Perspective: the top 11 priorities to improve trauma outcomes, from system to patient level

Abstract

Background The Haemorrhage, Airway, Breathing, Circulation, Disability, Exposure/Environmental control approach to individual patient management in trauma is well established and embedded in numerous training courses worldwide. Further improvements in trauma outcomes are likely to result from a combination of system-level interventions in prevention and quality improvement, and from a sophisticated approach to clinical innovation. Top eleven trauma priorities Based on a narrative review of remaining preventable mortality and morbidity in trauma, the top eleven priorities for those working throughout the spectrum of trauma care, from policy-makers to clinicians, should be: (1) investment in effective trauma prevention (likely to be the most cost-effective intervention); (2) prioritisation of resources, quality improvement and innovation in prehospital care (where the most preventable mortality remains); (3) building a high-performance trauma team; (4) applying evidence-based clinical interventions that stop bleeding, open & protect the airway, and optimise breathing most effectively; (5) maintaining enough circulating blood volume and ensuring adequate cardiac function; (6) recognising the role of the intensive care unit in modern damage control surgery; (7) prioritising good intensive care unit intercurrent care, especially prophylaxis for thromboembolic disease; (8) conducting a thorough tertiary survey, noting that on average the intensive care unit is where approximately 15% of injuries are detected; (9) facilitating early extubation; (10) investing in formal quantitative and qualitative quality assurance and improvement; and (11) improving clinical trial design. Conclusion Dramatic reductions in population trauma mortality and injury case fatality rate over recent decades have demonstrated the value of a comprehensive approach to trauma quality and process improvement. Continued attention to these principles, targeting areas with highest remaining preventable mortality while also prioritising functional outcomes, should remain the focus of both clinician and policy-makers.

Characteristics and Clinical Outcomes of Elderly Patients with Trauma Treated in a Local Trauma Center

“…Clinically, prompt hemostasis of bleeding and transfusion will reduce the PTDR because delayed bleeding control is the most common error in PTDR. This can also lead to a reduction of the PTDR of inter-hospital transfer to regional trauma centers [2,[18][19][20].…”

Challenges with Life-Threatening Injuries in the Room of Reanimation.

“…[2] Based on our data, the trauma system should be a national priority with the sole purpose of reducing morbidity, disability, and mortality and increasing survival in severe trauma of life-threatening injuries. [24] in waiting for the injured, a proper triage system should be formed according to the predetermined criteria of the triage system. After triage, the emergency doctor should be crucial in deciding the treatment plan according to the circumstances and with other specialties.…”

Severely injured patients: modern management strategies

“…The majority is caused by low-energy mechanisms and are often undertriaged ( 9 , 98 ). The recorded outcome of elderly trauma remains comparatively worse, despite the significant advances of modern systems ( 9 , 99 , 100 ). The reasons can be attributed to their undertriage, decreased physiologic reserves, frailty due to pre-existing comorbidities, worse tolerance to hypotension, higher complication and delirium risks, and challenges with rehabilitation and re-enablement ( 101 ).…”