Der Unfallchirurg
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Review Meta Analysis
[Better apprehension of errors in the early clinical treatment of the severely injured].
Every year preventable adverse events endanger a considerable number of patients. Current guidelines of the Federal Joint Committee require clinical quality management to provide amongst others an independent clinical risk management and a critical incident reporting system (CIRS). Such guidelines increase the pressure to actively deal with errors, even in emergency medicine. Human error is considered to be the main cause of preventable adverse events in high-risk industries, such as aviation. This observation is gladly directly transferred to clinical medicine. ⋯ Human error is the most important cause of preventable adverse events during emergency room resuscitation. Presumably, errors occur unintentionally and as a result of situational misjudgment. As such errors have marked consequences on mortality and morbidity of severely injured patients, an extensive risk management is mandatory for the improvement of quality and safety. Appropriate methods to record errors in order to allow a correct root cause analysis according to well-established protocols is a basic prerequisite.
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Comment Letter
[Gunshot and stabbing injuries : Look beyond the horizon].
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The initial diagnostic procedure of severely injured patients in the emergency room (ER) during the primary survey is first and foremost a clinical examination. The clinical S3 guidelines provide recommendations for the treatment of patients with severe and multiple injuries. ⋯ Key symptoms registered during the clinical examination are not sufficiently safe to be solely relied upon for further diagnostic and therapeutic decisions. This confirms the sense of purpose of the strict approach according to the advanced trauma life support (ATLS) algorithm. Red flags can serve as a warning to focus on relevant injuries early on. A rational imaging diagnostic procedure must follow.
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In order to ensure adequate treatment and to avoid complications, care bundles are increasingly being implemented. These are comprehensive and evidence-based procedures for the treatment of individual diseases or injuries which should be carried out for every patient. The aim of this study was to define a care bundle for the prehospital treatment of severely injured patients. ⋯ A bundle of six elements was suggested and a comprehensive summary of key items during prehospital management of severely injured patients was identified. In a next step the effectiveness of the care bundle should be evaluated in a clinical trial.