title: European trauma guideline compliance assessment: the ETRAUSS study.
abstract: BACKGROUND
  Haemorrhagic shock is the leading cause of preventable death in trauma patients. The 2013 European trauma guidelines emphasise a comprehensive, multidisciplinary, protocol-based approach to trauma care. The aim of the present Europe-wide survey was to compare 2015 practice with the 2013 guidelines.
  
  
  METHODS
  A group of members of the Trauma and Emergency Medicine section of the European Society of Intensive Care Medicine developed a 50-item questionnaire based upon the core recommendations of the 2013 guidelines, employing a multistep approach. The questionnaire covered five fields: care structure and organisation, haemodynamic resuscitation targets, fluid management, transfusion and coagulopathy, and haemorrhage control. The sampling used a two-step approach comprising initial purposive sampling of eminent trauma care providers in each European country, followed by snowball sampling of a maximum number of trauma care providers.
  
  
  RESULTS
  A total of 296 responses were collected, 243 (81 %) from European countries. Those from outside the European Union were excluded from the analysis. Approximately three-fourths (74 %) of responders were working in a designated trauma centre. Blunt trauma predominated, accounting for more than 90 % of trauma cases. Considerable heterogeneity was observed in all five core aspects of trauma care, along with frequent deviations from the 2013 guidelines. Only 92 (38 %) of responders claimed to comply with the recommended systolic blood pressure target, and only 81 (33 %) responded that they complied with the target pressure in patients with traumatic brain injury. Crystalloid use was predominant (n = 209; 86 %), and vasopressor use was frequent (n = 171, 76 %) but remained controversial. Only 160 respondents (66 %) declared that they used tranexamic acid always or often.
  
  
  CONCLUSIONS
  This is the first European trauma survey, to our knowledge. Heterogeneity is significant across centres with regard to the clinical protocols for trauma patients and as to locally available resources. Deviations from guidelines are frequent, differ from region to region and are dependent upon specialty training. Further efforts are required to provide consensus guidelines and to improve their implementation across European countries.
authors.affiliation: Department of Anaesthesiology & Critical Care, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France. sophiehamada@hotmail.com.
authors.forename: Sophie Rym
authors.initials: SR
authors.lastname: Hamada
authors.affiliation: Department of Anaesthesiology & Critical Care, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, 100 boulevard du Général Leclerc, 92110, Clichy, France. gausstoto@gmail.com.
authors.forename: Tobias
authors.initials: T
authors.lastname: Gauss
authors.affiliation: Department of Anaesthesiology, Perioperative and General Intensive Care Medicine, Salzburg University Hospital and Paracelsus Private Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria. j.pann@salk.at.
authors.forename: Jakob
authors.initials: J
authors.lastname: Pann
authors.affiliation: Department of Anaesthesiology, Perioperative and General Intensive Care Medicine, Salzburg University Hospital and Paracelsus Private Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria. martin.duenser@i-med.ac.at.
authors.forename: Martin
authors.initials: M
authors.lastname: Dünser
authors.affiliation: Department of Anaesthesiology & Critical Care, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, Marseille, France. marc.leone@ap-hm.fr.
authors.forename: Marc
authors.initials: M
authors.lastname: Leone
authors.affiliation: Department of Anaesthesiology & Critical Care, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France. jacques.duranteau@bct.aphp.fr.
authors.forename: Jacques
authors.initials: J
authors.lastname: Duranteau
mesh_terms: D001803:Blood Transfusion / Q000592:standards; D005060:Europe; D005440:Fluid Therapy / Q000592:standards; D019983:Guideline Adherence; D006470:Hemorrhage / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D014193:Trauma Centers / Q000592:standards / Q000706:statistics & numerical data; D014194:Traumatology / Q000592:standards; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014947:Wounds and Injuries / Q000628:therapy*
chemical_list: D014662:Vasoconstrictor Agents