Process related decisions and in-hospital transport times in polytrauma patients benefit from 24/7 in-house presence of trauma surgeons

• Published in: Injury 2021-02, Vol.52 (2), p.189-194
• Main Authors: van Wessem, Karlijn J.P., Leenen, Luke P.H.
• Format: Article
• Language: English
• Subjects: 24/7 in-house trauma surgeon; In-hospital transport times; Polytrauma patients
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2020.09.034

•Decisions for in-hospital transport order based on clinical signs in primary survey were rapid and accurate.•Possible preventable death was 1% in this polytrauma population.•Presence of dedicated trauma teams including 24/7 physical presence of trauma surgeons contribute to swift in-hospital transport times. Time and cause of death in polytrauma has shifted due to improvements in trauma and critical care. These include logistical improvements with dedicated trauma teams and in-house trauma surgeons. This study investigated in-hospital transport times and influence of process related decisions on mortality in polytrauma patients. A 6.5-year prospective study included consecutive polytrauma patients ≥15 years admitted to a Level-1 Trauma Center ICU with 24/7 in-house trauma surgeons. Demographics, physiologic parameters, pre- and in-hospital transport times were prospectively collected. Data are presented as median(IQR). 391 patients were included with median ISS of 29(22–36). 82 patients(21%) had a SBP≤90 mmHg on arrival in ED. 44 patients went from ED directly to OR for urgent surgery, all others had CT prior to OR and/or ICU. Patients who went directly to OR from ED had median transport time of 28(23–37) min. Patients who had CT after ED had median transport time of 31(25–42) min. 74(19%) patients died, majority caused by TBI(70%). Ten patients died