Adherence to strong recommendations of the German Polytrauma Guideline: an analysis of TraumaRegister DGU data over a...

The treatment of severely injured patients requires complex pre-hospital and in-hospital emergency interventions. The German Guideline on the Treatment of Multiple and/or Severe Injuries ('German Polytrauma Guideline') was developed to provide a standardized, evidence-based treatment approach for this purpose. High guideline adherence is supposed to positively affect quality of care and patient outcomes. The aim of this study is to quantify the adherence to the strong recommendations of the German Polytrauma Guideline in a sample of patients treated at all German trauma centres using data from the TraumaRegister DGU (TR-DGU, Trauma Registry) from over a decade (2011-2022). All strong recommendations from the 2016 version of the German Polytrauma Guideline that could be operationalised in the TR-DGU were selected. Adherence to these recommendations was examined for a population of adults (≥ 16 years) with severe injuries (injury severity score ≥ 16) who were directly admitted to a German trauma centre in the period of 2011-2022 and for whom TR-DGU data were available (N = 141,073). Adherence rates were calculated at the recommendation level. We found acceptable adherence rates for most of the investigated recommendations in the pre-hospital and in-hospital trauma data combined. Poor adherence rates were observed for pre-hospital decompression of tension pneumothoraxes, pre-hospital administration of tranexamic acid (TXA), exploratory thoracotomy in hemodynamically unstable patients with penetrating injuries, and decompression of space-occupying intracranial injuries. Our results indicate that many of the strong recommendations of the German Polytrauma Guideline are adhered to in the pre-hospital and in-hospital care of severely injured patients in Germany. We have also identified recommendations where measures should be taken to improve adherence. These results need to be interpreted in the context of the limitations of registry-based studies.The present study is registered as TRDGU project ID 2,023,008 and follows the publication guidelines of the TraumaRegister DGU.