Lehner M, Hoffmann F, Kammer B, Heinrich M, Falkenthal L, Wendling-Keim D, Kurz M
Klinik für Kinderchirurgie, Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität, München, Deutschland.
Kinderchirurgische Klinik, Kinderspital, Luzerner Kantonsspital, Spitalstrasse 20, 6000, Luzern, Schweiz.
Anaesthesist. 2018 Dec;67(12):914-921. doi: 10.1007/s00101-018-0500-z. Epub 2018 Oct 25.
In addition to infrastructural and conceptual planning, smooth interdisciplinary cooperation is crucial for trauma room care of severely injured children based on time-saving management and a clear set of priorities. The time to computed tomography (CT) is a well-accepted marker for the efficacy of trauma management. Up to now there are no guidelines in the literature for an adapted approach in pediatric trauma room care.
A step-by-step algorithm for pediatric trauma room care (Interdisciplinary Trauma Room Algorithm in Pediatric Surgery, iTRAP) was developed within the framework of an interdisciplinary team: pediatric surgeons, pediatric anaethesiologists, pediatric intensivists and pediatric radiologists. In two groups of patients from January 2014 to April 2015 (group 1) and from July 2015 to January 2017 (group 2) process quality was monitored by the time required for trauma room treatment until the CT scan was performed and used as a surrogate marker. Inclusion criteria were patients aged 0-16 years, who were evaluated in a level 1 pediatric trauma room with an injury severity score (ISS) ≥8 and the necessity for a CT scan.
Before (group 1) and after (group 2) implementation of iTRAP 16 patients were included in each group. There were no significant differences between the age and the ISS in the two groups of patients. The required time for trauma room treatment was significantly reduced from an average of 33.6 min before to 15.2 min after implementation of iTRAP (p < 0.01).
The required time for the trauma care room treatment could be significantly reduced by more than half after the implementation of iTRAP. The reasons were the interdisciplinary organization of the trauma room leadership, reorganization of patient transfer and improved briefing by emergency doctors.
Besides a well-organized trauma team, it is essential that the trauma room workflow is adapted to the specific structure of the hospital. Despite the limitations of the study the data demonstrate that the trauma room workflow enables an efficient management. By the interdisciplinary reorganization of the pediatric trauma room treatment with improved structures and standardized processes, patient care was more effective with a significant reduction in the time required for trauma room treatment. The suggested iTRAP concept could be used as a framework to establish individualized workflows for pediatric trauma room treatment in other hospitals. This algorithm should be supplemented by standardized operating procedures (SOPs) for the differentiated radiological diagnostic procedures in areas of traumatic brain injury (TBI), thoracic and abdominal trauma in children.
除了基础设施和概念规划外，基于节省时间的管理和明确的优先事项集，顺畅的跨学科合作对于严重受伤儿童的创伤室护理至关重要。计算机断层扫描（CT）检查时间是创伤管理效果的一个公认指标。到目前为止，文献中尚无针对儿科创伤室护理的适应性方法的指南。
在一个跨学科团队（儿科外科医生、儿科麻醉师、儿科重症监护医生和儿科放射科医生）的框架内，制定了一种儿科创伤室护理的逐步算法（小儿外科跨学科创伤室算法，iTRAP）。在2014年1月至201年4月（第1组）和2015年7月至2017年1月（第2组）的两组患者中，通过创伤室治疗直至进行CT扫描所需的时间来监测过程质量，并将其用作替代指标。纳入标准为年龄在0至16岁之间、在一级儿科创伤室接受评估且损伤严重程度评分（ISS）≥8且需要进行CT扫描的患者。
在实施iTRAP之前（第1组）和之后（第2组），每组均纳入16例患者。两组患者的年龄和ISS之间无显著差异。创伤室治疗所需时间从实施iTRAP前的平均33.6分钟显著减少至实施后的15.2分钟（p<0.01）。
实施iTRAP后，创伤护理室治疗所需时间可显著减少一半以上。原因是创伤室领导的跨学科组织、患者转运的重新安排以及急诊医生改进的情况通报。
除了组织良好的创伤团队外，创伤室工作流程适应医院的特定结构也至关重要。尽管该研究存在局限性，但数据表明创伤室工作流程能够实现高效管理。通过对儿科创伤室治疗进行跨学科重组，改善结构并标准化流程，患者护理更有效，创伤室治疗所需时间显著减少。所建议的iTRAP概念可作为在其他医院建立儿科创伤室治疗个性化工作流程的框架。该算法应以针对儿童创伤性脑损伤（TBI）、胸腹部创伤等不同放射学诊断程序的标准化操作程序（SOP）加以补充。
