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

PURPOSE 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. MATERIALS AND METHODS 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. RESULTS 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). CONCLUSION 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.

[1]  R. Stuttmann,et al.  New aspects in the emergency room management of critically injured patients: a multi-slice CT-oriented care algorithm. , 2007, Injury.

[2]  M. Sampson,et al.  Computed tomography whole body imaging in multi-trauma: 7 years experience. , 2006, Clinical radiology.

[3]  B. Röhrl1, *,et al.  Ganzkörper-MSCT beim Polytrauma: Abdominelle Verletzungen , 2005 .

[4]  G. Muhr,et al.  Anwendung der 16-Zeilen-Mehrdetektor-CT in der Initialdiagnostik beim Polytrauma: Eine Zeitanalyse , 2005 .

[5]  V. Nicolas,et al.  Prospektive, randomisierte Evaluation eines modifizierten Mehrdetektor-CT-Protokolls in der Initialdiagnostik beim Polytrauma , 2005 .

[6]  B. Marinček,et al.  Einsatz der Mehrschicht-Spiral-CT beim traumatologischen Notfall und ihre Auswirkungen auf den Untersuchungs- und Behandlungsalgorithmus , 2004 .

[7]  B. Bouillon,et al.  Die Bedeutung des Advanced Trauma Life Support® (ATLS®) im Schockraum , 2004, Der Unfallchirurg.

[8]  T. Ptak,et al.  Radiation dose is reduced with a single-pass whole-body multi-detector row CT trauma protocol compared with a conventional segmented method: initial experience. , 2003, Radiology.

[9]  C. Fink,et al.  Moderne CT-Diagnostik des akuten Thorax- und Abdominaltraumas , 2002, Der Radiologe.

[10]  M. Reiser,et al.  Whole-body computed tomography in polytrauma: techniques and management , 2002, European Radiology.

[11]  F. Gebhard,et al.  Zeitoptimiertes modernes Schockraummanagement unter Einsatz digitaler Techniken , 2002, Der Unfallchirurg.

[12]  S. Ruchholtz,et al.  Improvement in the therapy of multiply injured patients by introduction of clinical management guidelines. , 1998, Injury.

[13]  C. Aprahamian,et al.  "PALS for life!" A required trauma-oriented pediatric advanced life support course for pediatric and emergency medicine housestaff. , 1984, Annals of emergency medicine.

[14]  T. Weisse,et al.  CT-guided intervention using a patient laser marker system , 2009, European Radiology.

[15]  Dr. P. Hilbert D.E.A.A..  Schockraummanagement ohne konventionelle Radiographie? , 2006, Der Anaesthesist.