleeding control in the prehospital setting using manual pressure, haemostatic agents, tourniquets, pelvic stabilisation, or traction splints in patients with multiple and/or severe injuries. We considered patient-relevant clinical outcomes such as mortality and bleeding control. Transfusion requirements and haemodynamic stability were surrogate outcomes. Risk of bias was assessed using NICE 2012 checklists. The evidence was synthesised narratively, and expert consensus was used to develop recommendations and determine their strength. Fifteen studies were identified. Interventions covered were pelvic binders (n = 4 studies), pressure dressings (n = 1), tourniquets (n = 6), traction splints (n = 1), haemostatic agents (n = 3), and nasal balloon catheters (n = 1). Fourteen new recommendations were developed. All achieved strong consensus. Bleeding control is the basic objective of treatment. This can be easily justified based on empirical evidence. There is, however, a lack of reliable and high-quality studies that assess and compare methods for bleeding control in patients with multiple and/or severe injuries. The guideline provides reasonable and practical recommendations (although mostly with a low grade of recommendation) and also reveals several open research questions that can hopefully be answered when the guideline is revised again.

Background As part of the update of the S3 guideline on Polytrauma and severe injury care, criteria for the allocation of patients, divided into high risk of severe injury (HRSI; previously grade of recommendation [GoR] A) and moderate risk of severe injury (MRSI, formerly GoR B) criteria, were adapted. The aim of this study is to analyze the reasons for trauma room allocation by the emergency medical services based on these criteria groups. Materials and methods The present study is based on a survey in eight German trauma centers (supraregional [& Uuml;TZ] and regional trauma centers [RTZ]) regarding the reasons for patient allocation to the trauma room. Results Of the 211 questionnaires analyzed, HRSI was selected as the reason for referral in 55.9% and MRSI in 17.0%. In 18.9% of cases, a combination of HRSI and MRSI was used. In 8.0% of cases, neither of the two criteria was mentioned. In these cases, allocation was based on a provider decision. Allocation due to accidents from the old guideline continues to be frequently used. Conclusion The present evaluation shows that in many cases patient allocation to the trauma room is based on a combination of several trauma room activation criteria. Furthermore, old criteria, in particular regarding the mode of trauma, continue to be used despite the lack of validity in the updated guideline.

Accurate trauma triage ensures timely and specialized care for potentially critically injured patients. Undertriage remains a concern, particularly for patients without obvious vital sign derangements. This study evaluates the potential of biomarkers such as lactate, base deficit (BD), and blood glucose to improve triage score accuracy in identifying patients with severe injuries (Injury Severity Score [ISS] > 15) and predicting intensive care unit (ICU) admission without a high risk of severe injury (HRSI). This retrospective, single-center cohort study (2017–2021) included trauma patients with trauma team activation (TTA) due to mechanism of injury(MOI) and therefore only patients with moderate risk of severe injury criteria(MRSI). Exclusion criteria were any HRSI-criterion such as advanced airway management, Glasgow Coma Scale < 12, systolic blood pressure < 90 mmHg, and specific injury patterns. Biomarkers were collected upon emergency department (ED) admission. Logistic regression and receiver operating characteristic (ROC) curve analyses evaluated biomarker predictive value alone and in combination with existing triage scores. The study population included 3371 TTAs of which we were able to include 302 in our study-group. 15