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Level of Evidence Analysis for the Latest German National Guideline on Treatment of Patients with Severe and Multiple Injuries and ATLS

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Abstract

Purpose

Advanced Trauma Life Support (ATLS®) is one of the world’s best-known training programs for medical providers. Revisions of the ATLS manual have been evidence based for a number of years. In 2011, a level 3 (S3) evidence- and consensus-based guideline on the treatment of patients with severe and multiple injuries was published in Germany. The scope of this study was the systematic comparison of the educational content of the ATLS concept and the interdisciplinary “S3 polytrauma guideline.”

Methods

A total of 123 key recommendations of the guideline were compared with the content of the ATLS manual (9th edition). Depending on the level of agreement, the recommendations were classed in the following categories: (1) Agreement. (2) Minor variation. (3) Major variation.

Results

An overall 86 % conformity was found between the key recommendations of the guideline and the ATLS® manual. The ATLS® primary survey (ABCDE) showed an 85 % conformity. The degree of conformity for the individual priorities was as follows: A (Airway) 79 %, B (Breathing) 79 %, C (Circulation) 86 %, D (Disability) 93 %, E (Exposure) 100 %. The ATLS® secondary survey showed a 94 % conformity. The main differences were in the areas of anesthetic induction, fluid administration, and coagulation therapy.

Conclusions

According to our comparison, the educational content and manual of the ATLS are largely compatible with a high level of evidence S3 guideline. However, subsequent editions of both the ATLS® and the S3 guideline should re-examine and reassess a number of aspects.

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Abbreviations

ATLS® :

Advanced Trauma Life Support

GoR:

Grade of recommendation

References

  1. American College of Surgeons (2012) ATLS Manual, 9th edn. American College of Surgeons, Chicago

    Google Scholar 

  2. AWMF. S3—Guideline on treatment of patients with severe and multiple injuries. http://www.awmf.org/fileadmin/user_upload/Leitlinien/012_D_Ges_fuer_Unfallchirurgie/012-019e_S3_Severe_and_Multiple_Injuries_2012-11.pdf. Accessed 23 Nov 2014

  3. Oxford Center of Evidence-Based Medicine (CEBM) (2009) Levels of evidence. http://www.cebm.net/?o=1025. Accessed 20 Jul 2014

  4. Council of Europe (2001) Developing a methodology for drawing up guidelines on best medical practices recommendation rec (2001) 13 adopted by the Committee of Ministers of the Council of Europe on 10 October 2001 and explanatory memorandum. Council of Europe, Strasbourg Cedex

    Google Scholar 

  5. American College of Surgeons Committee on Trauma (2013) Advanced trauma life support (ATLS): the ninth edition. J Trauma Acute Care Surg 74:1363–1366

    Google Scholar 

  6. Kortbeek JB, Al Turki SA, Ali J et al (2008) Advanced trauma life support, 8th edition, the evidence for change. J Trauma 64:1638–1650

    Article  PubMed  Google Scholar 

  7. Wright JG, Swiontkowski MF, Heckman JD (2003) Introducing levels of evidence to the journal. Bone Joint Surg Am 85(1):1–3

    Article  Google Scholar 

  8. Mayglothling J, Duane TM, Gibbs M (2012) Emergency tracheal intubation immediately following traumatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 73(Suppl 4):333–340

    Article  Google Scholar 

  9. Ray DC, McKeown DW (2012) Etomidate for critically ill patients. Pro: yes we can use it. Eur J Anaesthesiol 29:506–510

    Article  CAS  PubMed  Google Scholar 

  10. de la Grandville B, Arroyo D, Walder B (2012) Etomidate for critically ill patients. Con: do you really want to weaken the frail? Eur J Anaesthesiol 29:511–514

    Article  PubMed  Google Scholar 

  11. Riddez L, Hahn RG, Brismar B (1997) Central and regional hemodynamics during acute hypovolemia and volume substitution in volunteers. Crit Care Med 25:635–640

    Article  CAS  PubMed  Google Scholar 

  12. Pitts RF, Ayer JL, Schiess WA (1948) The reabsorption and excretion of bicarbonate in normal man. Fed Proc 7:94

    CAS  PubMed  Google Scholar 

  13. Pitts RF, Ayer JI, Schiess WA et al (1949) The renal regulation of acid-base balance in man. The reabsorption and excretion of bicarbonate. J Clin Invest 28:35–44

    Article  CAS  PubMed Central  Google Scholar 

  14. Coran AG, Ballantine TV, Horwitz DL et al (1971) The effect of crystalloid resuscitation in hemorrhagic shock on acid-base balance: a comparison between normal saline and Ringer’s lactate solutions. Surgery 69:874–880

    CAS  PubMed  Google Scholar 

  15. Hankeln K, Lenz I, Häuser B (1988) Hemodynamic effect of 6 % hydroxyethyl starch (HES 200,000/0.62). Anaesthesist 37:167–172

    CAS  PubMed  Google Scholar 

  16. Healey MA, Davis RE, Liu FC (1998) Lactated ringer’s is superior to normal saline in a model of massive hemorrhage and resuscitation. J Trauma 45:894–899

    Article  CAS  PubMed  Google Scholar 

  17. Shires GT (1977) Pathophysiology and fluid replacement in hypovolemic shock. Ann Clin Res 9:144–150

    CAS  PubMed  Google Scholar 

  18. Zander R (1995) Declaring infusion solutions with base excess and potential base excess. Anasthesiol Intensivmed Notfallmed Schmerzther 30(Suppl 1):73–77

    Article  Google Scholar 

  19. Stukanov MM, Lukach VN, Girsh AO (2011) The homeostasis assessment by hemorrhagic shock. Khirurgiia (Mosk) 5:51–55

    Google Scholar 

  20. Nishijima DK, Zehtabchi S, Berrong J et al (2012) Utility of platelet transfusion in adult patients with traumatic intracranial hemorrhage and preinjury antiplatelet use: a systematic review. J Trauma Acute Care Surg 72:1658–1663

    Article  PubMed  Google Scholar 

  21. Ott MM, Eriksson E, Vanderkolk W (2010) Antiplatelet and anticoagulation therapies do not increase mortality in the absence of traumatic brain injury. J Trauma 68:560–563

    Article  CAS  PubMed  Google Scholar 

  22. Washington CW, Schuerer DJ, Grubb RL Jr (2011) Platelet transfusion: an unnecessary risk for mild traumatic brain injury patients on antiplatelet therapy. J Trauma 71:358–363

    Article  PubMed  Google Scholar 

  23. Cartmill M, Dolan G, Byrne JL (2000) Prothrombin complex concentrate for oral anticoagulant reversal in neurosurgical emergencies. Br J Neurosurg 14:458–461

    Article  CAS  PubMed  Google Scholar 

  24. Holcomb JB, Del Junco DJ, Fox EE (2012) The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: comparative effectiveness of a time-varying treatment with competing risks. Arch Surg 15:1–10

    Google Scholar 

  25. Meyer MA, Ostrowski SR, Windeløv NA et al (2011) Fibrinogen concentrates for bleeding trauma patients: what is the evidence? Vox Sang 101:185–190

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

Johannes Strum, MD, PhD, Bertil Bouillon, MD, PhD and NIS – Committee on Emergency Medicine, Intensive Care and Trauma Management, German Trauma Society (DGU) served as scientific advisors.

Conflict of interests

C.W. and T.P. are the board member of the ATLS Faculty Germany. C.W. is national director of ATLS Germany. M.Mü., C.W., M.Mu, H.T., F.W., M.R., A.W., S.F., and T.P. are instructors of the ATLS program in Germany and received an expense allowance.

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Authors and Affiliations

  1. BG Trauma Clinic Ludwigshafen, Clinic for Trauma and Orthopedic Surgery, University Hospital of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen am Rhein, Germany

    Matthias Münzberg & Christoph Wölfl

  2. Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Straße 200, 51109, Cologne, Germany

    Manuel Mutschler, Thomas Paffrath & Arasch Wafaisade

  3. Institute for Emergency Medicine and Management in Medicine (INM), University Hospital of Munich, Schillerstr. 53, 80336, Munich, Germany

    Heiko Trentzsch

  4. Department of Trauma, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany

    Felix Walcher

  5. Department for Orthopedics and Traumatology, Helios Clinic Siegburg, Ringstraße 49, 53721, Siegburg, Germany

    Marcus Raum

  6. Department of Trauma and Hand Surgery, University Hospital Düsseldorf, Düsseldorf, Germany

    Sascha Flohé

  7. ATLS Research Group Germany, Munich, Germany

    Matthias Münzberg, Manuel Mutschler, Thomas Paffrath, Heiko Trentzsch, Felix Walcher & Christoph Wölfl

Authors
  1. Matthias Münzberg
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  2. Manuel Mutschler
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  3. Thomas Paffrath
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  4. Heiko Trentzsch
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  5. Arasch Wafaisade
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  6. Felix Walcher
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  7. Marcus Raum
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  8. Sascha Flohé
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  9. Christoph Wölfl
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Corresponding author

Correspondence to Christoph Wölfl.

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Münzberg, M., Mutschler, M., Paffrath, T. et al. Level of Evidence Analysis for the Latest German National Guideline on Treatment of Patients with Severe and Multiple Injuries and ATLS. World J Surg 39, 2061–2067 (2015). https://doi.org/10.1007/s00268-015-3063-z

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  • DOI: https://doi.org/10.1007/s00268-015-3063-z

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