[Management of polytrauma patients in an international comparison]

Worlwide there will be an increase in polytraumatized patients. The number of death after trauma will increase from 5.1 Mill. to 8.4 Mill. The reason is the technical progress in the third world. In western countries there was a decrease in trauma death, in Germany below 8,000 due to traffic accidents in 1998. In most countries the paramedic system and ATLS are established (USA, South Africa). Long rescue times and inadequate shock treatment preclinically are the biggest problems in Russia and Greece. Worldwide the institution of trauma centers (Level I, II, III) has brought much better results comparing to nontrauma centers but is economically expensive. The annual number of polytraumatized patients (Level I 600-1,000 severe trauma, > 65 personal experience) is essential for the success rate. Infrastrucure, Algorithmus and the personal experience of the trauma leader are the keys for optimal results. One parameter for Quality measurement is the number of potentially preventable deaths. Retrospective analysis of treatment protocols and pathological results by an expert team is the best practical way. The results of level I trauma teams reach between 1 and 2% preventable deaths. A further instrument of quality improvement are Trauma registers like in US and England (MTOS) and the German Trauma register of the German Society of Trauma. The Trauma register in Germany contents till now 2.069 polytraumatized patients. The lethality is 18.6% (ISS 21 +/- 13), comparing to MTOS (ISS 12.8 +/- 11.3, lethality 9.2%). The differences in injury pattern show in the US three times more penetrating injuries than in the German Traumaregister (21.1% versus 7.2%).