Rolf Lefering

Universität Witten/Herdecke · Institute for Research in Operative Medicine (IFOM)

Background: Extremity fractures are common injuries in polytraumatized patients. Concomitant injuries to the soft tissue, vessels and nerves in these fractures are defined as mangled extremities. The decision for or against limb salvage is dependent on the patient’s physiology and the limb status. In severely injured patients with critical physiolo...

Background/Objectives: The number of seriously injured elderly patients is continuously rising. Several studies have underlined the benefit of orthogeriatric co-management in treating older patients with a proximal femur fracture. The basis of this orthogeriatric co-management is a certification as a Centre for Geriatric Trauma (ATZ). Data of serio...

With increasing survival rates, the functional outcome and quality of life of trauma patients are gaining more importance. Survivors suffer from chronic pain, psychosomatic disorders, and unemployment as well as increased post-traumatic morbidity, which can lead to an impaired quality of life. So far, the TraumaRegister DGU® records patient data du...

Zusammenfassung Fragestellung Die COVID-19-Pandemie führte im Jahr 2020 nicht nur zu einer großen Belastung des deutschen Gesundheitssystems, sondern ging auch mit einer Veränderung des gesellschaftlichen Lebens durch epidemiebedingte Maßnahmen einher. Aus dem erhöhten Behandlungsaufkommen von COVID-19-Erkrankten resultierten ebenfalls veränderte...

Fragestellung: Die Evidenzlage zeigt, dass chirurgische Stabilisierung von Rippenfrakturen (SSRF) vor allem in beatmungspflichtigen Patienten mit schwerem thorakalem Trauma vorteilhaft ist [1]. Bisher liegt nur wenig Evidenz zu primär nicht beatmungspflichtigen Patienten vor [2]. Ziel dieser Analyse ist die Auswertung des Einflusses von SSRF auf de...

Medical data registers are a key instrument of medical care research and a valuable tool for medical quality assurance. The structured plausibility tested documentation of large case numbers on a longitudinally oriented time axis with different points in time of data acquisition enables statements to be made on numerous relevant outcomes, not only...

Purpose Nonoperative management (NOM) for blunt splenic injuries (BSIs) is supported by both international and national guidelines in Germany, with high success rates even for severe organ injuries. Angioembolization (ANGIO) has been recommended for stabilizable patients with BSI requiring intervention since the 2016 German National Trauma Guidelin...

Background and Objectives: Postoperative monitoring, following free flap surgery, plays a crucial role in ensuring the survival of the flap. However, in microsurgery, not only the immediate postoperative monitoring period but also the choice of the right time for secondary surgeries is crucial for the free flap survival. There is no clear consensus...

Criteria for assessment of the significance of scientific articles are presented. The focus is on research design and methodology, illustrated by the classical study on prehospital volume treatment of severely injured individuals with penetrating torso injuries by Bickell et al. (1994). A well-thought out research design is crucial for the success...

Methods Due to demographic change, the number of polytraumatized geriatric patients (> 64 years) is expected to further increase in the coming years. In addition to the particularities of the accident and the associated injury patterns, prolonged inpatient stays are regularly observed in this group. The aim of the evaluation is to identify further...

The provision of highly specialized trauma teams for the primary care of patients with severe injuries is mandatory by current standards, even with the acceptance of a high expenditure of resources. In particular, the use of criteria according to the accident mechanism for trauma team activation (TTA) increasingly leads to overtriage. The aim of th...

Background: Thromboelastometry like ROTEM® is a point-of-care method used to assess the coagulation status of patients in a rapid manner being particularly useful in critical care settings, such as trauma, where quick and accurate assessment of coagulation can guide timely and appropriate treatment. Currently, this method is not yet comprehensively...

Purpose Delayed diagnosed injuries (DDI) in severely injured patients are an essential problem faced by emergency staff. Aim of the current study was to analyse incidence and type of DDI in a large trauma cohort. Furthermore, factors predicting DDI were investigated to create a score to identify patients at risk for DDI. Methods Multiply injured p...

Criteria for assessment of the significance of scientific articles are presented. The focus is on research design and methodology, illustrated by the classical study on prehospital volume treatment of severely injured individuals with penetrating torso injuries by Bickell et al. (1994). A well-thought out research design is crucial for the success...

Background Approximately 30,000 people are affected by severe injuries in Germany each year. Continuous progress in prehospital and hospital care has significantly reduced the mortality of polytrauma patients. With increasing survival rates, the functional outcome, health-related quality (hrQoL) of life and ability to work are now gaining importanc...

Purpose Mortality is the primary outcome measure in severely injured trauma victims. However, quality indicators for survivors are rare. We aimed to develop and validate an outcome measure based on length of stay on the intensive care unit (ICU). Methods The TraumaRegister DGU of the German Trauma Society (DGU) was used to identify 108,178 survivi...

Zusammenfassung An schweren Verletzungen versterben jedes Jahr Tausende von Personen in Deutschland. Aber woran versterben diese Patienten? Neben dem eigentlichen Trauma haben der prätraumatische Gesundheitsstatus, das Lebensalter und weitere Faktoren Einfluss auf das Versterben nach Trauma. Die vorliegende Arbeit versucht die Frage zu beantworten,...

Emergency medical services (EMS) treating critically injured patients can be staffed by emergency physicians (P-EMS) or by paramedics (EMT). The aim of this study was to determine whether P‑EMS or EMT triage affect trauma team alerting (TTA). Data from a 3-month observation period from 12 emergency departments were analyzed. Included were 3753 trau...

Purpose: The purpose of this study was to evaluate severe abdominal injury in child passengers of different ages of motor vehicle accidents and analyze the concomitant pattern of injury regarding injury severity, trauma management and outcome. Method: Data acquisition was performed using the Trauma Register DGU® (TR-DGU) in a 10-years period (2010–...

Criteria for assessment of the significance of scientific articles are presented. The focus is on research design and methodology, illustrated by the classical study on prehospital volume treatment of severely injured individuals with penetrating torso injuries by Bickell et al. (1994). A well-thought out research design is crucial for the success...

Criteria for assessment of the significance of scientific articles are presented. The focus is on research design and methodology, illustrated by the classical study on prehospital volume treatment of severely injured individuals with penetrating torso injuries by Bickell et al. (1994). A well-thought out research design is crucial for the success...

Background/Objective: This prospective, multicenter observational cohort study was carried out in 12 trauma centers in Germany and Switzerland. Its purpose was to evaluate the rate of undertriage, as well as potential consequences, and relate these with different Trauma Team Activation Protocols (TTA-Protocols), as this has not been done before in...

Background Acute hemorrhage is one of the most common causes of death in multiple trauma patients. Due to physiological changes, pre-existing conditions, and medication, older trauma patients are more prone to poor prognosis. Tranexamic acid (TXA) has been shown to be beneficial in multiple trauma patients with acute hemorrhage in general. The rela...

Background Major trauma and its consequences are one of the leading causes of death worldwide across all age groups. Few studies have conducted comparative age-specific investigations. It is well known that children respond differently to major trauma than elderly patients due to physiological differences. The aim of this study was to analyze the a...

Methods: Due to demographic change, the number of polytraumatized geriatric patients (> 64 years) is expected to further increase in the coming years. In addition to the particularities of the accident and the associated injury patterns, prolonged inpatient stays are regularly observed in this group. The aim of the evaluation is to identify further...

Background Pelvic Circumferential Compression Devices (PCCD) are standard in hemorrhage-control of unstable pelvic ring fractures (UPF). Controversial data on their usefulness exists. Aim of the study was to investigate whether prehospital application of PCCD can reduce mortality and transfusion requirements in UPF. Methods Retrospective cohort st...

Purpose Angioembolization (ANGIO) is highly valued in national and international guideline recommendations as a treatment adjunct with blunt liver trauma (BLT). The literature on BLT shows that treatment, regardless of the severity of liver injury, can be accomplished with a high success rate using nonoperative management (NOM). An indication for...

Background: The genitourinary system is not as commonly affected as many other organ systems in severely injured patients. Although a delayed and missed diagnosis of genitourinary injuries (GUIs) can severely compromise long-term outcomes, these injuries are frequently overlooked. Therefore, we present a scoring system designed to assist emergency...

Purpose Delayed diagnosed injuries (DDI) in severely injured patients are an essential problem faced by emergency staff. Aim of the current study was to analyse incidence and type of DDI in a large trauma cohort. Furthermore, factors predicting DDI were investigated to create a score to identify patients at risk for DDI. Methods Multiply injured pa...

Purpose The aim of the study was to evaluate how many patients are being transferred between trauma centers and and their characteristics in the 2006 initiated TraumaNetzwerk DGU ® (TNW). We further investigated the time point of transfer and differences in outcome, compared to patients not being transferred. We wanted to know how trauma centers ju...

Study Design: Retrospective database analysis. Objective: Polytraumatized patients with spinal injuries require tailor-made treatment plans. Severity of both spinal and concomitant injuries determine timing of spinal surgery. Aim of this study was to evaluate the role of spinal injury localization, severity and concurrent injury patterns on timing...

Purpose The purpose of this study was to identify predictive factors for peri-pelvic vascular injury in patients with pelvic fractures and to incorporate these factors into a pelvic vascular injury score (P-VIS) to detect severe bleeding during the prehospital trauma management. Methods To identify potential predictive factors, data were taken (1)...

Background and Objectives: Good scar management in burn care is essential. Nevertheless, there are no consistent recommendations regarding moisturizers for scar management. Our aim was to investigate and compare the effects of commonly used products on normal skin and burn scars. Materials and Methods: A total of 30 skin-healthy (control group) and...

Background and Objectives: Traumatic injuries are a significant public health issue worldwide, with persistent enhanced pain being a common complication following severe trauma. Persistent and chronic pain can have a profound impact on patients' quality of life, affecting physical, emotional, and social functioning. This study aimed to investigate...

Background: The treatment of major trauma patients requires intensive care capacity, which is a critical resource particularly during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, the aim of this study was to analyze the impact on major trauma care considering the intensive care treatment of COVID-19 positive patients. Methods: De...

Introduction: Trauma registries are a crucial component of trauma systems, as they could be utilized to perform a benchmarking of quality of care and enable research in a critical but important area of health care. The aim of this study is to compare the performance of two national trauma systems: Germany (TraumaRegister DGU ®,TR-DGU) and Israel (I...

Background Trauma registries are a crucial component of trauma systems, as they could be utilized to perform a benchmarking of quality of care and enable research in a critical but important area of health care. The aim of this study is to compare the performance of two national trauma systems: Germany (TraumaRegister DGU®, TR-DGU) and Israel (Isra...

Fragestellung: Jährlich erleiden in Deutschland etwa 30.000 Menschen ein schweres Trauma. Die Sterblichkeit konnte durch Fortschritte in der Behandlung gesenkt werden, aber Überlebende leiden oft unter chronischen Schmerzen, psychischen Folgeerkrankungen und Arbeitslosigkeit. Der berufliche Wiedereinstieg ist wichtig für die Lebensqualität und Teil...

Purpose In the last 20 years, the number of fatalities due to road traffic accidents (RTA) in Germany has steadily decreased from 7503 to 2724 per year. Due to legal regulations, educational measures and the continuous development of safety technology the number of severe traumatic injuries and injury patterns are most likely to change. The aim of...

Aim: Bystander cardiopulmonary resuscitation (CPR) significantly increases the survival rate after out-of-hospital cardiac arrest. Using population-based registries, we investigated the impact of lockdown due to Covid-19 on the provision of bystander CPR, taking background changes over time into consideration. Methods: Using a registry network,...

Background Particularly for pediatric trauma patients, it is of utmost importance that the right patient be treated in the right place at the right time. While unnecessary interhospital transfers must be avoided, the decision against transfer should not lead to higher complication rates in trauma centers without added pediatric qualifications. Ther...

Purpose Damage control orthopaedics (DCO) und early total care (ETC) are well-established strategies for managing severely injured patients. There is no definitive evidence of the superiority of DCO over ETC in polytrauma patients. We conducted this study to assess the probability of a polytraumatised patient undergoing DCO. In addition, the effect...

Introduction: Patients with traumatic brain injury (TBI) regularly require intensive care with prolonged invasive ventilation. Consequently, these patients are at increased risk of pulmonary failure, potentially requiring extracorporeal membrane oxygenation (ECMO). The aim of this work was to provide an overview of ECMO treatment in TBI patients b...

Scores sind als wichtiges Hilfsmittel zur Kommunikation und Bewertung auch in der Intensivmedizin nicht mehr wegzudenken. Sie reduzieren komplexe Einzelsituationen in Zahlenwerte und ermöglichen so vergleichende Betrachtungen. Sie unterscheiden sich nach Art, Zusammensetzung und Zielpopulation. Die wichtigsten Scores in der Intensivmedizin gehören...

Abstract Background The current German S3 guideline for polytrauma lists five criteria for prehospital intubation: apnea, severe traumatic brain injury (GCS ≤8), severe chest trauma with respiratory failure, hypoxia, and persistent hemodynamic instability. These guideline criteria, used in adults in daily practice, have not been previously studied...

(1) Background: The aim of this study was to investigate the effects of the pandemic on transfer rates of severely injured patients within the German TraumaNetzwerk of the DGU. Furthermore, cause of accident, rescue times, and trauma cases are compared to pre-pandemic times. (2) Methods: For this investigation patients documented in the TraumaRegis...

Background and Objectives: Scar formation after burn trauma has a significant impact on the quality of life of burn patients. Hypertrophic scars or keloids can be very distressing to patients due to potential pain, functional limitations, or hyper- or hypopigmentation. In a previous study comparing Suprathel® and the new and cheaper dressing epicit...

Introduction Traumatic brain injury (TBI) causes a major health-concern globally. Gender-dependent differences in mortality outcome after TBI have been controversially discussed. Materials and methods We conducted a retrospective, multicenter, matched-pair analysis using data collected by the TraumaRegister DGU® of the German Trauma Society betwee...

Introduction: Death from uncontrolled trauma haemorrhage and subsequent trauma-induced coagulopathy (TIC) is potentially preventable. Point-of-care devices such as rotational thromboelastometry (ROTEM®) are advocated to detect haemostatic derangements more rapidly than conventional laboratory diagnostics. Regarding reductions in RBC transfusion, t...

Background: Diabetic foot ulcers not only have a negative impact on patient mortality, morbidity and quality of life, but also require high resource utilization to achieve complete wound healing. The aim of this evaluation was to compare resource utilization of negative pressure wound therapy (NPWT) and standard moist wound care (SMWC) for diabeti...

Background: Persisting back pain is a frequent consequence after severe trauma including injury to the spine. Reports on the incidence and relevance of back pain in severely injured patients in the absence of direct injury to the spine are scarce. Objective: To assess the frequency of relevant back pain and its effect on health-related quality o...

Background Out-of-hospital cardiac arrest (OHCA) due to trauma is rare, and survival in this group is infrequent. Over the last decades, several new procedures have been implemented to increase survival, and a “Special circumstances chapter” was included in the European Resuscitation Council (ERC) guidelines in 2015. This article analysed outcomes...

Introduction Traumatic diaphragmatic rupture is a rare injury in the severely injured patient and is most commonly caused by blunt mechanisms. However, penetrating mechanisms can also dominate depending on regional and local factors. Traumatic diaphragmatic rupture is difficult to diagnose and can be missed by primary diagnostic procedures in the r...

Purpose Anaemia is one of the leading causes of death among severely injured patients. It is also known to increase the risk of death and prolong the length of hospital stay in various surgical groups. The main objective of this study is to analyse the anaemia rate on admission to the emergency department and the impact of anaemia on in-hospital mo...

Background: Identification of trauma patients at significant risk of death in the prehospital setting is challenging. The prediction probability of basic indices like vital signs, Shock Index (SI), SI multiplied by age (SIA) or the GCS is limited and more complex scores are not feasible on-scene. The Reverse SI multiplied by GCS score (rSIG) has b...

Purpose: This study aimed to identify the prevalence and predictors of spinal injuries that are suitable for immobilization. Methods: Retrospective cohort study drawing from the multi-center database of the TraumaRegister DGU®, spinal injury patients ≥ 16 years of age who scored ≥ 3 on the Abbreviated Injury Scale (AIS) between 2009 and 2016 wer...

Purpose Treatment strategies for femoral fracture stabilisation are well known to have a significant impact on the patient’s outcome. Therefore, the optimal choices for both the type of initial fracture stabilisation (external fixation/EF, early total care/ETC, conservative treatment/TC) and the best time point for conversion from temporary to defi...

Background: Various synthetic and biological wound dressings are available for the treatment of superficial burns, and standard care differs among hospitals. Nevertheless, the search for an ideal wound dressing offering a safe healing environment as well as optimal scar quality while being economically attractive is a continuing process. In recent...

Purpose The indication for pre-hospital endotracheal intubation (ETI) must be well considered as it is associated with several risks and complications. The current guidelines recommend, among other things, ETI in case of shock (systolic blood pressure < 90 mmHg). This study aims to investigate whether isolated hypotension without loss of consciousn...