title: Compliance with evidence-based clinical management guidelines in bleeding trauma patients.
abstract: BACKGROUND
  In 2007, the multidisciplinary European Task Force for Advanced Bleeding Care in Trauma published guidelines for the management of the bleeding trauma patient. The present study aimed to assess compliance with the European guidelines during the first 24 h in a level I trauma centre and to determine whether compliance impacts mortality.
  
  
  METHODS
  This was a retrospective study of consecutive bleeding trauma patients referred to a university hospital in France between 2010 and 2014. A reference document was developed on the basis of the European guidelines to transform the guidelines pragmatically into 22 objectively measurable criteria. We measured per-patient and per-criterion compliance rates and assessed the impact of guideline compliance on mortality.
  
  
  RESULTS
  A total of 121 bleeding trauma patients were included. The median (interquartile range) per-patient compliance rate was 75 (65-82)% and the per-criterion compliance rate 64 (57-81)%. Mortality rates were 18 and 32% at 24 h and 30 days, respectively. After adjusting for injury severity, per-patient compliance rates were associated with decreased mortality at 24 h (odds ratio per 10% increase in patient compliance score, 0.43; 95% confidence interval 0.26-0.71; P = 0.0001) and at 30 days (odds ratio per 10% increase in patient compliance score, 0.47; 95% confidence interval 0.31-0.72; P = 0.0004).
  
  
  CONCLUSIONS
  We found that compliance with protocols based on European guidelines impacts trauma outcome, because patient compliance was associated with survival. Further work is needed to improve adherence to these guidelines, with ongoing monitoring to ensure best practice and optimal patient outcome.
authors: Service d'anesthésie-réanimation, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.|INSERM UMR-S1140, Université Paris Descartes, Sorbonne Paris Cité, France.
authors: A
authors: A
authors: Godier
authors: CHU de Lille, Pôle d'anesthésie-réanimation, Lille, F-59000, France.
authors: M
authors: M
authors: Bacus
authors: CHU de Lille, Pôle d'anesthésie-réanimation, Lille, F-59000, France.
authors: E
authors: E
authors: Kipnis
authors: CHU de Lille, Pôle d'anesthésie-réanimation, Lille, F-59000, France.
authors: B
authors: B
authors: Tavernier
authors: CHU de Lille, Pôle d'anesthésie-réanimation, Lille, F-59000, France.|CHU Lille, Délégation Qualité Risques Vigilances, Lille, France.
authors: A
authors: A
authors: Guidat
authors: Institut d'Hématologie et de Transfusion, CHU Lille, Lille, France.|Université Lille, Inserm, CHU Lille, U1011 - EGID, Lille, F-59000, France.
authors: A
authors: A
authors: Rauch
authors: Université Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Lille, F-59000, France.
authors: E
authors: E
authors: Drumez
authors: Institut d'Hématologie et de Transfusion, CHU Lille, Lille, France.|Université Lille, Inserm, CHU Lille, U1011 - EGID, Lille, F-59000, France.
authors: S
authors: S
authors: Susen
authors: CHU de Lille, Pôle d'anesthésie-réanimation, Lille, F-59000, France delphine.garrigue@chru-lille.fr.|CHU Lille, Pôle de l'Urgence, Lille, F-59000, France.
authors: D
authors: D
authors: Garrigue-Huet
mesh_terms: D000328:Adult; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D005602:France; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000628:therapy*
keywords: bleeding; compliance; guidelines; mortality; trauma