Correspondence (letter to the editor): Obvious Structural Deficiencies

The authors presented a valuable and relevant analysis of the Trauma Registry (TR-DGU) of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie; DGU) in their article. In contrast to small single-center studies, the presented study is important because it features comprehensive German data of trauma patients over a time period from 1993 to 2008. In the meantime, such analyses have become essential and are therefore of crucial importance.

Retrospective studies are often limited in terms of identifying causes because not all relevant influencing factors can be identified post hoc, and the interpretation of the data can therefore become difficult (2). Although this retrospective study did not find any major differences for the analyzed target variables between the old and new German states, it highlights some important issues very clearly: the mean duration from the accident to the arrival of the emergency medical services in Germany was 19±13 minutes and 17±13 minutes, respectively, and therefore exceeds the response times stipulated in different federal states, mostly a maximum of 10–12 minutes, but no longer than 15 minutes in any federal state (3). Strictly speaking, the response time starts with the incoming call at the dispatch unit (not with the accident), but this accounts for a maximum of 1–2 minutes and is therefore negligible in the evaluation. In Germany, the time from the accident to hospital admission (76±35 versus 69±35 mins) and the duration of treatment in the shock-room (65±40 versus 72±43 min) are much longer in actual reality than is stipulated in the interdisciplinary S3 guideline on polytrauma, from the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF).

In order to improve the prognosis in polytraumatized patients, this serious structural deficiency in Germany’s emergency medical services will have to be eliminated. This would then mean a further reduction in polytrauma-induced mortality, since adherence to the “golden hour of shock” will become possible under these circumstances.