Background: The initial diagnostic procedure of severely injured patients in the emergency room (ER) during the primary survey is first and foremost a clinical examination. The clinical S3 guidelines provide recommendations for the treatment of patients with severe and multiple injuries.
Objectives: The study was performed to investigate the reliability of clinical key symptoms or red flags registered in the ER that lead to further diagnostic or therapeutic procedures.
Material and methods: An evaluation of key symptoms as a synopsis of the current literature considering aspects of probability calculation and medical experience was carried out.
Results: Key symptoms registered during the clinical examination are not sufficiently safe to be solely relied upon for further diagnostic and therapeutic decisions. This confirms the sense of purpose of the strict approach according to the advanced trauma life support (ATLS) algorithm. Red flags can serve as a warning to focus on relevant injuries early on. A rational imaging diagnostic procedure must follow.