How Often Are Protocols Followed at Level I Trauma Centers?

Area of Science:

• Orthopaedic Surgery
• Trauma Care
• Vascular Surgery

Background:

• Established evidence-based protocols aim to standardize care for complex trauma.
• Two Level I trauma centers implemented a protocol for managing long bone fractures requiring orthopaedic and vascular intervention.

Purpose of the Study:

• To analyze adherence to an evidence-based protocol.
• To determine the protocol's effect on clinical decision-making in trauma patients.
• To evaluate the protocol's impact on patient management.

Main Methods:

• Retrospective review of trauma databases from two Level I trauma centers.
• Inclusion criteria: 51 patients with long bone fractures needing revascularization and orthopaedic intervention, who survived to index intervention.
• Analysis of pre- and post-protocol intervention rates, including arterial shunting, external fixation, and definitive vascular surgery timing.

Main Results:

• Arterial shunt rates decreased from 9.5% pre-protocol to 3.3% post-protocol.
• External fixation as the index intervention (without a shunt) decreased from 63.2% to 31.0%.
• Definitive vascular surgery before external fixation increased from 28.6% to 56.7% post-protocol.

Conclusions:

• The evidence-based protocol did not demonstrate a significant effect on the management of combined orthopaedic and vascular injuries.
• Poor protocol adherence suggests a need for trauma centers to review protocol compliance and efficacy.
• Clinical judgment should guide patient care, even with established protocols.