Christian Probst

Universität Witten/Herdecke, Witten, North Rhine-Westphalia, Germany

Are you Christian Probst?

Claim your profile

Publications (114)130.03 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Cerebral air embolism (CAE) is a common, often lethal, complication in blunt and penetrating chest trauma. The factors affecting the outcome of CAE patients are poorly understood, and there is no generally accepted treatment algorithm. In this report, we present the case of a 28-year-old male motorcyclist with a massive CAE, including bilateral internal carotid artery air on computed tomographic examination following blunt chest trauma. With prehospital intubation, oxygen, transfusion, and open laparotomy but without any specific treatment regarding the CAE, a follow-up computed tomography (CT) scan approximately 6 hours later showed resolution of the cerebrovascular air. Recovery was unremarkable, and the patient was discharged neurologically intact after 22 days.
    Canadian Journal of Emergency Medicine 04/2015; DOI:10.1017/cem.2014.78 · 0.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Limiting the morbidity of open fractures requires highly specific initial treatment. In addition to a stringent surgical strategy, correct antibiotic prophylaxis seems to be associated with an improved outcome. In the current literature, the duration and type of antibiotic prophylaxis are under discussion. The aim of the study was to survey the current initial treatment regimes for open fractures in German emergency departments. With an online-based anonymous 16-item questionnaire all 3006 members of the German Trauma Society were surveyed. A total of 585 questionnaires (19.5 %) were returned completed. This article presents a descriptive analysis of the current state of treatment. Mainly specialists (35 %), senior physicians (30 %) and chief physicians (17 %) answered as well as interns (8 %) and out-patient practitioners (10 %). Of the participants 65 % did not accept the classification of emergency services; however, 93 % carried out urgent or emergency surgery, 84 % started an antibiotic prophylaxis in the emergency department and 63 % used a standard operating procedure (SOP). A total of 60 % used 1 antibiotic drug, 25 % used 2 and 15 % used 3 or more substances. An antibiotic treatment for more than 3 days was performed by 60 % of participants. The early initiation of antibiotic prophylaxis seems to be the standard practice in German emergency departments as well as early surgery. Strategies to improve the communication between prehospital and in-hospital teams, as well as graded antibiotic prophylaxis depending on the severity of soft tissue damage are needed.
    Der Unfallchirurg 01/2015; DOI:10.1007/s00113-014-2683-3 · 0.61 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Uncontrolled bleeding is the leading cause of shock in trauma patients and delays in recognition and treatment have been linked to adverse outcomes. For prompt detection and management of hypovolaemic shock, ATLS® suggests four shock classes based upon vital signs and an estimated blood loss in percent. Although this classification has been widely implemented over the past decades, there is still no clear prospective evidence to fully support this classification. In contrast, it has recently been shown that this classification may be associated with substantial deficits. A retrospective analysis of data derived from the TraumaRegister DGU® indicated that only 9.3% of all trauma patients could be allocated into one of the ATLS® shock classes when a combination of the three vital signs heart rate, systolic blood pressure and Glasgow Coma Scale was assessed. Consequently, more than 90% of all trauma patients could not be classified according to the ATLS® classification of hypovolaemic shock. Further analyses including also data from the UK-based TARN registry suggested that ATLS® may overestimate the degree of tachycardia associated with hypotension and underestimate mental disability in the presence of hypovolaemic shock. This finding was independent from pre-hospital treatment as well as from the presence or absence of a severe traumatic brain injury. Interestingly, even the underlying trauma mechanism (blunt or penetrating) had no influence on the number of patients who could be allocated adequately. Considering these potential deficits associated with the ATLS® classification of hypovolaemic shock, an online survey among 383 European ATLS® course instructors and directors was performed to assess the actual appreciation and confidence in this tool during daily clinical trauma care. Interestingly, less than half (48%) of all respondents declared that they would assess a potential circulatory depletion within the primary survey according to the ATLS® classification of hypovolaemic shock. Based on these observations, a critical reappraisal of the current ATLS® classification of hypovolaemic seems warranted.
    Injury 10/2014; 45:S35–S38. DOI:10.1016/j.injury.2014.08.015 · 2.46 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Trauma related injuries are a main cause for long-lasting morbidity and disability especially in younger patients with their productive years ahead. On a routine basis, we assessed health related quality of life two years after trauma of severely injured patients at our level-I trauma centre via posted survey.
    Injury 10/2014; 45 Suppl 3:S100-5. DOI:10.1016/j.injury.2014.08.028 · 2.46 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: While a kite surfer was preparing the kite it was caught by a gust of wind, which blew it 10 m into the air and the cords became entangled around the neck of the kite surfer causing strangulation. After admittance to hospital, the diagnostics revealed multiple injuries including a bilateral dissection of the internal carotid arteries, cerebral edema and multiple fractures. As kitesurfing is gaining popularity severe injuries are becoming more frequent. Safety precautions, such as preparing the kite with two persons, wearing safety equipment and using bars with a safety leash can prevent severe injuries.
    Der Unfallchirurg 08/2014; DOI:10.1007/s00113-014-2641-0 · 0.61 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In recent years, the treatment of trauma-associated coagulopathy and bleeding has advanced enormously. The aim of this study was to assess the current practice of coagulation and transfusion management in Germany.
    Der Unfallchirurg 06/2014; DOI:10.1007/s00113-014-2596-1 · 0.61 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Recently, our group has proposed a new classification of hypovolemic shock based on the physiological shock marker base deficit (BD). The classification consists of four groups of worsening BD and correlates with the extent of hypovolemic shock in severely injured patients. The aim of this study was to test the applicability of our recently proposed classification of hypovolemic shock in the context of severe traumatic brain injury (TBI). Between 2002 and 2011, patients >=16 years in age with an AIShead >= 3 have been retrieved from the German TraumaRegister DGU(R) database. Patients were classified into four strata of worsening BD [(class I (BD <= 2 mmol/l), class II (BD > 2.0 to 6.0 mmol/l), class III (BD > 6.0 to 10 mmol/l) and class IV (BD > 10 mmol/l)] and assessed for demographic and injury characteristics as well as blood product transfusions and outcomes. The cohort of severely injured patients with TBI was compared to a population of all trauma patients to assess possible differences in the applicability of the BD based classification of hypovolemic shock. From a total of 23,496 patients, 10,201 multiply injured patients with TBI (AIShead >= 3) could be identified. With worsening of BD, a consecutive increase of mortality rate from 15.9% in class I to 61.4% in class IV patients was observed. Simultaneously, injury severity scores increased from 20.8 (+/-11.9) to 41.6 (+/-17). Increments in BD paralleled decreasing hemoglobin, platelet counts and Quick's values. The number of blood units transfused correlated with worsening of BD. Massive transfusion rates increased from 5% in class I to 47% in class IV. Between multiply injured patients with TBI and all trauma patients, no clinically relevant differences in transfusion requirement or massive transfusion rates were observed. The presence of TBI has no relevant impact on the applicability of the recently proposed BD-based classification of hypovolemic shock. This study underlines the role of BD as a relevant clinical indicator of hypovolaemic shock during the initial assessment in respect to haemostatic resuscitation and transfusion requirements.
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 04/2014; 22(1):28. DOI:10.1186/1757-7241-22-28 · 1.93 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In the severely injured who survive the early posttraumatic phase, multiple-organ failure (MOF) is the main cause of morbidity and mortality. An enhanced prediction of MOF might influence individual monitoring and therapy of severely injured patients. We performed a retrospective analysis of a nationwide prospective database, the TraumaRegister DGU of the German Trauma Society. Patients with complete data sets (2002-2011) and a relevant trauma load (Injury Severity Score [ISS] ≥ 16), who were admitted to an intensive care unit, were included. Of a total of 31,154 patients enclosed in this study, 10,201 (32.7%) developed an MOF according to the Sequential Organ Failure Assessment score. During the study period, mortality of all patients decreased from 18.1% in 2002 to 15.3% in 2011 (p < 0.001). Meanwhile, MOF occurred significantly more often (24.6% in 2002 vs. 31.5% in 2011, p < 0.001), but mortality of MOF patients decreased (42.6% vs. 33.3%, p < 0.001). MOF patients who died survived 2 days less (11 days in 2002 vs. 8.9 days in 2011, p < 0.001). Independent risk factors for the development of MOF following severe trauma were age, ISS, head Abbreviated Injury Scale (AIS) score of 3 or higher, thoracic AIS score of 3 or higher, male sex, Glasgow Coma Scale (GCS) score of 8 or less, mass transfusion, base excess of less than -3, systolic blood pressure less than 90 mm Hg at admission, and coagulopathy. Over one decade, we observed an ongoing decrease of mortality after multiple trauma, accompanied by decreasing mortality in the subgroup with MOF. However, incidence of MOF in the severely injured increased significantly. Thus, MOF after multiple trauma remains a challenge in intensive care. The risk factors from multivariate analysis could be instrumental in anticipating the early development of MOF. Furthermore, a reliable prediction model might be supportive for patient enrolment in trauma studies, in which MOF marks the primary end point. Epidemiologic study, level III.
    04/2014; 76(4):921-8. DOI:10.1097/TA.0000000000000199
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Several studies have indicated that younger age is associated with worse recovery after pediatric traumatic brain injury (TBI) compared to elder children. In order to verify this association between long-term outcome after moderate to severe TBI and patient's age, direct comparison between different pediatric age groups as well as an adult population was performed. This investigation represents a retrospective cohort study at a level I trauma center including patients with moderate to severe, isolated TBI with a minimum follow-up of 10 years. According to their age at time of injury, patients were divided in pre-school (0-7 years), school (8-17 years) and adult (18-65 years) patients. Physical examination and standardized questionnaire on physical and psychological aspects (Glasgow Outcome Scale, Barthel Index, Impact of Event Scale, Hospital Anxiety and Depression Scale, short form 12) were performed. 135 traumatized patients were included. Physical and psychological long-term outcome was associated with injury severity but not with patients' age at time of injury. Outcome recovery measured by Glasgow Outcome Scale was demonstrated with best results for pre-school aged children (p = 0.009). According to the Hospital Anxiety and Depression Scale an increased incidence of anxiety (p = 0.010) and depression (p = 0.026) was evaluated in older patients. Long-term outcome perceptions after moderate to severe TBI presented in this study question current views of deteriorated recovery for the immature brain. The sustained TBI impact seemed not to reduce the child's ability to overcome the suffered impairment measured by questionnaire based psychological, physical and health related outcome scores. These results distinguish the relevance of rehabilitation and family support in the long term.
    Health and Quality of Life Outcomes 02/2014; 12(1):26. DOI:10.1186/1477-7525-12-26 · 2.10 Impact Factor
  • Zeitschrift fur Orthopadie und Unfallchirurgie 02/2014; 152(1):6-8. · 0.62 Impact Factor
  • Journal of injury & violence research 12/2013; DOI:10.5249/jivr.v7i2.561
  • Transfusion Medicine 11/2013; DOI:10.1111/tme.12089 · 1.31 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Reanimationen nach Trauma haben eine schlechte Prognose, und manche Experten diskutieren, ob die Initiierung von Reanimationsmaßnahmen überhaupt sinnvoll ist. Der Beitrag erörtert diese Frage anhand aktueller Studien und unter Berücksichtigung der ERC-Guidelines sowie der S3-Leitlinie Polytrauma.Recherche und Auswertung von Literatur und klinischen Studien.Die vorliegenden Studien zeigen, dass es Überlebende nach Traumareanimationen gibt. Der Anteil der Patienten, die nach präklinischer Reanimation die Klinik lebend verlassen, liegt zwischen 2 % und 7 %. Mehr als die Hälfte dieser Patienten hat ein neurologisches Defizit. Das rasche Erkennen eines Spannungspneumothorax und die Thoraxkompression können für das Überleben entscheidend sein.Bei Vorliegen eines Kreislaufstillstands nach Trauma soll unverzüglich mit der Reanimation begonnen werden, wenn keine sicheren Todeszeichen oder mit dem Leben nicht vereinbare Verletzungen vorliegen.
    Notfall 11/2013; 16(7). DOI:10.1007/s10049-013-1714-x · 0.32 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients of motor vehicle crashes (MVCs) suffering burns are challenging for the rescue team and the admitting hospital. These patients often face worse outcomes than crash patients with trauma only. Our analysis of the German In-depth Accident Study (GIDAS) database researches the detailed crash mechanisms to identify potential prevention measures. We analyzed the 2011 GIDAS database comprising 14,072 MVC patients and compared individuals with (Burns) and without (NoBurns) burns. Only complete data sets were included. Patients with burns obviously resulting of air bag deployment only were not included in the Burns group. Data acquisition by an on call team of medical and technical researchers starts at the crash scene immediately after the crash and comprises technical data as well as medical information until discharge from the hospital. Statistical analysis was done by Mann-Whitney-U-test. Level of significance was p<0.05. 14,072 MVC patients with complete data sets were included in the analysis. 99 individuals suffered burns (0.7%; group "Burns"). Demographic data and injury severity showed no statistical significant difference between the two groups of Burns and NoBurns. Injury severity was measured using the Injury Severity Score (ISS). Direct frontal impact (Burns: 48.5% vs. NoBurns: 33%; p<0.05) and high-energy impacts as represented by delta-v (m/s) (Burns: 33.5±21.4 vs. NoBurns: 25.2±15.9; p<0.05) were significantly different between groups as was mortality (Burns: 12.5% vs. NoBurns: 2.1%; p<0.05). Type of patients' motor vehicles and type of crash opponent showed no differences. Our results show, that frontal and high-energy impacts are associated with a frequency of burns. This may serve automobile construction companies to improve the burn safety to prevent flames spreading from the motor compartment to the passenger compartment. Communities may impose speed limits in local crash hot spots.
    Burns: journal of the International Society for Burn Injuries 10/2013; 39(8). DOI:10.1016/j.burns.2013.09.014 · 1.84 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Traumatic Brain Injury (TBI) may lead to significant impairments in personal, social and professional life. However, knowledge of the influence on long-term outcome after TBI is sparse. We therefore aimed to investigate the subjective effects of TBI on long-term outcome at a minimum of 10 years after trauma in one of the largest study populations in Germany. The current investigation represents a retrospective cohort study at a level I trauma center including physical examination or standardized questionnaires of patients with mild, moderate or severe isolated TBI with a minimum follow-up of 10 years. We investigated the subjective physical, psychological and social outcome evaluating the Glasgow Outcome Scale, short-form 12, and social as well as vocational living circumstances. 368 patients aged 0 to 88 years were included. Patients with severe TBI were younger compared to patients with moderate or mild TBI (p < 0.05). Patients with severe TBI lived more often as single after the trauma impact. A significantly worse outcome was associated with higher severity of TBI resulting in an increased incidence of mental disability. A professional decline was analyzed in case of severe TBI resulting in significant loss of salary. The severity of TBI significantly influenced the subjective social and living conditions. Subjective mental and physical outcome as well as professional life depended on the severity of TBI 10 years after the injury.
    Patient Safety in Surgery 10/2013; 7(1):32. DOI:10.1186/1754-9493-7-32
  • 10/2013; 75(4):745-746. DOI:10.1097/01.ta.0000436143.54880.14
  • [Show abstract] [Hide abstract]
    ABSTRACT: Trauma management in the emergency room is an important part of the treatment chain of the severely injured. Important decisions with respect to diagnostics and treatment must be made under time pressure. Successful trauma management in the emergency room requires a hospital tailored treatment protocol. This written protocol needs consent from all participating disciplines and must be known by all members of the resuscitation team. The ATLS® and the recently published clinical practice guidelines on multiple trauma can be of help in order to establish or update such protocols. In order to continuously evaluate and improve performance in the emergency room local quality circles are needed that truly follow that aim. Important factors are reliability of agreement between the different disciplines and continuous communication of results to the team members. In order to be successful such quality circles need people that care.
    Der Chirurg 08/2013; 84(9). DOI:10.1007/s00104-013-2476-1 · 0.52 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Laryngeal injuries are rare but potentially life-threatening injuries. Due to the topography of the neck, accompanying injuries of the greater blood vessels, cervical nerves, thoracic organs and spinal cord are common. Therefore in initial diagnostics, these must be excluded from injuries which determine the prognosis. A patient presented with ventral perforation of the larynx, initial dyspnea, hematemesis and left-sided emphysema of the neck. Cause of the findings, we treated the patient non-operatively in interdisciplinary consensus.
    Der Unfallchirurg 08/2013; 117(6). DOI:10.1007/s00113-013-2485-z · 0.61 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Musculoskeletal injuries are common in patients with multiple trauma resulting in pain, functional deficits, and disability. Traumatic brain injuries (TBIs) are common in severely injured patients potentially resulting in neurological impairment and permanent disability that would add to that from the musculoskeletal injuries. However, it is unclear to what degree the combination affects impairment. QUESTIONS/PURPOSES: We therefore asked whether added upper extremity injuries or TBI worsened the functional, psychological, and vocational status in multiple trauma patients. METHODS: We retrospectively reviewed 281 patients with multiple trauma: 229 with upper extremity injuries but without TBI (Group I), 32 with concomitant upper extremity injuries and TBI (Group II), and 20 with TBI but no upper extremity injuries (Group III). We assessed patients with the Glasgow Outcome Score (GOS), Hannover Score for Polytrauma Outcome, SF-12 (Physical Component Summary Score and Mental Component Summary Score), medical aid requirements, need of psychological support, and vocational living circumstances. The minimum followup was 10 years (median, 17.5 years; range, 10-28 years). RESULTS: Additional TBI in multiple trauma patients led to reduced function (GOS: Group I: 4.9 ± 0.2, Group II: 4.5 ± 0.7, Group III: 4.5 ± 0.8) resulting in vocational restrictions (job change: Group I: 74%, Group II: 91%, Group III: 90%). The combination of upper extremity and TBIs did not result in worse long-term scores compared with TBI alone. CONCLUSIONS: Rehabilitation and social reintegration in multiple trauma patients with TBI requires particular emphasis to minimize disability and vocational isolation. Musculoskeletal injuries should not be neglected to ensure the maximum extremity function given the impaired cognitive functions after TBI. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 05/2013; 471(9). DOI:10.1007/s11999-013-3031-6 · 2.88 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We report the functional and socioeconomic long-term outcome of patients with pelvic ring injuries. We identified 109 patients treated at a Level I trauma centre between 1973 and 1990 with multiple blunt orthopaedic injuries including an injury to the pelvic ring, with an Injury Severity Score (ISS) of ≥ 16. These patients were invited for clinical review at a minimum of ten years after the initial injury, at which point functional results, general health scores and socioeconomic factors were assessed. In all 33 isolated anterior (group A), 33 isolated posterior (group P) and 43 combined anterior/posterior pelvic ring injuries (group A/P) were included. The mean age of the patients at injury was 28.8 years (5 to 55) and the mean ISS was 22.7 (16 to 44). At review the mean Short-Form 12 physical component score for the A/P group was 38.71 (22.12 to 56.56) and the mean Hannover Score for Polytrauma Outcome subjective score was 67.27 (12.48 to 147.42), being significantly worse compared with the other two groups (p = 0.004 and p = 0.024, respectively). A total of 42 patients (39%) had a limp and 12 (11%) required crutches. Car or public transport usage was restricted in 16 patients (15%). Overall patients in groups P and A/P had a worse outcome. The long-term outcome of patients with posterior or combined anterior/posterior pelvic ring injuries is poorer than of those with an isolated anterior injury. Cite this article: Bone Joint J 2013;95-B:548-53.
    04/2013; 95-B(4):548-53. DOI:10.1302/0301-620X.95B4.30804

Publication Stats

716 Citations
130.03 Total Impact Points


  • 2012–2015
    • Universität Witten/Herdecke
      • Chair of Trauma Surgery/ Orthopedics
      Witten, North Rhine-Westphalia, Germany
  • 2005–2013
    • Hannover Medical School
      • Trauma Department
      Hanover, Lower Saxony, Germany
  • 2010
    • Leibniz Universität Hannover
      Hanover, Lower Saxony, Germany
  • 2007
    • Goethe-Universität Frankfurt am Main
      • Klinik für Unfall-, Hand-, und Wiederherstellungschirurgie
      Frankfurt am Main, Hesse, Germany
  • 2006
    • Ludwig Boltzmann Institute for Experimental and Clinical Traumatology
      Wien, Vienna, Austria
    • University of Leeds
      • School of Medicine
      Leeds, England, United Kingdom