Spanjersberg W R, Bergs E A, Mushkudiani N, Klimek M, Schipper I B
Erasmus MC, University Medical Center Rotterdam, Department of Surgery-Traumatology, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Emerg Med J. 2009 Jan;26(1):23-7. doi: 10.1136/emj.2008.058073.
To study advanced trauma life support (ATLS) protocol adherence prospectively in trauma resuscitation and to analyse time management of daily multidisciplinary trauma resuscitation at a level 1 trauma centre, for both moderately and severely injured patients.
All victims of severe blunt trauma were consecutively included. Patients with a revised trauma score (RTS) of 12 were resuscitated by a "minor trauma" team and patients with an RTS of less than 12 were resuscitated by a "severe trauma" team. Digital video recordings were used to analyse protocol compliance and time management during initial assessment.
From 1 May to 1 September 2003, 193 resuscitations were included. The "minor trauma" team assessed 119 patients, with a mean injury severity score (ISS) of 7 (range 1-45). Overall protocol compliance was 42%, ranging from 0% for thoracic percussion to 93% for thoracic auscultation. The median resuscitation time was 45.9 minutes (range 39.7-55.9). The "severe team" assessed 74 patients, with a mean ISS of 22 (range 1-59). Overall protocol compliance was 53%, ranging from 4% for thoracic percussion to 95% for thoracic auscultation. Resuscitation took 34.8 minutes median (range 21.6-44.1).
Results showed the current trauma resuscitation to be ATLS-like, with sometimes very low protocol compliance rates. Timing of secondary survey and radiology and thus time efficiency remains a challenge in all trauma patients. To assess the effect of trauma resuscitation protocols on outcome, protocol adherence needs to be improved.
前瞻性研究高级创伤生命支持（ATLS）协议在创伤复苏中的依从性，并分析一级创伤中心针对中度和重度受伤患者进行的日常多学科创伤复苏的时间管理。
连续纳入所有严重钝性创伤患者。修订创伤评分（RTS）为12的患者由“轻度创伤”团队进行复苏，RTS小于12的患者由“重度创伤”团队进行复苏。使用数字视频记录来分析初始评估期间的协议依从性和时间管理。
2003年5月1日至9月1日，共纳入193例复苏病例。“轻度创伤”团队评估了119例患者，平均损伤严重程度评分（ISS）为7（范围1 - 45）。总体协议依从率为42%，从胸部叩诊的0%到胸部听诊的93%不等。复苏中位时间为45.9分钟（范围39.7 - 55.9）。“重度创伤团队”评估了74例患者，平均ISS为22（范围1 - 59）。总体协议依从率为53%，从胸部叩诊的4%到胸部听诊的95%不等。复苏中位时间为34.8分钟（范围21.6 - 44.1）。
结果显示当前的创伤复苏类似ATLS，但有时协议依从率非常低。二次评估和放射检查的时间安排以及时间效率在所有创伤患者中仍然是一个挑战。为了评估创伤复苏协议对预后的影响，需要提高协议依从性。
