Protocol compliance and time management in blunt trauma resuscitation
Objectives: To study advanced trauma life support (ATLS) protocol adherence prospectively in trauma resuscitation and to analyse time management of daily multidisciplinary trauma resuscitation at a level 1 trauma centre, for both moderately and severely injured patients. Patients and methods: All victims of severe blunt trauma were consecutively included. Patients with a revised trauma score (RTS) of 12 were resuscitated by a "minor trauma" team and patients with an RTS of less than 12 were resuscitated by a "severe trauma" team. Digital video recordings were used to analyse protocol compliance and time management during initial assessment. Results: From 1 May to 1 September 2003, 193 resuscitations were included. The "minor trauma" team assessed 119 patients, with a mean injury severity score (ISS) of 7 (range 1-45). Overall protocol compliance was 42%, ranging from 0% for thoracic percussion to 93% for thoracic auscultation. The median resuscitation time was 45.9 minutes (range 39.7-55.9). The "severe team" assessed 74 patients, with a mean ISS of 22 (range 1-59). Overall protocol compliance was 53%, ranging from 4% for thoracic percussion to 95% for thoracic auscultation. Resuscitation took 34.8 minutes median (range 21.6-44.1). Conclusion: Results showed the current trauma resuscitation to be ATLS-like, with sometimes very low protocol compliance rates. Timing of secondary survey and radiology and thus time efficiency remains a challenge in all trauma patients. To assess the effect of trauma resuscitation protocols on outcome, protocol adherence needs to be improved.
|Keywords||article, blunt trauma, clinical protocol, falling, fracture, health services research, human, lung auscultation, major clinical study, observational study, percussion, priority journal, prospective study, resuscitation, time management, treatment duration, videorecording|
|Persistent URL||dx.doi.org/10.1136/emj.2008.058073, hdl.handle.net/1765/15077|
Spanjersberg, W.R., Bergs, E.A., Mushkudiani, N., Klimek, M., & Schipper, I.B.. (2009). Protocol compliance and time management in blunt trauma resuscitation. Emergency Medicine Journal: an international peer-reviewed journal for health professionals and researchers in emergency medicine, 26(1), 23–27. doi:10.1136/emj.2008.058073