[Polytrauma management in a period of change: time analysis of new strategies for emergency room treatment].
BACKGROUND
Quality management and the early implementation of whole-body multi-slice spiral computed tomography (whole-body MSCT) are becoming increasingly important in the management of patients with multiple trauma. The aim of this study was to evaluate both components with respect to the time factor for treatment.


METHODS
The investigation involved a retrospective data analysis of the time needed in the emergency room for the initial stabilization (phase A), completing the diagnosis (phase B) and the emergency room treatment (phase C). The investigation included three groups: trauma patients imaged in the emergency room with conventional imaging procedures (group I), with whole-body MSCT alone (group II) and those who were imaged with whole-body MSCT after the introduction of a quality management system with standard operating procedures (group III).


RESULTS
The times for resuscitation (phase A), for diagnostic evaluation (phase B) and for total treatment (phase C) were analyzed. The times for phase A were for group I (n=79) 10 min (interquartile range, IQR 8-12 min), group II (n=82) 13 min (IQR 10-17 min) and group III (n=79) 10 min (IQR 8-15 min; p<0.001). The times for phase B were 70 min (IQR 56-85 min) for group I, 23 min (IQR 17-33 min) for group II and 17 min (IQR 13-21 min; p<0.001) for group III. For phase C the times were 82 min (IQR 66-110 min) for group I, 47 min (IQR 37-59 min) for group II and 42 min (IQR 34-52 min; p<0.05) for group III.


CONCLUSIONS
Quality management and the early implementation of whole-body MSCT can accelerate the treatment work flow. A rapid initial diagnosis represents an important component in the high quality of treatment of polytrauma patients.
Wurmb
T
T
Klinik und Poliklinik für Anästhesiologie, Zentrum Operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacherstrasse 6, Würzburg, Germany. Wurmb_T@klinik.uni-wuerzburg.de
Balling
H
H
Frühwald
P
P
Keil
T
T
Kredel
M
M
Meffert
R
R
Roewer
N
N
Brederlau
J
J
D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005858:Germany; D006801:Humans; D009104:Multiple Trauma / Q000000981:diagnostic imaging* / Q000628:therapy*; D011785:Quality Assurance, Health Care; D012151:Resuscitation / Q000706:statistics & numerical data*; D013997:Time Factors; D013996:Time and Motion Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D051598:Whole Body Imaging / Q000706:statistics & numerical data*; D016526:Workload / Q000706:statistics & numerical data