ORIGINAL ARTICLES

Protocol compliance and time management in blunt trauma resuscitation

W R Spanjersberg¹, E A Bergs¹, N Mushkudiani², M Klimek³, I B Schipper¹

¹ Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
² Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
³ Department of Anaesthesiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

Correspondence to:
Dr I B Schipper, Erasmus MC, University Medical Center Rotterdam, Department of Surgery-Traumatology, PO Box 2040, 3000 CA Rotterdam, The Netherlands; i.schipper{at}erasmusmc.nl

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.

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