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Impact of the implementation of a trauma system on compliance with evidence-based clinical management guidelines in penetrating thoracic trauma

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Since 2014, a trauma system (TS) for the Provence-Alpes-Cote-d’Azur (PACA) region has been set up with protocols based on the European guidelines for the management of bleeding trauma patients. The present study aims to assess compliance with protocols in penetrating thoracic trauma on admission to a level I trauma centre and to determine whether compliance impacts morbidity and mortality.

Methods

This multicentric pre–post study included all penetrating thoracic trauma patients referred to Marseille area level I centres between January 2009 and December 2019. On the basis of the European guidelines, eight objectively measurable recommendations concerning the in-hospital trauma care for the first 24 h were analysed. Per-patient and per-criterion compliance rates and their impact on morbidity and mortality were evaluated before and after TS implementation.

Results

A total of 426 patients were included. No differences between the two groups (before and after 2014) were reported for demographics or injury severity. The median (interquartile range) per-patient compliance rate increased from 67% [0.50; 0.75] to 75% [0.67; 1.0] (p < 0.01) after implementation of a TS. The 30-day morbidity–mortality was, respectively, of 17% (30/173) and 13% (32/253) (p = 0.18) before and after TS implementation. A low per-patient compliance rate was associated with an increase in the 30-day morbidity–mortality rate (p < 0.01). Severity score-adjusted per-patient compliance rates were associated with decreased 30-day morbidity–mortality (odds ratio [IC 95%] = 0.98 [0.97; 0.99] p = 0.01).

Conclusion

Implementation of a TS was associated with better compliance to European recommendations and better outcomes for severe trauma patients. These findings should encourage strict adherence to European trauma protocols to ensure the best patient outcomes.

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Authors and Affiliations

  1. Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, French Military Health Service, Toulon, France

    Matthieu Vasse, Jean Philippe Avaro & Henri de Lesquen

  2. Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix Marseille University, Hôpitaux Universitaires de Marseille, Marseille, France

    Marc Leone

  3. CEReSS-Health Service Research and Quality of Life Center, Department of Medical Information, Aix Marseille University, Hôpitaux Universitaires de Marseille, Marseille, France

    Laurent Boyer

  4. Emergency Department, Hôpital de la Timone, Aix Marseille University, Hôpitaux Universitaires de Marseille, Marseille, France

    Pierre Michelet

  5. Department of Visceral Surgery, Laveran Military Teaching Hospital, French Military Health Service, Marseille, France

    Yvain Goudard

  6. Department of Anesthesiology and Intensive Care, Sainte Anne Military Teaching Hospital,, French Military Health Service, Toulon, France

    Michael Cardinale

  7. Department of Anesthesiology and Intensive Care, Laveran Military Teaching Hospital, French Military Health Service, Marseille, France

    Raphael Paris

  8. Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, Hôpital Nord, Aix Marseille University, Hôpitaux Universitaires de Marseille, Marseille, France

    Pascal Alexandre Thomas

Authors
  1. Matthieu Vasse
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  2. Marc Leone
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  3. Laurent Boyer
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  4. Pierre Michelet
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  5. Yvain Goudard
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  10. Henri de Lesquen
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Correspondence to Henri de Lesquen.

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Vasse, M., Leone, M., Boyer, L. et al. Impact of the implementation of a trauma system on compliance with evidence-based clinical management guidelines in penetrating thoracic trauma. Eur J Trauma Emerg Surg 49, 351–360 (2023). https://doi.org/10.1007/s00068-022-02071-1

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  • DOI: https://doi.org/10.1007/s00068-022-02071-1

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