Performance of a computerized protocol for trauma shock resuscitation.

Area of Science:

• Critical Care Medicine
• Trauma Surgery
• Health Informatics

Background:

• A computerized protocol was developed to standardize clinical decision-making for trauma shock resuscitation.
• This system was implemented in a metropolitan Level I trauma center's intensive care unit (ICU).
• The protocol incorporated options for resuscitation monitoring and intervention intensity.

Purpose of the Study:

• To report the overall performance of a computerized protocol for trauma shock resuscitation.
• To evaluate the protocol's effectiveness based on duration of use and clinician acceptance.
• To assess the protocol's reliability as a standard of care in a surgical ICU.

Main Methods:

• A rule-based, data-driven computerized protocol was developed using literature evidence and expert opinion.
• Clinicians used the protocol via bedside personal computers (PCs) to guide resuscitation decisions.
• Protocol instructions could be accepted or declined, with acceptance rates logged in a database.

Main Results:

• The study included 193 trauma patients over 2 years, with a mean Injury Severity Score of 27 and an 89% survival rate.
• The protocol generated 3724 instructions, averaging 19 per patient.
• Bedside clinicians accepted 94% of the computer-generated instructions.

Conclusions:

• The computerized protocol was successfully implemented as standard care for trauma shock resuscitation.
• High clinician acceptance (94%) indicates the protocol's appropriate design and utility.
• The system demonstrated reliability and effectiveness in guiding critical care decisions for trauma patients.