Quality improvement in trauma care
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EDITORIAL
Quality improvement in trauma care Ingo Marzi
Received: 31 December 2012 / Accepted: 4 January 2013 / Published online: 30 January 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Improvement of quality in the care of multiple trauma patients is an ongoing issue at the various setting (e.g., prehospital setting, emergency room, surgery, intensive care, and rehabilitation). We have recently published a variety of issues focusing on this field, and particularly on quality control in trauma registries [1]. Trauma registries around the world are currently in deep discussions aimed at identifying common definitions and quality parameters, and we are curious to see the first results of those discussions. In this issue, we focus on quality improvement of prehospital trauma care and possible structural changes in the future. In addition, we look at diagnostic approaches during initial emergency room care. Aubuchon et al. [2] from the Netherlands compared the prehospital care received by patients with severe traumatic brain injury today with that provided twenty years ago and found similar outcomes, despite the fact that the time at each scene had changed. Today, the time at the scene is almost four times as long as it was twenty years ago. This unexpected result demonstrates that traumatic brain injury remains one of the most challenging diagnoses to improve in the future. In this respect, Lansik and Leenen [3] performed a very thorough review of polytrauma care in the Netherlands. They came up with the concept that most severely injured patients would optimally be concentrated in high-volume trauma centers, including a well-organized prehospital system (e.g., helicopter, emergency physicians). Such centers could work closely with level II and III centers, allowing a well-defined rescue system.
I. Marzi (&) Department of Trauma Surgery, University Hospital, 60590 Frankfurt, Germany e-mail: [email protected]
Upon arrival at a trauma center, various well-defined diagnostic procedures take place according to the guidelines for trauma care (e.g., the updated S3 guideline in Germany: http://www.awmf.org/leitlinien/detail/ll/012019.html). Ultrasound is one of the procedures that is performed within the first few minutes after arrival [4]. While surgeons perform FAST (focused abdominal ultrasound in trauma) in most countries, radiologists are in charge of this in some settings. Tajoddini et al. [5] compared the quality of ultrasound performed by these two groups of physicians in cases of blunt abdominal trauma in a prospective manner. They demonstrated that both groups provided comparable diagnostic specificities considering the requirements of the emergency setting. In addition to ultrasound, CT scanning has found widespread use for the primary diagnosis of multiple trauma patients, leading to a better outcome [6]. However, the hazards of radiation need to be discussed, and further improvements in CT scanning technology and protocols are on the way. Kepros et al. [7] reviewed the residual risks of ionizing
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