Advanced Trauma Life Support Program Research Articles

Succeeding in Continuing Trauma Education During a Pandemic.

BackgroundCorona virus disease 2019 (Covid-19) impacted continuing medical education programs such as the Advanced Trauma Life Support (ATLS) course. Modifications made to medical training like teleconferencing could affect students’ learning success. We sought to evaluate the effects of the American College of Surgeons modifications on success rates in passing the ATLS course.MethodsThis study evaluated 28 ATLS 10th edition courses educating 898 students at our region before and after Covid-19 modifications. Traditional two-day courses were performed in-person while modified courses were conducted with a one-day teleconference followed by a second in-person practical day. We compared the characteristics and course pass rates between the traditional and modified ATLS courses.ResultsModified ATLS courses had significantly lower pass rates (81.0%; 95% confidence interval = [74.8–87.3]) compared to traditional ATLS courses (94.3%; [92.2–96.3]).ConclusionsModifications to the ATLS course are associated with lower student pass. This is possibly due to ineffective knowledge consolidation. Better modifications to the course are required such as use of electronic learning tools with modification to course schedule or returning to the traditional course but with the use of Covid-19 vaccines and other protective measures. These suggestions should be considered and evaluated further by ATLS program leaders.

Dr. James Styner and the development of Advanced Trauma Life Support

The Advanced Trauma Life Support program, or ATLS, is a trauma education system that has become the standard of care for initial management in emergent settings. Trauma is responsible for 10% of the world’s mortality, and comes at extensive cost, often with significant morbidity and rehabilitation1. ATLS provides an organized language and approach to the trauma patient that can be communicated globally and has been shown to significantly decrease mortality in the first hour post-admission2. It was originally designed for use in low resource settings after a devastating accident involving an orthopaedic surgeon’s family. The shortcomings in care that his family received spurred him to create an educational system that could be applied at any site.

The Effectiveness of Simulation Training in an Advanced Trauma Life Support Program for General Surgery Residents: A Pilot Study

Purpose: Although the Advanced Trauma Life Support (ATLS) course is now taught internationally, it has not been implemented in Korea. In recent years, interest has increased in simulation as a teaching tool in the ATLS course. We therefore hypothesized that simulation training would be a useful adjunct to the ATLS course. Methods: We designed a 1-day curriculum that included skill development workstations, expert lectures, trauma patient simulations, and group discussion for general surgery residents. We conducted a survey to evaluate participants’ level of understanding of the initial evaluation and treatment of trauma patients, their degree of knowledge and technical improvement, their satisfaction with the learning goals, and their overall satisfaction with the curriculum. We then analyzed the effects before and after the training. Results: Nine residents attended this course. None of the residents initially reported that they could perform a primary survey of trauma patients. The analysis revealed significant improvements after training in the questionnaire areas of “assembly of the team and preparation for resuscitation of a trauma patient” (p=0.008), “performance of a primary survey for trauma patients” (p=0.007), “resuscitative procedures for trauma patients” (p=0.008), “importance of re-evaluation” (p=0.007), “identifying the pitfalls associated with the initial assessment and management” (p=0.007), and “importance of teamwork” (p=0.007). Conclusions: After the ATLS simulation training, all participants showed significant improvements in their understanding of how to manage multiple trauma patients. Therefore, ATLS simulation training for residents will help in the management of trauma patients.

The history of bone marrow in orthopaedic surgery (part I trauma): trepanning, bone marrow injection in damage control resuscitation, and bone marrow aspiration to heal fractures.

One of the oldest procedures performed by man is trepanning of the bone and yet it was only in the last 40years that bone marrow aspiration has been used to treat nonunion disorders. These advances were possible due to improvements in instruments and in techniques to make holes in the bone, an history that began with skull trephinations around 8000-10,000years ago, and continued with sternum bone marrow injection for trauma resuscitation in the beginning of the twentieth century; this procedure had improved at the beginning of the twenty-first century to allow pelvis bone marrow aspiration for the treatment of nonunion. Trephined skulls from antiquity have been found in many parts of world, showing that trephining was ancient and widespread. Beginning with Neolithic period and the pre-Columbian Andean civilizations, the authors have traced the development of this surgical skill by describing the various surgical tools used to perform holes in the skull. These tools (trephines or trepan) were proposed at the end of the nineteenth century to study the bone marrow. At the beginning of the twentieth century, the sternum became the center of interest for the "in vivo" study of the bone marrow and the fluid injection in the sternum's bone marrow was described for resuscitation from shock during the World War II. With the introduction of plastic catheters and improved cannulation techniques, the need for intraosseous infusion as an alternative route for intravenous access diminished and sometimes abandoned. However, during the mid-1980s, James Orlowski allowed renaissance of the use of intraosseous infusion for paediatric resuscitation. Since then, this technique has become widespread and is now recognized as an alternative to intravenous access in adult emergencies; particularly, the intraosseous access has received class IIA recommendation from the Advanced Trauma Life Support program supported by the American College of Surgeons Committee on Trauma and bone marrow infusion is now recommended for "Damage Control" resuscitation. Although the pelvis bone contains half of the body's marrow volume, it was only in 1950 that the pelvis was proposed as a source for bone marrow aspiration and bone marrow-derived mesenchymal stem cells to improve healing of fractures. It will be many years before doing holes in the bone as orthopaedic trauma procedure will be relegated to the annals of history.

Validating the ATLS Shock Classification for Predicting Death, Transfusion, or Urgent Intervention

BackgroundThe Advanced Trauma Life Support (ATLS) shock classification has been accepted as the conceptual framework for clinicians caring for trauma patients. We sought to validate its ability to predict mortality, blood transfusion, and urgent intervention. Materials and methodsWe performed a retrospective review of trauma patients using the 2014 National Trauma Data Bank. Using initial vital signs data, patients were categorized into shock class based on the ATLS program. Rates for urgent blood transfusion, urgent operative intervention, and mortality were compared between classes. Results630,635 subjects were included for analysis. Classes 1, 2, 3, and 4 included 312,404, 17,133, 31, and 43 patients, respectively. 300,754 patients did not meet criteria for any ATLS shock class. Of the patients in class 1 shock, 2653 died (0.9%), 3123 (1.0%) were transfused blood products, and 7115 (2.3%) underwent an urgent procedure. In class 2, 219 (1.3%) died, 387 (2.3%) were transfused, and 1575 (9.2%) underwent intervention. In class 3, 7 (22.6%) died, 10 (32.3%) were transfused, and 13 (41.9%) underwent intervention. In class 4, 15 (34.9%) died, 19 (44.2%) were transfused, and 23 (53.5%) underwent intervention. For uncategorized patients, 21,356 (7.1%) died, 15,168 (5.0%) were transfused, and 23,844 (7.9%) underwent intervention. ConclusionsAlmost half of trauma patients do not meet criteria for any ATLS shock class. Uncategorized patients had a higher mortality (7.1%) than patients in classes 1 and 2 (0.9% and 1.3%, respectively). Classes 3 and 4 only accounted for 0.005% and 0.007%, respectively, of patients. The ATLS classification system does not help identify many patients in severe shock.

Complications Associated With Placement of Chest Tubes: A Trauma System Perspective

BackgroundThe insertion of a chest tube is a common procedure in trauma care, and the Advanced Trauma Life Support program teaches the insertion of chest tubes as an essential and life-saving skill. It is also recognized that the insertion of chest tubes is not without risks or complications. The purpose of this study was to evaluate complications of chest tube placement in a level 1 trauma center compared with those placed in surrounding referral hospitals. MethodsA retrospective matched cohort study of trauma patients was performed between those who underwent chest tube placement at the level 1 trauma center and those with a chest tube placed before transfer to the level 1 center between 2004 and 2013. Conditional logistic regression was used to compare the likelihood of complications and death between chest tube placement groups. ResultsFour thousand two hundred and sixteen trauma patients had a chest tube placed at the level 1 center, and 364 patients had a chest tube placed at an outside hospital before transfer. Two hundred and eighty-one patients were matched. Patients with a chest tube placed outside the trauma center had an increased likelihood of malposition (OR 7.2, 95% CI 3.6-14.6), residual hemothorax (OR 6.3, 95% CI 3.4-11.6), residual pneumothorax (OR 6.7, 95% CI 3.9-11.4), and having a second chest tube placed (OR 3.77, 95% CI 2.37-6.01). However, the patients with a chest tube placed outside of the trauma center were also less likely to develop pneumonia (OR 0.32, 95% CI 0.14-0.73). There were no differences in the odds of developing an empyema, the need for video-assisted thoracoscopic surgery, thoracotomy, or death. ConclusionsThere are opportunities for improving the care of patients who require chest tubes at both referring hospitals and the receiving trauma center. Improving the care of patients who require intercostal drainage requires a systems-based approach, focusing on training and quality improvement.

Cost Analysis of the Mongolian ATLS© Program: A Framework for Low- and Middle-Income Countries.

Trauma is the leading cause of death among Mongolians aged 24-44. To improve initial management of injured patients, the Mongolian National University of Medical Sciences (MNUMS) implemented the American College of Surgeons' (ACS) Advanced Trauma Life Support (ATLS) training program in 2015. Cost analysis demonstrates that such programs can have clear pathways to self-sufficiency. Costs associated with an ACS Mongolian ATLS program were quantified based on discussions with the Mongolian government, MNUMS, ATLS Australasia headquarters, and existing pricing data. Costs were then classified as either essential or contingencies. These classifications determined budgetary items for each program. Savings projections for contingencies included training Mongolian instructors and educators. Scenarios for funding the budget were then assessed. The minimum annual cost of ATLS in Mongolia, which includes 3 ATLS student courses/1 instructor course, is $10,709. A budget of $19,900 includes additional contingencies. The scenario that involves foreign instructors is the most expensive one. An initial investment of $85,000 to train Mongolian instructors reduces annual costs by $48,305 (71% reduction). An investment of $4050 to train a Mongolian educator will reduce costs by $1750 annually. ATLS can be sustained with 0.04% of Mongolia's current spending on public health and preventative services. Initial investment to train Mongolian ATLS instructors leads to substantial savings. Training a Mongolian educator lowers long-term costs. When minimum costs for ATLS courses are understood, these can be scaled up and supported with different contingencies and minimal funding by government or third-party stakeholders.

Global Collaboration to Modernize Advanced Trauma Life Support Training

Each year, thousands of surgeons and other trauma health care providers participate in the American College of Surgeon's Advanced Trauma Life Support (ATLS) program, which historically has allowed trainees to practice cricothyroidotomy, chest tube insertion, pericardiocentesis, venous cutdown, and diagnostic peritoneal lavage on live dogs, pigs, sheep, and goats. However, more than 99% of ATLS programs in the United States and Canada have now ended animal use, driven primarily by simulation technology advancements. This review details an international survey of animal versus simulation use in ATLS programs and summarizes the surgical training impact of a novel collaboration between the industry manufacturer of the TraumaMan human simulator, Simulab Corporation (Seattle, Washington), and an animal protection nongovernmental organization (NGO) based in Norfolk, Virginia, to replace animal use in ATLS programs with human simulators. From 2012 through 2017, the NGO e-mailed formal surveys concerning program statistics and animal use practices to ATLS officials in various countries (N = 64). The survey response rate was 87.5% and included pre- and post-comparison surveys relative to the industry-NGO simulation collaboration. Eighteen ATLS programs (32.1%) initially replied that they use nonanimal training methods, whereas 38 ATLS programs (67.8%) replied that they use animals for surgical skills training and cited financial constraints as the primary barrier to adopting human simulation methods. Through the industry-NGO collaboration, the NGO donated 119 TraumaMan models valued at nearly $3 million (USD) to ATLS programs in 22 countries, such that 75% of those ATLS programs surveyed by the NGO now use exclusively nonanimal simulation models. The industry-NGO collaboration successfully transformed the surgical skills laboratories of 22 international ATLS programs to replace animal use with nonanimal simulation models that are more anatomically realistic, cost less, and allow trainees to repeat surgical skills until proficiency.

Effect of Advanced Trauma Life Support program on medical interns’ performance in simulated trauma patient management

ObjectiveSince appropriate and timetable methods in trauma care have an important impact on patients’ outcome we evaluated the effect of Advanced Trauma Life Support (ATLS) program on medical interns’ performance in simulated trauma patient management MethodsA descriptive and analytical study before and after the training was conducted on 24 randomly selected undergraduate medical interns from Imam Reza Hospital in Mashhad, Iran. On the first day, we assessed interns’ clinical knowledge and their practical skill performance in confronting simulated trauma patients. After 2days of ATLS training, we performed the same study and evaluated their score again on the fourth day. The two findings, preand post- ATLS periods, were compared through SPSS version 15.0 software. P values less than 0.05 were considered statistically significant. ResultsOur findings showed that interns’ ability in all the three tasks improved after the training course. On the fourth day after training, there was a statistically significant increase in interns’ clinical knowledge of ATLS procedures, the sequence of procedures and skill performance in trauma situations (P<0.001, P=0.016 and P=0.01 respectively). ConclusionATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns.

Impact of ATLS training on preventable and potentially preventable deaths.

Multiple trauma continues to have a high incidence worldwide. Trauma is the leading cause of death among people between the ages of 10 and 40. The Advanced Trauma Life Support (ATLS) is the most widely accepted method for the initial control and treatment of multiple trauma patients. It is based on the following hypothesis: The application of the ATLS program may reduce preventable or potentially preventable deaths in trauma patients. The present article reports a retrospective study based on the records of prospectively evaluated trauma patients between January 2007 and December 2012. Trauma patients over the age of 18 admitted to the critical care unit or patients who died before hospital admission were included. A multidisciplinary committee looked for errors in the management of each patient and classified deaths into preventable, potentially preventable, or nonpreventable. We recorded the number of specialists at our center who had received training in the ATLS program. A total of 898 trauma patients were registered. The mean injury severity score was 21 (SD 15), and the mortality rate was 10.7 % (96 cases). There were 14 cases (14.6 %) of preventable or potentially preventable death. The main errors were delay in initiating suitable treatment and performing a computed tomography scan in cases of hemodynamic instability, followed by initiation of incorrect treatment or omission of an essential procedure. As the number of ATLS-trained professionals increases, the rates of potentially preventable or preventable death fall. Well-founded protocols such as the ATLS can help provide the preparation health professionals need. In our hospital environment, ATLS training has helped to reduce preventable or potentially preventable mortality among trauma patients.

Does ATLS trauma training fit into Western countries: evaluation of the first 8years of ATLS in Germany.

With over 2 million certified physicians worldwide, the Advanced Trauma Life Support (ATLS) program is one of the most successful international medical education programs. Germany joined the ATLS program in 2003. Before implementation of the program, there was a controversial discussion as to whether a country like Germany with a long history of trauma care needed ATLS at all. 197 courses with nearly 3,000 providers were performed until December 2010. We assessed the course evaluations since the implementation of ATLS in Germany using the participants' systematic feedback. During the course, each participant evaluated each presentation, skill station, and simulation on a rating scale from 1 to 4 (1 being the best, 4 being the worst). The participants completed the evaluation forms during the course and before they received their results. The course coordinator made sure that all forms were returned. The feedback forms were collected anonymously and were entered into a database. Statistical analysis was performed using frequencies and mean values. The cumulative evaluation of all courses revealed an average performance score of 1.39 (1.06-1.86; n=197). The lectures, skill stations, and simulations were individually evaluated as follows: lectures 1.61 (1.00-2.81; n=197), skill stations 1.40 (1.00-2.40; n=197), and surgical skill stations 1.35 (1.00-2.38; n=197). Practical skills simulation (case scenarios) received the highest grade of 1.24 (1.00-1.57; n=197). There were no significant changes during the time concerning the results of the evaluation. The overall assessment showed constantly good and excellent evaluations by the participants over the years. In general, skill stations and simulations performed better than lectures. According to these results, the course format is well accepted by the participants and, therefore, can be recommended to all physicians treating trauma patients. Our results also underline the value of such a course format in an industrial country with an already established trauma system.

Further recommendations for trauma training of Indian medical officers and medical students

Further recommendations for trauma training of Indian medical officers and medical students

Comparing the Standardized Live Trauma Patient and the Mechanical Simulator Models in the ATLS Initial Assessment Station

Mechanical simulators may be an acceptable substitute for the live patient model in trauma skills teaching and assessment. We compare these models in the initial assessment station of the Advanced Trauma Life Support (ATLS) course. After a pilot project utilizing both models in a provider ATLS course it appeared that the mechanical model would be satisfactory for ATLS teaching and assessment. Instructors (n = 32) and ATLS Students (n = 64) were randomly selected from our database and completed a questionnaire evaluating the patient model and the simulator after viewing a video in which the simulator replaced the patient model. The evaluators indicated whether the patient and simulator models were satisfactory and then compared them by indicating whether there was any difference between the models, indicating which was more challenging, interesting, dynamic, enjoyable, realistic, and better overall. Comments were also written in the evaluation form. All 32 instructors and 64 students indicated that both the patient and simulator models were satisfactory for teaching and testing ATLS resuscitation skills. At least 62 of the 64 students rated the simulator higher in all categories. Two students rated the patient model as more realistic and two noted no difference in terms of being more interesting. All 32 instructors indicated that the simulator was more challenging, interesting, dynamic, and better overall. Two of the 32 instructors indicated that the patient model was more enjoyable and two indicated that there was no difference as far as the models being realistic. Comments included inability to hear breath sounds that were changing in the patient model as opposed to the simulator model, and the simulator was more interesting and dynamic because the hemodynamic and physiologic parameters could be witnessed without being prompted by the instructor. One main concern expressed by the participants was the more costly simulator, and two instructors indicated that the scenarios could be improved to fit the superior capabilities of the simulator. There was strong support from both students and instructors for the use of the simulator as a satisfactory substitute for the live patient model. The cost of the simulator is considered a significant issue. However, in centers where simulators are readily available, it appears from our data that it is a very satisfactory substitute for the patient model in teaching and assessing trauma resuscitation skills in the ATLS program.

Improving trauma care in India: a recommendation for the implementation of ATLS training for emergency department medical officers

BackgroundTrauma is major cause of morbidity and mortality in India. The Advanced Trauma Life Support (ATLS) programme teaches a standardised method for the initial assessment and management of trauma patients, and has been adopted by more than 50 countries worldwide.AimWe sought to assess the theoretical knowledge of ATLS principles among emergency department (ED) medical officers (MOs) in Salem, Tamil Nadu, India, and from the Royal Adelaide Hospital, Adelaide, South Australia.MethodsAll MOs answered a trauma management quiz based on ATLS-type questions. Quiz scores were compared between senior and junior MO groups for each country, and within each professional group between countries. Categorical data were analysed using χ2. An α value less than 0.05 was deemed to be statistically significant.ResultsWe discovered significant differences in the theoretical knowledge of ED MOs from Salem compared with colleagues in Adelaide. Our results demonstrated the positive influence of completion of an ATLS programme upon obtaining a passing grade on the trauma quiz. We failed to determine a link between self-rated experience in trauma management and the ability to pass the quiz.ConclusionsOur study demonstrated the positive influence of completion of an ATLS-type programme on the score obtained on the trauma management quiz. Although previous work has demonstrated mixed results concerning improvement in the care of trauma patients following completion of an ATLS programme, we recommend that such programmes be integrated into the training of Indian ED MOs and suggest that ATLS should be viewed as an integral part of medical training.

The truth about trauma care

I read with interest the recent editorial by Southern and Sen [1] which outlined the history and current state of UK trauma training. They succeeded in steering a course through the sea of trauma acronyms, and it was refreshing to see some criticism of the mighty ATLS® from a pair of its instructors. However, I must take issue with a quote from the introductory paragraphs: ‘Numerous studies have shown that trauma patients are better managed by doctors who have attended the Advanced Trauma Life Support (ATLS) course’. Leaving aside ‘better managed’ for a moment, they reference just two papers [2, 3]. The first is essentially a retrospective impact study produced by a Canadian group using data from Trinidad and Tobago over a period of 9 years. It certainly demonstrates a change in that period, but does not prove cause and effect by any means. The second paper comes from the Netherlands and is another impact study, this time prospective over 3 years. Even the authors' claims for this study are pretty modest in their conclusion: ‘Our data demonstrate that after introduction of the ATLS program 1-h outcomes significantly improved, but overall outcomes are not’. Perhaps ‘better managed’ simply equates with adhering to the guidelines, rather than changing mortality or morbidity. While I am plainly an unbeliever, the Cochrane Collaboration appears to agree with me [4]. Their conclusion on reviewing the effect of ATLS training includes the statement: ‘There is no clear evidence that ATLS training (or similar) impacts on the outcome for victims of trauma…Further, there is no evidence that trauma management systems incorporating ATLS training impact positively on outcome’. The ATLS and similar resuscitation courses have become bizarrely popular over the last 18 years. Why? Because they lend structure to chaos, because they encourage the concept of teamwork and, as Southern and Sen point out, they have become essential CV items. These may be reasons enough, but let's not pretend that these courses actually save lives. In fact, I wonder if such courses aren't a classic case of making the doctors feel better, but failing to have the same effect on the patients. I have been a motorcyclist for 27 years and will undoubtedly require some decent trauma care at some point in the future.

Orthopaedic Trauma for the General Orthopaedist

The Advanced Trauma Life Support program of the American College of Surgeons has developed a de facto standard of care for the first hour of treatment of patients with trauma who are treated in North America. No equivalent for the treatment of orthopaedic trauma has been established. We provide an overview of the important topics every orthopaedist treating patients with musculoskeletal trauma should be familiar with. The topics include: (1) diagnosis of musculoskeletal injury and documentation of physical exam; (2) pelvic ring injuries; (3) open fractures; (4) compartment syndrome; (5) the timing of definitive fixation in the patient with polytrauma; (6) delayed diagnosis of musculoskeletal injury; and (7) deep venous thrombosis prophylaxis.

Clinical impact of advanced trauma life support

The Advanced Trauma Life Support (ATLS) course sponsored by the American College of Surgeons Committee On Trauma (ACSCOT) presents a standardized method of initial trauma care. This study attempted to measure any changes in morbidity and mortality in trauma patients after the introduction of ATLS training. Over a 3-year period (May 1996 to September 1997—pre-ATLS period; December 1997 to April 1999—post-ATLS period), 63 trauma patients with an Injury Severity Scale (ISS) ≥16 (n = 31, pre-ATLS and n = 32, post-ATLS) were prospectively studied in two community teaching hospitals. There was no significant difference in mortality rate between groups (48% [15 of 31] pre-ATLS vs. 30% [10 of 32] post-ATLS; P = .203, Fisher exact test). Mortality rates within the ISS range of 16 to 25 were 64% (nine of 14 pre-ATLS) versus 29% (five of 17 post-ATLS), and for the ISS 26 to 35 subgroup, 40% (four of 10 pre-ATLS) versus 25% (two of eight post-ATLS), and within the ISS 36 to 75 subgroup, 29% (two of seven pre-ATLS) versus 43% (three of seven post-ATLS). There was a significant difference in mortality during the first 60 minutes after admission: 0.0% post-ATLS versus 24.2% pre-ATLS ( P = .002, Fisher exact test (95% confidence interval ranged from 12–45% in the pre-ATLS group and 0–11% in the post-ATLS group). According to the TRISS methodology (a worldwide-accepted mathematical method to calculate chances of survival through logistical regression),ATLS improved outcome from sub-“Major Trauma Outcome Study” (MTOS) standard results (z = −2.9 to a MTOS standard result z = −0.49). Our data demonstrate that introduction of the ATLS program significantly improved trauma patient outcome in the first hour after admission, as well as improvement from sub-MTOS standard to MTOS standard levels.

Military Trauma Life Support: A Comprehensive Training Program for Military Physicians

The Israel Defense Forces Medical Corps prepares Israeli physicians for their field duty as providers of prehospital trauma care under combat conditions. Many physicians have no previous experience with emergency medicine. Military trauma education has been improving continuously to meet this challenge. In 1990, the Advanced Trauma Life Support program was launched in Israel. In 1998, a task-oriented approach to military trauma. Military Trauma Life Support, was introduced. This course is integrated in the 3-month training period of medical officers. Its objectives are to provide a comprehensive curriculum in prehospital military trauma, to simulate realistic combat scenarios and injury patterns, and to add practical skills and prehospital experience. The practical section includes definitive airway management in hospital operating rooms, emergency procedures training on cadavers, and prehospital experience on civilian emergency medical services ambulances.

Trauma surgeons, trauma centres

Trauma is an important health problem. With the anticipated decline in communicable diseases and nutritional problems in the next millennium, trauma might replace communicable diseases as a problem and rank second only to non‐communicable diseases. Trauma is a surgical disease and a general surgeon’s leadership is imperative to the success of regional trauma systems. Designation of trauma centres would improve patient outcomes, increase surgeons’ experience and reduce costs in health care. The success of the Advanced Trauma Life Support Programme has shown how the input of surgeons can change the concept of our care for trauma victims. The lack of local trauma data has limited our appraisal to intellectual guessing. To objectively appraise local demand, a territory‐wide major trauma outcome study should be conducted in Hong Kong.

Outcome of raising blood pressure in patients with penetrating trunk wounds

In many countries, the management of patients with traumatic wounds follows the guidelines from the American College of Surgeons Advanced Trauma Life Support Program for Physicians (ATLS) 1 American College of Surgeons. Shock. In: American College of Surgeons, ed. American College of Surgeons, Committee on Trauma. Advanced trauma life support program for physicians: instructor manual, 1997. Google Scholar but the protocol relating to penetrating wounds has recently come under scrutiny. Investigators have suggested that under ideal conditions delaying fluid resuscitation until operative intervention may improve survival. 2 Bickell WH Wall Jr, MJ Pepe PE et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries.. N Engl J Med. 1994; 331: 1105-1109 Crossref PubMed Scopus (1692) Google Scholar Raising the blood pressure in these patients may lead to increased haemorrhage caused by dislodgement of thrombus. 3 Shafton GW Clive CJ Dennis C Harris B Fundamentals of physiologic control of arterial hemorrhage.. Surgery. 1965; 58: 851-856 PubMed Google Scholar Intravenous fluids may also dilute coagulation factors 4 Bickell WH Bruttig SP Millnamow GA OBenar J Wake CE The detrimental effects of intravenous crystalloid after aortotomy in swine.. Surgery. 1991; 110: 529-536 PubMed Google Scholar and lower blood viscosity, decreasing resistance to flow around an incomplete thrombus. 5 Bickell WH Bruttig SP Millnamow GA OBenar J Wake CE Use of hypertonic saline/dextran versus lactated Ringer's solution as a resuscitation fluid after uncontrolled aortic hemorrhage in anesthetized swine.. Ann Emerg Med. 1992; 21: 1077-1085 Summary Full Text PDF PubMed Scopus (149) Google Scholar We tested the hypothesis that raising blood pressure between admission and operation in patients with penetrating wounds to the trunk had a deleterious effect on outcome, under a more realistic worst-case scenario.