Siebers C, Huber-Wagner S, Ivanova N, Jacob M, Heindl B, Kanz K-G
Klinik für Anaesthesiologie, Campus Innenstadt, Klinikum der Universität München, 80336 München.
Anaesthesist. 2009 Dec;58(12):1216-22. doi: 10.1007/s00101-009-1646-5.
In cases involving major trauma life-threatening situations should be immediately diagnosed and treated. Clinical algorithms can potentially decrease the rate of complications and errors. The purpose of this study was to investigate the incidence of deviations from a multislice computed tomography based trauma room algorithm.
During a primary trauma survey an independent study monitor observed the on site treatment sequence step by step. Time intervals between admission and start of each procedure were recorded. Deviations from the algorithm and delays were analyzed.
In 57 trauma patients a total of 49 deviations were documented. Median time between admission and transfer to the adjacent MSCT room was 9 min. Of the patients 11 were bypassed to the MSCT suite without a primary survey (19.3%). In 2 cases an absence of non-invasive blood pressure monitoring was recorded (3.5%) and 3 patients with potential cervical spine trauma were not immobilized at the scene or during primary survey (5.3%). In 8 cases focused assessment with sonography for trauma (FAST) was not performed (14%). Contrary to the algorithm 10 patients received an arterial or central venous line during initial treatment (18%) resulting in a median delay of 8 min. The deviations from the algorithm resulted in no adverse effects on complications or mortality.
Self-critical analysis of trauma resuscitation can increase the quality of treatment by revealing constantly recurring faults.
在涉及重大创伤的病例中，应立即诊断并治疗危及生命的情况。临床算法有可能降低并发症和错误的发生率。本研究的目的是调查与基于多层计算机断层扫描的创伤室算法的偏差发生率。
在初次创伤评估期间，一名独立的研究监测人员逐步观察现场治疗顺序。记录入院与每个程序开始之间的时间间隔。分析与算法的偏差和延迟情况。
在57例创伤患者中，共记录到49处偏差。入院至转至相邻多层螺旋CT室的中位时间为9分钟。11例患者未经初次评估就被直接送往多层螺旋CT检查室（19.3%）。2例患者未进行无创血压监测（3.5%），3例有潜在颈椎创伤的患者在现场或初次评估期间未进行固定（5.3%）。8例患者未进行创伤重点超声评估（FAST）（14%）。与算法相反，10例患者在初始治疗期间接受了动脉或中心静脉置管（18%），导致中位延迟8分钟。与算法的偏差未对并发症或死亡率产生不良影响。
对创伤复苏进行自我批评分析可通过揭示反复出现的问题来提高治疗质量。
