QUALITY OF ADMISSION SERVICES AND EMERGEN CY TREATMENT IN CASES OF MULTIPLE INJURIES

Ondue delay between hospital admission and the beginning or urgent ope rative procedures is considered as a major mortality risk for polytrau matized patients in any trauma center. As part of a quality control st udy at our institution (Kantonsspital, University of Basel), the time spent for early resuscitation and diagnostic procedures was therefore prospectively recorded in 20 patients (mean age 38 years) with a mean ISS of 26.9 (range: 13 to 43). Time spent in the resuscitation room av eraged 31.4 min (range: 10 to 50 min). Conventional radiographic diagn ostic procedures took 34.7 more min (range: 20 to 60 min). An addition al CT scan was performed in 15 patients requiring 19.5 min per region (head/thorax/abdomen/spine). Four patients underwent angiography neces sitating 28 more min (mean). Time elapsed between admission and arriva l of the patient in the OR or the ICU respectively accounted for an av erage of 89 min (range 22 to 200 min). For comparable injury severitie s this interval was shorter during the day than during the night (77 a nd 103 min respectively). Diagnoses established during this period wer e both accurate and comprehensive, as detectable from the low rate of missed diagnosis (three minor fractures). Although our results match f avorably with figures reported in the literature we feel that further improvements could be achieved by performing the conventional radiogra phic procedures simultaneously with the early resuscitation in the res uscitation room. At present time, for reasons of X-ray protection, thi s is not possible in our institution.