Traumatic injuries are amongst the leading causes of death worldwide, frequently as a result of uncontrolled hemorrhage. Critical deficiencies in clotting factors have been noted in trauma-induced coagulopathy. However, the exact underlying conditions that result in devastating coagulopathies remain unclear. The purpose of this study was to elucidate these underlying deficiencies. Blood samples were drawn from 45 severely injured trauma patients on their arrival at the resuscitation room, and the activities of all soluble clotting factors and routine coagulation tests were assessed. The Mann–Whitney-U-test was used to assess differences in coagulation activity between the patients and healthy controls. Furthermore, Spearman’s rank correlation was used to analyze the blood work. After severe trauma the levels of serum fibrinogen and calcium were significantly reduced. Furthermore, traumatized patients had a significantly increased International Normalized Ratio (INR) compared to healthy controls. The median activities of all clotting factors were reduced after severe multiple trauma, with the exception of factor VIII, which was increased. Statistically significant differences were observed for factors II (80 vs. 122 %, P < 0.0001), V (76 vs. 123 %, P < 0.0001), VII (90 vs. 114 %, P = 0.002), VIII (200 vs. 108 %, P < 0.0001), and X (86 vs. 122 %, P < 0.0001). Spearman’s correlation indicated a significant negative correlation between INR on arrival with fibrinogen and levels of factors II, V, and VII, whereas Partial Thromboplastin Time was significantly negatively correlated with factor VIII (all P < 0.0001). These findings suggest a general but rather moderate impairment of clotting factor activities following severe multiple trauma. In the concept of a calculated coagulation therapy, this could demand for the use of factor concentrates with higher ratios of clotting factors. Finally, the physiological importance of strongly elevated factor VIII activity remains unclear, but a possible interference with ex vivo measurements of Partial Thromboplastin Time has to be considered.

Trauma in pediatric patients is a major cause of death. This study investigated differences between decedents and survivors. Furthermore, an analysis of preventable and potential preventable trauma deaths was conducted and errors in the acute trauma care were investigated.

This retrospective cross-sectional epidemiological study deals with sport-specific injury patterns in show jumping. A total of 363 show jumpers of all levels (S) answered a retrospective questionnaire about injuries and overuse damages which occurred in the course of their careers. Demographic data and information on injuries in various body regions were collected. In addition to descriptive analysis, significance tests were performed. For better statistical comparability with other sports, exposure time was extrapolated with total career duration and weekly training hours, and injuries per 1000 jumping hours were calculated. The study included 251 (69%) women and 112 (31%) men, who were on average 26.9 ± 10.9 years old. The injury rate for the entire collective was 3.7 per 1000 h of exposure. The most frequently affected body region was the head (31%). Overuse complaints play a subordinate role and mainly affect the upper extremities (65%). The riders of the professional lower performance levels are less likely to injure themselves per 1000 h than riders of the higher performance levels. Riders who often or always wore a helmet suffered significantly fewer head injuries (p = 0.008) and had a significantly lower total injury duration than riders who did not wear a helmet (p = 0.006). Similarly, the study showed that riders who often or always wore a safety vest suffered significantly fewer spinal injuries (p = 0.017) and had significantly fewer injuries per 1000 riding hours (p = 0.031) than riders who did not wear a safety vest. Based on the present results, there should be an extension of the general helmet requirement and a requirement to wear safety vests in show jumping in general.

Physical examination courses are an essential part of the education of medical students. The aim of this study was to ascertain the factors influencing students’ motivation and willingness to participate in a physical examination course. Students were asked to complete a questionnaire subdivided into five domains: anthropometric data, religiousness, motivation to take part in physical examination courses, willingness to be physically examined at 11 different body regions by peers or a professional tutor and a field for free text. The questionnaire was completed by 142 medical students. The importance of the examination course was rated 8.7 / 10 points, the score for students’ motivation was 7.8 / 10 points. Willingness to be physically examined ranged from 6 to 100% depending on body part and examiner. Female students were significantly less willing to be examined at sensitive body parts (breast, upper body, groin and the hip joint; p = .003 to < .001), depending on group composition and / or examiner. Strictly religious students showed significantly less willingness to undergo examination of any part of the body except the hand (p = .02 to < .001). Considering BMI, willingness to be examined showed comparable rates for normal weight and under- / overweight students in general (80% vs. 77%). Concerning the composition of the group for physical examination skills courses, students preferred self-assembled over mixed gender and same gender groups. Peer physical examination is a method to improve students’ skills. While motivation to participate in and acceptance of the physical examination course appears to be high, willingness to be examined is low for certain parts of the body, e.g. breast and groin, depending on religiousness, gender and examiner. Examination by a professional medical tutor did not lead to higher acceptance. Most students would prefer to choose their team for physical examination courses themselves rather than be assigned to a group.