title: [Prehospital assessment of injury type and severity in severely injured patients by emergency physicians : An analysis of the TraumaRegister DGU®].
abstract: BACKGROUND
  Prehospital assessment of injury type and severity by emergency medical services physicians impacts treatment including appropriate destination hospital selection, especially in (potentially) life-threatening cases. Injuries which are underestimated or overlooked by the emergency physician can delay adequate therapy and thus significantly influence the overall outcome. The current study used data from the TraumaRegister DGU® to evaluate the reliability of prehospital injury assessments made by emergency physicians.
  
  
  METHODS
  Data of 30,777 patients from the TraumaRegister DGU® between 1993 and 2009 were retrospectively evaluated. Using the abbreviated injury scale (AIS), subjective prehospital assessments of injury severity by emergency physicians were correlated with objectively identified injuries diagnosed after admission to hospital. For this evaluation, prehospital injury assessments rated moderate or severe by the emergency physician as well as injuries diagnosed in hospital with an AIS score ≥3 points were deemed relevant.
  
  
  RESULTS
  The 30,777 patients with an injury severity score (ISS) ≥ 9 suffered a total of 202,496 injuries and of these 26 % (51,839 out of 202,496) were considered relevant with an AIS ≥3 points. The most frequent relevant injuries were to the head (47 %) and chest (46 %). Of the 51,839 relevant injuries, the prehospital assessment by the emergency physician was accurate for 71 % and in 29 % of the cases relevant injuries were underestimated. Relevant injuries were unrecognized or underestimated in prehospital assessments for almost 1 out of every 7 cases of head trauma, almost 1 out of every 3 thoracic trauma and almost 1 out of every 2 abdominal and pelvic trauma.
  
  
  CONCLUSIONS
  The assessment of injury severity by emergency medical services physicians based on physical examination at the scene of the trauma is not very reliable. Thus, mechanisms of injury and overall presentation as well as identifiable injuries and vital parameters should be recognized by the emergency physician when considering treatment strategies and choice of appropriate destination hospital. The patient should be re-evaluated in a priority-oriented manner at the latest on arrival in the trauma room to avoid the consequences of unrecognized or underestimated injuries.
authors.affiliation: Orthopädie und Unfallchirurgie, Asklepios Krankenhaus Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Deutschland. EmrahEsmer@gmx.de.
authors.forename: E
authors.initials: E
authors.lastname: Esmer
authors.affiliation: Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Martin-Luther- Universität Halle-Wittenberg, Magdeburger Straße 22, 06112, Halle(Saale), Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: Derst
authors.affiliation: Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Lefering
authors.affiliation: Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Martin-Luther- Universität Halle-Wittenberg, Magdeburger Straße 22, 06112, Halle(Saale), Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Schulz
authors.affiliation: Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Martin-Luther- Universität Halle-Wittenberg, Magdeburger Straße 22, 06112, Halle(Saale), Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Siekmann
authors.affiliation: Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Martin-Luther- Universität Halle-Wittenberg, Magdeburger Straße 22, 06112, Halle(Saale), Deutschland.
authors.forename: K-S
authors.initials: KS
authors.lastname: Delank
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis* / Q000453:epidemiology*; D010820:Physicians / Q000706:statistics & numerical data*; D015995:Prevalence; D012042:Registries; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Emergency medical services; Injury; Multiple injuries; Severely injured; TraumaRegister DGU®