[Emergency room management of severely injured patients].
BACKGROUND
In cases involving major trauma life-threatening situations should be immediately diagnosed and treated. Clinical algorithms can potentially decrease the rate of complications and errors. The purpose of this study was to investigate the incidence of deviations from a multislice computed tomography based trauma room algorithm.


METHODS
During a primary trauma survey an independent study monitor observed the on site treatment sequence step by step. Time intervals between admission and start of each procedure were recorded. Deviations from the algorithm and delays were analyzed.


RESULTS
In 57 trauma patients a total of 49 deviations were documented. Median time between admission and transfer to the adjacent MSCT room was 9 min. Of the patients 11 were bypassed to the MSCT suite without a primary survey (19.3%). In 2 cases an absence of non-invasive blood pressure monitoring was recorded (3.5%) and 3 patients with potential cervical spine trauma were not immobilized at the scene or during primary survey (5.3%). In 8 cases focused assessment with sonography for trauma (FAST) was not performed (14%). Contrary to the algorithm 10 patients received an arterial or central venous line during initial treatment (18%) resulting in a median delay of 8 min. The deviations from the algorithm resulted in no adverse effects on complications or mortality.


CONCLUSIONS
Self-critical analysis of trauma resuscitation can increase the quality of treatment by revealing constantly recurring faults.
Siebers
C
C
Klinik für Anaesthesiologie, Campus Innenstadt, Klinikum der Universität München, 80336 München. christian.siebers@med.uni-muenchen.de
Huber-Wagner
S
S
Ivanova
N
N
Jacob
M
M
Heindl
B
B
Kanz
K-G
KG
D000328:Adult; D000368:Aged; D000465:Algorithms; D001794:Blood Pressure / Q000502:physiology; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005858:Germany; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011785:Quality Assurance, Health Care; D012151:Resuscitation; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000628:therapy*; D055815:Young Adult