Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Coagulation disorders are of utmost importance in emergency surgery as well as for secondary organ failure of polytraumatized patients. In order to get hold of the early onset of these disorders, blood samples were harvested from 20 randomly selected patients (Injury Severity Score mean = 36.7 +/- 10.5) on the scene of emergency (mean = 18 [10-29] min after trauma) and at the time of hospital admission (mean = 78 [58-98] min after trauma). In addition to the activation of intravascular coagulation and the consumption of physiological inhibitors, high amounts (10- to 50-fold above normal) of degradation products (FgDP, FbDP, TDP, D-dimers) are present on the scene, already. The influence of hemodilution due to high-volume resuscitation is discussed.
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Multicenter Study Clinical Trial Controlled Clinical Trial
[Acute abdominal pain--standardized findings as diagnostic support. Results of a prospective multicenter intervention study and testing of a computer-assisted diagnosis system].
Despite powerful diagnostic tools (e.g. ultrasound, special laboratory investigations), the diagnosis of acute abdominal pain is still a considerable problem. Several studies in the UK have shown that the diagnostic accuracy can be improved by structured and standardized history taking and clinical examination and by computer-aided diagnosis. In the framework of a concerted action of the European Community we have conducted a prospective multicenter interventional trial comparing two consecutive phases: a) a baseline phase in clinical routine without additional intervention, b) a test phase with structured and standardized history and clinical examination (questionnaire, documentation programme). ⋯ Computer-aided diagnosis resulted in a diagnostic accuracy of 51%. The introduction of structured and standardized history taking and clinical examination has not brought any improvement of the good results in clinical routine. It is doubtful, whether existing systems of computer-aided diagnosis are able to significantly decrease the still remaining error rate of 20%.