Kuhn-Régnier Sarah, Stickel Michael, Link Björn-Christian, Fischer Henning, Babst Reto, Beeres Frank J P
Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Lucerne, Switzerland.
Interdisziplinäres Notfallzentrum, Luzerner Kantonsspital, Lucerne, Switzerland.
Eur J Trauma Emerg Surg. 2019 Apr;45(2):309-314. doi: 10.1007/s00068-017-0894-3. Epub 2018 Jan 6.
Traditionally, in the German-speaking countries, trauma patients are treated by general surgeons specialized in trauma surgery known as the Unfallchirurg. Over the last decade, a trend towards a lower influence of surgeons and a higher influence of subspecialties in the emergency department has been noted. With additional transformations in the health care system towards highly specialized medicine and the arising of new (sub-) specialties, diversification in the management of the trauma patient appears to occur. The new curricula for surgical disciplines providing trauma care will widen this issue even further, moreover, triggered by the Anglo-American medical model. The primary aim of this study was to evaluate the current situation in German-speaking countries concerning the management of trauma patients. The interfaces between emergency physicians, orthopaedic and general surgeons have been investigated concerning the management of the trauma patients. Additionally, different future scenarios have been evaluated.
An online questionnaire was submitted to members of the German Society of Trauma and Orthopaedic Surgery [Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU)], including both general and orthopaedic surgeons, emergency physicians and also some members from Austria, the Netherlands and Switzerland. Questions dealt with demographic data, the current situation in the clinic of the responders in terms of management of mono- and polytrauma patients as well as fracture care. In addition, various future scenarios were evaluated.
293 members of the DGOU answered the questionnaire. The majority of the responders (45%) were orthopaedic surgeons and 34% were general trauma surgeons. Sixty-two per cent of hospitals run their emergency departments with emergency physicians. Treatment of both mono- and polytrauma patients in the emergency department is equally distributed between general and orthopaedic surgeons. Fracture care, however, is predominantly (65%) being performed by general trauma surgeons in both mono- and polytrauma patients. The majority of the respondents (80%) do not want to change the current situation and predict that in the future fracture care will still be performed by general surgeons' specialized in trauma surgery. Approximately two-thirds of the responders do not believe that emergency physicians will play a bigger role in the management of trauma patients in the future.
Despite the growing importance of emergency physicians, separated in the emergency room between surgical and internal medicine fields, in the acute care of surgical patients in the emergency departments, their role in the management of the polytraumatized patients remains limited. More than 13 years after the new curricula for orthopaedic and general surgery have been implemented in Germany, fracture care is still predominantly provided by general surgeons specialized in trauma surgery. In conclusion, it seems that the general surgeon specialized in trauma surgery still plays and wants to play the key role in the management of the polytrauma patient and fracture care in German-speaking countries.
传统上，在德语国家，创伤患者由专门从事创伤外科的普通外科医生（即创伤外科医生）治疗。在过去十年中，人们注意到一种趋势，即外科医生的影响力降低，而急诊科亚专业的影响力增加。随着医疗保健系统向高度专业化医学的进一步转变以及新的（亚）专业的出现，创伤患者的管理似乎出现了多样化。提供创伤护理的外科学科的新课程将进一步扩大这一问题，此外，这一问题还受到英美医学模式的推动。本研究的主要目的是评估德语国家创伤患者管理的现状。就创伤患者的管理而言，对急诊医生、骨科医生和普通外科医生之间的接口进行了调查。此外，还评估了不同的未来情景。
向德国创伤与矫形外科学会[Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU)]的成员发送了一份在线问卷，其中包括普通外科医生和骨科医生、急诊医生，以及一些来自奥地利、荷兰和瑞士的成员。问题涉及人口统计学数据、受访者所在诊所处理单处和多处创伤患者以及骨折护理的现状。此外，还评估了各种未来情景。
293名DGOU成员回答了问卷。大多数受访者（45%）是骨科医生，34%是普通创伤外科医生。62%的医院由急诊医生管理其急诊科。急诊科中单处和多处创伤患者的治疗在普通外科医生和骨科医生之间分布均匀。然而，骨折护理主要（65%）由普通创伤外科医生对单处和多处创伤患者进行。大多数受访者（80%）不想改变现状，并预测未来骨折护理仍将由专门从事创伤外科的普通外科医生进行。大约三分之二的受访者不相信急诊医生未来在创伤患者管理中会发挥更大作用。
尽管急诊医生的重要性日益增加，他们在急诊室中被分为外科和内科领域，但在急诊科外科患者的急性护理中，他们在多处创伤患者管理中的作用仍然有限。在德国实施骨科和普通外科新课程13年多后，骨折护理仍然主要由专门从事创伤外科的普通外科医生提供。总之，在德语国家，专门从事创伤外科的普通外科医生似乎仍然并希望在多处创伤患者的管理和骨折护理中发挥关键作用。
