[The classification of the severely and multiply injured--what has been established?]. / Klassifikation Schwer- und Mehrfachverletzter--was hat sich bewährt?

Among the numerous scores available for the quantitative evaluation of injury severity, only few have proved themselves effective in clinical practice. The "Revised Trauma Score"--based on physiological variables--is the most widespread in preclinical use. The "Injury Severity Score"--based on anatomical data--is the most accepted for defined indices. However, a combination of the two, known as the "Trauma and Injury Severity Score (TRISS)", represents an international standard for quality control. Recent experience with TRISS in central Europe has shown that an increasing number of patients cannot be registered due to missing data. One reason for this is the intense preclinical treatment and its influence on physiological variables. The practicability of this method for quality control--combined with additional efforts--must be questioned in Germany. A score system based, for example, on the obligatory score of the "International Classification of Diseases", might be a good alternative with less effort required for each patient. Further investigations are necessary, however, before any final decisions are made.

[Effect of conjugated PRP vaccines on the incidence of invasive diseases caused by Haemophilus influenzae Type B in childhood]. / Auswirkung der konjugierten PRP-Impfstoffe auf die Inzidenz invasiver Erkrankungen durch Haemophilus influenzae Typ b im Kindesalter.

Prior to the introduction of conjugate vaccines, Haemophilus influenzae type b (Hib) was the leading cause of severe invasive infections in young children, in Switzerland as in other countries. From 1976 to 1990, 150 children were treated for Hib meningitis at the Children's Hospital of Lucerne, corresponding to an annual incidence of 9.2 cases per 100,000 children aged under 15 years. In the same time period, the case fatality rate for meningitis was 4%. 87.3% of the meningitis cases occurred among children aged under 5 years. For this age group an annual incidence of 26.4 cases per 100,000 children was calculated. From 1979 to 1990, 141 children were hospitalized for epiglottitis, corresponding to an annual incidence of 10.9 cases per 100,000 children aged under 15. The introduction of conjugated vaccines resulted in a significant reduction in the frequency of invasive Hib disease. From 1991 to 1992, 9 cases each of meningitis and epiglottitis were observed. In 1993, only one case of meningitis and 2 cases of epiglottitis were seen. For children under 15 years these 21 cases represent annual incidences of 3.2 cases of meningitis and 3.6 cases of epiglottitis per 100,000 children. 2 of 10 meningitis cases occurred in twice vaccinated children under 2 years of age with no signs of immunodeficiency, and another case was seen in a 5-month-old infant vaccinated with only one dose. Assuming a vaccination coverage of 70% among children under 5 during the years 1991 and 1992, the calculated efficacy is 80 to 85% for the vaccine PRP-D in this predominantly affected age group during the period when only this vaccine was available.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparison of various trauma score systems. An overview]. / Vergleich verschiedener Traumascoresysteme. Eine Ubersicht.

Among the more than 50 scoring systems available for quantitative evaluation of injury severity, only a few have proved effective in clinical practice. In particular, the Revised Trauma Score (RTS), referring to physiological variables, has proved effective in preclinical use and otherwise, the Injury Severity Score (ISS), referring to anatomical data. There is a tendency in the development of new scoring systems to aim at higher predictive accuracy, forfeiting practicability. The initial purpose of scoring--an early assessment of the risks--is being pushed into the background. The TRISS method, which includes the RTS, ISS, patient's age, and mechanism of injury, is regarded as the international standard. However, it has the disadvantage of a low sensitivity of 60% for blunt trauma, resulting in a high rate of unexpected deaths. Reasons for this are underestimation of head injuries, multiple injuries to one body region, and failure to take full account of the individual patient's age. The new ASCOT method, in which the ISS is replaced by the Anatomic Profile, and the age of the patient is given more consideration, hardly brings better results--in spite of quite time-consuming methods. When the scoring systems currently available are applied their specific deficiencies and limited evidence must be borne in mind. Nevertheless, they are an important scientific instrument for comparative examinations, and indispensable for quality assurance and economic analyses. To improve the predictive accuracy, biochemical parameters and chronic diseases should be considered, in addition to existing scores.

[Successful treatment of a severe drowning accident after 20 minutes submersion]. / Erfolgreiche Behandlung eines schweren Ertrinkungsunfalls nach 20minütiger Submersion

Report on successful post-drowning cardiopulmonary resuscitation of a 2-year-old boy who had lain for 20 min in cold water at 5-7 degrees C. Because of severe pulmonary complications after primary resuscitation--e.g. pulmonary edema, repeated mediastinal and subcutaneous emphysema, pneumoperitoneum and bilateral pneumothorax--spontaneous respiration remained insufficient for 36 days. Under appropriate treatment the patient recovered completely except for slight muscular hypotrophy of the left thigh. 14 months after the submersion no other neurological or pulmonary sequelae could be detected.