Design and prospective evaluation of an algorithm for penetrating truncal injuries

• Published in: Critical care medicine Vol. 16; no. 12; p. 1191
• Main Authors: Liu, M, Shoemaker, W C, Kram, H B, Harrier, H D
• Format: Journal Article
• Language: English
• Published: United States 01.12.1988
• Subjects: Algorithms; Clinical Protocols; Decision Trees; Emergencies; Heart Arrest - etiology; Heart Arrest - mortality; Humans; Prospective Studies; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - mortality; Wounds, Penetrating - complications; Wounds, Penetrating - mortality; Wounds, Penetrating - therapy
• ISSN: 0090-3493
• DOI: 10.1097/00003246-198812000-00004

The major aim was to develop a branch-chain decision tree for penetrating truncal injury and to subject this to a prospective trial of its feasibility to track management decisions. In contrast to the conventional trauma study which focuses on highly selected, well-defined surgical problems, this algorithmic approach was designed to look at the whole gamut of problems of unselected patients with penetrating injury as they enter the ED. The branch-chain algorithm primarily focuses on priorities, order of procedures, and the immediate therapeutic options. The algorithm was used to track clinical management of 280 consecutive patients with penetrating truncal injuries; 31 were dead on arrival, 12 were alive on admission but died during their hospitalization. Of 209 patients whose management was in satisfactory compliance, four (2%) died; eight (20%) of 40 patients who had major deviations from the algorithm died (p less than .01).