Vogel T, Kampmann P, Bürklein D, Böhm H, Ockert B, Kirchhoff C, Kanz K G, Pfeifer K J, Mutschler W
Klinik für Orthopädie und Unfallchirurgie, Klinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791 Bochum, Deutschland.
Unfallchirurg. 2008 Nov;111(11):869-77. doi: 10.1007/s00113-008-1504-y.
The implementation of clinical pathways has a proven positive effect on the diagnostic workup and initiation of therapy in osteoporotic fracture patients. Unlike in most countries, fracture care in Germany is provided by so-called trauma surgeons. Therefore, it is essential to focus on the trauma surgeon for correct diagnostic workup and therapy initiation after a fragility fracture. A questionnaire was mailed to 409 departments of traumatology inquiring about the existence of a standardized clinical pathway for diagnosis and treatment of patients with fragility fractures. One of the central issues of the survey was whether those pathways comply with national guidelines. Only institutions that stated that they followed a clinical pathway were analyzed. 80% of institutions took part in our survey, 35% of which reported following a defined clinical pathway. Diagnostic workup is in concordance with the national guidelines in 30%, and therapy is guideline-based in 51%, with 12% basing both diagnostic workup and therapy on the guidelines. Thus, the vast majority of German traumatology departments do not follow national guidelines regarding osteoporosis diagnostics and therapy in patients with fragility fractures, leading to a great opportunity to improve fragility fracture care by means of both education and interdisciplinary cooperation.
临床路径的实施已被证明对骨质疏松性骨折患者的诊断检查和治疗启动具有积极作用。与大多数国家不同，德国的骨折护理由所谓的创伤外科医生提供。因此，对于脆性骨折后正确的诊断检查和治疗启动而言，关注创伤外科医生至关重要。我们向409个创伤科邮寄了一份问卷，询问是否存在针对脆性骨折患者的标准化临床诊断和治疗路径。该调查的核心问题之一是这些路径是否符合国家指南。仅对那些表示遵循临床路径的机构进行分析。80%的机构参与了我们的调查，其中35%报告遵循明确的临床路径。30%的机构在诊断检查方面符合国家指南，51%的机构在治疗方面以指南为依据，12%的机构在诊断检查和治疗两方面均以指南为基础。因此，绝大多数德国创伤科在脆性骨折患者的骨质疏松症诊断和治疗方面未遵循国家指南，这为通过教育和跨学科合作来改善脆性骨折护理提供了巨大契机。
