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

Area of Science:

• Emergency Medicine
• Radiology
• Trauma Surgery

Background:

• Immediate recognition and treatment of life-threatening conditions are critical in major trauma.
• Multislice computed tomography (MSCT) is increasingly used in European trauma centers for rapid diagnosis.
• Data on process failures and quality assurance in MSCT trauma surveys are limited.

Purpose of the Study:

• To evaluate the process of MSCT in trauma resuscitation under operational conditions.
• To identify failure modes contributing to delays in completing whole-body CT (WBCT) scans.
• To provide empirical data for quality assurance in trauma imaging.

Main Methods:

• An independent study monitor observed trauma room treatment over a 10-month period.
• Inclusion criteria focused on patients admitted directly from the accident scene with monitor presence.
• Data collection involved documenting the course of WBCT, including non-contrast head CT (CCT) and contrast-enhanced trunk CT (TCT).

Main Results:

• Whole-body CT (WBCT) was performed in 57 patients.
• Head CT (CCT) completion was delayed in 20% of cases, with a median delay of 5 minutes.
• Contrast-enhanced trunk CT (TCT) completion was delayed in 25% of cases due to preventable errors, with a median delay of 5 minutes.

Conclusions:

• Under real-world conditions, approximately 20-25% of CT scans in major trauma cases experienced delays.
• Preventable delays stemmed from issues like incorrect equipment setup and deviations from established trauma protocols.
• Implementing strategies such as revised checklists and optimized trauma bay design, potentially guided by failure mode and effect analysis (FMEA), can mitigate these delays and enhance quality assurance.