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The German Guideline on the Treatment of Multiple and\/or Severe Injuries (\u2018German Polytrauma Guideline\u2019) was developed to provide a standardized, evidence-based treatment approach for this purpose. High guideline adherence is supposed to positively affect quality of care and patient outcomes. The aim of this study is to quantify the adherence to the strong recommendations of the German Polytrauma Guideline in a sample of patients treated at all German trauma centres using data from the TraumaRegister DGU (TR-DGU, Trauma Registry) from over a decade (2011\u20132022). All strong recommendations from the 2016 version of the German Polytrauma Guideline that could be operationalised in the TR-DGU were selected. Adherence to these recommendations was examined for a population of adults (\u2265\u200916 years) with severe injuries (injury severity score\u2009\u2265\u200916) who were directly admitted to a German trauma centre in the period of 2011\u20132022 and for whom TR-DGU data were available (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u2009141,073). Adherence rates were calculated at the recommendation level. We found acceptable adherence rates for most of the investigated recommendations in the pre-hospital and in-hospital trauma data combined. Poor adherence rates were observed for pre-hospital decompression of tension pneumothoraxes, pre-hospital administration of tranexamic acid (TXA), exploratory thoracotomy in hemodynamically unstable patients with penetrating injuries, and decompression of space-occupying intracranial injuries. Our results indicate that many of the strong recommendations of the German Polytrauma Guideline are adhered to in the pre-hospital and in-hospital care of severely injured patients in Germany. We have also identified recommendations where measures should be taken to improve adherence. These results need to be interpreted in the context of the limitations of registry-based studies.\n                  <\/jats:p>\n                  <jats:p>The present study is registered as TRDGU project ID 2,023,008 and follows the publication guidelines of the TraumaRegister DGU.<\/jats:p>","DOI":"10.1038\/s41598-026-61248-5","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T13:45:30Z","timestamp":1784123130000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Adherence to strong recommendations of the German Polytrauma Guideline: an analysis of TraumaRegister DGU data over a decade"],"prefix":"10.1038","volume":"16","author":[{"given":"Katharina","family":"Fetz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Bieler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Imach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Lefering","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K\u00e4the","family":"Goossen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"issue":"1","key":"61248_CR1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1136\/injuryprev-2015-041616","volume":"22","author":"JA Haagsma","year":"2016","unstructured":"Haagsma, J. 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Level 3-Guideline on the treatment of patients with severe\/multiple injuries (AWMF Registry Number 012\u2013019), Version 2.0 (07\/2011), archived version available on request at (2011). https:\/\/www.awmf.org\/kontakt"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-61248-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-61248-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-61248-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T14:01:30Z","timestamp":1784124090000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-61248-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":50,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["61248"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-61248-5","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]},"assertion":[{"value":"18 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The DB is a chairman of the Committee on Emergency Medicine, Intensive Care, and Trauma Management (Sektion NIS) of the German Trauma Society (DGU) and the coordinator of the S3 Guideline Polytrauma Version 4.0 (2022). RL is a consultant for AUC GmbH and has received research support (third-party funds) from AUC GmbH. SI is the speaker of the working group TraumaRegister DGU of the Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS). KG is the lead guideline methodologist for the S3 Guideline Polytrauma Version 4.0 (2022). The other authors (KF, IS, DB) declare that they have no competing financial interests. They received no financial funding.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The present study and protocol was conducted in accordance with the publication guidelines of the TraumaRegister DGU and was registered and approved by the TR-DGU review board as TR-DGU project ID 2023-008.\u00a0Patients are included in the TraumaRegister DGU on the basis of informed consent obtained from the patient and\/or their legal guardian(s), according to the registry\u2019s procedures. According to the guidelines of the responsible state medical association\n                      48,49\n                      , an ethical vote was not necessary for a retrospective anonymous analysis using routinely collected data. All methods were carried out in accordance with relevant guidelines and regulations, including applicable data-protection requirements, and in line with the principles of the Declaration of Helsinki.","order":2,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"22264"}}