title: Protocol compliance and time management in blunt trauma resuscitation.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Erasmus MC, University Medical Center Rotterdam, Department of Surgery-Traumatology, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: W R
authors.initials: WR
authors.lastname: Spanjersberg
authors.forename: E A
authors.initials: EA
authors.lastname: Bergs
authors.forename: N
authors.initials: N
authors.lastname: Mushkudiani
authors.forename: M
authors.initials: M
authors.lastname: Klimek
authors.forename: I B
authors.initials: IB
authors.lastname: Schipper
mesh_terms: D000328:Adult; D002985:Clinical Protocols / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D009426:Netherlands; D010348:Patient Care Team; D011446:Prospective Studies; D012151:Resuscitation / Q000592:standards*; D017748:Time Management; D014949:Wounds, Nonpenetrating / Q000628:therapy*