IMPROVEMENT IN THE THERAPY OF MULTIPLY INJURED PATIENTS BY INTRODUCTION OF CLINICAL MANAGEMENT GUIDELINES

A trauma algorithm representing the guidelines for the management of e mergency treatment of severe blunt trauma was implemented at our insti tution in 1994. By comparison of two prospectively recorded cohorts of multiply injured patients, the clinical efficacy of these guidelines was analysed. The Algorithm cohort comprised 74 patients over the peri od January 1994 to June 1996, and the Control cohort 126 patients over the period April 1988 to December 1993. To evaluate procedural qualit y of early clinical trauma management, nine criteria were applied. Aft er implementation of the algorithm there was an improvement in all par ameters reflected by a significant reduction of missed injuries and im portant time savings. Mortality rates in the cohorts were calculated a fter subdivision into three groups (I-III) with moderate (ISS: 18-24), high (ISS: 25-49) and very high (ISS: 50-75) injury severity. All coh ort subgroups were comparable with respect to ISS values, age, inital loss of consciousness (GCS) and shock rate. In all subgroups of the Al gorithm cohort mortality rates were reduced: group I: 0 Versus 20 per cent (p<0.05); group II: 8 versus 24 per cent (p<0.05); group III: 40 versus 71 per cent. Improvements in both therapeutic process and outco me were observed after implementation of the trauma algorithm. (C) 199 8 Elsevier Science Ltd. All rights reserved.