Improvement in the therapy of multiply injured patients by introduction of clinical management guidelines

Ruchholtz, Steffen; Zintl, B.; Nast-Kolb, D.; Waydhas, Christian; Lewan, Ulrike; Kanz, Karl‐Georg; Schwender, D.; Pfeifer, K. J.; Schweiberer, L.

doi:10.1016/s0020-1383(97)00150-2

Cited by 48 publications

(25 citation statements)

References 17 publications

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“…The additional regular CT scan of the skull base (b), performed later, shows better resolution of the bleeding site with an increase in size compared to the initial study provement in several parameters such as reductions in missed injuries, time taken for diagnosis and treatment, and mortality rates [16]. Fast spiral CT (RUSH-CT) as part of these algorithms reduces the time needed for diagnostic work-up and allows early therapeutic intervention.…”

Section: Discussionmentioning

confidence: 99%

New method for fast spiral CT of trauma patients: RUSH CT

Linsenmaier

Rieger

Brandl

et al. 2000

Emergency Radiology

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Aim: The purpose of this study was to develop a fast scanning protocol for spiral CT of emergency trauma patients (RUSH-CT) in order to accelerate the diagnostic work-up. Method: In a consecutive series 446 trauma patients underwent spiral CT; of these, 51 emergency patients underwent a modified protocol (RUSH-CT) on a recent technology scanner (Somatom Plus 4). Scanning time was compared between the RUSH-CT and the regular protocols. Results: The average time for RUSH-CT, comprising one pilot scan and three spiral scans, including preparation time and monitor reading was 15 min (range 12±18 min; n = 51). Using regular organ protocols comprising two pilot scans and four spiral scans, the control group had an average scanning time of 35 min. In comparison to the conventional organ protocols, total scanning time could be reduced by the RUSH-CT by 57 % (P < 0.01). Conclusion: Fast spiral CT (RUSH-CT) significantly reduces the time needed for diagnostic work-up and allows early therapeutic intervention. CT diagnosis can be completed within the first 30 min after the patient's admission.

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Section: Discussionmentioning

confidence: 99%

New method for fast spiral CT of trauma patients: RUSH CT

Linsenmaier

Rieger

Brandl

et al. 2000

Emergency Radiology

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“…For multipletrauma patients, the total time spent in the CT suite through early diagnosis to initiation of treatment has a profound influence on the patient's outcome [10,11]. On the other hand, it is crucial for image quality that the optimal protocol is chosen, especially with regard to patient positioning [12].…”

Section: Introductionmentioning

confidence: 99%

A novel multiple-trauma CT-scanning protocol using patient repositioning

et al. 2006

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Emergency CT examination is considered to be a trade-off between a short scan time and the acceptance of artifacts. This study evaluates the influence of patient repositioning on artifacts and scan time. Eighty-three consecutive multiple-trauma patients were included in this prospective study. Patients were examined without repositioning (group 1, n=39) or with patient rotation to feetfirst with arms raised for scanning the chest and abdomen/ pelvis (group 2, n=44). The mean scan time was 21 min in group 1 and 25 min in group 2 (P=0.01). The mean repositioning time in group 2 was 8 min. Significantly, more artifacts were observed in group 1 (with a repeated scan in 7%) than in group 2 (P=0.0001). This novel multiple-trauma CT-scanning protocol with patient repositioning achieves a higher image quality with significantly fewer artifacts than without repositioning but increases scan time slightly.

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“…Mit dem gleichen Evidenzgrad konnte aufgezeigt werden, dass bei einer interdisziplinären Schockraumleitung durch Absprachen zwischen den Fachdisziplinen Unfallchirurgie, Chirurgie und Anästhesie eine entsprechende Qualität gewährleistet ist. Eigene Untersuchungen konnten über nun zwei Dekaden zeigen, dass interdisziplinäre Leitlinien sowie ein klinikinternes Qualitätsmanagementsystem zu einer signifikanten Verbesserung (Evidenzlevel 2b) der Behandlungsqualität führten [23,31,32].…”

Section: Das Geeignete Zielkrankenhausunclassified

“…Zur Gewährleistung derartiger Diagnostik-und Behandlungsabläufe sind schriftliche Leitlinien wie beispielsweise Algorithmen sinnvoll, die für alle Beteiligten Personen Verbindlichkeit besitzen [22,32]. Dabei sind exakt der Ablauf sowie die Zuständigkeit jeder einzelnen beteiligten Person festzulegen.…”

Section: Cmeunclassified

“…Seit 1998 erfolgt eine jährliche Qualitätsrückmeldung an die teilnehmenden Kliniken des Traumaregisters. In mehreren Untersuchungen zur Bedeutung dieses kontinuierlichen Datenrück-laufs konnte aufgezeigt werden, dass in diesen Kliniken sowohl eine Reihe qualitätsverbessernder Maßnahmen als auch eine deutliche Verbesserung des Behandlungsprozesses an sich nachweisbar war[31,32,33].…”

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Management des Polytraumas

Nast-Kolb

Ruchholtz

Waydhas

et al. 2006

Chirurg

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The first hours after trauma are decisive. Therefore the treatment chosen demands very strict planning according to concepts of modern quality management. This begins with the fastest possible and most efficient delivery of injured patients to the applicable clinic. Such institutions are permanently ready and have at their service all the necessary diagnostic techniques and surgical and intensive care methods. Effective shock treatment entails standardized procedures accompanied by up-to-date diagnostic and therapeutic measures. After admittance and therapy of life-threatening injuries (immediate measures, damage control surgery), early-stage surgery will follow (soft tissue injuries and fractures). Strategy of damage control orthopedics is growing in acceptance because of the potential danger to life functions due to pro- and anti-inflammatory response induced additional trauma caused by following surgery. Fractures initially stabilized by external fixation can consecutively be treated safely by secondary conversion osteosynthesis. A considerable improvement in quality can be attained through therapeutic procedures approved by all concomitant disciplines and standardized systems with internal and external control methods.

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Improvement in the therapy of multiply injured patients by introduction of clinical management guidelines

Cited by 48 publications

References 17 publications

New method for fast spiral CT of trauma patients: RUSH CT

New method for fast spiral CT of trauma patients: RUSH CT

A novel multiple-trauma CT-scanning protocol using patient repositioning

Management des Polytraumas

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