[Analysis of failure modes in multislice computed tomography during primary trauma survey].

Abstract

In the case of major trauma, immediate recognition and treatment of life-threatening conditions are essential. An increasing number of European trauma centers use MSCT during the primary trauma survey due to its high diagnostic precision and speed. However, there is currently little empirical data about failures in this process to practice quality assurance. The aim of this study was to evaluate this process under operating resuscitation conditions and to identify failure modes that caused delays in completion.
An independent study monitor documented the course of trauma room treatment during a 10-month period. The inclusion criteria were patients who were admitted directly from the accident scene and the study monitor was present at the time of admission.
According to our ATLS-based trauma algorithm whole-body CT (WBCT) consists of non-contrast head CT (CCT) and contrast-enhanced trunk CT (TCT). 57 trauma patients receiving 45 WBCT. 5 single CCT and 4 single TCT studies were evaluated. After initial resuscitation, CCT was obtained within 17 min of trauma room admission (IQR 13.0 - 20.0). In 20 % (95 %CI 9 - 31 %) of the cases, a CCT delay of median 5.0 min (IQR 3.8 - 8.0) was observed caused by e. g. earings, piercings and ECG cables in the scan field or intoxicated patients. Contrast-enhanced TCT was performed after 23.0 min (IQR 19.0 - 27.0). Due to preventable errors 12 of the 49 TCT studies were delayed (25 % 95 %CI 12 - 37 %) for 5 min (IQR 3.0 - 8.0).
Under "front line" conditions every fifth CCT and every fourth TCT study was completed with a median delay of 5 min. An independent process analysis revealed that unpreventable delays were due to uncooperative patients or system failure. Preventable delays were due to errors such as short intravenous lines or deviation from trauma room algorithms. Preventable delays could be avoided by addressing human and technical aspects such as revising checklists and functional architecture of the trauma bay. The failure mode and effect analysis (FMEA) method would assure quality in this process.