Stefan Wirth MD, Presenter: Nothing to Disclose

Christian Siebers, Abstract Co-Author: Nothing to Disclose

Chlodwig Kirchhoff, Abstract Co-Author: Nothing to Disclose

Karl-Georg Kanz MD, Abstract Co-Author: Nothing to Disclose

Maximilian F. Reiser MD, Abstract Co-Author: Nothing to Disclose

The evaluate MSCT procedures during the primary survey in major trauma under operating resuscitation conditions and identify typical problems that caused delays in completion.

An independent study monitor documented the course of trauma room treatment during a 10 month period. The inclusion criteria were; patients who were admitted directly from the accident scene and; the study monitor was present at admission.

According to our ATLS-based trauma algorithm whole-body CT (WBCT) consists of non-contrast head CT (CCT) and contrast-enhanced trunk CT (TCT). 57 trauma patients receiving 45 WBCT, 5 single CCT and 4 single TCT studies were evaluated. After initial resuscitation CCT was obtained within 17 min after trauma room admission (IQR 13.0-20.0). In 20% (95%CI 9-31%) of the cases a CCT delay of median 5.0 min (IQR 3.8-8.0) was observed caused by e.g. ECG cables in the scan field or intoxicated patients. Contrast-enhanced TCT was performed after 23.0 min (IQR 19.0-27.0) whereas 12 of the 49 TCT studies were delayed (25%; 95%CI 12-37%) for 5 min (IQR 3.0-8.0).

Under "front line" conditions every fifth CCT and every fourth TCT study was completed with a median delay of 5 min. An independent process analysis revealed that unpreventable delays were due to uncooperative patients or system failure. Preventable delays were due to problems with intravenous lines or deviation from trauma room algorithms. Preventable delays could be avoided by addressing human and technical aspects such as revising checklists and functional architecture of the trauma bay. The failure mode and effect analysis (FMEA) method would assure quality in this process.

Preventable delays of whole body CT in major trauma patients were primarily due to deviation from interdisciplinary trauma room algorithms.

Wirth, S, Siebers, C, Kirchhoff, C, Kanz, K, Reiser, M, Quality Assurance of Multislice Computed Tomography Procedures during Primary Trauma Survey.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6010667.html