Protocol compliance and time management in blunt trauma resuscitation.
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.
Spanjersberg
W R
WR
Erasmus MC, University Medical Center Rotterdam, Department of Surgery-Traumatology, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Bergs
E A
EA
Mushkudiani
N
N
Klimek
M
M
Schipper
I B
IB
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*