Der Unfallchirurg
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Trauma represents one of the leading causes of death in children. Beside an injury pattern that differs from adult trauma patients, children seem to develop multiple organ dysfunction syndrome (MODS) less frequently. Compared to adult MODS, pediatric MODS has also been described to occur earlier in the posttraumatic course. ⋯ Therefore, the purpose of this review is to summarize current knowledge on this topic in order to investigate the prognostic significance of different parameters.
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Since the implementation of the diagnosis-related system there has been a continuous lack of finances in the treatment of multiple injured patients. The current investigation summarizes consecutive patients from a level I trauma centre and tests the hypothesis that an injury severity score (ISS) based reimbursement would be an improvement in the cost-effectiveness of this patient population. ⋯ Improvements have been made with the recent adjustment of the reimbursement within the last year. Nevertheless, several factors identified in this study require additional adjustment: the ISS, the requirement of blood transfusion and the presence of additional chest trauma should be weighted in the calculation of reimbursement.
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Injuries to the scapholunate ligament are the most frequent cause of carpal instability. Therefore, if a scapholunate lesion is not diagnosed, it may result in a severe dysfunction of the wrist. ⋯ The diagnostic of an isolated ligament lesion and a ligament injury associated with a fracture of the distal radius is presented. Finally, an algorithm for treatment based on the stage of injury is proposed.
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Despite advances in medicine in head trauma management, traumatic brain injury (TBI) still remains a serious health concern, affecting people regardless of age. It is a leading cause of morbidity and mortality particularly in children and young adults. Therefore, studies are being carried out to try to establish reliable biomarkers to improve the accuracy of TBI diagnosis and associated secondary pathologies. ⋯ This review provides a critical assessment of biomarkers currently under investigation and their clinical value for the diagnosis, treatment and outcome prediction of TBI.