title: Level of Evidence Analysis for the Latest German National Guideline on Treatment of Patients with Severe and Multiple Injuries and ATLS.
abstract: OBJECTIVE
  Advanced Trauma Life Support (ATLS®) is one of the world's best-known training programs for medical providers. Revisions of the ATLS manual have been evidence based for a number of years. In 2011, a level 3 (S3) evidence- and consensus-based guideline on the treatment of patients with severe and multiple injuries was published in Germany. The scope of this study was the systematic comparison of the educational content of the ATLS concept and the interdisciplinary "S3 polytrauma guideline."
  
  
  METHODS
  A total of 123 key recommendations of the guideline were compared with the content of the ATLS manual (9th edition). Depending on the level of agreement, the recommendations were classed in the following categories: (1) Agreement. (2) Minor variation. (3) Major variation.
  
  
  RESULTS
  An overall 86% conformity was found between the key recommendations of the guideline and the ATLS® manual. The ATLS® primary survey (ABCDE) showed an 85% conformity. The degree of conformity for the individual priorities was as follows: A (Airway) 79%, B (Breathing) 79%, C (Circulation) 86%, D (Disability) 93%, E (Exposure) 100%. The ATLS® secondary survey showed a 94% conformity. The main differences were in the areas of anesthetic induction, fluid administration, and coagulation therapy.
  
  
  CONCLUSIONS
  According to our comparison, the educational content and manual of the ATLS are largely compatible with a high level of evidence S3 guideline. However, subsequent editions of both the ATLS® and the S3 guideline should re-examine and reassess a number of aspects.
authors.affiliation: BG Trauma Clinic Ludwigshafen, Clinic for Trauma and Orthopedic Surgery, University Hospital of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen am Rhein, Germany, matt.muenzberg@web.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Münzberg
authors.forename: Manuel
authors.initials: M
authors.lastname: Mutschler
authors.forename: Thomas
authors.initials: T
authors.lastname: Paffrath
authors.forename: Heiko
authors.initials: H
authors.lastname: Trentzsch
authors.forename: Arasch
authors.initials: A
authors.lastname: Wafaisade
authors.forename: Felix
authors.initials: F
authors.lastname: Walcher
authors.forename: Marcus
authors.initials: M
authors.lastname: Raum
authors.forename: Sascha
authors.initials: S
authors.lastname: Flohé
authors.forename: Christoph
authors.initials: C
authors.lastname: Wölfl
mesh_terms: D061906:Advanced Trauma Life Support Care / Q000379:methods*; D019317:Evidence-Based Medicine; D005858:Germany; D006801:Humans; D009104:Multiple Trauma / Q000628:therapy*; D017410:Practice Guidelines as Topic; D015599:Trauma Severity Indices