Ingo Marzi

University Hospital Frankfurt, Frankfurt, Hesse, Germany

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Publications (370)509.45 Total impact

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    ABSTRACT: Abstract Background: Trauma patients sustaining abdominal trauma exhibit high risk of organ failure and/or sepsis aggravating morbidity and mortality during the post-traumatic course. The present study re-evaluates L- and I-FABPs (small fatty acid binding proteins) as early biomarkers for abdominal injury (AI) in a large cohort of patients and analyzes their potential as indicators of specific organ failure and their association with sepsis and/or mortality in the post-traumatic course. Methods: This prospective study included 134 multiply traumatized patients (ISS≥16). Fifty-nine had AI (abbreviated AI Scale, AISAbd≥3) and 75 had no AI (noAI). Twenty healthy volunteers served as controls. Plasma I- and L-FABP levels were measured at the admittance to the emergency room (d0) and up to 10 days daily (d1-d10) using ELISA. Sepsis, organ failure, multiple organ failure (MOF) and mortality were assessed. Results: Median L- and I-FABP in the AI-group [258 (IQR=71-500) ng/mL and 328 (IQR=148-640) pg/mL, respectively] were higher compared to noAI-group [30 (IQR=18-50) ng/mL and 60 (IQR=40-202) pg/mL, p>0.05] on d0. Sensitivity and specificity to detect AI were 80% and 75% for L-FABP, 78% and 62% for I-FABP. Both FABPs decline with the post-traumatic course to control levels. On d0 and d1, FABPs correlate with the Sepsis-related Organ Failure Assessment (SOFA) score of the following day (d0: ρ:0.33, ρ:0.46, d1: ρ:0.48, ρ:0.35). No other correlations were found. Eight percent of all patients developed sepsis, 18% pneumonia, 4% urinary tract infection, 3% acute kidney failure and one MOF. FABPs correlated neither with Simplifed Acute Physiology Score (SAPS)-II nor to sepsis. All patients with acute kidney failure demonstrated enhanced L-FAPB levels before the increase of serum creatinine levels. Conclusions: Our results confirm the potential of L- and I-FABP to indicate abdominal injuries initially after trauma. Except L-FABP as indicator of acute kidney failure both FABPs have to be further evaluated as predictors for other organ failures, sepsis and/or mortality.
    Clinical chemistry and laboratory medicine : CCLM / FESCC. 10/2014;
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    ABSTRACT: Scoring systems commonly attempt to reduce complex clinical situations into one-dimensional values by objectively valuing and combining a variety of clinical aspects. The aim is to allow for a comparison of selected patients or cohorts. To appreciate the true value of scoring systems in patients with multiple injuries it is necessary to understand the different purposes of quantifying the severity of specific injuries and overall trauma load, being: (1) clinical decision making; (2) triage; (3) planning of trauma systems and resources; (4) epidemiological and clinical research; (5) evaluation of outcome and trauma systems, including quality assessment; and (6) estimation of costs and allocation of resources. For the first two, easy-to estimate scores with immediate availability are necessary, mainly based on initial physiology. More sophisticated scores considering age, gender, injury pattern/severity and more are usually used for research and outcome evaluation, once the diagnostic and therapeutic process has been completed. For score development large numbers of data are necessary and thus, it appears as a logical consequence that large registries as the TraumaRegister DGU(®) of the German Trauma Society (TR-DGU) are used to derive and validate clinical scoring systems. A variety of scoring systems have been derived from this registry, the majority of them with focus on hospital mortality. The most important among these systems is probably the RISC score, which is currently used for quality assessment and outcome adjustment in the annual audit reports. This report summarizes the various scoring systems derived from the TraumaRegister DGU(®) over the recent years.
    Injury 10/2014; 45 Suppl 3:S29-34. · 2.46 Impact Factor
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    ABSTRACT: The purpose of this work was to retrospectively evaluate clinical and radiological results after surgical treatment for scapholunate ligament ruptures.
    Der Orthopade. 08/2014;
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    ABSTRACT: OBJECTIVE. The optimal treatment of intervertebral disk lesions accompanying thoracolumbar fractures remains controversial. To evaluate short- and medium-term progression of intervertebral disk lesions accompanying vertebral fractures, MRI scans obtained after trauma were compared with scans obtained at an average follow-up of 1 year, by means of our clinically useful classification of traumatic intervertebral disk lesions. MATERIALS AND METHODS. MRI scans of 54 disks in patients with trauma-induced single-level thoracolumbar fractures were analyzed retrospectively. All patients underwent posterior stabilization using a titanium internal fixator. Exclusion criteria were malignant vertebral collapse, spondylodiskitis, osteoporotic fractures, and degenerative disk disease in the uninjured disks. Morphologic changes and signal alterations of the adjacent disks were compared using routine MRI scans obtained after trauma and at an average follow-up of 1 year. Disks were divided according to their signals into four categories, from grade 0 to grade 3. RESULTS. Of the disks studied after trauma (n = 54), 27.8% were determined to be grade 0, 31.5% were grade 2, and 40.7% were grade 3. In the follow-up examination, MRI detected grade 0 in 13% of disks. Hence, more than 50% of the disks with grade 0 after trauma changed into grade 2 lesions, resulting in 46.3% grade 2 lesions. Grade 3 disk lesions (40.7%) remained the same without any sign of recovery. CONCLUSION. In the current study, we found progressive disk degradation and creeping in instrumented and nonfused segments in thoracolumbar fractures. For further validation, randomized controlled long-term outcome investigations seem mandatory as the next step in future clinical research.
    AJR. American journal of roentgenology. 07/2014; 203(1):140-5.
  • B Auner, I Marzi
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    ABSTRACT: Multiple trauma in children is rare so that even large trauma centers will only treat a small number of cases. Nevertheless, accidents are the most common cause of death in childhood whereby the causes are mostly traffic accidents and falls. Head trauma is the most common form of injury and the degree of severity is mostly decisive for the prognosis. Knowledge on possible causes of injury and injury patterns as well as consideration of anatomical and physiological characteristics are of great importance for treatment. The differences compared to adults are greater the younger the child is. Decompression and stopping bleeding are the main priorities before surgical fracture stabilization. The treatment of a severely injured child should be carried out by an interdisciplinary team in an approved trauma center with expertise in pediatrics. An inadequate primary assessment involves a high risk of early mortality. On the other hand children have a better prognosis than adults with comparable injuries.
    Der Chirurg 05/2014; 85(5):451-64. · 0.52 Impact Factor
  • I Marzi, T Lustenberger
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    ABSTRACT: In patients with severe pelvic fractures, exsanguinating hemorrhage represents the major cause of death within the first 24 h. Despite advances in management, the mortality rate in these patients remains significantly high. Recently, multiple treatment algorithms have been proposed for patients with severe pelvic fractures; however, the optimal modalities in particular in the hemodynamically unstable patient are still a matter of lively debate.This review article focuses on the recent body of knowledge on the different treatment options in patients with severe pelvic fractures and proposes the possible role of each modality in the management of these patients. The MEDLINE database was searched for medical literature addressing the management of severe pelvic fractures with specific attention given to recent, clinically relevant publications. Angiography and embolization have emerged as excellent methods for addressing arterial bleeding. Mechanical pelvic stabilization and surgical hemostasis by pelvic packing, on the other hand, may effectively control venous bleeding and bleeding from the fractured bony surface. However, since there is no precise way to determine the major source of bleeding that is responsible for the hemodynamic instability, controversy remains over the timing and optimal order of angiography, mechanical pelvic stabilization, and packing. The author's own approach to these patients includes angiographic embolization as a first-line treatment only in hemodynamically stable patients with an arterial blush seen in the computed tomography scan, indicating acute arterial bleeding. Hemodynamically unstable patients are immediately transferred to the operating room, where pelvic packing and mechanical stabilization of the pelvic ring are carried out. Optionally, a subsequent postoperative angio-embolization is performed if signs of further bleeding remain present.
    Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. 04/2014;
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    ABSTRACT: To report our experience using C-arm cone beam CT (C-arm CBCT) combined with the new remote operated positioning and guidance system, iSYS1, for needle guidance during spinal interventions. A C-arm CBCT with a flat panel angiography system was acquired (Artis Zeego; Siemens Healthcare Sector, Forchheim, Germany). Reconstruction of CT-like images and planning of the needle path were performed using a common workstation. The needle holder of iSYS1 acted as a guide during insertion of Kirschner (K) wires. 20 percutaneous K wires were placed in the pedicles at T2-T3, T7-T12, and L1-L2 in a cadaver specimen. Postprocedure C-arm CBCT scans were obtained to confirm the accuracy of the K wire placement. All K wire placements were successfully performed. Mean planning time with Syngo iGuide was 4:16 min, mean positioning time of iSYS1 was 3:35 min, and mean placement time of the K wires was 2:22 min. Mean total intervention time was 10:13 min per pedicle. A mean deviation of 0.35 mm between the planned path and the placed K wire with a mean path length of 6.73 cm was documented. Our results demonstrate the potential of combining C-arm CBCT with iSYS1 for safe and accurate percutaneous placement of pedicle K wires in spinal interventions.
    Journal of Neurointerventional Surgery 03/2014; · 2.50 Impact Factor
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    ABSTRACT: Our goal was to assess the technical results in patients who underwent long-axis sacroplasty for the treatment of sacral insufficiency fractures (SIF) by radiofrequency-induced high-viscosity bone cement augmentation. Twelve patients with bilateral sacral fractures were treated by augmentation with radiofrequency-activated, high-viscosity polymethylmethacrylate (PMMA) bone cement under local anesthesia. CT-guided sacroplasty was performed by using a long-axis approach through a single entry point. Thirty-six vertebrae were treated in 12 sessions under a combination of CT and fluoroscopic guidance using a bilateral access and a cavity-creating osteotome prior to remote-controlled, hydraulically driven cement injection. The visual analogue scale (VAS) score before sacroplasty and at 1 and 3 months after the treatment was obtained. PMMA leaks were evaluated retrospectively using the post-interventional CT. The mean amount of high-viscosity PMMA injected per patient was 7.8 ml. No major adverse events were observed. In the first 4 days after the procedure, the mean VAS score decreased from 8.1 ± 1.9 to mean 3.1 ± 1.2 and was followed by a gradual but continuous decrease throughout the rest of the follow-up period at 24 weeks (mean 2.2 ± 1.1) and 48 weeks (mean 2.1 ± 1.4). CT fluoroscopy-guided sacral augmentation was safe and effective in all 12 patients with osteoporotic SIF.
    Skeletal Radiology 01/2014; · 1.74 Impact Factor
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    ABSTRACT: Background. Hypoxia-inducible factor-1 α (HIF-1 α ) and NF- κ B play important roles in the inflammatory response after hemorrhagic shock and resuscitation (H/R). Here, the role of myeloid HIF-1 α in liver hypoxia, injury, and inflammation after H/R with special regard to NF- κ B activation was studied. Methods. Mice with a conditional HIF-1 α knockout (KO) in myeloid cell-line and wild-type (WT) controls were hemorrhaged for 90 min (30 ± 2 mm Hg) and resuscitated. Controls underwent only surgical procedures. Results. After six hours, H/R enhanced the expression of HIF-1 α -induced genes vascular endothelial growth factor (VEGF) and adrenomedullin (ADM). In KO mice, this was not observed. H/R-induced liver injury in HIF-1 α KO was comparable to WT. Elevated plasma interleukin-6 (IL-6) levels after H/R were not reduced by HIF-1 α KO. Local hepatic hypoxia was not significantly reduced in HIF-1 α KO compared to controls after H/R. H/R-induced NF- κ B phosphorylation in liver did not significantly differ between WT and KO. Conclusions. Here, deleting HIF-1 α in myeloid cells and thereby in Kupffer cells was not protective after H/R. This data indicates that other factors, such as NF- κ B, due to its upregulated phosphorylation in WT and KO mice, contrary to HIF-1 α , are rather key modulators of inflammation after H/R in our model.
    Mediators of Inflammation 01/2014; 2014:930419. · 3.88 Impact Factor
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    ABSTRACT: Chronic ethanol abuse is known to increase susceptibility to infections after injury, in part, by modification of macrophage function. Several intracellular signalling mechanisms are involved in the initiation of inflammatory responses, including the nuclear factor- κ B (NF- κ B) pathway. In this study, we investigated the systemic and hepatic effect of chronic ethanol feeding on in vivo activation of NF- κ B in NF- κ B(EGFP) reporter gene mice. Specifically, the study focused on Kupffer cell proinflammatory cytokines IL-6 and TNF- α and activation of NF- κ B after chronic ethanol feeding followed by in vitro stimulation with lipopolysaccharide (LPS). We found that chronic ethanol upregulated NF- κ B activation and increased hepatic and systemic proinflammatory cytokine levels. Similarly, LPS-stimulated IL-1 β release from whole blood was significantly enhanced in ethanol-fed mice. However, LPS significantly increased IL-6 and TNF- α levels. These results demonstrate that chronic ethanol feeding can improve the responsiveness of macrophage LPS-stimulated IL-6 and TNF- α production and indicate that this effect may result from ethanol-induced alterations in intracellular signalling through NF- κ B. Furthermore, LPS and TNF- α stimulated the gene expression of different inflammatory mediators, in part, in a NF- κ B-dependent manner.
    Mediators of Inflammation 01/2014; 2014:808695. · 3.88 Impact Factor
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    ABSTRACT: Treating large bone defects represents a major challenge in traumatic and orthopedic surgery. Bone tissue engineering provides a promising therapeutic option to improve the local bone healing response. In the present study tissue biocompatibility, systemic toxicity and tumorigenicity of a newly developed composite material consisting of polylactic acid (PLA) and 20% or 40% bioglass (BG20 and BG40), respectively, were analyzed. These materials were seeded with mesenchymal stem cells (MSC) and endothelial progenitor cells (EPC) and tested in a rat calvarial critical size defect model for 3 months and compared to a scaffold consisting only of PLA. Serum was analyzed for organ damage markers such as GOT and creatinine. Leukocyte count, temperature and free radical indicators were measured to determine the degree of systemic inflammation. Possible tumor occurrence was assessed macroscopically and histologically in slides of liver, kidney and spleen. Furthermore, the concentrations of serum malondialdehyde (MDA) and sodium oxide dismutase (SOD) were assessed as indicators of tumor progression. Qualitative tissue response towards the implants and new bone mass formation was histologically investigated. BG20 and BG40, with or without progenitor cells, did not cause organ damage, long-term systemic inflammatory reactions or tumor formation. BG20 and BG40 supported bone formation, which was further enhanced in the presence of EPCs and MSCs. This investigation reflects good biocompatibility of the biomaterials BG20 and BG40 and provides evidence that additionally seeding EPCs and MSCs onto the scaffold does not induce tumor formation.
    PLoS ONE 01/2014; 9(2):e87642. · 3.53 Impact Factor
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    ABSTRACT: Arbeitsbedingte HIV-Übertragungen bei medizinischem Personal sind selten, wurden jedoch in der Literatur wiederholt beschrieben. Der frühzeitige Beginn der medikamentösen HIV-Postexpositionsprophylaxe (HIV-PEP) ist entscheidend, um eine Infektion nach Virustransmission zu verhindern. Die Frage, ob eine HIV-PEP erforderlich ist, muss deswegen umgehend geklärt werden. Hier stellen wir ein Interventionsprogramm in einem Universitätsklinikum vor, das einen Vollzeitzugang (24-7-365) für Mitarbeiter nach beruflicher HIV-Exposition bietet.
    Der Chirurg 01/2014; 85(1). · 0.52 Impact Factor
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    ABSTRACT: Sprunggelenkverletzungen gehören zu den häufigsten Verletzungen im Kindesalter. Dennoch sind Untersuchungen zur Epidemiologie und Langzeitfolgen an großen Fallzahlen selten. In der gesetzlichen Unfallversicherung werden große Patientenkollektive mittels eines standardisierten Dokumentationssystems erfasst. Mit Hilfe dieser Datenbank wurden retrospektiv Daten der Unfallkasse Hessen zur Epidemiologie, Therapie, Komplikationen und zum langfristigen Outcome von Sprunggelenkverletzungen bei Schülern (Am häufigsten lagen den Sprunggelenkverletzungen Unfälle im Sport (33 %), in der Pause (24 %) und im Treppenhaus (18 %) der Schule zugrunde. In 21 % der Fälle lag eine Bandverletzung vor, in 79 % eine Fraktur. Die durchschnittliche Behandlungszeit (Median) betrug 45 Tage. Bei 11 Patienten wurde ein Rentengutachten erstellt, bei 4 Patienten verblieb eine dauerhafte Minderung der Erwerbsfähigkeit von 10 %. Relevante Langzeitfolgen von kindlichen Sprunggelenksverletzungen werden somit im berufsgenossenschaftlichen Heilverfahren selten festgestellt.
    Trauma und Berufskrankheit 01/2014; 16(1).
  • M Voth, C Nau, I Marzi
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    ABSTRACT: Spinal injuries are generally very rare in childhood. Fractures of the thoracic and lumbar spine occur mainly in older children and adolescents. Exact knowledge of the anatomy is essential for accurate diagnosis in still incomplete ossification. With increasing age the classification can be performed by using the AO classification over the age of 8 years. Neurological symptoms in the thoracic and lumbar spine occur mainly in adolescence. Conventional radiography is the standard diagnostic tool for thoracic and lumbar spinal injuries. With the appearance of abnormal neurological deficits magnetic resonance imaging (MRI) diagnostics should also be performed and for operative cases computed tomography (CT) scans are mandatory. The most common fractures of the thoracic and lumbar spine are compression fractures (type A) which can generally be treated conservatively due to the stable situation but unstable fractures of the thoracic and lumbar spine (types B and C) are stabilized dorsally (internal fixation). Ventral stabilization with vertebral body replacement is occasionally necessary in adolescents. Spinal injuries in children have a good overall prognosis.
    Der Unfallchirurg 12/2013; 116(12):1062-1068. · 0.64 Impact Factor
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    ABSTRACT: Occupational transmission of HIV among healthcare personnel is rare but has repeatedly been published in the literature. Early initiation of postexposure HIV prophylaxis (HIV-PEP) is crucial to prevent virus transmission. For this reason the need for HIV-PEP has to be evaluated immediately and if necessary, started as soon as possible. This article presents an early intervention program in a university hospital which enables healthcare personnel immediate 24/7/365 access to a HIV-PEP prophylaxis kit following occupational HIV exposure.
    Der Chirurg 11/2013; · 0.52 Impact Factor
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    ABSTRACT: The Masquelet induced membrane technique for reconstructing large diaphyseal defects has been shown to be a promising clinical treatment, yet relatively little is known about the cellular, histological and biochemical make-up of these membranes and how they produce this positive clinical outcome. We compared cellular make-up, histological changes and growth factor expression in membranes induced around femur bone defects and in subcutaneous pockets at 2, 4 and 6 weeks after induction, and to the periosteum. We found that membranes formed around bone defects were similar to those formed in subcutaneous pockets; however, both were significantly different from periosteum with regard to structural characteristics, location of blood vessels and overall thickness. Membranes induced at the femur defect (at 2 weeks) and in periosteum contain mesenchymal stem cells (MSCs; STRO-1+) which were not found in membranes induced subcutaneously. BMP-2, TGFβ and VEGF were significantly elevated in membranes induced around femur defects in comparison to subcutaneously induced membranes, whereas SDF-1 was not detectable in membranes induced at either site. We found that osteogenic and neovascular activity had mostly subsided by 6 weeks in membranes formed at both sites. It was conclude that cellular composition and growth factor content in induced membranes depends on the location where the membrane is induced and differs from periosteum. Osteogenic and neovascular activity in the membranes is maximal between 2 and 4 weeks and subsides after 6. Based on this, better and quicker bone healing might be achieved if the PMMA cement were replaced with a bone graft earlier in the Masquelet technique. Copyright © 2013 John Wiley & Sons, Ltd.
    Journal of Tissue Engineering and Regenerative Medicine 11/2013; · 4.43 Impact Factor
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    ABSTRACT: Multislice computed tomography (MSCT) is the diagnostic criterion standard for the initial evaluation of patients with suspected multiple injuries. Besides scanning for injuries directly related to the initial trauma, MSCT scans can reveal pathologies unrelated to the trauma of clinical relevance.The aim of the present study was to determine the frequency and follow-up course of incidental findings in patients with multiple injuries. This is a retrospective analysis of prospectively collected data on 2,242 patients with suspected multiple injuries at a Level I trauma center from 2006 to 2010.The MSCT reports were retrospectively reviewed regarding abnormal findings not related to trauma. These incidental findings were classified on a four-point level scoring system with respect to clinical importance and urgency for further diagnostic and therapeutic procedures. During initial trauma center evaluation in the emergency department, 2,246 patients met our inclusion criteria. A total of 2,036 patients (90.7%) underwent MSCT; 1,142 (50.9%) of the patients had one or more incidental findings. A total of 2,844 incidental findings were detected. Overall, 349 tumor findings were noted (12.3% of all incidental findings); 113 findings were suspicious for malignant processes or metastasis. According to our classification, 168 (5.9%) of the incidental findings required urgent follow-up (Level 4), and 527 (18.5%) of the incidental findings required a follow-up before discharge (Level 3). MSCT in patients with multiple injuries reveals one or more incidental findings in more than one of two patients. A scoring system classifying for relevance of incidental findings was introduced and could be applied in routine trauma care in the future. Epidemiologic study, level III.
    The journal of trauma and acute care surgery. 10/2013; 75(5):848-53.
  • European Journal of Trauma and Emergency Surgery 10/2013; · 0.26 Impact Factor
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    ABSTRACT: After severe multiple injuries (first hit) a two-phase immunological response with early hyperinflammation followed by immunosuppression can be observed. This process involves a variety of humoral and cellular factors. Depending on the individual predisposition, overall injury severity and injury pattern, both reactions can lead to sepsis and multiorgan failure. Various clinical and intensive care parameters indicate stabilization of specific organ functions. The clinical course can be positively influenced by adequate intensive care therapy, avoiding iatrogenic second hits by non-emergency surgical interventions during a phase of immunological dysregulation. Important decision parameters besides time to initial trauma include adequate oxygenation, no coagulopathy, declining inflammatory mediators and normalized serum lactate.
    Der Chirurg 08/2013; · 0.52 Impact Factor
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    ABSTRACT: Background: The number of patients in German emergency departments has been rising for years. This means additional need of staff and infrastructure for hospitals.Methods: In this monocentric retrospective analysis the patient population of the central emergency department (ZNA) at the university hospital Frankfurt was investigated. Major symptoms, diagnoses with respect to diagnose-related groups and modes of admission to the emergency department have been analyzed.Results: During 3 months, a total of 7376 patients presented to the ZNA. Analysis focused on 2186 patients referred to the department of internal medicine: most patients presented spontaneously (50.6 %), 38.2 % were admitted by ambulance services, only 9.7 % were admitted by a primary physician. 44.9 % of these patients were hospitalized, mainly with cardiological, pneumological and gastroenterological disorders. The predominant major symptoms were acute chest pain (15.4 %), abdominal pain (7.1 %) and syncope or collapse (6.1 %). Patients hospitalized via ZNA contributed 31.9 % of the total revenues of internal medicine departments. 31.7 % of all hospitalized patients were admitted to the hospital by the ZNA.Conclusion: Emergency departments become more and more a regular part of ambulatory patients health care and contribute efficiently to the economic revenue of hospitals.
    DMW - Deutsche Medizinische Wochenschrift 07/2013; 138(27):1401-1405. · 0.65 Impact Factor

Publication Stats

3k Citations
509.45 Total Impact Points

Institutions

  • 2008–2014
    • University Hospital Frankfurt
      Frankfurt, Hesse, Germany
  • 2002–2014
    • Goethe-Universität Frankfurt am Main
      • • Klinik für Unfall-, Hand-, und Wiederherstellungschirurgie
      • • Zentrum der Chirurgie
      Frankfurt, Hesse, Germany
  • 2006–2012
    • Medical University of South Carolina
      • Department of Pharmaceutical Sciences
      Charleston, South Carolina, United States
  • 2011
    • Universität Witten/Herdecke
      • Institute for Research in Operative Medicine (IFOM)
      Witten, North Rhine-Westphalia, Germany
  • 2010
    • Universitätsmedizin Göttingen
      • Department of Trauma Surgery and Orthopedics
      Göttingen, Lower Saxony, Germany
  • 2007–2009
    • Orthopädische Universitätsklinik Friedrichsheim
      Frankfurt, Hesse, Germany
  • 1990–2003
    • Universität des Saarlandes
      • • Klinik für Unfall-, Hand- und Wiederherstellungschirurgie
      • • Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie
      Saarbrücken, Saarland, Germany
  • 2000
    • University of Cologne
      Köln, North Rhine-Westphalia, Germany
  • 1993
    • Ludwig Boltzmann Institute for Experimental and Clinical Traumatology
      Wien, Vienna, Austria
  • 1989–1992
    • University of North Carolina at Chapel Hill
      • Department of Pharmacology
      Chapel Hill, NC, United States