Polytrauma care - Clinic for Trauma Surgery, Orthopaedics and Plastic Surgery

jump to main navigation skip to content

Clinic for Trauma Surgery, Orthopaedics and
Plastic Surgery

Polytrauma care

The UMG's transregional trauma centre plays a central role in caring for the severely injured – it is the largest maximum-care provider within a 150-kilometre radius. Maximum care hospitals are characterised by highly differentiated medical-technical facilities and capital medical equipment, among other things.

In our central surgical emergency department, an interdisciplinary team of doctors and nurses is available to provide treatment around the clock. It treats around 800 seriously injured people every year, with more than 300 of these patients being in a life-threatening condition. In addition to trauma surgery, its specialist departments include anaesthesiology, radiology, neuroradiology, neurosurgery, general surgery, cardiovascular and thoracic surgery, oral and maxillofacial surgery, as well as all other operative and conservative specialist areas.

We deploy a range of different resources to treat the patient upon their arrival in the emergency trauma room; the exact resources we utilise will depend on the mechanism of injury (MOI), the severity of the injury and the patient's condition. The emergency doctor will therefore directly contact the trauma surgeon on duty and register the patient’s injury severity score at the patient entrance.

Thanks to our highly qualified team, we are able to provide optimum treatment to every seriously injured person and call on additional specialist disciplines at any time if required. In particularly severe, life-threatening cases, over 20 doctors can temporarily be made available to help out in the emergency trauma room.

If your issue is an emergency, please directly contact our central emergency department: +49 551 39 8601

If you would like to schedule an appointment regarding aftercare during our consultation hour, please click here!

Data reflective of high quality of care

In addition to our obligations as a transregional trauma centre within the Göttingen-Kassel trauma network, we play a central role in overseeing the quality of care that is provided to the seriously injured – both in-house and within the trauma network. To this end, the accident and care data are logged – in detail and right down to the exact minute – in the DGU's Trauma Register (www.traumaregister.de). As a result, each clinic receives a data set for itself as a trauma treatment provider and the trauma network receives a data set as an association of several trauma centres. The clinics can then use this data set to help evaluate and optimise their own quality of care.

The annual report on the figures for 2013 shows, for example, that 11.5 percent of the patients admitted were deemed unlikely to survive on arrival due to the seriousness of their injuries, the immediate consequences of their accident, and pre-existing conditions. However, in actual fact, 91.2 percent of admitted patients survived, meaning that only 8.8 percent actually died. Averaged over the past ten years, one can in fact see a significant difference between projected and actual lethality (see Fig. 1 from the 2014 annual report, Trauma Register of the German Trauma Society (DGU). 

Prognostizierte Letalität und tatsächlicher Krankenhausaufenthalt

Figure 1: Projected lethality and actual hospital stay (from DGU trauma register 2014 annual report)

When compared with all international clinics that enter their data into the DGU's Trauma Register, we are one of the best ranked clinics thanks to our high case count and the stark difference between our predicted and observed lethality. In the graphic below (Figure 2) from the Trauma Register’s 2014 annual report, the UMG is highlighted by the red dot. The remaining yellow dots represent the other trauma centres that enter their data into the Trauma Register. All hospitals located below the x-axis have a positive balance regarding lethality. While we were able to achieve a notable reduction in lethality in 2013, the impact of this was not statistically significant. We are, however, achieving statistical significance with our mean value from the past ten years (see green bar in Figure 1).

Prognostizierte und beobachtete Letalität
Figure 2: Projected and observed lethality (from DGU trauma register 2014 annual report)

 

When seriously injured people who are in a life-threatening condition are treated in our emergency trauma room, the severity of their injuries is calculated using the so-called Injury Severity Score (ISS). The ISS uses the term “polytrauma”, which denotes simultaneous injuries to several body regions or organ systems, whereby a single one of these injuries or the combination of several is life-threatening for the person affected. A patient is registered as a polytrauma patient if their ISS is >15 points. Figure 3 shows the average ISS (red dot) recorded in our emergency trauma room in 2013 and compares it to the average ISS recorded in the DGU’s Trauma Registry. The blue curve shows all patients treated in the emergency trauma room along with the different severities of injury according to the ISS.

ISS in Schockraum Unfallchirurgie UMG (roter Punkt) aus dem Jahr 2013 im Vergleich zum mittleren ISS im Traumaregister der DGU

Figure 3: ISS in the UMG trauma surgery emergency trauma room (red dot) in 2013 compared to the average ISS in the DGU’s Trauma Register (from DGU trauma register 2014 annual report)

The aim of the evaluations is to help us continuously improve the care our clinic provides to the seriously injured. In addition to pure survival, our priority is also on preserving the patient’s quality of life, which simultaneously requires both the fastest and the most thorough care possible. Between 2012 and 2014, we managed to steadily reduce the time in the emergency trauma room for the most seriously injured, with the average time in 2014 being about half the average time in 2012. Now, a patient will be undergoing their initial emergency surgery in the operating theatre less than 25 minutes after arriving in the emergency trauma room. Before that, around 90 percent of all admitted patients are extensively diagnosed in a special polytrauma scanner by means of a novel multislice CT, and their circulation and breathing are stabilised.

72 percent of patients can be discharged straight home after their inpatient treatment. 20 percent are transferred directly to a special rehab clinic.