Errors in adult trauma resuscitation: a systematic review

Abstract

Introduction Trauma resuscitation at dedicated trauma centers typically consist of ad-hoc teams performing critical tasks in a time-limited manner. This creates a high stakes environment apt or avoidable errors. Reporting of errors in trauma resuscitation is generally center-dependent and lacks common terminology. Methods We conducted a systematic review by searching Ovid Medline, Scopus and Embase from inception to February 24, 2021 for errors in adult trauma resuscitation. English studies published after 2001 were included. Studies were assessed by two independent reviewers for meeting inclusion/exclusion criteria. Errors were characterized from the included studies and a summary table was developed. Our review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020152875). ResultsThe literature search retrieved 4658 articles with 26 meeting eligibility criteria. Errors were identified by morbidity and mortality rounds or other committee in 62%, missed injuries on tertiary assessment or radiology review in 12%, deviations from algorithmic guidelines in 12% or predefined for chest tube complications, critical incident reporting, aspiration or delays in care. In total there were 39 unique error types identified and divided into 9 categories including Emergency Medical Services handover, airway, assessment of injuries, patient monitoring and access, transfusion/blood related, management of injuries, team communication/dynamics, procedure error and disposition. Conclusions Overall, our systematic review identified 39 unique error types in trauma resuscitation. Identifying these errors is imperative in developing systems for improvement of trauma care.

Defining adverse events during trauma resuscitation: a modified RAND Delphi study

“…An initial list of AEs based on a completed systematic review and clinical experience was drafted by BN. 5 This list was then shared with the investigating team that included two emergency physician/trauma team leaders who are experts in human factors and medical education (AP, CMH) and two trauma surgeons with expertise in trauma team assessment (RPD, MWC). Each team member added additional AEs based on their perspectives.…”

“…In round 1, participants received the list of 57 AEs developed from a systematic review. 5 Participants were asked to rate AEs on a scale of 1-7: ► 1-3: Not important, should not be included in the final list of adverse events. ► 4-6: Important, should be included in the final list of adverse events.…”

“…Identified AEs from previous studies are often recognized through morbidity and mortality reviews, which are primarily physician driven and lack the input and expertise of non-physician healthcare providers. 5 The creation of a taxonomy of AEs with input from experts of various interprofessional backgrounds represents an opportunity to standardize how hospitals assess quality improvement (QI) and patient safety initiatives for trauma resuscitation.…”

Towards a classification system for errors in trauma resuscitation: is it time?

“…Table 1 Additional categories and suggested modifications to the proposed classification system of trauma errors proposed by Nikouline et al [1] a Additional category b Suggested modifications to category proposed by Nikouline et al [1] Category Topics Staff safety and safe practice a Blood and body fluid exposure, sharps injury, violence towards staff Systems issues due to deviations from system-specific processes or protocols a…”

“…In this issue of CJEM, Nikouline and colleagues [1] report the results of a systematic review to identify and codify the types of errors made in adult trauma resuscitation. As reporting of errors in trauma resuscitation often varies between centers with inconsistent use of terminology [2], one potential benefit of the review is to take us closer toward developing a consistent terminology and classification system for errors in trauma resuscitation.…”