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Introduction
Delay in the management of major trauma results in deterioration of the patient's condition and has a negative impact on prognosis. Rapid detection of organ injuries is essential, but comprehensive assessment within a short time period is very difficult. Establishment of a protocol for the initial management of trauma patients is effective and strongly recommended. In our hospital, we routinely use a trauma protocol that we developed in accordance with the Advanced Trauma Life Support guidelines.
We previously questioned the usefulness of a standardized protocol for all trauma patients. Trauma patients have injuries with varying degrees of severity, and we consider that a single standardized protocol cannot provide reasonable and effective management for all patients regardless of clinical presentation. Our current initial trauma protocol targets patients with major trauma, and includes a complete physical survey, blood sampling, and imaging tests. We strongly suspect that the majority of trauma patients do not need such extensive investigation, and that this protocol results in excessive use of medical resources.
Several reports have discussed the potential usefulness of developing a separate protocol for evaluation of minor trauma patients. However, no previous studies have reported on the usefulness or cost–benefit ratio of the initial diagnostic tests carried out in the emergency department (ED). The aim of this study was to evaluate the frequency and usefulness of the initial diagnostic tests carried out in blunt trauma patients in our ED.
Methods
Current procedures for the management of trauma patients in our ED
Emergency medical coordinators, resident doctors, and paramedical staff are alerted when a trauma patient arrives in the ED. A coordinator directs the initial trauma protocol. Most patients undergo routine focused abdominal sonography for trauma, blood sampling, and plane X‐ray. The results of blood tests and imaging tests are accessed by our computer network. Medical coordinators routinely interpret X‐rays, and a radiologist is consulted in difficult cases. Subsequent management is then discussed. The revised trauma score (RTS), injury severity score (ISS), and other patient data are registered in a trauma database.
Grouping of patients
We developed a unique scoring system to identify potential major trauma patients (Table ). The RTS is currently widely used during field assessments of the severity of trauma. The RTS is easily calculated from the...