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3. The Elderly Patient

Author

Lustenberger, Thomas, Inaba, Kenji, Degiannis, Elias, editor, Doll, Dietrich, editor, and Velmahos, George C., editor

Published
2023
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6. Pediatric Polytrauma Management

Author

Lustenberger, Thomas, Marzi, Ingo, Pape, Hans-Christoph, editor, Borrelli Jr., Joseph, editor, Moore, Ernest E., editor, Pfeifer, Roman, editor, and Stahel, Philip F., editor

Published
2022
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14. The Permanent-Transitory Confusion: Implications for Tests of Market Efficiency and for Expected Inflation During Turbulent and Tranquil Times

Author

Cukierman, Alex, Lustenberger, Thomas, Meltzer, Allan, Hagemann, Harald, Series Editor, Dal Pont Legrand, Muriel, Series Editor, Dimand, Robert W., Series Editor, Trautwein, Hans-Michael, Series Editor, Arnon, Arie, Advisory Editor, Aspromourgos, Tony, Advisory Editor, Assous, Michaël, Advisory Editor, Avtonomov, Vladimir, Advisory Editor, Caldari, Katia, Advisory Editor, Cardoso, José Luís, Advisory Editor, Mendes Cunha, Alexandre, Advisory Editor, Dupont-Kieffer, Ariane, Advisory Editor, Forget, Evelyn, Advisory Editor, Ikeda, Yukihiro, Advisory Editor, Johnson, Marianne, Advisory Editor, Kurz, Heinz, Advisory Editor, Lenfant, Jean-Sébastien, Advisory Editor, Liu, Qunyi, Advisory Editor, Marcuzzo, Maria Cristina, Advisory Editor, Rivot, Sylvie, Advisory Editor, Schabas, Margaret, Advisory Editor, Schefold, Bertram, Advisory Editor, van den Berg, Richard, Advisory Editor, Weber, Isabella Maria, Advisory Editor, Zappia, Carlo, Advisory Editor, Young, Warren, editor, and van der Beek, Karine, editor

Published
2020
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15. Early major fracture care in polytrauma--priorities in the context of concomitant injuries: A Delphi consensus process and systematic review.

Author

Pfeifer, Roman, Klingebiel, Felix Karl-Ludwig, Balogh, Zsolt J., Beeres, Frank J. P., Coimbra, Raul, Fang, Christian, Giannoudis, Peter V., Hietbrink, Falco, Hildebrand, Frank, Kurihara, Hayato, Lustenberger, Thomas, Marzi, Ingo, Oertel, Markus F., Peralta, Ruben, Rajasekaran, Shanmuganathan, Schemitsch, Emil H., Vallier, Heather A., Zelle, Boris A., Kalbas, Yannik, and Pape, Hans-Christoph

Published
2024
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20. The Elderly Patient

Author

Lustenberger, Thomas, Inaba, Kenji, Velmahos, George C., editor, Degiannis, Elias, editor, and Doll, Dietrich, editor

Published
2017
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28. The Elderly Patient

Author

Lustenberger, Thomas, Inaba, Kenji, Velmahos, George C., editor, Degiannis, Elias, editor, and Doll, Dietrich, editor

Published
2012
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38. Kostenfaktor 'ambulante Wundversorgung' in der Notaufnahme

Author

Schindler, Cora R., Lustenberger, Thomas, Marzi, Ingo, and Verboket, René D.

Subjects
EBM, Gesundheitsökonomie, Emergency room, Originalien, Wound care, Vergütung, Hospitals, University, Notaufnahme, Remuneration, Outpatients, Ambulatory Care, Humans, Wundversorgung, Health economics, Emergency Service, Hospital
Abstract

In addition to highly specialized medicine, the initial treatment of wounds and minor surgical interventions are generally necessary basic services of emergency care in hospitals. The reimbursement of outpatient emergency services for persons with statutory insurance is currently based on the uniform assessment standard (EBM), where the recording of business expenses in the private practice sector serves as the basis for the calculation. Hospitals have considerably higher maintenance costs than medical practices.In this article the resulting cost-revenue ratio of outpatient wound care in an emergency department is analyzed through the reimbursement according to EBM.The data were collected in the emergency surgical department of the University Hospital Frankfurt am Main over 12 months. Included were all patients who received sutured wound care during this period. The costs incurred were compared to the remuneration according to EBM 01210 (or 01212) with the additional flat rate for small surgical procedures EBM 02301.During the observation period 1548 patients were treated, i.e. 19.52% of all trauma surgery cases. The resulting costs of a standard wound care of 45.40 € are offset by a remuneration of 31.83 €. The calculation of the total revenue shows a deficit amount of 13.57 € per outpatient case, this corresponds to an annual deficit of 21,006.36 €.It could be shown that even without consideration of the relevant holding costs, cost coverage cannot be achieved in any case. The previous reimbursement of outpatient wound care on the basis of the EBM appears to be inadequate. In the future, an adjustment or supplementary remuneration seems to be necessary in order to ensure sufficient quality of care.HINTERGRUND: Die Erstversorgung von Wunden und kleinere chirurgische Eingriffe gehören neben der hochspezialisierten Medizin zu den allgemein notwendigen Grundleistungen der Notfallversorgung in den Kliniken. Die Vergütung der ambulanten Notfallleistungen für gesetzlich Versicherte erfolgt derzeit nach dem Einheitlichen Bewertungsmaßstab (EBM), welchem die betriebswirtschaftliche Aufwandserfassung des niedergelassenen Sektors als Kalkulationsgrundlage dient. Krankenhäuser haben im Vergleich zu Arztpraxen wesentlich höhere Vorhaltungskosten.In dieser Arbeit wird das entstehende Kosten-Erlös-Verhältnis der ambulanten Wundversorgung in einer Notaufnahme durch die Vergütung nach EBM analysiert.Die Daten wurden in der Notaufnahme des Universitätsklinikums Frankfurt am Main über 12 Monate erhoben. Eingeschlossen wurden alle Patienten, die in diesem Zeitraum eine Wundversorgung mittels Naht erhielten. Die Kosten wurden der Abrechnung nach EBM 01210 (bzw. 01212) mit der Zusatzpauschale für kleinchirurgische Eingriffe EBM 02301 gegenübergestellt.Im Beobachtungszeitraum wurden 1548 Patienten versorgt; das entspricht 19,52 % aller unfallchirurgischen Fälle. Den Kosten einer Standardwundversorgung in Höhe von 45,40 € steht eine Vergütung von 31,83 € gegenüber. Die Berechnung des Gesamterlöses weist einen Defizitbetrag von 13,57 € pro ambulantem Fall auf; dies entspricht einem Jahresdefizit von 21.006,36 €.Es konnte gezeigt werden, dass ohne Betrachtung der relevanten Vorhaltekosten in keinem Fall eine Kostendeckung erreicht werden kann. Die bisherige Vergütung der ambulanten Wundversorgung nach EBM erscheint unzureichend. Eine Anpassung bzw. Zusatzvergütung scheint notwendig, um eine ausreichende Versorgungsqualität in Zukunft sicherstellen zu können.

Published
2020

48. Predicting tracheostomy in multiple injured patients with severe thoracic injury (AIS ≥ 3) with the new T3P-Score: a multivariable regression prediction analysis.

Author

Bläsius, Felix M., Wutzler, Sebastian, Störmann, Philipp, Lustenberger, Thomas, Frink, Michael, Maegele, Marc, Weuster, Matthias, Bayer, Jörg, Horst, Klemens, Caspers, Michael, Seekamp, Andreas, Marzi, Ingo, Hildebrand, Frank, and Andruszkow, Hagen

Subjects
SEPSIS, TRACHEOTOMY, REGRESSION analysis, INDEPENDENT variables, INTENSIVE care units, PREDICTIVE validity
Abstract

Multiple trauma patients with severe chest trauma are at increased risk for tracheostomy. While the risk factors associated with the need for tracheostomy are well established in the general critical care population, they have not yet been validated in a cohort of patients suffering severe thoracic trauma. This retrospective cohort study analysed data on patients aged 18 years or older who were admitted to one of the six participating academic level I trauma centres with multiple injuries, including severe thoracic trauma (AISThorax ≥ 3) between 2010 and 2014. A multivariable binary regression was used to identify predictor variables for tracheostomy and to develop the Tracheostomy in Thoracic Trauma Prediction Score (T3P-Score). The study included 1019 adult thoracic trauma patients, of whom 165 underwent tracheostomy during their intensive care unit (ICU) stay. Prehospital endotracheal intubation (adjusted OR [AOR]: 2.494, 95% CI [1.412; 4.405]), diagnosis of pneumonia during the ICU stay (AOR: 4.374, 95% CI [2.503; 7.642]), duration of mechanical ventilation (AOR: 1.008/hours of intubation, 95% CI [1.006; 1.009]), and an AISHead ≥ 3 (AOR 1.840, 95% CI [1.039; 3.261]) were independent risk factors for tracheostomy. Patients with sepsis had a lower risk of tracheostomy than patients without sepsis (AOR 0.486, 95% CI [0.253; 0.935]). The T3P-Score had high predictive validity for tracheostomy (ROCAUC = 0.938, 95% CI [0.920, 0.956]; Nagelkerke's R2 was 0.601). The T3P-Score's specificity was 0.68, and the sensitivity was 0.96. The severity of thoracic trauma did not predict the need for tracheostomy. Follow-up studies should validate the T3P-Score in external data sets and study the reasons for the reluctant use of tracheostomy in patients with severe thoracic trauma and subsequent sepsis. Trial registration: The study was applied for and registered a priori with the respective ethics committees. [ABSTRACT FROM AUTHOR]

Published
2023
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