Sauvetage au combat: Connaître et appliquer la procédure

Preventable deaths in trauma patients associated with non adherence to management guidelines

Marson CA et Al. Rev Bras Ter Intensiva. 2010; 22(3):220-228

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Connaître, maîtriser chacune des composantes d'une procédure et les mettre en oeuvre est  un facteur de survie des blessés. Le respect de la procédure du sauvetage au combat apparait fondamental. Il est nécessaire de le rappeler.

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Objectives: To evaluate patients treated for traumatic injuries and to identify adherence to guidelines recommendations of treatment and association with death. The recommendations adopted were defined by the committee on trauma of the American College of Surgeons in advanced trauma life support.

Methods: Retrospective cohort study conducted at a teaching hospital. The study population was victims of trauma ≥ 12 years of age with injury severity scores ≥ 16 who were treated between January 1997 and December 2001. Data collection was divided into three phases: pre-hospital, in-hospital, and post-mortem. The data collected were analyzed using EPI INFO.

Results: We analyzed 207 patients, 147 blunt trauma victims (71%) and 60 (29%) penetrating trauma victims. Trauma victims had a 40.1% mortality rate. We identified 221 non adherence events that occurred in 137 patients. We found a mean of 1.61 non adherence per patient, and it occurred less frequently in survivors (1.4) than in non-survivors (1.9; p=0.033). According to the trauma score and injury severity score methodology, 54.2% of deaths were considered potentially preventable. Non adherence occurred 1.77 times more frequently in those considered potentially preventable deaths compared to other non-survivors (95% CI: 1.12–2.77; p=0.012), and 92.9% of the multiple non adherence occurred in the first group (p=0.029).

Conclusions: Non adherence occurred more frequently in patients with potentially preventable deaths. Non adherence to guidelines recommendations can be considered a contributing factor to death in trauma victims and can lead to an increase in the number of potentially preventable deaths.