BACKGROUND: In cases involving major trauma life-threatening situations should be immediately diagnosed and treated. Clinical algorithms can potentially decrease the rate of complications and errors. The purpose of this study was to investigate the incidence of deviations from a multislice computed tomography based trauma room algorithm. MATERIALS AND METHODS: During a primary trauma survey an independent study monitor observed the on site treatment sequence step by step. Time intervals between admission and start of each procedure were recorded. Deviations from the algorithm and delays were analyzed. RESULTS: In 57 trauma patients a total of 49 deviations were documented. Median time between admission and transfer to the adjacent MSCT room was 9 min. Of the patients 11 were bypassed to the MSCT suite without a primary survey (19.3%). In 2 cases an absence of non-invasive blood pressure monitoring was recorded (3.5%) and 3 patients with potential cervical spine trauma were not immobilized at the scene or during primary survey (5.3%). In 8 cases focused assessment with sonography for trauma (FAST) was not performed (14%). Contrary to the algorithm 10 patients received an arterial or central venous line during initial treatment (18%) resulting in a median delay of 8 min. The deviations from the algorithm resulted in no adverse effects on complications or mortality. CONCLUSION: Self-critical analysis of trauma resuscitation can increase the quality of treatment by revealing constantly recurring faults.
BACKGROUND: In cases involving major trauma life-threatening situations should be immediately diagnosed and treated. Clinical algorithms can potentially decrease the rate of complications and errors. The purpose of this study was to investigate the incidence of deviations from a multislice computed tomography based trauma room algorithm. MATERIALS AND METHODS: During a primary trauma survey an independent study monitor observed the on site treatment sequence step by step. Time intervals between admission and start of each procedure were recorded. Deviations from the algorithm and delays were analyzed. RESULTS: In 57 traumapatients a total of 49 deviations were documented. Median time between admission and transfer to the adjacent MSCT room was 9 min. Of the patients 11 were bypassed to the MSCT suite without a primary survey (19.3%). In 2 cases an absence of non-invasive blood pressure monitoring was recorded (3.5%) and 3 patients with potential cervical spine trauma were not immobilized at the scene or during primary survey (5.3%). In 8 cases focused assessment with sonography for trauma (FAST) was not performed (14%). Contrary to the algorithm 10 patients received an arterial or central venous line during initial treatment (18%) resulting in a median delay of 8 min. The deviations from the algorithm resulted in no adverse effects on complications or mortality. CONCLUSION: Self-critical analysis of trauma resuscitation can increase the quality of treatment by revealing constantly recurring faults.
Authors: S Ruchholtz; B Zintl; D Nast-Kolb; C Waydhas; D Schwender; K J Pfeifer; L Schweiberer Journal: Unfallchirurg Date: 1997-11 Impact factor: 1.000
Authors: T Wurmb; P Frühwald; J Brederlau; B Steinhübel; M Frommer; H Kuhnigk; M Kredel; J Knüpffer; W Hopfner; J Maroske; R Moll; R Wagner; A Thiede; G Schindler; N Roewer Journal: Anaesthesist Date: 2005-08 Impact factor: 1.041
Authors: Stefan Huber-Wagner; Rolf Lefering; Lars-Mikael Qvick; Markus Körner; Michael V Kay; Klaus-Jürgen Pfeifer; Maximilian Reiser; Wolf Mutschler; Karl-Georg Kanz Journal: Lancet Date: 2009-03-25 Impact factor: 79.321