Lessons learned during the sliding gantry CT implementation in a trauma suite

Benjamin Lucas1, Matthias Meng1, Wiebke Schirrmeister1, Gerald Pliske2, Felix Walcher1, Jan Philipp Schüttrumpf1
1Department of Trauma Surgery, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
2Department of Trauma Surgery, Otto Von Guericke University Magdeburg, Magdeburg, Germany

Tóm tắt

Early detection of bleeding is important for managing trauma cases in the emergency department (ED). Several trauma suites are equipped with computed tomography (CT) scanners to reduce the time to CT. In the last decade, sliding gantry CT has been implemented in trauma suites, highlighting conventional techniques' advantages. We investigated the change in the time to CT and the challenges faced during the implementation. Trauma suite treatments with a conventional CT scanner between January and December 2016 formed the control group. From January to April 2017, trauma suites were modified, and treatment was outsourced to an interim trauma suite. By May 2017, trauma suites were equipped with a sliding gantry CT scanner. Treatments from May to July 2017 formed the transition group, and those from August to December 2017 formed the routine use group. We evaluated the time to CT in all groups and considered the reasons for the delays in the transition and routine use groups. On sliding gantry CT implementation, although time to CT remained unaffected in the transition group, it significantly reduced in the routine use group, independent of injury severity score. The incidence of cable management problems was significantly higher in the latter group. We have demonstrated a decrease in the time to CT with the implementation of a sliding gantry CT. However, due to a higher number of cable management problems in the routine use group, we recommend regular refresher team training with routine use.

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Tài liệu tham khảo

Rhee P, Joseph B, Pandit V, Aziz H, Vercruysse G, Kulvatunyou N, et al. Increasing trauma deaths in the United States. Ann Surg. 2014;260:13–21.

Debus F, Lefering R, Lechler P, Ruchholtz S, Frink M. Frühe klinische Versorgungsstrategien für schwerverletzte Patienten mit Abdominaltrauma. Chirurg. 2019;90:752–7.

Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006;60(Supplement):S3-11.

Henderson KIM, Coats TJ, Hassan TB, Brohi K. Audit of time to emergency trauma laparotomy. Br J Surg. 2000;87:472–6.

Hilbert P, Zur Nieden K, Hofmann GO, Hoeller I, Koch R, Stuttmann R. New aspects in the emergency room management of critically injured patients: A multi-slice CT-oriented care algorithm. Injury. 2007;38:552–8.

American College of Surgeons. Committee on trauma. Advanced trauma life support: Student course manual. Washington: American College of Surgeons; 2018.

Fleming S, Bird R, Ratnasingham K, Sarker SJ, Walsh M, Patel B. Accuracy of FAST scan in blunt abdominal trauma in a major London trauma centre. Int J Surg. 2012;10:470–4.

Cheung KS, Wong HT, Leung LP, Tsang TC, Leung GKK. Diagnostic accuracy of Focused Abdominal Sonography for Trauma in blunt abdominal trauma patients in a trauma centre of Hong Kong. Chin J Traumatol. 2012;15:273–8.

Walcher F, Kirschning T, Müller MP, Byhahn C, Stier M, Rüsseler M, et al. Accuracy of prehospital focused abdominal sonography for trauma after a 1-day hands-on training course. Emerg Med J. 2010;27:345–9.

Salim A, Sangthong B, Martin M, Brown C, Plurad D, Demetriades D. Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: Results of a prospective study. Arch Surg. 2006;141:468–73.

Huber-Wagner S, Lefering R, Qvick LM, Körner M, Kay MV, Pfeifer KJ, et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet. 2009;373:1455–61.

Hessmann MH, Hofmann A, Kreitner K, Lott C, Rommens PM. The benefit of multi-slice computed tomography in the emergency room management of polytraumatized patients. Eur J Trauma. 2005;31:231–8.

Furugori S, Kato M, Abe T, Iwashita M, Morimura N. Treating patients in a trauma room equipped with computed tomography and patients’ mortality: a non-controlled comparison study. World J Emerg Surg. 2018;13:16.

Frellesen C, Boettcher M, Wichmann JL, Drieske M, Kerl JM, Lehnert T, et al. Evaluation of a dual-room sliding gantry CT concept for workflow optimisation in polytrauma and regular in- and outpatient management. Eur J Radiol. 2015;84:117–22.

Vogl TJ, Frellesen C, Bauer RW, Kerl M, Zacharowski K, Marzi I, et al. Multidisciplinary sliding-gantry CT: From concept to reality. J Comput Assist Tomogr. 2015;39:290–4.

Kippnich M, Schorscher N, Kredel M, Markus C, Eden L, Gassenmaier T, et al. Dual-room twin-CT scanner in multiple trauma care: first results after implementation in a level one trauma centre. Eur J Trauma Emerg Surg. 2021;47:1847–52.

Champion HR, Copes WS, Sacco WJ, Lawnick MM, Keast SL, Bain LW, et al. The major trauma outcome study: establishing national norms for trauma care. J Trauma. 1990;30:1356–65.

Paffrath T, Lefering R, Flohé S, TraumaRegister DGU. How to define severely injured patients? - An Injury Severity Score (ISS) based approach alone is not sufficient. Injury. 2014;45(Supplement 3):S64–9.

Yeguiayan JM, Yap A, Freysz M, Garrigue D, Jacquot C, Martin C, et al. Impact of whole-body computed tomography on mortality and surgical management of severe blunt trauma. Crit Care. 2012;16:R101.

Huber-Wagner S, Biberthaler P, Häberle S, Wierer M, Dobritz M, Rummeny E, et al. Whole-body CT in haemodynamically unstable severely injured patients: a retrospective, multicentre study. PLoS ONE. 2013;8: e68880. https://doi.org/10.1371/journal.pone.0068880.

Bieler D, Hörster A, Lefering R, Franke A, Waydhas C, Huber-Wagner S, et al. Evaluation of new quality indicators for the TraumaRegister DGU® using the systematic QUALIFY methodology. Eur J Trauma Emerg Surg. 2020;46:449–60.