Article
[Quality management of interdisciplinary treatment of polytrauma. Possibilities and limits of retrospective routine data collection].
Departemente Chirurgie, Universitätsspital Basel, Basel.
Der Anaesthesist (impact factor:
0.99).
07/2007;
56(7):673-8.
DOI:10.1007/s00101-007-1192-y
pp.673-8
Source: PubMed
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Citations (0)
- Cited In (2)
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Article: In search of benchmarking for mortality following multiple trauma: a Swiss trauma center experience.
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ABSTRACT: The manifestations associated with non-survival after multiple trauma may vary importantly between countries and institutions. The aim of the present study was to assess the quality of performance by comparing actual mortality rates to the literature. The study involved evaluation of a prospective consecutive multiple trauma cohort (injury severity score, ISS > 16) primarily admitted to a university hospital. Univariate and multivariate testing of routine parameters and scores, such as the Trauma and Injury Severity Score (TRISS), was used to determine their predictive powers for mortality. The 30-day mortality of 22.8% (n = 54) exactly matched predicted TRISS versions of Champion or the Major Trauma Outcome Study for our 237 multiple trauma patients (42.8 +/- 20.9 years; ISS 29.5 +/- 11.5). Univariate analysis revealed significant differences between survivors and non-survivors when compared for age, ISS, Glasgow coma scale (GCS), pulse oximeter saturation (SapO2), hemoglobin, prothrombin time, and lactate. In multivariate analysis, age, ISS, and GCS (P < 0.001 each) functioned as major independent prognostic parameters of both 24 h and 30-day mortality. Various TRISS versions hardly differed in their precision (area under the curve [AUC] 0.83-0.84), but they did differ considerably in their level of requirement, with the TRISS using newer National Trauma Data Bank coefficients (NTDB-TRISS) offering the highest target benchmark (predicted mortality 13%, Z value -5.7) in the prediction of 30-day mortality. Because of the current lack of a single, internationally accepted scoring system for the prediction of mortality after multiple trauma, the comparison of outcomes between medical centers remains unreliable. To achieve effective quality control, a practical benchmarking model, such as the TRISS-NTDB, should be used worldwide.World Journal of Surgery 08/2009; 33(11):2477-89. · 2.36 Impact Factor -
Article: Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM)-guided administration of fibrinogen concentrate and prothrombin complex concentrate.
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ABSTRACT: The appropriate strategy for trauma-induced coagulopathy management is under debate. We report the treatment of major trauma using mainly coagulation factor concentrates. This retrospective analysis included trauma patients who received >or= 5 units of red blood cell concentrate within 24 hours. Coagulation management was guided by thromboelastometry (ROTEM). Fibrinogen concentrate was given as first-line haemostatic therapy when maximum clot firmness (MCF) measured by FibTEM (fibrin-based test) was <10 mm. Prothrombin complex concentrate (PCC) was given in case of recent coumarin intake or clotting time measured by extrinsic activation test (EXTEM) >1.5 times normal. Lack of improvement in EXTEM MCF after fibrinogen concentrate administration was an indication for platelet concentrate. The observed mortality was compared with the mortality predicted by the trauma injury severity score (TRISS) and by the revised injury severity classification (RISC) score. Of 131 patients included, 128 received fibrinogen concentrate as first-line therapy, 98 additionally received PCC, while 3 patients with recent coumarin intake received only PCC. Twelve patients received FFP and 29 received platelet concentrate. The observed mortality was 24.4%, lower than the TRISS mortality of 33.7% (P = 0.032) and the RISC mortality of 28.7% (P > 0.05). After excluding 17 patients with traumatic brain injury, the difference in mortality was 14% observed versus 27.8% predicted by TRISS (P = 0.0018) and 24.3% predicted by RISC (P = 0.014). ROTEM-guided haemostatic therapy, with fibrinogen concentrate as first-line haemostatic therapy and additional PCC, was goal-directed and fast. A favourable survival rate was observed. Prospective, randomized trials to investigate this therapeutic alternative further appear warranted.Critical care (London, England) 04/2010; 14(2):R55. · 4.61 Impact Factor
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Keywords
clinical variables
comparable results
decreasing hemoglobin level
German Association
Glasgow Coma Scale
hospital outcome
initial period
interdisciplinary multiple trauma management
management sequence
multiple trauma patients retrospective analysis
patients [Injury Severity Score
preliminary critical comparison
prognostic relevant data
quality management
retrospective analysis
Significant parameters
time-consuming prospective studies
Trauma Injury Severity Score
univariate analysis
university hospital
