Teaching Advanced Trauma Life Support (ATLS): A nationwide retrospective analysis of 8202 lessons taught in Germany

Luedi, Markus M.; Wölfl, C; Wieferich, Katharina; Dogjani, Agron; Kauf, Peter; Doll, Dietrich

doi:10.1016/j.jsurg.2016.06.010

Cited by 14 publications

(7 citation statements)

References 9 publications

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“…The current ATLS algorithm teaches that focused abdominal sonography for trauma (FAST) should be used for assessing circulation in the primary survey, with chest X-rays or computed tomography (CT) scans as part of the diagnostic workup in the secondary survey. 3 In addition, the current advanced cardiac life support (ACLS) algorithm states that ultrasound can/should be used for inclusion/exclusion of reversible causes of cardiac arrest. Despite numerous proven benefits of ultrasonography, however, it has not yet been included in the ATLS algorithm, probably due to a lack of high-quality studies.…”

Section: To the Editormentioning

confidence: 99%

Ultrasound Offers a Change to Refine ATLS Standards

Bello

Sauter

Doll

et al. 2021

Anesthesia &Amp; Analgesia

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Section: To the Editormentioning

confidence: 99%

Ultrasound Offers a Change to Refine ATLS Standards

Bello

Sauter

Doll

et al. 2021

Anesthesia &Amp; Analgesia

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“…In industrialized countries, mortality and disability-adjusted life-years attributable to blunt multiple trauma decreased markedly during the past decades . Advanced Trauma Life Support (ATLS), implementation of trauma centers and networks, hemostatic resuscitation, early pelvic stabilization, point-of-care ultrasonography, resuscitative endovascular balloon occlusion of the aorta, and other complex interventions contributed to this trend . Controversy exists about contrast-enhanced, whole-body computed tomography (WBCT) as a primary screening modality for suspected multiple trauma .…”

Section: Introductionmentioning

confidence: 99%

Association of Low-Dose Whole-Body Computed Tomography With Missed Injury Diagnoses and Radiation Exposure in Patients With Blunt Multiple Trauma

et al. 2020

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Initial whole-body computed tomography (WBCT) for screening patients with suspected blunt multiple trauma remains controversial and a source of excess radiation exposure. OBJECTIVE To determine whether low-dose WBCT scanning using an iterative reconstruction algorithm does not increase the rate of missed injury diagnoses at the point of care compared with standard-dose WBCT with the benefit of less radiation exposure. DESIGN, SETTING, AND PARTICIPANTS This quasi-experimental, prospective time-series cohort study recruited 1074 consecutive patients admitted for suspected blunt multiple trauma to an academic metropolitan trauma center in Germany from September 3, 2014, through July 26, 2015, for the standard-dose protocol, and from August 7, 2015, through August 20, 2016, for the low-dose protocol. Five hundred sixty-five patients with suspected blunt multiple trauma prospectively received standard-dose WBCT, followed by 509 patients who underwent low-dose WBCT. Confounding was controlled by segmented regression analysis and a secondary multivariate logistic regression model. Data were analyzed from January 16, 2017, through October 14, 2019. INTERVENTIONS Standard-or low-dose WBCT. MAIN OUTCOMES AND MEASURES The primary outcome was the incidence of missed injury diagnoses at the point of care, using a synopsis of clinical, surgical, and radiological findings as an independent reference test. The secondary outcome was radiation exposure with either imaging strategy. RESULTS Of 1074 eligible patients, 971 (mean [SD] age, 52.7 [19.5] years; 649 men [66.8%]) completed the study. A total of 114 patients (11.7%) had multiple trauma, as defined by an Injury Severity Score of 16 or greater. The proportion of patients with any missed injury diagnosis at the point of care was 109 of 468 (23.3%) in the standard-dose and 107 of 503 (21.3%) in the low-dose WBCT groups (risk difference, −2.0% [95% CI, −7.3% to 3.2%]; unadjusted odds ratio, 0.89 [95% CI, 0.66-1.20]; P = .45). Adjustments for autocorrelation and multiple confounding variables did not alter the results. Radiation exposure, measured by the volume computed tomography dose index, was lowered from a median of 11.7 (interquartile range, 11.7-17.6) mGy in the standard-dose WBCT group to 5.9 (interquartile range, 5.9-8.8) mGy in the low-dose WBCT group (P < .001). CONCLUSIONS AND RELEVANCE Low-dose WBCT using iterative image reconstruction does not appear to increase the risk of missed injury diagnoses at the point of care compared with standard-dose protocols while almost halving the exposure to diagnostic radiation.

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“…Although vertebral pathology was well defined, with further analysis based on it, the occurrence and extent of concomitant trauma sequelae was not explicitly mentioned. From other trauma studies we know that the need for damage control procedures or a higher amount of tissue trauma leading to damage control procedures may change outcome, complication rate, and mortality substantially [2][3][4]. As the complication rate of this cohort is low, it seems that severe trauma patients needing damage control resuscitation/procedures may have undergone initial resuscitation in the first treating hospital before being transferred to the trauma centre.…”

Section: Dear Editormentioning

confidence: 99%

Letter to the editor regarding “Epidemiologic analysis of 8000 acute vertebral fractures: evolution of treatment and complications at 10-year follow-up”

Doll

Luedi

2022

J Orthop Surg Res

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In this letter to the editor, we discuss the article by Bigdon et al., published recently in the Journal of Orthopaedic Surgery and Research, about their accurate single-centre cohort study of 8000 vertebral fractures in 4772 patients. As the complication rate of this cohort is low, it seems that severe trauma patients needing damage control resuscitation/procedures may have undergone damage control in the first treating hospital before being transferred to the trauma centre. It will be interesting to see how both activity and health trends within the ageing population will change osteoporotic occurrence of fractures and enable more conservative trends versus operative stabilization to continue an active life even in the seventh or eighth decade.

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Teaching Advanced Trauma Life Support (ATLS): A nationwide retrospective analysis of 8202 lessons taught in Germany

Cited by 14 publications

References 9 publications

Ultrasound Offers a Change to Refine ATLS Standards

Ultrasound Offers a Change to Refine ATLS Standards

Association of Low-Dose Whole-Body Computed Tomography With Missed Injury Diagnoses and Radiation Exposure in Patients With Blunt Multiple Trauma

Letter to the editor regarding “Epidemiologic analysis of 8000 acute vertebral fractures: evolution of treatment and complications at 10-year follow-up”

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