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Trends in intubation rates and durations in ventilated severely injured trauma patients: an analysis from the TraumaRegister DGU®



Endotracheal intubation in severely injured patients is known to be a risk factor for systemic complications. We aimed to examine the changes in intubation rates and durations in severely injured trauma patients, and rates of the systemic complications associated with ventilation changes by using a large trauma registry over the period of 13 years.


Patient demographics, Injury Severity Score (ISS), ventilation days, ventilation free days (VFD), and prevalence of systemic complications (sepsis and multiple organ failure (MOF)) were obtained from the TraumaRegister DGU® and were compared over the study period.


During the study period (2002 – 2014), 35,232 patients were recorded in TraumaRegister DGU®. 72.7 % of patients (n = 25,629) were intubated, and 27.3 % (n = 9603) of patients did not require mechanical ventilation throughout their hospital stay. The mean age was 48 ± 21 years, mean ISS was 27.9 ± 11.5, mean length of ICU stay was 11.7 ± 13.8 days, mean time on mechanical ventilator was 7.1 ± 11.3 days, and mean ventilation free days (spontaneous respiration) was 19.5 ± 11.9 days. We observed a reduction in the intubation rates (87.5 % in 2002 versus 63.6 % in 2014), and early extubation (10 ventilation days in 2002, and 5.9 days in 2014) over time.


Our study reveals a reduction in intubation rates and ventilation duration during the observation period. Moreover, we were able to observe decreased incidence of systemic complications such as sepsis over the 13 year study period, while no changes in incidence of MOF were registered. The exact relationship can not be proven in our study. This needs to be addressed in further analysis.


Mechanical ventilation is a criteria for intensive care unit admission, when there is a clinical sign that the patient cannot maintain or suitably protect their airway, or maintain adequate oxygenation or ventilation [1]. Studies have reported that intubation is a risk factor for ventilator-associated pneumonia and pulmonary infections [2]. In addition, pulmonary infections may trigger the development of systemic complications, such as acute respiratory distress syndrome (ARDS), sepsis or multiple organ failure (MOF) [3]. These serious clinical conditions affect the treatment strategies in trauma and may negatively influence the outcomes of trauma patients [46].

Factors that can affect pulmonary function include concurrent chest trauma and altered mental status [7, 10]. Recent studies have reported that 70–90 % of chest injuries are caused by blunt trauma [8]. The severity of pulmonary contusions correlates with the development of pulmonary infections, respiratory failure, and mortality [4, 6, 9]. Furthermore, severe impairment of consciousness due to a traumatic brain injury with a Glasgow Coma Score (GCS) ≤ 8 is considered to be an indication for intubation [10] according to the current guidelines [11]. Endotracheal intubation in trauma patient with a GCS ≤ 8 is also recommended in both pre-hospital and in-hospital settings [11].

The objective of this study was to test whether the intubation rates and duration of ventilation have changed over the last decade in severely injured trauma patients. Moreover, we aimed to examine whether changes in the incidence of systemic complications such as sepsis and multiple organ failure have occurred.


The trauma register DGU®

The TraumaRegister DGU® of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie, DGU) was founded in 1993. The aim of this multi-centre database is to provide anonymous and standardized documentation of severely injured patients. Data are collected prospectively in four consecutive time phases from the site of the accident until discharge from hospital: A) pre-hospital phase, B) emergency room and initial surgery, C) Intensive Care Unit (ICU) and D) discharge. The documentation includes detailed information on demographics, injury patterns, comorbidities, pre- and in-hospital management, course of intensive care unit stay, relevant laboratory findings including data on transfusion, and outcome of each individual. The inclusion criterion is admission to hospital via the emergency room with subsequent ICU care.

The infrastructure for documentation, data management, and data analysis is provided by AUC-Academy for Trauma Surgery (AUC - Akademie der Unfallchirurgie GmbH), a company affiliated with the German Trauma Society. The scientific leadership is provided by the Committee on Emergency Medicine, Intensive Care and Trauma Management (Section NIS) of the German Trauma Society. The participating hospitals submit their data anonymously into a central database via a web-based application. Scientific data analysis is approved according to a peer review procedure established by Section NIS.

The participating hospitals are primarily located in Germany (90 %), but a rising number of hospitals in other countries contribute data as well (at the time of publication, this included Austria, Belgium, China, Finland, Luxembourg, Slovenia, Switzerland, The Netherlands, and the United Arab Emirates). Currently, approximately 25,000 cases from more than 600 hospitals are entered into the database per year.

The present study is in line with the publication guidelines of the TraumaRegister DGU® and registered as TR-DGU project ID 2011–024.

Patient enrollment & clinical data collection

Data were obtained from the TraumaRegister DGU®. Patient’s records acquired between 1.4.2002 and 31.12.2014 were used. Patients eligible for enrollment in the study were at least 16 years of age, admitted to the ICU after being resuscitated, and had an Injury Severity Score (ISS) ≥ 16 points.

Clinical data, including age, gender, ISS, length of ICU stay (LOS), hospital LOS, days on mechanical ventilator, and mortality rates were collected. AIS-05 (according to the updated 2005 injury code) [12] and ISS scores were calculated for each patient [13, 14]. Laboratory results and other basic demographic data were recorded in the database.

Study design & selection criteria

Patients’ clinical data were analyzed to assess the intubation rate, duration of ventilation and ventilator free days. The following criteria were used for patient selection: preclinical intubation and patient intubation during the clinical course in hospital, ventilator free days (VFD; defined as the number of days between successful weaning from mechanical ventilation and day 28 after study enrollment) (spontaneous respiration) [15], severe head and thoracic injuries as Abbreviated Injury Score (AIS) ≥ 3 [16]. The diagnosis of sepsis was made according to the criteria of the American College of Chest Physicians / Society of Critical Care Medicine (ACCP-SCCM) consensus conference committee [17, 18]. Sepsis was defined as the systemic response to infection, manifested by two or more of the following conditions as a result of infection: (1) temperature >38 °C or <36 °C; (2) heart rate >90 beats per minute; (3) respiratory rate >20 breaths per minute or PaC02 < 32 mm Hg; and white blood cell count > 12,OOOIcu mm, <4,OOO/cu mm, or > 10 % immature (band) forms.

Organ function status was evaluated according to the Sequential Organ Failure Assessment (SOFA) score [19]. Organ function was considered to be inappropriate and marked as organ failure when the SOFA score was ≥ 3. Moreover, multiple organ failure (MOF) was defined as simultaneous failure of at least two organs.

Statistical analysis

Incidences are presented as percentages, while continuous values are presented as mean ± standard deviation (SD), and median (MD). Due to the large sample size, even minor differences between the groups tended to become statistically significant. Therefore formal statistical testing was largely avoided. The interpretation of results, however, focused on clinically relevant differences rather than on significant P-values. Data were analyzed using the Statistical Package for the Social Sciences (SPSS; Version 18, Chicago, IL, USA).


Demographic data & clinical outcomes

Over the 13 year study period, 35,232 trauma patients admitted to the ICU were enrolled in the study. The majority of patients in the study population were male (73 %) with a mean age of 48 ± 2 years (MD 48 years), and a mean ISS of 27.9 ± 11.5 points (MD 25 points). The majority of patients had blunt injury (96 %). In this cohort, the average ICU LOS was 11.7 ± 13.8 days (MD 7 days), the mean number of days on a mechanical ventilator was 7.1 ± 11.3 days (MD 2 days), and the mean number of ventilator free days was 19.5 ± 11.9 days (MD 26 days) (Table 1). Accordingly, we identified 25,629 intubated patients and 9,603 not intubated patients (i.e., exhibited ventilation) throughout their hospital stay (Table 2).

Table 1 Demographics and outcomes of the study population presented as mean ± SD (SD = standard deviation)
Table 2 Demographics and outcomes of the intubated sub-cohort, presented as mean ± SD (SD = standard deviation)

Injury severity by body region in the intubated Sub-cohort

We sought to determine the severity and regions of injury in our intubated cohort. We observed a continuous decrease in the ISS (28.5 in 2002 and 26.8 in 2014), in GCS < 9 (34.4 % in 2002 and 28.3 % in 2014), and in rate of severe extremity injuries (AIS ≥ 3) (40.4 % in 2002 and 29.6 % in 2014) of the intubated cohort over the study period (2002–2014). However, we observed no differences in head injury (AIS-1 ≥ 3) (55.1 % in 2002 and 55.5 % in 2014) or chest injury patterns among patients (AIS-3 ≥ 3) (60.5 % in 2002 and 55.8 % in 2014) (Table 3).

Table 3 Mean Injury Severity Score (ISS) over the 13 year study period, and the associated components of head injury (AIS-1 ≥ 3), chest injury (AIS-3 ≥ 3), and extremity injury (AIS-5 ≥ 3). GCS (Glasgow Coma Scale)

Changes in ventilation rate and duration over time

During the study period, we observed a reduction in the intubation rates (87.5 % in 2002 versus 63.6 % in 2014) among all intubated patients (Fig. 1). We also observed earlier extubation at the beginning of the study period as compared to later, with an average of 10 ventilation days in 2002 and 5.9 days in 2014 (Fig. 1). Moreover, the intubation rates for the survivor’s cohort decreased when compared with the non-survivors (Fig. 2).

Fig. 1
figure 1

Changes in intubation rates and duration during the 13 year study period. Intubation rates showed a reduction over the course of the study. A pattern of earlier extubation was observed over time. Legend: Intubation rates (triangles), Intubation duration (squares). Intubation rate and duration over time

Fig. 2
figure 2

Changes in the intubation rates for survivors & non-survivors during the 13 year study period. We observed a reduction in the intubation rates for the survivors cohort when compared to the non-survivors. Intubation rate in survivors and non-survivors

Rate of systemic complications

We observed a minor decrease in the annual incidence of sepsis over the course of the study (13.1 % in 2002 and 7.5 % 2014). Moreover, there were no relevant changes in the incidence of multiple organ failure (28 % in 2002 and 30.9 % in 2014) over the study period (Fig. 3).

Fig. 3
figure 3

Systemic complications in the intubated cohort. No changes in the trends of MOF was observed. A minor continuous decrease in sepsis incidence was registered in the intubated cohort over time. Incidences of sepsis and multiple organ failure


Over the past decade, improvements in the management of trauma patient care, such as transport to specialized trauma centers, early goal-directed therapy and resuscitation, have improved the outcome in severely injured patients. Moreover, ventilation in trauma patients is challenging because of the difficulty in achieving an optimal balance between sufficient ventilation and the avoidance of additional barotrauma to the lungs [20, 21].

We observed a marked decrease in the need for intubation over the study period. Accordingly, we observed a reduction in the intubation rates of the survivor’s cohort. This decrease might be associated with an overall decrease of the injury severity (ISS decrease over the years) and reduced rate of unconscious patients (GCS < 9). Especially, the incidence of severe (AIS ≥ 3) extremity injuries appear to has decreased over the observation period. One explanation is the continuous improvements of active and passive care safety and car safety regulations. However, the incidence of severe (AIS ≥ 3) chest and brain injuries did not change over the years. This gradual reduction in mechanical support may be explained by improvements in the treatment of severely injured patients as well [21, 22]. The latter changes have included consensus regarding the exact indications for intubation/ventilation, which have been introduced by surgical and anesthesiological societies (EAST, S3 Guideline). Moreover, the ATLS (Advanced Trauma Life Support) concept has become the standard for trauma care in emergency departments and advanced pre-clinical services and may also reduce the intubation rate due to a more standardized and strict approach. On the other hand, no major changes in the intubation rates for the non-survivors cohort were observed over the study period (97.6 % in 2002 and 92.9 % in 2014), which can be explained by the short observation period through the hospitalization, as the peak of deaths in most traumatic non-survivors patients is around the first 24 h post injury due to the direct head injury or massive bleeding.

With the increased recognition of the risks and economic consequences of prolonged ventilation, identification of strategies that reduce the duration of mechanical ventilation have been suggested [2325]. Our data showed a reduction in the mechanical ventilator days over time, as in 2002 the mean number of mechanical ventilator days was 10 while the mean of 5.9 days was measured in 2014. Protocol–directed ventilator weaning has been shown to significantly reduce the duration of mechanical ventilation when compared with physician-directed methods [26, 27]. The likelihood of complications secondary to severe trauma is the consequence of the direct mechanical damage to the pulmonary parenchyma as well as the indirect systemic and pulmonary sequelae. Furthermore, the severity of pulmonary contusion correlates with the development of pulmonary infections, respiratory failure, sepsis, MOF, and mortality [4, 28]. Böhmer et al. have recently published an analysis of changes of ICU treatment over a period of 10 years [29] . This study confirmed a general trend towards reduced ventilation time and shorter stay in ICU as well. In comparison to our study, Böhmer et al. has included all patients (intubated and non-intubated) admitted to ICU also with less severe injuries (ISS ≥ 9). In addition, this analysis included only level 1 (supra-regional) and level 2 (regional) trauma care centers in Germany that participated continuously in the TR-DGU for 10 years (2002 to 2011). Thus the patient population considered by Böhmer et al. came from a much smaller group of hospitals.

Despite the changes in the ventilation rates and duration, we did not observe marked differences in the incidence of MOF and a minor decrease of sepsis incidence in our study; sepsis was reported in 11 % of patients in 2002, and 7.5 % in 2014 and the incidence of MOF was 28 % in 2002 and 30.9 % in 2014. The development of sepsis and MOF is dependent on multiple risk factors including the pattern of organ injury (abdominal, thoracic, head, etc.), presence of open fractures and soft tissue contamination, surgical strategy chosen (DCO (Damage Control Orthopedics) versus ETC. (Early Total Care)), and treatment in the ICU [6, 3032]. These parameters could not be determined and evaluated in this study. It is very difficult to conclude that the decrease of the intubation reduced the rate of the systemic complications, since several factors beside the intubation, play a role. However, we feel that the intubation rate and short ventilation time might be indicators for improved treatment and decrease of the systemic complications.

We recognize that there are limitations to our study. TraumaRegister DGU® includes a large number of patients; their validity is restricted due to the detection of minor statistical differences without mandatory clinical relevance. In the absence of adequate statistical testing methods to manage this limitation we decided to present the descriptive variables of our study population without statistical significances. However, this does not restrict the identification of clinically significant effects and trends. Moreover, other parameters of interest, such as time point of intubation, Non-Invasive Ventilation (NIV), the presence of mis-intubation, number of re-intubation due to repeated surgery, lung function, lung injury, and development of ventilation associated pneumonia, might be of importance; however, these parameters are not registered in this database. Furthermore, no information was available regarding the indications for intubation, reintubation, and extubation in our cohort. Finally, we understand that our data registry contains data from several institutions that may use different practice guidelines and different methodology to determine the time for weaning.


In conclusion, the current study demonstrates a decrease in the ventilation rates, and suggests an increase in early weaning over the last decade. Moreover, we have observed a decrease in the severity and patterns of injury over the study period. Importantly, we were able to observe decreased incidence of systemic complications such as sepsis over the 13 year study period, while no changes in incidence of MOF were registered. The exact relationship can not be proven in our study. This needs to be addressed in further analysis.



Abbreviated Injury Score


Intensive Care Unit


Injury Severity Score


Multiple Organ Dysfunction Score


Multiple organ failure


Systemic Inflammatory Response Syndrome

Total LOS:

Total Length of Stay


Ventilator free days


  1. Smith G, Nielsen M. ABC of intensive care. Criteria for admission. BMJ. 1999;318(7197):1544–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, Jaeschke RZ, Brun-Buisson C. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med. 1998;129(6):433–40.

    Article  CAS  PubMed  Google Scholar 

  3. Pierson DJ. Complications associated with mechanical ventilation. Crit Care Clin. 1990;6(3):711–24.

    CAS  PubMed  Google Scholar 

  4. Namas RA, Vodovotz Y, Almahmoud K, Abdul-Malak O, Zaaqoq A, Namas R, Mi Q, Barclay D, Zuckerbraun B, Peitzman AB, et al. Temporal Patterns of Circulating Inflammation Biomarker Networks Differentiate Susceptibility to Nosocomial Infection Following Blunt Trauma in Humans. Ann Surg. 2014;263(1):191–8.

    Article  Google Scholar 

  5. Almahmoud K, Namas RA, Zaaqoq AM, Abdul-Malak O, Namas R, Zamora R, Sperry J, Billiar TR, Vodovotz Y. Prehospital Hypotension Is Associated With Altered Inflammation Dynamics and Worse Outcomes Following Blunt Trauma in Humans. Crit Care Med. 2015;43(7):1395–404.

    Article  CAS  PubMed  Google Scholar 

  6. Almahmoud K, Namas RA, Abdul-Malak O, Zaaqoq AM, Zamora R, Zuckerbraun B, Sperry J, Peitzman AB, Billiar TR, Vodovotz Y. Impact of Injury Severity on Dynamic Inflammation Networks Following Blunt Trauma. Augusta: Shock; 2015. In Press.

    Google Scholar 

  7. Richter M, Krettek C, Otte D, Wiese B, Stalp M, Ernst S, Pape HC. Correlation between crash severity, injury severity, and clinical course in car occupants with thoracic trauma: a technical and medical study. J Trauma. 2001;51(1):10–6.

    Article  CAS  PubMed  Google Scholar 

  8. Karmy-Jones R, Jurkovich GJ, Shatz DV, Brundage S, Wall Jr MJ, Engelhardt S, Hoyt DB, Holcroft J, Knudson MM. Management of traumatic lung injury: a Western Trauma Association Multicenter review. J Trauma. 2001;51(6):1049–53.

    CAS  PubMed  Google Scholar 

  9. Brown D, Namas RA, Almahmoud K, Zaaqoq A, Sarkar J, Barclay DA, Yin J, Ghuma A, Abboud A, Constantine G, et al. Trauma in silico: Individual-specific mathematical models and virtual clinical populations. Sci Transl Med. 2015;7(285):285ra261.

    Article  Google Scholar 

  10. Badjatia N, Carney N, Crocco TJ, Fallat ME, Hennes HM, Jagoda AS, Jernigan S, Letarte PB, Lerner EB, Moriarty TM, et al. Guidelines for prehospital management of traumatic brain injury 2nd edition. Prehosp Emerg Care. 2008;12 Suppl 1:S1–52.

    Article  PubMed  Google Scholar 

  11. Dunham CM, Barraco RD, Clark DE, Daley BJ, Davis 3rd FE, Gibbs MA, Knuth T, Letarte PB, Luchette FA, Omert L, et al. Guidelines for emergency tracheal intubation immediately after traumatic injury. J Trauma. 2003;55(1):162–79.

    Article  PubMed  Google Scholar 

  12. Gennarelli TA, Wodzin E. AIS 2005: a contemporary injury scale. Injury. 2006;37(12):1083–91.

    Article  PubMed  Google Scholar 

  13. Baker SP, O’Neill B, Haddon Jr W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.

    Article  CAS  PubMed  Google Scholar 

  14. Glance LG, Osler TM, Mukamel DB, Meredith W, Dick AW. Expert consensus vs empirical estimation of injury severity: effect on quality measurement in trauma. Arch Surg. 2009;144(4):326–32. discussion 332.

    Article  PubMed  Google Scholar 

  15. Schoenfeld DA, Bernard GR. Statistical evaluation of ventilator-free days as an efficacy measure in clinical trials of treatments for acute respiratory distress syndrome. Crit Care Med. 2002;30(8):1772–7.

    Article  PubMed  Google Scholar 

  16. Mommsen P, Zeckey C, Andruszkow H, Weidemann J, Fromke C, Puljic P, van Griensven M, Frink M, Krettek C, Hildebrand F. Comparison of different thoracic trauma scoring systems in regards to prediction of post-traumatic complications and outcome in blunt chest trauma. J Surg Res. 2012;176(1):239–47.

    Article  PubMed  Google Scholar 

  17. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. 1992. Chem Rev. 2009;136(5 Suppl):e28.

    Google Scholar 

  18. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–55.

    Article  CAS  PubMed  Google Scholar 

  19. Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793–800.

    Article  CAS  PubMed  Google Scholar 

  20. Richter T, Ragaller M. Ventilation in chest trauma. J Emerg Trauma Shock. 2011;4(2):251–9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Arora S, Singh PM, Trikha A. Ventilatory strategies in trauma patients. J Emerg Trauma Shock. 2014;7(1):25–31.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Robinson BR, Mueller EW, Henson K, Branson RD, Barsoum S, Tsuei BJ. An analgesia-delirium-sedation protocol for critically ill trauma patients reduces ventilator days and hospital length of stay. J Trauma. 2008;65(3):517–26.

    Article  CAS  PubMed  Google Scholar 

  23. Karcz MK, Papadakos PJ. Noninvasive ventilation in trauma. World J Crit Care Med. 2015;4(1):47–54.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Riley B. Strategies for ventilatory support. Br Med Bull. 1999;55(4):806–20.

    Article  CAS  PubMed  Google Scholar 

  25. Blackwood B, Alderdice F, Burns K, Cardwell C, Lavery G, O’Halloran P. Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis. BMJ. 2011;342:c7237.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Glover G, Connolly B, Di Gangi S, Ayers L, Terblanche M, Beale R, Hart N. An observational cohort study to determine efficacy, adherence and outcome of the early initiation of pressure support ventilation during mechanical ventilation. BMJ Open Respir Res. 2014;1(1):e000028.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bonten MJ, Kollef MH, Hall JB. Risk factors for ventilator-associated pneumonia: from epidemiology to patient management. Clin Infect Dis. 2004;38(8):1141–9.

    Article  PubMed  Google Scholar 

  28. Kollef MH, Shapiro SD, Silver P, St John RE, Prentice D, Sauer S, Ahrens TS, Shannon W, Baker-Clinkscale D. A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med. 1997;25(4):567–74.

    Article  CAS  PubMed  Google Scholar 

  29. Böhmer AB, Poels M, Kleinbrahm K, Lefering R, Paffrath T, Bouillon B, Defosse JM, Gerbershagen MU, Wappler F, Joppich R. Change of initial and ICU treatment over time in trauma patients. An analysis from the TraumaRegister DGU®. Langenbecks Arch Surg. 2016;401(4):531–40.

    Article  PubMed  Google Scholar 

  30. Pape HC, Hildebrand F, Pertschy S, Zelle B, Garapati R, Grimme K, Krettek C, Reed 2nd RL. Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopedic surgery. J Trauma. 2002;53(3):452–61. discussion 461–452.

    Article  PubMed  Google Scholar 

  31. Pape HC, Giannoudis PV, Krettek C, Trentz O. Timing of fixation of major fractures in blunt polytrauma: role of conventional indicators in clinical decision making. J Orthop Trauma. 2005;19(8):551–62.

    Article  PubMed  Google Scholar 

  32. Pape HC, Tornetta 3rd P, Tarkin I, Tzioupis C, Sabeson V, Olson SA. Timing of fracture fixation in multitrauma patients: the role of early total care and damage control surgery. J Am Acad Orthop Surg. 2009;17(9):541–9.

    Article  PubMed  Google Scholar 

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All data generated or analyzed during this study are included in this published article [and its supplementary information files].

Authors’ contributions

All authors were involved in the research project and preparation of the manuscript. RP, PHC, and FH: All made a substantial contribution to conception and design, and gave a critical and final approval. RL has performed a statistical analysis. KA, MT, HA, KH: All authors collected the data and made an analysis and interpretation of these data. They also made a draft of the manuscript and revisions. All authors read and approved the final version of the manuscript.

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The authors declare that they have no competing interests.

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Ethics approval and consent to participate

This study followed the guidelines of the revised UN declaration of Helsinki in 1975 and its latest amendment in 1996 (42nd general meeting). The study was approved by the internal review board of the Sektion NIS (Sektion Notfall, Intensivmedizin und Schwerverletztenversorgung) of the German Trauma Society (DGU). The present study is in line with the publication guidelines of the TraumaRegister DGU® and registered as TR-DGU project ID 2011–024. There was no need for written informed consent from the participants.

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Almahmoud, K., Teuben, M., Andruszkow, H. et al. Trends in intubation rates and durations in ventilated severely injured trauma patients: an analysis from the TraumaRegister DGU®. Patient Saf Surg 10, 24 (2016).

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