Current Problems in Surgery
Volume 44, Issue 12 , Pages 778-833 , December 2007

Pitfalls in the Evaluation and Management of the Trauma Patient

References 

  1. Health Resources and Services Administration. Model Trauma System Planning and Evaluation. U.S. Department of Health & Human Services; 2006;
  2. Cook RI, O’Connor M, Render M, Woods D. Operating at the sharp end: the human factors of complex technical work and its implications for patient safety. In:  Manuel BM,  Nora PF editor. Surgical Patient Safety: Essential Information for Surgeons in Today’s Environment. 1st ed.. Chicago: American College of Surgeons; 2004;
  3. Reason J. Human Error. 1st ed. Cambridge, UK: Cambridge University Press; 1990;
  4. In:  Kohn LT,  Corrigan JM,  Donaldson MS editor. To Err Is Human: Building a Safer Health System. 1st ed.. Washington, DC: National Academies Press; 2000;
  5. Rasmussen J, Jensen A. Mental procedures in real-life tasks: a case study of electronic troubleshooting. Ergonomics. 1974;17:293–307
  6. Helmreich RL, Foushee HC. Why crew resource management? (Empirical and theoretical bases of human factors training in aviation). In:  Wiener E,  Kanki B,  Helmreich R editor. Cockpit Resource Management. San Diego, CA: Academic Press; 1993;p. 3–45
  7. Mackersie RC, Rhodes M. Patient safety and trauma care. In:  Manuel BM,  Nora PF editor. Surgical Patient Safety: Essential Information for Surgeons in Today’s Environment. 1st ed. Chicago: American College of Surgeons; 2004;
  8. Lester H, Tritter JQ. Medical error: a discussion of the medical construction of error and suggestions for reforms of medical education to decrease error. Med Educ. 2001;35:855–861
  9. Sox HC, Woloshin S. How many deaths are due to medical error? (Getting the number right). Eff Clin Pract. 2000;3(6):277–283
  10. Ioannidis J, Lau J. Evidence on interventions to reduce medical errors (An overview and recommendations for future research). J Gen Internal Med. 2001;16:325–334
  11. Gaba DM. Research techniques in human performance using realistic simulation. In:  Henson L,  Lee A,  Basford A editor. Simulators in Anesthesiology Education. New York: Plenum Publishing; 1998;p. 93–102
  12. Lee SK, Pardo M, Gaba D, et al. Trauma assessment training with a patient simulator: a prospective, randomized study. J Trauma. 2003;55(4):651–657
  13. Howard SK, Gaba DM, Fish KJ, Yang G, Sarnquist FH. Anesthesia crisis resource management training: teaching anesthesiologists to handle critical incidents. Aviat Space Environ Med. 1992;63(9):763–770
  14. Holzman RS, Cooper JB, Gaba DM, Philip JH, Small SD, Feinstein D. Anesthesia crisis resource management: real-life simulation training in operating room crises. J Clin Anesth. 1995;7(8):675–687
  15. Helmreich RL, Schaefer HG. Team performance in the operating room. In:  Bogner MS editors. Human Error in Medicine. Hillside, NJ: Lawrence Erlbaum & Associates; 1994;
  16. Sexton JB, Thomas EJ, Helmreich RL. Error, stress, and teamwork in medicine and aviation: Cross sectional surveys. Br Medical J. 2000;320:745–749
  17. Hoyt DB, Shackford SR, Fridland PH, Mackersie RC, Hansbrough JF, Wachtel TL, et al. Video recording trauma resuscitations: an effective teaching technique. J Trauma. 1988;28(4):435–440
  18. Michaelson M, Levi L. Videotaping in the admitting area: a most useful tool for quality improvement of the trauma care. Eur J Emerg Med. 1997;4(2):94–96
  19. Oakley E, Stocker S, Staubli G, Young S. Using video recording to identify management errors in pediatric trauma resuscitation. Pediatrics. 2006;117(3):658–664
  20. Gordon JA, Oriol NE, Cooper JB. Bringing good teaching cases “to life”: a simulator-based medical education service. Acad Med. 2004;79(1):23–27
  21. Beaubien JM, Baker DP. The use of simulation for training teamwork skills in health care: how low can you go?. [review] Qual Saf Health Care. 2004;13(suppl 1):i51–i56
  22. Resources for the Optimal Care of the Injured Patient, 2006. Chicago: American College of Surgeons; 2006;
  23. Lerner EB. Studies evaluating current field triage: 1966-2005. Prehosp Emerg Care. 2006;10(3):303–306
  24. Jemmett ME, Kendal KM, Fourre MW, Burton JH. Unrecognized misplacement of endotracheal tubes in a mixed urban to rural emergency medical services setting. Acad Emerg Med. 2003;10(9):961–965
  25. Bair AE, Smith D, Lichty L. Intubation confirmation techniques associated with unrecognized non-tracheal intubations by pre-hospital providers. J Emerg Med. 2005;28(4):403–407
  26. Dorges V, Wenzel V, Knacke P, Gerlach K. Comparison of different airway management strategies to ventilate apneic, nonpreoxygenated patients. Crit Care Med. 2003;31(3):800–804
  27. Davis DP, Valentine C, Ochs M, Vilke GM, Hoyt DB. The Combitube as a salvage airway device for paramedic rapid sequence intubation. Ann Emerg Med. 2003;42(5):697–704
  28. Rabitsch W, Schellongowski P, Staudinger T, et al. Comparison of a conventional tracheal airway with the Combitube in an urban emergency medical services system run by physicians. Resuscitation. 2003;57(1):27–32
  29. Schaumann N, Lorenz V, Schellongowski P, et al. Evaluation of Seldinger technique emergency cricothyroidotomy versus standard surgical cricothyroidotomy in 200 cadavers. Anesthesiology. 2005;102(1):7–11
  30. Advanced Trauma Life Support. 7th ed.. Chicago: The American College of Surgeons; 2004;
  31. Gonzalez RP, Ickler J, Gachassin P. Complementary roles of diagnostic peritoneal lavage and computed tomography in the evaluation of blunt abdominal trauma. J Trauma. 2001;51(6):1128–1136
  32. Davis JW, Hoyt DB, McArdle S, Mackersie RC, et al. An analysis of errors causing morbidity and mortality in a trauma system: a guide for quality improvement. J Trauma. 1992;32(5):660–666
  33. Miller MT, Pasquale MD, Bromberg WJ, Wasser TE, Cox J. Not so FAST. J Trauma. 2003;54(1):52–59discussion 59-60.
  34. Griffin XL, Pullinger R. Are diagnostic peritoneal lavage or focused abdominal sonography for trauma safe screening investigations for hemodynamically stable patients after blunt abdominal trauma? (A review of the literature). J Trauma. 2007;62(3):779–784
  35. Gonzalez RP, Ickler J, Gachassin P. Complementary roles of diagnostic peritoneal lavage and computed tomography in the evaluation of blunt abdominal trauma. J Trauma. 2001;51(6):1128–1134discussion 1134-6
  36. Mele TS, Stewart K, Marokus B, O’Keefe GE. Evaluation of a diagnostic protocol using screening diagnostic peritoneal lavage with selective use of abdominal computed tomography in blunt abdominal trauma. J Trauma. 1999;46(5):847–852
  37. Alyono D, Morrow CE, Perry JF. Reappraisal of diagnostic peritoneal lavage criteria for operation in penetrating and blunt trauma. Surgery. 1982;92(4):751–757
  38. Stephen DJ, Kreder HJ, et al. Early detection of arterial bleeding in acute pelvic trauma. J Trauma. 1999;47(4):638–642
  39. Pereira SJ, O’Brien DP, et al. Dynamic helical computed tomography scan accurately detects hemorrhage in patients with pelvic fracture. Surgery. 2000;128(4):678–685
  40. Biffl WL, Smith WR, Moore EE, et al. Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures. Ann Surg. 2001;233(6):843–850
  41. Balogh Z, Caldwell E, Heetveld M, D’Amours S, Schlaphoff G, Harris I, et al. Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference?. J Trauma. 2005;58(4):778–782
  42. Krieg JC, Mohr M, Ellis TJ, Simpson TS, Madey SM, Bottlang M. Emergent stabilization of pelvic ring injuries by controlled circumferential compression: a clinical trial. J Trauma. 2005;59(3):659–664
  43. Cherry RA, Williams J, George J, Ali J. The effectiveness of a human patient simulator in the ATLS shock skills station. J Surg Res. 2007;139(2):229–235Epub Dec 11, 2006
  44. Bickell WH, Wall MJ, Pepe PE, Martin RR, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994;331(17):1105–110927
  45. In:  Jacobs LM,  Gross RI,  Luk SS editor. Advanced Trauma Operative Management: Surgical Strategies for Penetrating Trauma. 2004;Woodbury, CT: Cine’-Med
  46. http://www.trauma.org/index.php/resources/general/definitive_surgical_trauma_care/
  47. Beaulieu Y. Bedside echocardiography in the assessment of the critically ill. Crit Care Med. 2007;35(suppl 5):S235–S249
  48. Marymont J, Murphy GS. Intraoperative monitoring with transesophageal echocardiography: indications, risks, and training. Anesthesiol Clin. 2006;24(4):737–753
  49. Davis JW, Parks SN, Kaups KL, Gladen HE, O’Donnell-Nicol S. Admission base deficit predicts transfusion requirements and risk of complications. J Trauma. 1996;41(5):769–774
  50. Zehtabchi S, Baron BJ. Utility of base deficit for identifying major injury in elder trauma patients. Acad Emerg Med. 2007;14(9):829–831Epub 2007; June 28
  51. Geeraedts LM, Demiral H, Schaap NP, Kamphuisen PW, Pompe JC, Frolke JP. “Blind” transfusion of blood products in exsanguinating trauma patients. Resuscitation. 2007;73(3):382–388Epub 2007 Feb 9
  52. Malone DL, Hess JR, Fingerhut A. Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol. J Trauma. 2006;60(suppl 6):S91–S96
  53. Ketchum L, Hess JR, Hiippala S. Indications for early fresh frozen plasma, cryoprecipitate, and platelet transfusion in trauma. J Trauma. 2006;60(suppl 6):S51–S58
  54. Boffard KD, Riou B, Warren B, Choong PI, Rizoli S, et al. Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials. J Trauma. 2005;59(1):8–15
  55. Rizoli SB, Boffard KD, Riou B. Recombinant activated factor VII as an adjunctive therapy for bleeding control in severe trauma patients with coagulopathy: subgroup analysis from two randomized trials. Crit Care. 2006;10(6):R178;21
  56. Yasaka M, Oomura M, Ikeno K, et al. Effect of prothrombin complex concentrate on INR and blood coagulation system in emergency patients treated with warfarin overdose. Ann Hematol. 2003;82(2):121–123
  57. Baker RI, Coughlin PB, Gallus AS, et al. Warfarin reversal: consensus guidelines, on behalf of the Australasian Society of Thrombosis and Haemostasis. Med J Aust. 2004;181(9):492–497
  58. Aoki N, Wall MJ, Demsar J, et al. Predictive model for survival at the conclusion of a damage control laparotomy. Am J Surg. 2000;180:540–545
  59. Asensio JA, McDuffie L, Petrone P, et al. Reliable variables in the exsanguinated patient which indicate damage control and predict outcome. Am J Surg. 2001;182:743–751
  60. Germanos S, Gourgiotis S, Villias C, Bertucci M, Dimopoulos N, Salemis N. Damage control surgery in the abdomen: an approach for the management of severe injured patients. Int J Surg. 2007;May 13
  61. Brundage SI, Jurkovich GJ, Hoyt DB, Patel NY, Ross SE, Marburger R, et al. WTA Multi-institutional Study Group Western Trauma Association Stapled versus sutured gastrointestinal anastomoses in the trauma patient: a multicenter trial. J Trauma. 2001;51(6):1054–1061
  62. Dunsire MJ, Field J, Valentine S. Delayed diagnosis of cardiac tamponade following isolated blunt abdominal trauma. Br J Anaesth. 2001;87(2):309–312
  63. Kern KB. Postresuscitation myocardial dysfunction. Cardiol Clin. 2002;20(1):89–101
  64. J Kloner RA, Jennings RB. Consequences of brief ischemia: stunning, preconditioning, and their clinical implications: part 2. Circulation. 2001;104(25):3158–3167
  65. Yee ES, Verrier ED, Thomas AN. Management of air embolism in blunt and penetrating thoracic trauma. J Thorac Cardiovasc Surg. 1983;85(5):661–668
  66. Ho AM-H, Ling E. Systemic air embolism after lung trauma. Anesthesiology. 1999;90(2):564–575
  67. Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma. 2004;56(6):1261–1265
  68. Rorabeck CH. The treatment of compartment syndromes. J Bone Joint Surg. 1984;66:93–97
  69. Scalea TM, Bochicchio GV, Habashi N, McCunn M, Shih D, McQuillan K, et al. Increased intra-abdominal, intrathoracic, and intracranial pressure after severe brain injury: multiple compartment syndrome. J Trauma. 2007;62(3):647–656
  70. Tremblay LN, Feliciano DV, Rozycki GS. Secondary extremity compartment syndrome. J Trauma. 2002;53(5):833–837
  71. Shoemaker WC, Appel P, Bland R. Use of physiologic monitoring to predict outcome and to assist in clinical decisions in critically ill postoperative patients. Am J Surg. 1983;146(1):43–50
  72. Poeze M, Greve JW, Ramsay G. Meta-analysis of hemodynamic optimization: relationship to methodological quality. Crit Care. 2005;9(6):R771–R779
  73. Kern JW, Shoemaker WC. Meta-analysis of hemodynamic optimization in high-risk patients. Crit Care Med. 2002;30(8):1686–1692
  74. McKinley BA, Valdivia A, Moore FA. Goal-oriented shock resuscitation for major torso trauma: what are we learning?. Curr Opin Crit Care. 2003;9(4):292–299
  75. Velmahos GC, Demetriades D, Shoemaker WC, et al. Endpoints of resuscitation of critically injured patients: normal or supranormal? (A prospective randomized trial). Ann Surg. 2000;232(3):409–418
  76. Wiedemann HP, Wheeler AP, Bernard GR, et al. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564–2575
  77. Houshian S, Larsen MS, Holm C. Missed injuries in a level I trauma center. J Trauma. 2002;52(4):715–719
  78. Janjua KJ, Sugrue M, Deane SA. Prospective evaluation of early missed injuries and the role of tertiary trauma survey. J Trauma. 1998;44(6):1000–1006discussion 1006-7
  79. Buduhan G, McRitchie DI. Missed injuries in patients with multiple trauma. J Trauma. 2000;49(4):600–605
  80. Enderson BL, Reath DB, Meadors J, Dallas W, DeBoo JM, Maull KI. The tertiary trauma survey: a prospective study of missed injury. J Trauma. 1990;30(6):666–669
  81. Biffl WL, Harrington DT, Cioffi WG. Implementation of a tertiary trauma survey decreases missed injuries. J Trauma. 2003;54(1):38–43
  82. Koenig TR, West OC. Diagnosing acute traumatic aortic injury with computed tomography angiography: signs and potential pitfalls. Curr Probl Diagn Radiol. 2004;33(3):97–105
  83. Brennan TV, Lipshutz GS, Posselt AM, Horn JK. Congenital cleft spleen with CT scan appearance of high-grade splenic laceration after blunt abdominal trauma. J Emerg Med. 2003;25(2):139–142
  84. Lynch RM, Neary P, Jackson T, Duthie GS, Early AS. Traumatic pseudorupture of the diaphragm. Accid Emerg Nurs. 2004;12(1):58–59
  85. Miller PR, Croce MA, Bee TK, Malhotra AK, Fabian TC. Associated injuries in blunt solid organ trauma: implications for missed injury in nonoperative management. J Trauma. 2002;53(2):238–242discussion 242-4
  86. Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349(26):2510–2518
  87. Schneidereit NP, Simons R, Nicolaou S, et al. Utility of screening for blunt vascular neck injuries with computed tomographic angiography. J Trauma. 2006;60(1):209–215
  88. Mayberry JC, Brown CV, Mullins RJ, Velmahos GC. Blunt carotid artery injury: the futility of aggressive screening and diagnosis. Arch Surg. 2004;139(6):609–612
  89. Fabian TC. Damage control in trauma: laparotomy wound management acute to chronic. Surg Clin North Am. 2007;87(1):73–93
  90. Schecter WP, Ivatury RR, Rotondo MF, Hirshberg A. Open abdomen after trauma and abdominal sepsis: a strategy for management. J Am Coll Surg. 2006;203(3):390–396
  91. Howdieshel TR, Proctor CD, Sternberg E, et al. Temporary abdominal closure followed by definitive abdominal wall reconstruction of the open abdomen. Am J Surg. 2004;188(3):301–306
  92. Jernigan TW, Fabian TC, Croce MA, et al. Staged management of giant abdominal wall defects: acute and long-term results. Ann Surg. 2003;238(3):349–355
  93. Kress JP, Pohlman AS, O’Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342(20):1471–1477
  94. Kress JP, Gehlbach B, Lacy M, et al. The long-term psychological effects of daily sedative interruption on critically ill patients. Am J Respir Crit Care Med. 2003;168(12):1457–1461
  95. Esteban A, Frutos F, Tobin MJ, et al. Spanish Lung Failure Collaborative Group A comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med. 1995;332:345
  96. Ely EW, Meade MO, Haponik EF, et al. Mechanical ventilator weaning protocols driven by non-physician health-care professionals: evidence-based clinical practice guidelines. Chest. 2001;120:454S–463S
  97. Scheinhorn DJ, Chao DC, Stearn-Hassenpflug M. Liberation from prolonged mechanical ventilation. Crit Care Clin. 2002;18(3):569–595
  98. Lellouche F, Mancebo J, Jolliet P, et al. A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. Am J Respir Crit Care Med. 2006;174:894–900
  99. Holbrook TL, Anderson JP, Sieber WJ, et al. Outcome after major trauma 12-month and 18-month follow-up results from the trauma recovery project. J Trauma. 1999;46(5):765–773
  100. Holbrook TL, Hoyt DB. The impact of major trauma: quality-of-life outcomes are worse in women than in men, independent of mechanism and injury severity. J Trauma. 2004;56(2):284–290
  101. Wan JJ, Morabito DJ, Khaw L, Knudson MM, Dicker RA. Mental illness as an independent risk factor for unintentional injury and injury recidivism. J Trauma. 2006;61(6):1299–1304
  102. Zatzick DF, Kang SM, Hinton L, et al. Posttraumatic concerns: a patient-centered approach to outcome assessment after traumatic physical injury. Med Care. 2001;39(4):327–339
  103. Gruen RL, Jurkovich GJ, McIntyre LK, Foy HM, Maier RM. Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths. Ann Surg. 2006;244(3):371–380
  104. Vassar MJ, Holcroft JJ, Knudson MM, Kizer KW. Fractures in access to and assessment of trauma systems. J Am Coll Surg. 2003;197(5):717–725
  105. Nathens AB, Jurkovich GJ, MacKenzie EJ, Rivara FP. A resource-based assessment of trauma care in the United States. J Trauma. 2004;56(1):173–178
  106. MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354(4):366–378
  107. Nathens AB, Jurkovich GJ, Cummings P, Rivara FP, Maier RV. The effect of organized systems of trauma care on motor vehicle crash mortality. JAMA. 2000;283(15):1990–1994
  108. Utter GH, Maier RV, Rivara FP, Mock CN, Jurkovich GJ, Nathens AB. Inclusive trauma systems: do they improve triage or outcomes of the severely injured?. J Trauma. 2006;60(3):529–535

PII: S0011-3840(07)00138-4

doi: 10.1067/j.cpsurg.2007.09.006

Current Problems in Surgery
Volume 44, Issue 12 , Pages 778-833 , December 2007

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