28.
Introducing a standardized algorithm for managing multitrauma
patients in the Trauma Centre, Rigshospitalet
Adrina Kalasho, Henrik Eckardt
Faculty of Medicine University of Copenhagen; Department of Orthopaedic
Surgery, Rigshospitalet
Background:
Pape has suggested an algorithm for identifying multitrauma
patients in need of Damage Control Orthopaedics (DCO). A combination of
anatomic and physiological parameters defines the patients as either stable,
borderline, unstable or in extremis. Stable patients receive Early Total Care
(
ETC), borderline and unstable patients undergo DCO, and those in extremis
are resuscitated. This algorithm was introduced in the Trauma Centre,
Rigshospitalet, in 2011.
Purpose / Aim of Study:
The purpose is to describe the triage patterns before
and after implementation of the Pape algorithm and elucidate potential
differences for further investigations in the future.
Materials and Methods:
The algorithm was applied on patients with Injury
Severity Score> 15 and orthopaedic injuries at admission time (P+). Patients
were categorized and managed accordingly. The visitation, number of DCO
and ETC, Pape classification, mortality, ventilator days, ICU and total hospital
stay were extracted retrospectively and compared to a corresponding group
from a similar period last year when visitation was carried out without any
defined criteria (P-). This is thus a retrospective descriptive study.
Findings / Results:
33
patients were included in group P+ and 35 in P-. DCO
was performed 4 times and ETC 3 times in P+, compared to 1 DCO and 7 ETC
in P-. There were otherwise similar visitation patterns. More patients were
classified as being unstable or in extremis in group P+. 278 days were spent in
the ICU in total and 205 on ventilator in the same group, compared to 403 and
400
days in group P-. Hospital stay was 591 (P+) and 792 (P-) days. 3 patients
died in P+, compared to 2 in P-.
Conclusions:
The results are not conclusive. There could however be a trend
towards performing more DCO and assessing patients differently with the
algorithm, besides fewer days in ICU and hospital.
