title: Trauma resuscitation errors and computer-assisted decision support.
abstract: OBJECTIVE
  This project tested the hypothesis that computer-aided decision support during the first 30 minutes of trauma resuscitation reduces management errors.
  
  
  METHODS
  Ours was a prospective, open, randomized, controlled interventional study that evaluated the effect of real-time, computer-prompted, evidence-based decision and action algorithms on error occurrence during initial resuscitation between January 24, 2006, and February 25, 2008.
  
  
  METHODS
  A level I adult trauma center.
  
  
  METHODS
  Severely injured adults.
  
  
  METHODS
  The primary outcome variable was the error rate per patient treated as demonstrated by deviation from trauma care algorithms. Computer-assisted video audit was used to assess adherence to the algorithms.
  
  
  RESULTS
  A total of 1171 patients were recruited into 3 groups: 300 into a baseline control group, 436 into a concurrent control group, and 435 into the study group. There was a reduction in error rate per patient from the baseline control group to the study group (2.53 to 2.13, P = .004) and from the control group to the study group (2.30 to 2.13, P = .04). The difference in error rate per patient from the baseline control group to the concurrent control group was not statistically different (2.53 to 2.30, P = .21). A critical decision was required every 72 seconds, and error-free resuscitations were increased from 16.0% to 21.8% (P = .049) during the first 30 minutes of resuscitation. Morbidity from shock management (P = .03), blood use (P < .001), and aspiration pneumonia (P = .046) were decreased.
  
  
  CONCLUSIONS
  Computer-aided, real-time decision support resulted in improved protocol compliance and reduced errors and morbidity. Trial Registration clinicaltrials.gov Identifier: NCT00164034.
authors.affiliation: Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia. m.fitzgerald@alfred.org.au
authors.forename: Mark
authors.initials: M
authors.lastname: Fitzgerald
authors.forename: Peter
authors.initials: P
authors.lastname: Cameron
authors.forename: Colin
authors.initials: C
authors.lastname: Mackenzie
authors.forename: Nathan
authors.initials: N
authors.lastname: Farrow
authors.forename: Pamela
authors.initials: P
authors.lastname: Scicluna
authors.forename: Robert
authors.initials: R
authors.lastname: Gocentas
authors.forename: Adam
authors.initials: A
authors.lastname: Bystrzycki
authors.forename: Geraldine
authors.initials: G
authors.lastname: Lee
authors.forename: Gerard
authors.initials: G
authors.lastname: O'Reilly
authors.forename: Nick
authors.initials: N
authors.lastname: Andrianopoulos
authors.forename: Linas
authors.initials: L
authors.lastname: Dziukas
authors.forename: D Jamie
authors.initials: DJ
authors.lastname: Cooper
authors.forename: Andrew
authors.initials: A
authors.lastname: Silvers
authors.forename: Alfredo
authors.initials: A
authors.lastname: Mori
authors.forename: Angela
authors.initials: A
authors.lastname: Murray
authors.forename: Susan
authors.initials: S
authors.lastname: Smith
authors.forename: Yan
authors.initials: Y
authors.lastname: Xiao
authors.forename: Dion
authors.initials: D
authors.lastname: Stub
authors.forename: Frank T
authors.initials: FT
authors.lastname: McDermott
authors.forename: Jeffrey V
authors.initials: JV
authors.lastname: Rosenfeld
mesh_terms: D000328:Adult; D000465:Algorithms; D003658:Decision Making, Computer-Assisted; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors; D011446:Prospective Studies; D012151:Resuscitation; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014741:Video Recording; D014947:Wounds and Injuries / Q000628:therapy*