Evidence of Prolonged Monitoring of Trauma Patients Admitted via Trauma Resuscitation Unit without Primary Proof of Severe Injuries.

Martin Heinrich,Christoph Biehl,Lydia Anastasopoulou,Christian Heiss,Florian Brenck,Gabor Szalay,Matthias Lany

doi:10.3390/jcm9082516

Abstract

Introductio: Although management of severely injured patients in the Trauma Resuscitation Unit (TRU) follows evidence-based guidelines, algorithms for treatment of the slightly injured are limited. Methods: All trauma patients in a period of eight months in a Level I trauma center were followed. Retrospective analysis was performed only in patients ≥18 years with primary TRU admission, Abbreviated Injury Scale (AIS) ≤ 1, Maximum Abbreviated Injury Scale (MAIS) ≤ 1 and Injury Severity Score (ISS) ≤3 after treatment completion and ≥24 h monitoring in the units. Cochran’s Q-test was used for the statistical evaluation of AIS and ISS changes in units. Results: One hundred and twelve patients were enrolled in the study. Twenty-one patients (18.75%) reported new complaints after treatment completion in the TRU. AIS rose from the Intermediate Care Unit (IMC) to Normal Care Unit (NCU) 6.2% and ISS 6.9%. MAIS did not increase >2, and no intervention was necessary for any patient. No correlation was found between computed tomography (CT) diagnostics in TRU and AIS change. Conclusions: The data suggest that AIS, MAIS and ISS did not increase significantly in patients without a severe injury during inpatient treatment, regardless of the type of CT diagnostics performed in the TRU, suggesting that monitoring of these patients may be unnecessary.

Highlights

IntroductionAcute care of trauma patients in Germany, Austria, Switzerland, the Netherlands, Belgium and Luxembourg is ensured by local, regional and supraregional trauma centers (level I-III) according to the TraumaNetwork DGU® initiative
Acute care of trauma patients in Germany, Austria, Switzerland, the Netherlands, Belgium and Luxembourg is ensured by local, regional and supraregional trauma centers according to the TraumaNetwork DGU® initiative.TraumaNetwork DGU® initiative has enabled the German Society for Trauma Surgery (DGU) to establish first-class nationwide care for the severely injured
While the diagnostic steps of the primary survey are strictly defined in the treatment protocol and are identical for all patients, diagnostic imaging in the Trauma Resuscitation Unit (TRU) is individually adapted to each trauma patient by the trauma team

Summary

Introduction

Acute care of trauma patients in Germany, Austria, Switzerland, the Netherlands, Belgium and Luxembourg is ensured by local, regional and supraregional trauma centers (level I-III) according to the TraumaNetwork DGU® initiative. TraumaNetwork DGU® initiative has enabled the German Society for Trauma Surgery (DGU) to establish first-class nationwide care for the severely injured. According to the guidelines of the DGU and the “Association of the Scientific Medical Societies in Germany” specific criteria must be fulfilled for the activation of the Trauma Resuscitation Unit (TRU). These criteria are divided into three groups: “disturbance of vital signs”, “detected injuries” and “mechanism of the accident or accident constellation” [2,3]. Based on the last criterion, it has been observed that in Germany that many slightly injured patients are admitted to the TRU, yet only one in five are severely injured with an Injury Severity Score (ISS) ≥ 16 [4,5]

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