title: Introduction of a treatment algorithm can improve the early management of emergency patients in the resuscitation room.
abstract: BACKGROUND
  Successful management of emergency patients with multiple trauma in the hospital resuscitation room depends on the immediate diagnosis and rapid treatment of the most life-threatening injuries. In order to reduce the time spent in the resuscitation room, an in-hospital algorithm was developed in an interdisciplinary team approach with respect to local structures. The aim of the study was to analyse whether this algorithm affects the interval between hospital admission and the completion of diagnostic procedures and the start of life-saving interventions. Moreover, in-hospital mortality was investigated before and after the algorithm was introduced.
  
  
  METHODS
  In this prospective study, all consecutive trauma patients in the resuscitation room were investigated before (group I, 01/04-10/04) and after (group II, 01/05-11/05) introduction of the algorithm. The times between hospital admission and the end of the diagnostic procedures (ultrasound [sono], chest X-ray [CF], and cranial computed tomography [CCT]), and between hospital admission and the start of life-saving interventions were registered and in-hospital mortality analysed.
  
  
  RESULTS
  In the study period, 170 patients in group I and 199 patients in group II were investigated. Injury severity score (ISS) were comparable between the two groups. The intervals between admission and completion of diagnostic procedures were significantly lower after the algorithm was introduced (mean+/-S.D.): sono (11 +/- 10 min versus 7 +/- 6 min, p < 0.05), CF (21 +/- 12 min versus 12 +/- 9 min, p < 0.01), and CCT (55 +/- 27 min versus 32 +/- 14 min, p < 0.01). Moreover, the interval to the start of life-saving interventions was significantly shorter (126 +/- 90 min versus 51 +/- 20 min, p < 0.01). After introducing the algorithm, in-hospital mortality was reduced significantly from 33.3% to 16.7% (p < 0.05) in the most severely injured patients (ISS>or=25).
  
  
  CONCLUSIONS
  The introduction of an algorithm for early management of emergency patients significantly reduced the time spent in the resuscitation room. The periods to completion of sono, CF, and CCT, respectively, and the start of life-saving interventions were significantly shorter after introduction of the algorithm. Moreover, introduction of the algorithm reduced mortality in the most severely injured patients. Although further investigations are needed to evaluate the effects of the Heidelberg treatment algorithm in terms of outcome and mortality, the time reduction in the resuscitation room seems to be beneficial.
authors.affiliation: Department of Anesthesiology and Emergency Medicine, University of Heidelberg, 110, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Bernhard
authors.forename: Torben K
authors.initials: TK
authors.lastname: Becker
authors.forename: Tim
authors.initials: T
authors.lastname: Nowe
authors.forename: Marko
authors.initials: M
authors.lastname: Mohorovicic
authors.forename: Marcus
authors.initials: M
authors.lastname: Sikinger
authors.forename: Thorsten
authors.initials: T
authors.lastname: Brenner
authors.forename: Goetz M
authors.initials: GM
authors.lastname: Richter
authors.forename: Boris
authors.initials: B
authors.lastname: Radeleff
authors.forename: Peter-Jürgen
authors.initials: PJ
authors.lastname: Meeder
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Bernd W
authors.initials: BW
authors.lastname: Böttiger
authors.forename: Eike
authors.initials: E
authors.lastname: Martin
authors.forename: André
authors.initials: A
authors.lastname: Gries
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D011446:Prospective Studies; D012151:Resuscitation / Q000592:standards*; D013997:Time Factors; D014193:Trauma Centers / Q000592:standards*