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Compliance with the European trauma guidelines: An observational single centre study
Y Rossignol1, O Huet1, X Chapalain1
1Department of Anaesthesiology and Surgical Intensive Care, Centre Hospitalier et Universitaire de Brest, Université de Bretagne Occidentale, 29200 Brest, France.
Insights
Compliance with European trauma guidelines varied in a French trauma center. Nine recommendations were well-followed, but early coagulopathy treatment and TBI management require improvement.
Area of Science:
- Trauma Care
- Clinical Guidelines
- Patient Management
Background:
- European trauma guidelines aim to standardize early trauma care, focusing on coagulopathy and bleeding.
- Compliance with these guidelines is crucial for improving patient outcomes in trauma centers.
Purpose of the Study:
- To assess adherence to European trauma guidelines in a French referral trauma center.
- To identify areas of good compliance and areas needing improvement in trauma patient management.
Main Methods:
- Retrospective review of medical charts for trauma patients (Injury Severity Score ≥16).
- Assessment of compliance with 21 specific recommendations within the first 24 hours of admission.
Main Results:
- Nine out of 21 recommendations showed good compliance (≥80%).
- Inconsistent compliance (50-79%) was noted for six recommendations, including fibrinogen levels and mean arterial pressure targets.
- Poor compliance (<50%) was observed for early lactate measurement, tranexamic acid administration, and normocapnia in TBI patients.
Conclusions:
- While some European trauma guidelines are well-implemented, significant improvements are needed in early coagulopathy diagnosis and treatment.
- Specific focus is required on achieving target mean arterial pressure and maintaining normocapnia in traumatic brain injury (TBI) patients.
Objectives:
The European trauma guidelines were developed to assist clinicians in the early phase of trauma management to diagnose and treat coagulopathy and bleeding. This study aimed to determine compliance with these European trauma guidelines in a French referral trauma centre.
Methods:
Medical charts of trauma patients with an injury severity score≥16 admitted between January 2013 and December 2014 were reviewed. Compliance with 21 recommendations in the first 24-hours of patient management was assessed.
Results:
There were 145 patients with median ISS of 34 [IQR 25-41]. A good level of compliance (i.e. applied in≥80% of patients) was identified for nine recommendations, inconsistent compliance (i.e. applied in 50 to 79% of patients) for six recommendations, including fibrinogen levels at hospital admission and achievement of a target mean arterial blood pressure (MAP)>80mmHg in patients with major bleeding and TBI (55.5%), and poor compliance (i.e. applied in<50% of patients) for another six recommendations. Poorly applied recommendations included early measurement of lactate or base deficit (32%), early administration of tranexamic acid (18%), and achievement of normocapnia in patients with TBI undergoing invasive ventilation (3%).
Conclusions:
In a referral trauma centre, nine of the 21 evaluable recommendations in the European trauma guidelines were applied in≥80% of patients. Early diagnosis and treatment of trauma-related coagulopathy was identified as an area for significant practice improvement. In patients with TBI, efforts should be made to achieve the targeted MAP and to maintain normocapnia.
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